[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1542 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  1st Session
                                S. 1542

   To amend titles XIX and XXI of the Social Security Act to improve 
  Medicaid and the Children's Health Insurance Program for low-income 
                                mothers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 10, 2021

Mr. Booker (for himself, Ms. Baldwin, Mrs. Gillibrand, Mr. Blumenthal, 
Ms. Stabenow, and Ms. Warren) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend titles XIX and XXI of the Social Security Act to improve 
  Medicaid and the Children's Health Insurance Program for low-income 
                                mothers.

    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 ``Maximizing Outcomes for Moms through 
Medicaid Improvement and Enhancement of Services Act'' or the ``MOMMIES 
Act''.

SEC. 2. ENHANCING MEDICAID AND CHIP BENEFITS FOR LOW-INCOME PREGNANT 
              INDIVIDUALS.

    (a) Extending Continuous Medicaid and CHIP Coverage for Pregnant 
and Postpartum Individuals.--
            (1) Medicaid.--Title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) is amended--
                    (A) in section 1902(e)--
                            (i) in paragraph (6), by striking ``60-day 
                        period (beginning on the last day of her 
                        pregnancy)'' and inserting ``1-year period 
                        beginning on the last day of the pregnancy (or 
                        such longer period beginning on such day as the 
                        State may elect)''; and
                            (ii) by striking paragraph (16);
                    (B) in section 1902(l)(1)(A), by striking ``60-day 
                period beginning on the last day of the pregnancy'' and 
                inserting ``1-year period beginning on the last day of 
                the pregnancy or such longer period beginning on such 
                day as the State may elect'';
                    (C) in section 1903(v)(4)(A)(i), by striking ``60-
                day period beginning on the last day of the pregnancy'' 
                and inserting ``1-year period beginning on the last day 
                of the pregnancy or such longer period beginning on 
                such day as the State may elect''; and
                    (D) in section 1905(a), in the 4th sentence in the 
                matter following paragraph (30), by striking ``60-day 
                period beginning on the last day of her pregnancy'' and 
                inserting ``1-year period beginning on the last day of 
                the pregnancy, or such longer period beginning on such 
                day as the State may elect,''.
            (2) CHIP.--Title XXI of the Social Security Act (42 U.S.C. 
        1397 et seq.) is amended--
                    (A) in section 2107(e)(1)(J)--
                            (i) by striking ``Paragraphs (5) and 
                        (16)''; and
                            (ii) by striking ``(relating to'' and all 
                        that follows through the period and inserting 
                        ``(relating to the provision of medical 
                        assistance to pregnant individuals during and 
                        following pregnancy under title XIX).''; and
                    (B) in section 2112--
                            (i) in subsection (d)(2)(A), by striking 
                        ``60-day period'' and all that follows through 
                        the semicolon and inserting ``1-year period 
                        beginning on the last day of the pregnancy, or 
                        such longer period beginning on such day as the 
                        State may elect, ends;''; and
                            (ii) in subsection (f)(2)--
                                    (I) by striking ``60-day period 
                                (beginning on the last day of the 
                                pregnancy)'' and inserting ``1-year 
                                period beginning on the last day of the 
                                pregnancy, or such longer period 
                                beginning on such day as the State may 
                                elect,''.
    (b) Requiring Full Benefits for Pregnant and Postpartum 
Individuals.--
            (1) 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) Coverage of full benefits for at least 1 year for 
        pregnant and postpartum individuals.--
                    ``(A) In general.--Any individual who, while 
                pregnant, is eligible for and has received medical 
                assistance under the State plan approved under this 
                title or a waiver of such plan (including during a 
                period of retroactive eligibility under subsection 
                (a)(34)) shall continue to be eligible under the plan 
                or waiver for medical assistance through the end of the 
                month in which the 1-year period beginning on the last 
                day of the pregnancy, or such longer period beginning 
                on such day as the State may elect, ends, regardless of 
                the basis for the individual's eligibility for medical 
                assistance, including if the individual's eligibility 
                for medical assistance is on the basis of being 
                pregnant.
                    ``(B) Scope of benefits.--The medical assistance 
                provided for a pregnant or postpartum individual 
                described in subparagraph (A) shall--
                            ``(i) include all items and services 
                        covered under the State plan (or waiver) that 
                        are not less in amount, duration, or scope, or 
                        are determined by the Secretary to be 
                        substantially equivalent, to the medical 
                        assistance available for an individual 
                        described in subsection (a)(10)(A)(i); and
                            ``(ii) be provided for the individual while 
                        pregnant and during the 1-year period that 
                        begins on the last day of the pregnancy, or 
                        such longer period beginning on such day as the 
                        State may elect, and ends on the last day of 
                        the month in which such period ends.''.
            (2) 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 ``during the 
        period described in such section,''.
