[Congressional Record Volume 166, Number 169 (Tuesday, September 29, 2020)]
[House]
[Pages H5000-H5003]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         HELPING MEDICAID OFFER MATERNITY SERVICES ACT OF 2020

  Mr. PALLONE. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 4996) to amend title XIX of the Social Security Act to 
provide for a State option under the Medicaid program to provide for 
and extend continuous coverage for certain individuals, and for other 
purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4996

       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 ``Helping Medicaid Offer 
     Maternity Services Act of 2020'' or the ``Helping MOMS Act of 
     2020''.

     SEC. 2. MODIFICATIONS TO CERTAIN COVERAGE UNDER MEDICAID AND 
                   CHIP FOR PREGNANT AND POSTPARTUM WOMEN.

       (a) State Option.--Section 1902(e) of the Social Security 
     Act (42 U.S.C. 1396a(e)) is amended by adding at the end the 
     following new paragraph:

[[Page H5001]]

       ``(16) Extending certain coverage for pregnant and 
     postpartum women.--At the option of the State, the State plan 
     (or waiver of such State plan) may provide that an individual 
     who, while pregnant, is eligible for and has received medical 
     assistance under the State plan approved under this title (or 
     waiver of such plan) (including during a period of 
     retroactive eligibility under subsection (a)(34)) shall, in 
     addition to remaining eligible under paragraph (5) for all 
     pregnancy-related and postpartum medical assistance available 
     under the State plan (or wavier) through the last day of the 
     month in which the 60-day period (beginning on the last day 
     of her pregnancy) ends, remain eligible under the State plan 
     (or waiver) for medical assistance and such medical 
     assistance shall include all services covered under the State 
     plan (or waiver) that is not less in amount, duration, or 
     scope, or is determined by the Secretary to be substantially 
     equivalent, to the medical assistance available for an 
     individual described in subsection (a)(10)(A)(i) for the 
     period beginning on the first day occurring after the end of 
     such 60-day period and ending on the last day of the month in 
     which the one-year period (beginning on the last day of her 
     pregnancy) ends.''.
       (b) Application to CHIP.--
       (1) In general.--Section 2107(e)(1) of the Social Security 
     Act (42 U.S.C. 1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (J) through (S) as 
     subparagraphs (K) through (T), respectively; and
       (B) by inserting after subparagraph (I) the following new 
     subparagraph:
       ``(J) In the case of a State that has elected to apply the 
     option under section 1902(e)(16) with respect to coverage for 
     pregnant and postpartum women under title XIX, the provisions 
     of such section with respect to coverage of pregnant and 
     postpartum women under this title, except that such coverage 
     shall be required and not at the option of the State.''.
       (2) Optional coverage of targeted low-income pregnant 
     women.--Section 2112(d)(2)(A) of the Social Security Act (42 
     U.S.C. 1397ll(d)(2)(A)) is amended by inserting after ``60-
     day period'' the following: ``, or, in the case that section 
     1902(e)(16) applies to the State child health plan (or waiver 
     of such plan) pursuant to section 2107(e)(1), the 1-year 
     period''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to State elections made under 
     paragraph (16) of section 1902(e) of the Social Security Act 
     (42 U.S.C. 1396a(e)), as added by subsection (a), under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.) on or 
     after the first day of the first fiscal year quarter 
     beginning at least one year after the date of the enactment 
     of this Act.

     SEC. 3. MACPAC REPORT.

       (a) 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:
       (1) Information about coverage for doula services under 
     State Medicaid programs that currently provide coverage for 
     such services, including the type of doula services offered 
     (such as prenatal, labor and delivery, postpartum support, 
     and also community-based and traditional doula services).
       (2) An analysis of barriers to covering doula services 
     under State Medicaid programs.
       (3) 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.
       (4) 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.
       (b) Stakeholder Consultation.--In developing the report 
     required under subsection (a), MACPAC shall consult with 
     relevant stakeholders, including--
       (1) States;
       (2) organizations representing consumers, including those 
     that are disproportionately impacted by poor maternal health 
     outcomes;
       (3) organizations and individuals representing doula 
     services providers, including community-based doula programs 
     and those who serve underserved communities, including 
     communities of color, and communities facing linguistic or 
     cultural barriers; and
       (4) organizations representing health care providers.

     SEC. 4. GAO REPORT.

