[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4100 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 4100
To amend title XIX of the Social Security Act to provide coverage under
the Medicaid program for services provided by doulas and midwives, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 27, 2022
Ms. Warren (for herself, Mr. Booker, Mr. Casey, Mr. Padilla, Mr.
Sanders, Ms. Duckworth, and Mr. Blumenthal) 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 coverage under
the Medicaid program for services provided by doulas and midwives, 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 ``Mamas First Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) According to the Centers for Disease Control and
Prevention, the maternal mortality rate varies drastically for
women by race and ethnicity. On average, there are 12.7 deaths
per 100,000 live births for White women, 43.5 deaths per
100,000 live births for African-American women, 32.5 deaths for
American Indian and Alaskan Native women, and 14.4 deaths per
100,000 live births for women of other ethnicities. While
maternal mortality disparately impacts African-American women
and indigenous women, this urgent public health crisis
traverses race, ethnicity, socioeconomic status, educational
background, and geography.
(2) United States maternal mortality rates are the highest
in the developed world and are increasing rapidly.
(3) Many of these maternal deaths are likely preventable.
(4) According to the National Institutes of Health, doula-
assisted mothers are four times less likely to have a low-
birth-weight baby, two times less likely to experience a birth
complication involving themselves or their baby, and
significantly more likely to initiate breastfeeding.
(5) Midwife-led care is associated with cost savings,
decreased rates of intervention, lower cesarean rates, lower
preterm birth rates, and healthier outcomes for mothers and
babies.
(6) Midwives may practice in any setting, including the
home, community, hospitals, birth centers, clinics, or health
units.
SEC. 3. MEDICAID COVERAGE OF SERVICES PROVIDED BY DOULAS AND MIDWIVES.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)--
(A) in paragraph (30), by striking ``and'' at the
end;
(B) by redesignating paragraph (31) as paragraph
(32); and
(C) by inserting after paragraph (30) the following
new paragraph:
``(31) services and care, including prenatal, delivery, and
postpartum care, that is provided in a culturally congruent
manner (as defined in subsection (kk)) by doulas, midwives, and
tribal midwives (as those terms are defined in subsection
(jj)), that is provided in the home, community, a hospital,
birth center, clinic, health unit, or is furnished via
telehealth to the extent authorized under State law; and''; and
(2) by adding at the end the following:
``(jj) Doulas, Midwives, and Tribal Midwife Defined.--For purposes
of subsection (a)(31):
``(1) Doulas defined.--The term `doula' means an individual
who--
``(A) has completed 60 hours of foundational
training;
``(B) is certified by an organization, which has
been established for not less than five 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
``(C) maintains such certification by completing
such required continuing education.
``(2) Midwives defined.--The term `midwife' means a midwife
who meets at a minimum the international definition of the
midwife and global standards for midwifery education as
established by the International Confederation of Midwives.
``(3) Tribal midwife defined.--The term `tribal midwife'
means an individual who is recognized by an Indian tribe (as
defined in section 4 of the Indian Health Care Improvement Act
(25 U.S.C. 1603)) to practice midwifery for such tribe.
``(kk) Culturally Congruent Care Defined.--For purposes of
subsection (a)(31), the term `culturally congruent care', with respect
to maternity care, means care that is provided in agreement with the
preferred cultural values, beliefs, worldview, language, and practices
of the health care consumer and other stakeholders.''.
(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
(30)'' and inserting ``(30), and (31)''.
(c) Conforming Amendments.--
(1) Section 1902(nn)(3) of the Social Security Act (42
U.S.C. 1396a(nn)(3)) is amended by striking ``(30)'' and
inserting ``(32)''.
(2) Section 1905(a) of the Social Security Act (42 U.S.C.
1396d(a)) is amended, in the 5th sentence, by striking ``(30)''
and inserting ``(32)''.
(d) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply with respect to medical
assistance furnished on or after January 1, 2022.
(2) 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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