    (c) Requiring Coverage of Oral Health Services for Pregnant and 
Postpartum Individuals.--
            (1) Medicaid.--Section 1905 of the Social Security Act (42 
        U.S.C. 1396d) is amended--
                    (A) in subsection (a)(4)--
                            (i) by striking ``; and (D)'' and inserting 
                        ``; (D)'';
                            (ii) by striking ``; and (E)'' and 
                        inserting ``; (E)'';
                            (iii) by striking ``; and (F)'' and 
                        inserting ``; (F)''; and
                            (iv) by inserting ``; and (G) oral health 
                        services for pregnant and postpartum 
                        individuals (as defined in subsection (jj))'' 
                        after ``(or waiver of such plan)''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jj) Oral Health Services for Pregnant and Postpartum 
Individuals.--
            ``(1) In general.--For purposes of this title, the term 
        `oral health services for pregnant and postpartum individuals' 
        means dental services necessary to prevent disease and promote 
        oral health, restore oral structures to health and function, 
        and treat emergency conditions that are furnished to an 
        individual during pregnancy (or during the 1 year period that 
        begins on the last day of the pregnancy, or such longer period 
        beginning on such day as the State may elect).
            ``(2) Coverage requirements.--To satisfy the requirement to 
        provide oral health services for pregnant and postpartum 
        individuals, a State shall, at a minimum, provide coverage for 
        preventive, diagnostic, periodontal, and restorative care 
        consistent with recommendations for comprehensive perinatal 
        oral health services and dental services during pregnancy from 
        the American Academy of Pediatric Dentistry and the American 
        College of Obstetricians and Gynecologists.''.
            (2) CHIP.--Section 2103(c)(6)(A) of the Social Security Act 
        (42 U.S.C. 1397cc(c)(6)(A)) is amended by inserting ``or a 
        targeted low-income pregnant individual'' after ``targeted low-
        income child''.
            (3) Technical amendment.--Section 2112(d)(2) of the Social 
        Security Act (42 U.S.C. 1397ll(d)(2)) is amended--
                    (A) in the paragraph header, by inserting ``; 
                targeted low-income pregnant individual'' after 
                ``woman''; and
                    (B) by striking ``the term `targeted low-income 
                pregnant woman' means'' and inserting ``the terms 
                `targeted low-income pregnant woman' and `targeted low-
                income pregnant individual' mean''.
    (d) Maintenance of Effort.--
            (1) Medicaid.--Section 1902 of the Social Security Act (42 
        U.S.C. 1396a) is amended--
                    (A) in paragraph (74), by striking ``subsection 
                (gg); and'' and inserting ``subsections (gg) and 
                (tt);''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(tt) Maintenance of Effort Related to Low-Income Pregnant 
Individuals.--For calendar quarters beginning on or after the date of 
enactment of this subsection, and before January 1, 2025, no Federal 
payment shall be made to a State under section 1903(a) for amounts 
expended under a State plan under this title or a waiver of such plan 
if the State--
            ``(1) has in effect under such plan eligibility standards, 
        methodologies, or procedures (including any enrollment cap or 
        other numerical limitation on enrollment, any waiting list, any 
        procedures designed to delay the consideration of applications 
        for enrollment, any income counting rules, or similar 
        limitation with respect to enrollment) for individuals 
        described in subsection (l)(1) who are eligible for medical 
        assistance under the State plan or waiver under subsection 
        (a)(10)(A)(ii)(IX) that are more restrictive than the 
        eligibility standards, methodologies, or procedures, 
        respectively, for such individuals under such plan or waiver 
        that are in effect on the date of the enactment of the 
        Maximizing Outcomes for Moms through Medicaid Improvement and 
        Enhancement of Services Act; or
            ``(2) reduces the amount, duration, or scope of medical 
        assistance available to individuals described in subsection 
        (l)(1) who are eligible for medical assistance under such plan 
        or waiver under subsection (a)(10)(A)(ii)(IX) from what the 
        State provided to such individuals under such plan or waiver on 
        the date of the enactment of the Maximizing Outcomes for Moms 
        through Medicaid Improvement and Enhancement of Services 
        Act.''.
            (2) CHIP.--Section 2112 of the Social Security Act (42 
        U.S.C. 1397ll), as amended by subsection (a), is further 
        amended by adding at the end the following subsection:
    ``(g) Maintenance of Effort.--For calendar quarters beginning on or 
after January 1, 2022, and before January 1, 2025, no payment may be 
made under section 2105(a) with respect to a State child health plan if 
the State--
            ``(1) has in effect under such plan eligibility standards, 
        methodologies, or procedures (including any enrollment cap or 
        other numerical limitation on enrollment, any waiting list, any 
        procedures designed to delay the consideration of applications 
        for enrollment, or similar limitation with respect to 
        enrollment) for targeted low-income pregnant individuals that 
        are more restrictive than the eligibility standards, 
        methodologies, or procedures, respectively, under such plan 
        that are in effect on the date of the enactment of the 
        Maximizing Outcomes for Moms through Medicaid Improvement and 
        Enhancement of Services Act; or
            ``(2) provides pregnancy-related assistance to targeted 
        low-income pregnant individuals under such plan at a level that 
        is less than the level at which the State provides such 
        assistance to such individuals under such plan on the date of 
        the enactment of the Maximizing Outcomes for Moms through 
        Medicaid Improvement and Enhancement of Services Act.''.