       (a) In General.--Not later than 2 years after the date of 
     the enactment of this Act and every five years thereafter, 
     the Comptroller General of the United States shall submit to 
     Congress a report on the State adoption, 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 such Act, of extending coverage to 365 
     days postpartum pursuant to the provisions of (and amendments 
     made by this Act). Such report shall include the information 
     and recommendations described in subsection (b) and shall 
     also identify ongoing gaps in coverage for--
       (1) pregnant women under the Medicaid program and the 
     Children's Health Insurance Program; and
       (2) postpartum women under the Medicaid program and the 
     Children's Health Insurance Program who received assistance 
     under either such program during their pregnancy.
       (b) Content of Report.--The report under subsection (a) 
     shall include the following:
       (1) Information regarding the extent to which States have 
     elected to extend coverage to 365 days postpartum pursuant to 
     the provisions of (and amendments made by this Act), 
     including which States make the election and when, impacts on 
     perinatal insurance churn in those States compared to States 
     that did not make such election, other health impacts of such 
     election including regarding maternal mortality and morbidity 
     rates, and impacts on State and Federal Medicaid spending.
       (2) Information about the abilities, successes, and 
     challenges of State Medicaid agencies in--
       (A) transitioning their eligibility systems to incorporate 
     such an election by a State and in determining whether 
     pregnant and postpartum women are eligible under another 
     insurance affordability program; and
       (B) transitioning any such women who are so eligible to 
     coverage under such a program, pursuant to section 1943(b)(3) 
     of the Social Security Act (42 U.S.C 1396w-3(b)(3)).
       (3) Information on factors contributing to ongoing gaps in 
     coverage resulting from women transitioning from coverage 
     under the Medicaid program or Children's Health Insurance 
     Program that disproportionately impact underserved 
     populations, including low-income women, women of color, 
     women 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 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))).
       (4) Recommendations for addressing and reducing such gaps 
     in coverage.
       (5) Such other information as the Comptroller General 
     determines appropriate.

     SEC. 5. REPORT ON MEDICAID BUNDLED PAYMENTS FOR PREGNANCY-
                   RELATED SERVICES.

       Not later than 2 years after the date of the enactment of 
     this Act, the Medicaid and CHIP Payment Advisory Commission 
     shall submit to Congress a report containing an analysis of 
     the use of bundled payments for reimbursing health care 
     providers with respect to pregnancy-related services 
     furnished under State plans (or waivers of such plans) under 
     title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.).

     SEC. 6. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT FOR SINGLE 
                   SOURCE DRUGS AND INNOVATOR MULTIPLE SOURCE 
                   DRUGS.

       Section 1927(c)(2)(D) of the Social Security Act (42 U.S.C. 
     1396r-8(c)(2)(D)) is amended by inserting after ``December 
     31, 2009,'' the following: ``and before January 1, 2023,''.

     SEC. 7. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(3) of the Social Security Act (42 U.S.C 
     1396w-1(b)(3)) is amended--
       (1) in subparagraph (A), by striking ``for fiscal year 2025 
     and thereafter, $1,960,000,000'' and inserting ``for fiscal 
     year 2022 and thereafter, $9,286,000,000''; and
       (2) in subparagraph (B), by striking ``fiscal year 2025'' 
     and inserting ``fiscal year 2022''.

     SEC. 8. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Oregon (Mr. Walden) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on H.R. 4996.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield myself such time as I may 
consume.
  I rise today in strong support of H.R. 4996, the Helping Medicaid 
Offer Maternity Services Act, or the Helping MOMS Act of 2020.
  The U.S. has some of the world's leading healthcare providers. We 
have cutting-edge researchers and first-class facilities for those who 
can afford it.
  At the same time, women are more likely to die from complications 
from

[[Page H5002]]

childbirth here in the U.S. than in other nations in the developed 
world. Maternal mortality especially affects women of color. Black 
women and American Indian and Alaska Native women are three times more 
likely than White women to die from pregnancy-related causes. Even more 
tragically, most of these deaths are preventable.
  These statistics are unacceptable. They are an indictment of our 
healthcare system, Madam Speaker, and I believe we can do better.
  Ensuring that women have access to health insurance for the first 
year postpartum is an obvious first step that we can take to ensure 
that all women, regardless of income, have access to the care they need 
for the critical first year after giving birth.
  Currently, Medicaid covers pregnant women for 60 days postpartum. 
After that, many women lose eligibility and go without a consistent 
source of care. The Helping MOMS Act would build on this coverage by 
giving States the option to extend Medicaid coverage to women to a full 
year postpartum.
  This bill is endorsed by the American College of Obstetricians and 
Gynecologists, the Association of Maternal and Child Health Programs, 
the National Birth Equity Collaborative, the March of Dimes, and many 
more organizations.
  I want to commend Representative Robin Kelly for her passion and 
commitment to this bill and to improving the lives of new mothers.
  I also want to thank and recognize Representative   Michael Burgess, 
the ranking member of the Health Subcommittee, for his steadfast 
leadership on the Republican side.
  Finally, I want to recognize the efforts of Representatives Lauren 
Underwood, Cathy Rodgers, Ayanna Pressley, and Buddy Carter for their 
leadership on this issue and their commitment to bipartisan solutions.
  Too many children in this country, Madam Speaker, grow up knowing 
their mothers only as a fading picture on the wall or as someone whose 
name brings a bittersweet smile and a tear to friends and loved ones. 
It doesn't have to be this way.
  This bill will not singlehandedly fix the maternal health crisis in 
this country, but it will mean that more of these children will have a 
mother to take care of them, tuck them in at night, comfort them in 
moments of need, and share in their moments of joy and sorrow. I urge 
my colleagues to support this bill for these children and their 
mothers.
  Madam Speaker, I reserve the balance of my time.
  Mr. WALDEN. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise today in support of H.R. 4996. This is the 
Helping Medicaid Offer Maternity Services, or MOMS, Act of 2019. It was 
introduced by Representative Kelly from Illinois and Dr. Burgess from 
Texas.
  As you have heard, this legislation gives States the option to extend 
the length of continuous postpartum eligibility for Medicaid to 12 
months. Now, this is a critically important bill. Despite everything 
that is going on in the country, it is an example of, once again, 
Congress coming together to do the right thing for the right reason.
  This bipartisan legislation furthers the Committee on Energy and 
Commerce's mission to address maternal mortality, which we all agree 
needs further attention, and to improve the health outcomes in 
expectant or new moms.
  Last Congress, Madam Speaker, President Trump signed bipartisan 
legislation from our committee into law to advance maternal health. We 
are now building on that progress today.
  Medicaid is the largest single-payer of maternity care in the United 
States. Medicaid covered 43 percent of all births in 2017, the latest 
data we have. Now, in some of our States, the share of healthcare costs 
of births financed by Medicaid is even higher. As such, this program 
plays a significant role in improving maternal health and helping to 
eliminate preventable maternal mortality.
  I want to thank Ms. Kelly and Dr. Burgess for leading this effort, 
and I want to thank Chairman Pallone and his staff for working together 
to find a path forward with this important legislation.
  Getting this measure signed into law will have a meaningful impact on 
the maternal mortality crisis. We will make a difference with this 
legislation. We will save more moms' lives.
  Madam Speaker, I urge all Members to support this legislation, and I 
reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield such time as she may consume to 
the gentlewoman from Illinois (Ms. Kelly), the sponsor of the bill.
  Ms. KELLY of Illinois. Madam Speaker, I rise to encourage my 
colleagues to support the Helping MOMS Act. This bipartisan 
legislation, which I authored together with my colleagues on the House 
Energy and Commerce Committee, would allow States to use their own 
funds to extend Medicaid coverage for new moms to the entire postpartum 
period of 1 year, which is the recommendation of medical professionals 
and experts. Right now, States must seek a waiver from the Secretary of 
Health and Human Services to expand postpartum coverage beyond 60 days.

