[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3443 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3443

   To amend title XIX of the Social Security Act to provide Medicaid 
  coverage for all pregnant and postpartum women, to provide coverage 
 under the Medicaid program for services provided by doulas, midwives, 
           and lactation consultants, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 11, 2020

   Mr. Casey introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend title XIX of the Social Security Act to provide Medicaid 
  coverage for all pregnant and postpartum women, to provide coverage 
 under the Medicaid program for services provided by doulas, midwives, 
           and lactation consultants, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improving Coverage and Care for 
Mothers Act''.

SEC. 2. EXTENDING MEDICAID ELIGIBILITY TO ALL PREGNANT WOMEN.

    (a) In General.--Section 1905(n)(1) of the Social Security Act (42 
U.S.C. 1396d(n)(1)) is amended to read as follows:
            ``(1) a woman who is pregnant and through the end of the 
        month in which the 365-day period (beginning on the last day of 
        her pregnancy) ends; and''.
    (b) Conforming Amendments.--Title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) is amended--
            (1) in section 1902--
                    (A) in subsection (a)(10)(C)--
                            (i) in clause (ii), by striking ``must make 
                        available medical assistance--'' and all that 
                        follows through ``individual described in 
                        subparagraph (A)'' and inserting ``must make 
                        available medical assistance to individuals 
                        under the age of 18 who (but for income and 
                        resources) would be eligible for medical 
                        assistance as an individual described in 
                        subparagraph (A)(i)'';
                            (ii) in clause (iii)--
                                    (I) by striking ``must include (I) 
                                with respect to'' and inserting ``must 
                                include, with respect to''; and
                                    (II) by striking ``; and (II)'' and 
                                all that follows through ``delivery 
                                services'';
                    (B) in subsection (e), by striking paragraph (6);
                    (C) in subsection (l)(1)(A), by inserting ``before 
                January 1, 2020,'' before ``women during pregnancy''; 
                and
                    (D) in subsection (ii)(1)(A), by inserting ``that 
                was in effect as of January 1, 2020'' after ``pregnant 
                women'';
            (2) in section 1920(b)(1)(A), by striking ``that the family 
        income'' and all that follows through ``income level of 
        eligibility'' and inserting ``that the woman is eligible for 
        medical assistance''; and
            (3) in section 1937(a)(2)(B), by amending clause (i) to 
        read as follows:
                            ``(i) Qualified pregnant women.--The 
                        individual is a qualified pregnant woman (as 
                        defined in section 1905(n)(1)).''.

SEC. 3. EXTENDING CONTINUOUS MEDICAID AND CHIP COVERAGE FOR PREGNANT 
              AND POSTPARTUM WOMEN.

    (a) Extending Continuous Medicaid and CHIP Coverage for Pregnant 
and Postpartum Women.--
            (1) Medicaid.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) in section 1902(e)(5), by striking ``60-day 
                period'' and inserting ``365-day period'';
                    (B) in section 1902(l)(1)(A), by striking ``60-day 
                period'' and inserting ``365-day period'';
                    (C) in section 1903(v)(4)(A)(i), by striking ``60-
                day period'' and inserting ``365-day period''; and
                    (D) in section 1905(a), in the 4th sentence in the 
                matter following paragraph (30), by striking ``60-day 
                period'' and inserting ``365-day period''.
            (2) CHIP.--Section 2112 of the Social Security Act (42 
        U.S.C. 1397ll) is amended by striking ``60-day period'' each 
        place it appears and inserting ``365-day period''.
            (3) Conforming amendment.--Section 1938(b)(2)(C) of the 
        Social Security Act (42 U.S.C. 1396u-8(b)(2)(C)) is amended by 
        striking ``previous 60 days'' and inserting ``previous 365 
        days''.
    (b) Requiring Full Benefits for Pregnant and Postpartum Women.--
            (1) Medicaid.--
                    (A) In general.--Paragraph (5) of section 1902(e) 
                of the Social Security Act (24 U.S.C. 1396a(e)) is 
                amended to read as follows:
            ``(5) Any woman who is eligible for medical assistance 
        under the State plan or a waiver of such plan and who is, or 
        who while so eligible becomes, pregnant, shall continue to be 
        eligible under the plan or waiver for medical assistance 
        through the end of the month in which the 365-day period 
        (beginning on the last day of her pregnancy) ends, regardless 
        of the basis for the woman's eligibility for medical 
        assistance, including if the woman's eligibility for medical 
        assistance is on the basis of being pregnant.''.
                    (B) Conforming amendment.--Section 1902(a)(10) of 
                the Social Security Act (42 U.S.C. 1396a(a)(10)) is 
                amended in the matter following subparagraph (G) by 
                striking ``(VII) the medical assistance'' and all that 
                follows through ``complicate pregnancy,''.
            (2) CHIP.--
                    (A) Section 2107(e)(1) of the Social Security Act 
                (42 U.S.C. 1397gg(e)(1)) is amended--
                            (i) by redesignating subparagraphs (H) 
                        through (S) as subparagraphs (I) through (T), 
                        respectively; and
                            (ii) by inserting after subparagraph (G), 
                        the following:
                    ``(H) Section 1902(e)(5) (requiring 365-day 
                continuous coverage for pregnant and postpartum 
                women).''.
                    (B) Section 2112 of the Social Security Act (42 
                U.S.C. 1397ll) is amended, in subsections (d)(2) and 
                (f)(2), by striking ``60-day period'' each place it 
                appears and inserting ``365-day period''.