    (e) Enhanced FMAP.--Section 1905 of the Social Security Act (42 
U.S.C. 1396d), as amended by subsection (c), is further amended--
            (1) in subsection (b), by striking ``and (ii)'' and 
        inserting ``(ii), and (kk)''; and
            (2) by adding at the end the following new subsection:
    ``(kk) Increased FMAP for Additional Expenditures for Low-Income 
Pregnant Individuals.--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 Maximizing Outcomes 
for Moms through Medicaid Improvement and Enhancement of Services Act 
(as determined by the Secretary), shall be equal to 100 percent.''.
    (f) GAO Study and Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to Congress a report on the gaps in 
        coverage for--
                    (A) pregnant individuals under the Medicaid program 
                under title XIX of the Social Security Act (42 U.S.C. 
                1396 et seq.) and the Children's Health Insurance 
                Program under title XXI of the Social Security Act (42 
                U.S.C. 1397aa et seq.); and
                    (B) postpartum individuals under the Medicaid 
                program and the Children's Health Insurance Program who 
                received assistance under either such program during 
                their pregnancy.
            (2) Content of report.--The report required under this 
        subsection shall include the following:
                    (A) Information about the abilities and successes 
                of State Medicaid agencies in determining whether 
                pregnant and postpartum individuals are eligible under 
                another insurance affordability program, and in 
                transitioning any such individuals who are so eligible 
                to coverage under such a program at the end of their 
                period of eligibility for medical assistance, pursuant 
                to section 435.1200 of the title 42, Code of Federal 
                Regulations (as in effect on September 1, 2018).
                    (B) Information on factors contributing to gaps in 
                coverage that disproportionately impact underserved 
                populations, including low-income individuals, Black, 
                Indigenous, and other individuals of color, individuals 
                who reside in a health professional shortage area (as 
                defined in section 332(a)(1)(A) of the Public Health 
                Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals 
                who are members of a medically underserved population 
                (as defined by section 330(b)(3) of such Act (42 U.S.C. 
                254b(b)(3)(A))).
                    (C) Recommendations for addressing and reducing 
                such gaps in coverage.
                    (D) Such other information as the Comptroller 
                General deems necessary.
            (3) Data disaggregation.--To the greatest extent possible, 
        the Comptroller General shall dissagregate data presented in 
        the report, including by age, gender identity, race, ethnicity, 
        income level, and other demographic factors.
    (g) Effective Date.--The amendments made by subsections (a) and (b) 
shall take effect January 1, 2021.

SEC. 3. MATERNITY CARE HOME DEMONSTRATION PROJECT.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended by inserting the following new section after section 1947:

``SEC. 1948. MATERNITY CARE HOME DEMONSTRATION PROJECT.

    ``(a) In General.--Not later than 1 year after the date of the 
enactment of this section, the Secretary shall establish a 
demonstration project (in this section referred to as the 
`demonstration project') under which the Secretary shall provide grants 
to States to enter into arrangements with eligible entities to 
implement or expand a maternity care home model for eligible 
individuals.
    ``(b) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means an 
        entity or organization that provides medically accurate, 
        comprehensive maternity services to individuals who are 
        eligible for medical assistance under a State plan under this 
        title or a waiver of such a plan, and may include:
                    ``(A) A freestanding birth center.
                    ``(B) An entity or organization receiving 
                assistance under section 330 of the Public Health 
                Service Act.
                    ``(C) A federally qualified health center.
                    ``(D) A rural health clinic.
                    ``(E) A health facility operated by an Indian tribe 
                or tribal organization (as those terms are defined in 
                section 4 of the Indian Health Care Improvement Act).
            ``(2) Eligible individual.--The term `eligible individual' 
        means a pregnant individual or a formerly pregnant individual 
        during the 1-year period beginning on the last day of the 
        pregnancy, or such longer period beginning on such day as a 
        State may elect, who is--
                    ``(A) enrolled in a State plan under this title, a 
                waiver of such a plan, or a State child health plan 
                under title XXI; and
                    ``(B) a patient of an eligible entity which has 
                entered into an arrangement with a State under 
                subsection (g).