  With Medicaid providing coverage for more than half of new American 
moms, expanding Medicaid would save lives. Study after study has proven 
this to be the case. This bill will help correct a hurdle that has 
existed for too many women.
  Tragically, we know that our Nation's maternal mortality crisis, like 
so many public health challenges, is taking a disproportionate toll on 
African-American moms. Black moms die at 2\1/2\ times the rate of White 
moms. In my home State of Illinois, the disparity grows to six times. 
It is time for us to give new moms that opportunity to stay healthy by 
seeing their doctors.
  On top of removing the waiver requirement, this bill also studies the 
availability of, access to, and success of doulas in providing care to 
moms before, during, and after birth within the Medicaid program.
  For those unfamiliar with the term, a doula is a trained companion 
who, while not always a healthcare professional, supports mothers 
through the pregnancy process. Studies have shown that doulas are a 
powerful and cost-effective way to improve care delivery and prevent 
maternal death.
  Before closing, I want to thank my colleagues from Texas and 
Washington for their leadership and support. Likewise, I would like to 
thank the more than dozen organizations that endorsed this legislation, 
including the American College of Obstetricians and Gynecologists.
  While the Helping MOMS Act is a compromise and not as comprehensive 
as I had hoped, this is a major step forward that Congress can and 
should take in a bipartisan way to help save mothers' lives.
  In 2020, starting or growing a family should never cost a woman her 
life, so I urge a ``yes'' on the Helping MOMS Act. It will help ensure 
healthy and happy moms, babies, and families across America.
  Mr. WALDEN. Madam Speaker, I have no other speakers on this measure. 
I would encourage its passage.
  I yield back the balance of my time.
  Mr. PALLONE. Madam Speaker, I would urge support for the bill, and I 
also yield back the balance of my time.
  Ms. ESHOO. Madam Speaker, I rise in support of H.R. 4996, the Helping 
MOMS Act of 2019. I'm proud to have advanced this bipartisan bill 
through my Health Subcommittee and I'm pleased to support it on the 
Floor today.
  My thanks to Reps. Kelly, Burgess, Underwood, Rodgers, Pressley, and 
Carter for introducing the Helping Medicaid Offer Maternity Services 
Act, a bipartisan bill to make it easier for states to expand Medicaid 
or CHIP coverage for one year postpartum.
  While the uninsured rate among postpartum women has decreased thanks 
to the Affordable Care Act, many women still lose Medicaid coverage two 
months after having a baby.
  In Texas, Georgia, and Oklahoma, 20 percent of new mothers are 
uninsured. Lack of coverage keeps women from receiving needed care, 
including mental health services to detect and treat postpartum 
depression.
  This bill makes it easier for states to expand coverage by removing 
administrative red tape and by offering a small financial incentive to 
states to expand postpartum care.
  I think we should go further and make postpartum coverage a mandatory 
benefit in the Medicaid program, but I'm pleased we're taking this step 
today to make it an easy option for states.
  I ask my colleagues to join me in voting for this bill.

[[Page H5003]]

  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 4996, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________