SEC. 4. MEDICAID COVERAGE OF SERVICES PROVIDED BY DOULAS, MIDWIVES, AND 
              LACTATION CONSULTANTS.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (29), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (30) as paragraph 
                (31); and
                    (C) by inserting after paragraph (29) the following 
                new paragraph:
            ``(30) services, including--
                    ``(A) prenatal, delivery, postpartum, and lactation 
                consulting services, provided by doulas, midwives, and 
                lactation consultants (as those terms are defined in 
                subsection (gg)) to the extent authorized under State 
                law; and
                    ``(B) services included in the components of 
                postpartum care identified by the American College of 
                Obstetricians and Gynecologists in Committee Opinion 
                Number 736 published in May of 2018 (or any successor 
                opinion or publication); and''; and
            (2) by adding at the end the following new subsection:
    ``(gg) Doulas and Midwives Defined.--For purposes of subsection 
(a)(30):
            ``(1) Doulas defined.--The term `doula' means an individual 
        who--
                    ``(A) is certified by an organization, which has 
                been established for not less than 5 years and which 
                requires the completion of continuing education to 
                maintain such certification, to provide non-medical 
                advice, information, emotional support, and physical 
                comfort to an individual during such individual's 
                pregnancy, childbirth, and postpartum period; and
                    ``(B) maintains such certification by completing 
                such required continuing education.
            ``(2) Midwives defined.--
                    ``(A) In general.--The term `midwife' means a 
                certified midwife, certified professional midwife, and 
                Tribal-recognized midwife.
                    ``(B) Certified midwife.--For purposes of 
                subparagraph (A), the term `certified midwife' means an 
                individual who is certified by the American Midwifery 
                Certification Board to practice midwifery.
                    ``(C) Certified professional midwife.--For purposes 
                of subparagraph (A), the term `certified professional 
                midwife' means an individual who--
                            ``(i) is certified by the North American 
                        Registry of Midwives to practice midwifery for 
                        normal, low-risk pregnancies and childbirths;
                            ``(ii) completes--
                                    ``(I) a midwifery education program 
                                accredited by the Midwifery Education 
                                and Accreditation Council or any other 
                                entity recognized by the Department of 
                                Education; or
                                    ``(II) the requirements to obtain a 
                                Midwifery Bridge Certificate from the 
                                North American Registry of Midwives; 
                                and
                            ``(iii) maintains the certification 
                        described in clause (i) by completing any 
                        required continuing education for such 
                        certification.
                    ``(D) Tribal-recognized midwife.--For purposes of 
                subparagraph (A), the term `Tribal-recognized midwife' 
                means an individual who is recognized by an Indian 
                tribe (as defined in section 4 of the Indian Health 
                Care Improvement Act) to practice midwifery for such 
                tribe.
            ``(3) Lactation consultant defined.--The term `lactation 
        consultant' means an individual who is a specialist who--
                    ``(A) is trained to--
                            ``(i) focus on the needs and concerns of a 
                        breastfeeding mother and baby; and
                            ``(ii) prevent, recognize, and solve 
                        breastfeeding difficulties;
                    ``(B) is certified by an organization, which has 
                been established for not less than 5 years and which 
                requires the completion of continuing education to 
                maintain such certification, to provide lactation 
                consulting services; and
                    ``(C) maintains such certification by completing 
                such required continuing education.''.
    (b) Requiring Mandatory Coverage Under State Plan.--Section 
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) 
is amended, in the matter preceding clause (i), by striking ``and 
(29)'' and inserting ``(29), and (30)''.

SEC. 5. INCREASED FMAP FOR ADDITIONAL EXPENDITURES.

    Section 1905 of the Social Security Act (42 U.S.C. 1396d), as 
amended by section 4, is further amended--
            (1) in subsection (b), by striking ``and (ff)'' and 
        inserting ``(ff), and (hh)''; and
            (2) by adding at the end the following:
    ``(hh) Increased FMAP for Additional Expenditures for Medical 
Assistance to Pregnant and Postpartum Women.--For calendar quarters 
beginning on or after January 1, 2021, notwithstanding subsection (b), 
the Federal medical assistance percentage for a State, with respect to 
the additional amounts expended by such State for medical assistance 
under the State plan under this title or a waiver of such plan that are 
attributable to requirements imposed by the amendments made by the 
Improving Coverage and Care for Mothers Act (as determined by the 
Secretary), shall be equal to 100 percent.''.

SEC. 6. EFFECTIVE DATE.

    (a) In General.--Subject to subsection (b), the amendments made by 
this Act shall apply with respect to medical assistance furnished on or 
after January 1, 2021.
    (b) Exception for State Legislation.--In the case of a State plan 
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
that the Secretary of Health and Human Services determines requires 
State legislation in order for the respective plan to meet any 
requirement imposed by amendments made by this section, the respective 
plan shall not be regarded as failing to comply with the requirements 
of such title solely on the basis of its failure to meet such an 
additional requirement before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the case of a State that 
has a 2-year legislative session, each year of the session shall be 
considered to be a separate regular session of the State legislature.
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