    ``(c) Goals of Demonstration Project.--The goals of the 
demonstration project are the following:
            ``(1) To improve--
                    ``(A) maternity and infant care outcomes;
                    ``(B) birth equity;
                    ``(C) health equity for--
                            ``(i) Black, Indigenous, and other people 
                        of color;
                            ``(ii) lesbian, gay, bisexual, transgender, 
                        queer, non-binary, and gender nonconfirming 
                        individuals;
                            ``(iii) people with disabilities; and
                            ``(iv) other underserved populations;
                    ``(D) communication by maternity, infant care, and 
                social services providers;
                    ``(E) integration of perinatal support services, 
                including community health workers, doulas, social 
                workers, public health nurses, peer lactation 
                counselors, lactation consultants, childbirth 
                educators, peer mental health workers, and others, into 
                health care entities and organizations;
                    ``(F) care coordination between maternity, infant 
                care, oral health services, and social services 
                providers within the community;
                    ``(G) the quality and safety of maternity and 
                infant care;
                    ``(H) the experience of individuals receiving 
                maternity care, including by increasing the ability of 
                an individual to develop and follow their own birthing 
                plans; and
                    ``(I) access to adequate prenatal and postpartum 
                care, including--
                            ``(i) prenatal care that is initiated in a 
                        timely manner;
                            ``(ii) not fewer than 5 post-pregnancy 
                        visits to a maternity care provider; and
                            ``(iii) interpregnancy care.
            ``(2) To provide coordinated, evidence-based, respectful, 
        culturally and linguistically appropriate, and person-centered 
        maternity care management.
            ``(3) To decrease--
                    ``(A) severe and preventable maternal morbidity and 
                maternal mortality;
                    ``(B) overall health care spending;
                    ``(C) unnecessary emergency department visits;
                    ``(D) disparities in maternal and infant care 
                outcomes, including racial, economic, disability, 
                gender-based, and geographical disparities;
                    ``(E) racial, gender, economic, and other 
                discrimination among among health care professionals;
                    ``(F) racism, discrimination, disrespect, and abuse 
                in maternity care settings;
                    ``(G) the rate of cesarean deliveries for low-risk 
                pregnancies;
                    ``(H) the rate of preterm births and infants born 
                with low birth weight; and
                    ``(I) the rate of avoidable maternal and newborn 
                hospitalizations and admissions to intensive care 
                units.
    ``(d) Consultation.--In designing and implementing the 
demonstration project the Secretary shall consult with stakeholders, 
including--
            ``(1) States;
            ``(2) organizations representing relevant health care 
        professionals, including oral health services professionals;
            ``(3) organizations, particularly reproductive justice and 
        birth justice organizations led by people of color, that 
        represent consumers of maternal health care, including 
        consumers of maternal health care who are disproportionately 
        impacted by poor maternal health outcomes;
            ``(4) representatives with experience implementing other 
        maternity care home models, including representatives from the 
        Center for Medicare and Medicaid Innovation;
            ``(5) community-based health care professionals, including 
        doulas, lactation consultants, and other stakeholders;
            ``(6) experts in promoting health equity and combating 
        racial bias in health care settings; and
            ``(7) Black, Indigenous, and other maternal health care 
        consumers of color who have experienced severe maternal 
        morbidity.
    ``(e) Application and Selection of States.--
            ``(1) In general.--A State seeking to participate in the 
        demonstration project shall submit an application to the 
        Secretary at such time and in such manner as the Secretary 
        shall require.
            ``(2) Selection of states.--
                    ``(A) In general.--The Secretary shall select at 
                least 10 States to participate in the demonstration 
                project.
                    ``(B) Selection requirements.--In selecting States 
                to participate in the demonstration project, the 
                Secretary shall--
                            ``(i) ensure that there is geographic and 
                        regional diversity in the areas in which 
                        activities will be carried out under the 
                        project;
                            ``(ii) ensure that States with significant 
                        disparities in maternal and infant health 
                        outcomes, including severe maternal morbidity, 
                        and other disparities based on race, income, or 
                        access to maternity care, are included; and
                            ``(iii) ensure that at least 1 territory is 
                        included.
    ``(f) Grants.--
            ``(1) In general.--From amounts appropriated under 
        subsection (l), the Secretary shall award 1 grant for each year 
        of the demonstration project to each State that is selected to 
        participate in the demonstration project.
            ``(2) Use of grant funds.--A State may use funds received 
        under this section to--
                    ``(A) award grants or make payments to eligible 
                entities as part of an arrangement described in 
                subsection (g)(2);
                    ``(B) provide financial incentives to health care 
                professionals, including community-based health care 
                workers and community-based doulas, who participate in 
                the State's maternity care home model;
                    ``(C) provide adequate training for health care 
                professionals, including community-based health care 
                workers, doulas, and care coordinators, who participate 
                in the State's maternity care home model, which may 
                include training for cultural humility and antiracism, 
                racial bias, health equity, reproductive and birth 
                justice, trauma-informed care, home visiting skills, 
                and respectful communication and listening skills, 
                particularly in regards to maternal health;
                    ``(D) pay for personnel and administrative expenses 
                associated with designing, implementing, and operating 
                the State's maternity care home model;
                    ``(E) pay for items and services that are furnished 
                under the State's maternity care home model and for 
                which payment is otherwise unavailable under this 
                title;
                    ``(F) pay for services and materials to ensure 
                culturally and linguistically appropriate 
                communication, including--
                            ``(i) language services such as 
                        interpreters and translation of written 
                        materials; and
                            ``(ii) development of culturally and 
                        linguistically appropriate materials; and 
                        auxiliary aids and services; and
                    ``(G) pay for other costs related to the State's 
                maternity care home model, as determined by the 
                Secretary.
            ``(3) Grant for national independent evaluator.--
                    ``(A) In general.--From the amounts appropriated 
                under subsection (l), prior to awarding any grants 
                under paragraph (1), the Secretary shall enter into a 
                contract with a national external entity to create a 
                single, uniform process to--
                            ``(i) ensure that States that receive 
                        grants under paragraph (1) comply with the 
                        requirements of this section; and
                            ``(ii) evaluate the outcomes of the 
                        demonstration project in each participating 
                        State.
                    ``(B) Annual report.--The contract described in 
                subparagraph (A) shall require the national external 
                entity to submit to the Secretary--
                            ``(i) a yearly evaluation report for each 
                        year of the demonstration project; and
                            ``(ii) a final impact report after the 
                        demonstration project has concluded.
                    ``(C) Secretary's authority.--Nothing in this 
                paragraph shall prevent the Secretary from making a 
                determination that a State is not in compliance with 
                the requirements of this section without the national 
                external entity making such a determination.
    ``(g) Partnership With Eligible Entities.--
            ``(1) In general.--As a condition of receiving a grant 
        under this section, a State shall enter into an arrangement 
        with one or more eligible entities that meets the requirements 
        of paragraph (2).
            ``(2) Arrangements with eligible entities.--Under an 
        arrangement between a State and an eligible entity under this 
        subsection, the eligible entity shall perform the following 
        functions, with respect to eligible individuals enrolled with 
        the entity under the State's maternity care home model--
                    ``(A) provide culturally and linguistically 
                appropriate congruent care, which may include prenatal 
                care, family planning services, medical care, mental 
                and behavioral care, postpartum care, and oral health 
                services to such eligible individuals through a team of 
                health care professionals, which may include 
                obstetrician-gynecologists, maternal-fetal medicine 
                specialists, family physicians, primary care providers, 
                oral health providers, physician assistants, advanced 
                practice registered nurses such as nurse practitioners 
                and certified nurse midwives, certified midwives, 
                certified professional midwives, physical therapists, 
                social workers, traditional and community-based doulas, 
                lactation consultants, childbirth educators, community 
                health workers, peer mental health supporters, and 
                other health care professionals;
                    ``(B) conduct a risk assessment of each such 
                eligible individual to determine if their pregnancy is 
                high or low risk, and establish a tailored pregnancy 
                care plan, which takes into consideration the 
                individual's own preferences and pregnancy care and 
                birthing plans and determines the appropriate support 
                services to reduce the individual's medical, social, 
                and environmental risk factors, for each such eligible 
                individual based on the results of such risk 
                assessment;
                    ``(C) assign each such eligible individual to a 
                culturally and linguistically appropriate care 
                coordinator, which may be a nurse, social worker, 
                traditional or community-based doula, community health 
                worker, midwife, or other health care provider, who is 
                responsible for ensuring that such eligible individual 
                receives the necessary medical care and connections to 
                essential support services;
                    ``(D) provide, or arrange for the provision of, 
                essential support services, such as services that 
                address--
                            ``(i) food access, nutrition, and exercise;
                            ``(ii) smoking cessation;
                            ``(iii) substance use disorder and 
                        addiction treatment;
                            ``(iv) anxiety, depression, trauma, and 
                        other mental and behavioral health issues;
                            ``(v) breast feeding, chestfeeding, or 
                        other infant feeding options supports, 
                        initiation, continuation, and duration;
                            ``(vi) stable, affordable, safe, and 
                        healthy housing;
                            ``(vii) transportation;
                            ``(viii) intimate partner violence;
                            ``(ix) community and police violence;
                            ``(x) home visiting services;
                            ``(xi) childbirth and newborn care 
                        education;
                            ``(xii) oral health education;
                            ``(xiii) continuous labor support;
                            ``(xiv) group prenatal care;
                            ``(xv) family planning and contraceptive 
                        care and supplies; and
                            ``(xvi) affordable child care;
                    ``(E) as appropriate, facilitate connections to a 
                usual primary care provider, which may be a 
                reproductive health care provider;
                    ``(F) refer to guidelines and opinions of medical 
                associations when determining whether an elective 
                delivery should be performed on an eligible individual 
                before 39 weeks of gestation;
                    ``(G) provide such eligible individual with 
                evidence-based and culturally and linguistically 
                appropriate education and resources to identify 
                potential warning signs of pregnancy and postpartum 
                complications and when and how to obtain medical 
                attention;
                    ``(H) provide, or arrange for the provision of, 
                culturally and linguistically appropriate pregnancy and 
                postpartum health services, including family planning 
                counseling and services, to eligible individuals;
                    ``(I) track and report postpartum health and birth 
                outcomes of such eligible individuals and their 
                children;
                    ``(J) ensure that care is person-centered, 
                culturally and linguistically appropriate, and patient-
                led, including by engaging eligible individuals in 
                their own care, including through communication and 
                education; and
                    ``(K) ensure adequate training for appropriately 
                serving the population of individuals eligible for 
                medical assistance under the State plan or waiver of 
                such plan, including through reproductive justice, 
                birth justice, birth equity, and anti-racist 
                frameworks, home visiting skills, and knowledge of 
                social services.
    ``(h) Term of Demonstration Project.--The Secretary shall conduct 
the demonstration project for a period of 5 years.
    ``(i) Waiver Authority.--To the extent that the Secretary 
determines necessary in order to carry out the demonstration project, 
the Secretary may waive section 1902(a)(1) (relating to statewideness) 
and section 1902(a)(10)(B) (relating to comparability).
    ``(j) Technical Assistance.--The Secretary shall establish a 
process to provide technical assistance to States that are awarded 
grants under this section and to eligible entities and other providers 
participating in a State maternity care home model funded by such a 
grant.
    ``(k) Report.--
            ``(1) In general.--Not later than 18 months after the date 
        of the enactment of this section and annually thereafter for 
        each year of the demonstration project term, the Secretary 
        shall submit a report to Congress on the results of the 
        demonstration project.
            ``(2) Final report.--As part of the final report required 
        under paragraph (1), the Secretary shall include--
                    ``(A) the results of the final report of the 
                national external entity required under subsection 
                (f)(3)(B)(ii); and
                    ``(B) recommendations on whether the model studied 
                in the demonstration project should be continued or 
                more widely adopted, including by private health plans.
    ``(l) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary, for each of fiscal years 2022 through 
2029, such sums as may be necessary to carry out this section.''.

SEC. 4. REAPPLICATION OF MEDICARE PAYMENT RATE FLOOR TO PRIMARY CARE 
              SERVICES FURNISHED UNDER MEDICAID AND INCLUSION OF 
              ADDITIONAL PROVIDERS.

    (a) Reapplication of Payment Floor; Additional Providers.--
            (1) In general.--Section 1902(a)(13) of the Social Security 
        Act (42 U.S.C. 1396a(a)(13)) is amended--
                    (A) in subparagraph (B), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in subparagraph (C), by striking the semicolon 
                and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) payment for primary care services (as defined 
                in subsection (jj)(1)) furnished in the period that 
                begins on the first day of the first month that begins 
                after the date of enactment of the Maximizing Outcomes 
                for Moms through Medicaid Improvement and Enhancement 
                of Services Act by a provider described in subsection 
                (jj)(2)--
                            ``(i) at a rate that is not less than 100 
                        percent of the payment rate that applies to 
                        such services and the provider of such services 
                        under part B of title XVIII (or, if greater, 
                        the payment rate that would be applicable under 
                        such part if the conversion factor under 
                        section 1848(d) for the year were the 
                        conversion factor under such section for 2009);
                            ``(ii) in the case of items and services 
                        that are not items and services provided under 
                        such part, at a rate to be established by the 
                        Secretary; and
                            ``(iii) in the case of items and services 
                        that are furnished in rural areas (as defined 
                        in section 1886(d)(2)(D)), health professional 
                        shortage areas (as defined in section 
                        332(a)(1)(A) of the Public Health Service Act 
                        (42 U.S.C. 254e(a)(1)(A))), or medically 
                        underserved areas (according to a designation 
                        under section 330(b)(3)(A) of the Public Health 
                        Service Act (42 U.S.C. 254b(b)(3)(A))), at the 
                        rate otherwise applicable to such items or 
                        services under clause (i) or (ii) increased, at 
                        the Secretary's discretion, by not more than 25 
                        percent;''.
            (2) Conforming amendments.--
                    (A) Section 1902(a)(13)(C) of the Social Security 
                Act (42 U.S.C. 1396a(a)(13)(C)) is amended by striking 
                ``subsection (jj)'' and inserting ``subsection 
                (jj)(1)''.
                    (B) Section 1905(dd) of the Social Security Act (42 
                U.S.C. 1396d(dd)) is amended--
                            (i) by striking ``Notwithstanding'' and 
                        inserting the following:
            ``(1) In general.--Notwithstanding'';
                            (ii) by striking ``section 1902(a)(13)(C)'' 
                        and inserting ``subparagraph (C) of section 
                        1902(a)(13)'';
                            (iii) by inserting ``or for services 
                        described in subparagraph (D) of section 
                        1902(a)(13) furnished during an additional 
                        period specified in paragraph (2),'' after 
                        ``2015,'';
                            (iv) by striking ``under such section'' and 
                        inserting ``under subparagraph (C) or (D) of 
                        section 1902(a)(13), as applicable''; and
                            (v) by adding at the end the following:
            ``(2) Additional periods.--For purposes of paragraph (1), 
        the following are additional periods:
                    ``(A) The period that begins on the first day of 
                the first month that begins after the date of enactment 
                of the Maximizing Outcomes for Moms through Medicaid 
                Improvement and Enhancement of Services Act.''.
    (b) Improved Targeting of Primary Care.--Section 1902(jj) of the 
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
            (1) by redesignating paragraphs (1) and (2) as clauses (i) 
        and (ii), respectively and realigning the left margins 
        accordingly;
            (2) by striking ``For purposes of subsection (a)(13)(C)'' 
        and inserting the following:
            ``(1) In general.--
                    ``(A) Definition.--For purposes of subparagraphs 
                (C) and (D) of subsection (a)(13)''; and
            (3) by inserting after clause (ii) (as so redesignated) the 
        following:
                    ``(B) Exclusions.--Such term does not include any 
                services described in subparagraph (A) or (B) of 
                paragraph (1) if such services are provided in an 
                emergency department of a hospital.
            ``(2) Additional providers.--For purposes of subparagraph 
        (D) of subsection (a)(13), a provider described in this 
        paragraph is any of the following:
                    ``(A) A physician with a primary specialty 
                designation of family medicine, general internal 
                medicine, or pediatric medicine, or obstetrics and 
                gynecology.
                    ``(B) An advanced practice clinician, as defined by 
                the Secretary, that works under the supervision of--
                            ``(i) a physician that satisfies the 
                        criteria specified in subparagraph (A);
                            ``(ii) a nurse practitioner or a physician 
                        assistant (as such terms are defined in section 
                        1861(aa)(5)(A)) who is working in accordance 
                        with State law; or
                            ``(iii) or a certified nurse-midwife (as 
                        defined in section 1861(gg)) or a certified 
                        professional midwife who is working in 
                        accordance with State law.
                    ``(C) A rural health clinic, federally qualified 
                health center, health center that receives funding 
                under title X of the Public Health Service Act, or 
                other health clinic that receives reimbursement on a 
                fee schedule applicable to a physician.
                    ``(D) An advanced practice clinician supervised by 
                a physician described in subparagraph (A), another 
                advanced practice clinician, or a certified nurse-
                midwife.
                    ``(E) A midwife who is working in accordance with 
                State law.''.
    (c) Ensuring Payment by Managed Care Entities.--
            (1) In general.--Section 1903(m)(2)(A) of the Social 
        Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
                    (A) in clause (xii), by striking ``and'' after the 
                semicolon;
                    (B) by realigning the left margin of clause (xiii) 
                so as to align with the left margin of clause (xii) and 
                by striking the period at the end of clause (xiii) and 
                inserting ``; and''; and
                    (C) by inserting after clause (xiii) the following:
            ``(xiv) such contract provides that (I) payments to 
        providers specified in section 1902(a)(13)(D) for primary care 
        services defined in section 1902(jj) that are furnished during 
        a year or period specified in section 1902(a)(13)(D) and 
        section 1905(dd) are at least equal to the amounts set forth 
        and required by the Secretary by regulation, (II) the entity 
        shall, upon request, provide documentation to the State, 
        sufficient to enable the State and the Secretary to ensure 
        compliance with subclause (I), and (III) the Secretary shall 
        approve payments described in subclause (I) that are furnished 
        through an agreed upon capitation, partial capitation, or other 
        value-based payment arrangement if the capitation, partial 
        capitation, or other value-based payment arrangement is based 
        on a reasonable methodology and the entity provides 
        documentation to the State sufficient to enable the State and 
        the Secretary to ensure compliance with subclause (I).''.
            (2) Conforming amendment.--Section 1932(f) of the Social 
        Security Act (42 U.S.C. 1396u-2(f)) is amended--
                    (A) by striking ``section 1902(a)(13)(C)'' and 
                inserting ``subsections (C) and (D) of section 
                1902(a)(13)''; and
                    (B) by inserting ``and clause (xiv) of section 
                1903(m)(2)(A)'' before the period.

SEC. 5. MACPAC REPORT AND CMS GUIDANCE ON INCREASING ACCESS TO DOULA 
              SERVICES FOR MEDICAID BENEFICIARIES.

    (a) MACPAC Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Medicaid and CHIP Payment and 
        Access Commission (referred to in this section as ``MACPAC'') 
        shall publish a report on the coverage of doula services under 
        State Medicaid programs, which shall at a minimum include the 
        following:
                    (A) Information about coverage for doula services 
                under State Medicaid programs that currently provide 
                coverage for such care, including the type of doula 
                services offered (such as prenatal, labor and delivery, 
                postpartum support, and also community-based and 
                traditional doula services).
                    (B) An analysis of barriers to covering doula 
                services under State Medicaid programs.
                    (C) An identification of effective strategies to 
                increase the use of doula services in order to provide 
                better care and achieve better maternal and infant 
                health outcomes, including strategies that States may 
                use to recruit, train, and certify a diverse doula 
                workforce, particularly from underserved communities, 
                communities of color, and communities facing linguistic 
                or cultural barriers.
                    (D) Recommendations for legislative and 
                administrative actions to increase access to doula 
                services in State Medicaid programs, including actions 
                that ensure doulas may earn a living wage that accounts 
                for their time and costs associated with providing care 
                and community-based doula program administration and 
                operation.
            (2) Stakeholder consultation.--In developing the report 
        required under paragraph (1), MACPAC shall consult with 
        relevant stakeholders, including--
                    (A) States;
                    (B) organizations, especially reproductive justice 
                and birth justice organizations led by people of color, 
                representing consumers of maternal health care, 
                including those that are disproportionately impacted by 
                poor maternal health outcomes;
                    (C) organizations and individuals representing 
                doulas, including community-based doula programs and 
                those who serve underserved communities, including 
                communities of color, and communities facing linguistic 
                or cultural barriers;
                    (D) organizations representing health care 
                providers; and
                    (E) Black, Indigenous, and other maternal health 
                care consumers of color who have experienced severe 
                maternal morbidity.
    (b) CMS Guidance.--
            (1) In general.--Not later than 1 year after the date that 
        MACPAC publishes the report required under subsection (a)(1), 
        the Administrator of the Centers for Medicare & Medicaid 
        Services shall issue guidance to States on increasing access to 
        doula services under Medicaid. Such guidance shall at a minimum 
        include--
                    (A) options for States to provide medical 
                assistance for doula services under State Medicaid 
                programs;
                    (B) best practices for ensuring that doulas, 
                including community-based doulas, receive reimbursement 
                for doula services provided under a State Medicaid 
                program, at a level that allows doulas to earn a living 
                wage that accounts for their time and costs associated 
                with providing care and community-based doula program 
                administration; and
                    (C) best practices for increasing access to doula 
                services, including services provided by community-
                based doulas, under State Medicaid programs.
            (2) Stakeholder consultation.--In developing the guidance 
        required under paragraph (1), the Administrator of the Centers 
        for Medicare & Medicaid Services shall consult with MACPAC and 
        other relevant stakeholders, including--
                    (A) State Medicaid officials;
                    (B) organizations representing consumers of 
                maternal health care, including those that are 
                disproportionately impacted by poor maternal health 
                outcomes;
                    (C) organizations representing doulas, including 
                community-based doulas and those who serve underserved 
                communities, such as communities of color and 
                communities facing linguistic or cultural barriers; and
                    (D) organizations representing medical 
                professionals.

SEC. 6. GAO REPORT ON STATE MEDICAID PROGRAMS' USE OF TELEHEALTH TO 
              INCREASE ACCESS TO MATERNITY CARE.

    Not later than 1 year after the date of the enactment of this Act, 
the Comptroller General of the United States shall submit a report to 
Congress on State Medicaid programs' use of telehealth to increase 
access to maternity care. Such report shall include the following:
            (1) The number of State Medicaid programs that utilize 
        telehealth that increases access to maternity care.
            (2) With respect to State Medicaid programs that utilize 
        telehealth that increases access to maternity care, information 
        about--
                    (A) common characteristics of such programs' 
                approaches to utilizing telehealth that increases 
                access to maternity care;
                    (B) differences in States' approaches to utilizing 
                telehealth to improve access to maternity care, and the 
                resulting differences in State maternal health 
                outcomes, as determined by factors described in 
                subsection (C); and
                    (C) when compared to patients who receive maternity 
                care in-person, what is known about--
                            (i) the demographic characteristics, such 
                        as race, ethnicity, sex, sexual orientation, 
                        gender identity, disability status, age, and 
                        preferred language of the individuals enrolled 
                        in such programs who use telehealth to access 
                        maternity care;
                            (ii) health outcomes for such individuals, 
                        including frequency of mortality and severe 
                        morbidity, as compared to individuals with 
                        similar characteristics who did not use 
                        telehealth to access maternity care;
                            (iii) the services provided to individuals 
                        through telehealth, including family planning 
                        services, mental health care services, and oral 
                        health services;
                            (iv) the devices and equipment provided to 
                        individuals for remote patient monitoring and 
                        telehealth, including blood pressure monitors 
                        and blood glucose monitors;
                            (v) the quality of maternity care provided 
                        through telehealth, including whether maternity 
                        care provided through telehealth is culturally 
                        and linguistically appropriate;
                            (vi) the level of patient satisfaction with 
                        maternity care provided through telehealth to 
                        individuals enrolled in State Medicaid 
                        programs;
                            (vii) the impact of utilizing telehealth to 
                        increase access to maternity care on spending, 
                        cost savings, access to care, and utilization 
                        of care under State Medicaid programs; and
                            (viii) the accessibility and effectiveness 
                        of telehealth for maternity care during the 
                        COVID-19 pandemic.
            (3) An identification and analysis of the barriers to using 
        telehealth to increase access to maternity care under State 
        Medicaid programs.
            (4) Recommendations for such legislative and administrative 
        actions related to increasing access to telehealth maternity 
        services under Medicaid as the Comptroller General deems 
        appropriate.
                                 <all>