,i #aah? ,,congress #a/ ,session ,h4 ,r4 #fgaf ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,decemb] #aa1 #bjbc,mrs4 ,watson ,coleman 7= h]self1 ,mr4 ,boyle ( ,p5nsylvania1 ,ms4 ,wilson ( ,florida1 ,mr4 ,payne1 ,mr4 ,grijalva1 ,mr4 ,johnson ( ,georgia1 ,mr4 ,evans1 ,mr4 ,connolly1 ,ms4 ,*u1 ,mr4 ,torres ( ,new ,york1 ,mr4 ,pocan1 ,ms4 ,lee ( ,cali=nia1 ,mr4 ,coh51 ,ms4 ,norton1 ,mr4 ,c>son1 ,mrs4 ,hayes1 ,ms4 ,crockett1 ,mr4 ,meeks1 ,mr4 ,c>t] ( ,l\isiana1 ,mr4 ,jackson ( ,ill9ois1 ,ms4 ,/ev5s1 ,ms4 ,bonamici1 ,mr4 ,swalwell1 ,ms4 ,m5g1 ,ms4 ,lois ,frankel ( ,florida1 & ,ms4 ,%]rill7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means1 ,education & ! ,work=ce1 & ,ov]sight & ,acc\ntability1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xxvii ( ! ,public ,heal? ,s]vice ,act to provide = a special enrollm5t p]iod = pregnant wom51 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,heal?y ,mat]nity & ,ob/etric ,m$ic9e ,act or ! ,heal?y ,,mom ,act4 #b4 ,f9d+s2 purpose 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,pregnancy is a significant life ev5t = millions ( wom5 9 ! ,unit$ ,/ates ea* ye>4 7#b7 ,= m ?an #cj ye>s1 our ,nation1 ?r\gh ! ,m$icaid program1 has recogniz$ t pregnant wom5 ne$ imm$iate access to af=dable c>e1 & has all[$ wom5 :o meet income-eligibility requirem5ts to enroll 9 ,m$icaid cov]age :5 !y become pregnant4 7#c7 ,congress recogniz$ ! c5tral importance ( mat]nity cov]age by classify+ mat]nity & newborn c>e z "o ( ! t5 ess5tial heal? b5efits t mu/ n[ be cov]$ on mo/ individual & small gr\p heal? insurance plans "u section #acjb7;b77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a774 7#d7 ,congress has also recogniz$ ! significant *all5ge ( mat]nal mortality & ! ne$ to elim9ate disp>ities 9 mat]nal heal? outcomes = pregnancy-relat$ & pregnancy-associat$ dea?s1 & to improve heal? outcomes = bo? mo!rs & babies ?r\gh passage ( ! ,prev5t+ ,mat]nal ,dea?s ,act ( #bjah 7,public ,law #aae-cdd74 7#e7 ,access to compreh5sive mat]nity cov]age all[s wom5 to access important pregnancy-relat$ c>e1 :i* is demon/rat$ to improve heal? outcomes = wom5 & newborns & r$uce f9ancial co/s = bo? consum]s & insur]s4 7#f7 ,un9sur$ wom51 wom5 ) gr&fa!r$ & transitional heal? plans1 self-fund$ /ud5t heal? plans1 & cata/rophic & high-d$uctible heal? plans may lack access to compreh5sive & af=dable mat]nity cov]age4 7#g7 ,employ] heal? plans t exclude dep5d5t daught]s f mat]nity cov]age leave "y wom5 )\t cov]age = _! pregnancy1 ev5 ?\gh ,f$]al law has long held t treat+ pregnancy diff]5tly ?an o!r conditions is sex-bas$ discrim9ation4 7#h7 ,a special enrollm5t p]iod is especially important = "y adults1 :o are at high risk = un9t5d$ pregnancies1 yet "y adults are frequ5tly enroll$ 9 cata/rophic cov]age1 :i* (t5 has few] b5efits1 m re/rictions1 & high] d$uctibles4 7#i7 ,?is cov]age w\ld be an equaliz] = communities ( color4 ,! mat]nal mortality rate v>ies dra/ically by race & e?nicity1 & :]e a woman lives4 ,! ris+ mat]nal mortality rate 9 ! ,unit$ ,/ates is driv5 pr$om9antly by ! disproportionately high ,african-,am]ican mat]nal mortality rate1 :i* is f\r times m ?an ! rate = ,:ite wom54 7#aj7 ,accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion1 ab\t #gjj wom5 die ea* ye> 9 ! ,unit$ ,/ates f pregnancy-relat$ complications4 ,black & ,am]ican ,indian_/,alaska ,native wom5 are ab\t ?ree times m likely to die f a pregnancy-relat$ cause ?an ,:ite wom54 7#aa7 ,data demon/rates t #c 9 #e pregnancy relat$ dea?s c\ld be prev5t$4 ,improv+ access to c>e is "o way to help prev5t dea?s1 reg>dless ( race or e?nicity4 7#ab7 ,timely mat]nity c>e improves ! heal? ( pregnant wom51 z well z bir? outcomes & ! heal? ( babies ?r\gh\t _! lifetimes4 ,pregnancy-relat$ mat]nal mortality is ?ree to f\r times high] among wom5 :o receive no mat]nity c>e comp>$ to wom5 :o d4 ,regul> mat]nity c>e c detect or mitigate s]i\s pregnancy-relat$ heal? complications1 includ+ preeclampsia1 plac5tal abruption1 complications f diabetes1 complications f he>t disease1 & ,graves' disease1 all ( :i* c result 9 morbidity or mortality = ! "m or newborn4 7#ac7 ,! ,c5t]s = ,disease ,control & ,prev5tion reports t m ?an half ( all mat]nal dea?s occur at deliv]y or 9 ! fir/ po/p>tum ye>1 :]eas j m ?an "o-?ird ( pregnancy-relat$ or pregnancy-associat$ dea?s occur :ile a p]son is /ill pregnant4 ,yet1 = wom5 eligible = ! ,m$icaid program on ! basis ( pregnancy1 su* ,m$icaid cov]age lapses at ! end ( ! mon? on :i* ! #fj? po/p>tum day l&s4 7#ad7 ,timely mat]nity c>e & adequate po/p>tum c>e c r$uce %ort- & long-t]m heal? c>e co/s4 ,if a woman does n h access to af=dable mat]nity c>e dur+ h] pregnancy1 & %e or h] newborn exp]i5ces pregnancy complications t result 9 heal? problems aft] bir?1 _! insur] may end up pay+ mu* high] co/s ?an if ! insur] _h cov]$ ! woman's mat]nity c>e dur+ h] pregnancy4 ,int5sive mat]nity c>e c r$uce hospital & neonatal int5sive c>e unit admissions among infants1 result+ 9 co/ sav+s ( #a1gfh to #e1efj p] bir?4 ,= wom5 ) high-risk pregnancies1 int5sive mat]nity c>e saves #a4cg = e #a inve/$ 9 mat]nity c>e4 7b7 ,purpose ,! purpose ( ?is ,act is to protect ! heal? ( wom5 & newborns by ensur+ t all wom5 eligible = cov]age ?r\gh ! ,ex*anges e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7 & wom5 eligible = o!r individual or gr\p heal? plan cov]age c access af=dable heal? cov]age dur+ _! pregnancy4 #c4 ,provid+ = a special enrollm5t p]iod = pregnant individuals 7a7 ,public ,heal? ,s]vice ,act ,section #bgjb7;b77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#a7;b77#b77 is am5d$ by ins]t+ 1 includ+ a special enrollm5t p]iod = pregnant individuals1 beg9n+ on ! date on :i* ! pregnancy is report$ to ! heal? insurance issu] be=e ! p]iod at ! end4 7b7 ,pati5t protection & af=dable c>e act ,section #acaa7;c77#f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by /rik+ & at ! end2 7#b7 by r$esignat+ subp>agraph 7,d7 z subp>agraph 7,e72 & 7#c7 by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 a special enrollm5t p]iod = pregnant individuals1 beg9n+ on ! date on :i* su* pregnancy is report$ to ! ,ex*ange2 & 4 7c7 ,special enrollm5t p]iods 7#a7 ,int]nal ,rev5ue ,code ,section #ihja7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf 7#bf ,u4,s4,c4 #ihja7;f77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,= pregnant individuals 7,a7 ,a gr\p heal? plan %all p]mit an employee :o is eligible1 b n enroll$1 = cov]age "u ! t]ms ( ! plan 7or a dep5d5t ( su* an employee if ! dep5d5t is eligible1 b n enroll$1 = cov]age "u su* t]ms7 to enroll = cov]age "u ! t]ms ( ! plan ^u pregnancy1 ) ! special enrollm5t p]iod beg9n+ on ! date on :i* ! pregnancy is report$ to ! gr\p heal? plan or ! pregnancy is confirm$ by a heal? c>e provid]4 7,b7 ,! ,secret>y %all promulgate regulations ) respect to ! special enrollm5t p]iod "u subp>agraph 7,a71 includ+ e/abli%+ a "t p]iod = pregnant individuals to enroll 9 cov]age & effective date ( su* cov]age4 4 7#b7 ,,erisa ,section #gja7;f7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaha7;f77 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,= pregnant individuals 7,a7 ,a gr\p heal? plan or heal? insurance issu] 9 connection ) a gr\p heal? plan %all p]mit an employee :o is eligible1 b n enroll$1 = cov]age "u ! t]ms ( ! plan 7or a dep5d5t ( su* an employee if ! dep5d5t is eligible1 b n enroll$1 = cov]age "u su* t]ms7 to enroll = cov]age "u ! t]ms ( ! plan ^u pregnancy1 ) ! special enrollm5t p]iod beg9n+ on ! date on :i* ! pregnancy is report$ to ! gr\p heal? plan or heal? insurance issu] or ! pregnancy is confirm$ by a heal? c>e provid]4 7,b7 ,! ,secret>y %all promulgate regulations ) respect to ! special enrollm5t p]iod "u subp>agraph 7,a71 includ+ e/abli%+ a "t p]iod = pregnant individuals to enroll 9 cov]age & effective date ( su* cov]age4 4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbe4 #d4 ,cov]age ( mat]nity c>e = dep5d5t *ildr5 ,section #bgai;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7 is am5d$-- 7#a7 9 subsection 7e71 by ins]t+ 7o!r ?an subsection 7f77 aft] ?is section2 & 7#b7 by add+ at ! end ! foll[+3 7f7 ,cov]age ( mat]nity c>e ,n lat] ?an ,janu>y #a1 #bjbe1 a gr\p heal? plan1 or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age1 t provides cov]age = dep5d5ts %all ensure t su* plan or cov]age includes cov]age = mat]nity c>e associat$ ) pregnancy1 *ildbir?1 & po/p>tum c>e = all p>ticipants1 b5efici>ies1 or enrollees1 includ+ dep5d5ts1 includ+ cov]age ( labor & deliv]y4 ,su* cov]age %all be provid$ to all pregnant dep5d5ts reg>dless ( age4 4 #e4 ,f$]al employee heal? b5efit plans 7a7 ,cov]age ( pregnancy 7#a7 ,9 g5]al ,! ,director ( ! ,(fice ( ,p]sonnel ,managem5t %all issue su* regulations z are necess>y to ensure t pregnancy is consid]$ a *ange 9 family /atus & a qualify+ life ev5t = an individual :o is eligible to enroll1 b is n enroll$1 9 a heal? b5efit plan "u *apt] #hi title #e1 ,unit$ ,/ates ,code4 7#b7 ,effective date ,! requirem5t 9 p>agraph 7#a7 %all apply ) respect to any contract ent]$ into "u section #hijb ( su* title beg9n+ #ab mon?s aft] ! date ( enactm5t ( ?is ,act4 7b7 ,designat+ c]ta9 ,,fehbp-,relat$ s]vices z except$ s]vices "u ! ,anti-,defici5cy ,act 7#a7 ,9 g5]al ,section #hije ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 7j7 ,any s]vices by an (fic] or employee "u ?is *apt] relat+ to enroll+ individuals 9 a heal? b5efits plan "u ?is *apt]1 or *ang+ ! enrollm5t ( an individual already s enroll$ due to an ev5t describ$ 9 section #e7;a77#a7 ( ! ,heal?y ,,mom ,act1 %all be deem$1 = purposes ( section #acdb ( title #ca1 s]vices = em]g5cies involv+ ! safety ( human life or ! protection ( prop]ty4 4 7#b7 ,application ,! am5dm5t made by p>agraph 7#a7 %all apply to any lapse 9 appropriations beg9n+ on or aft] ! date ( enactm5t ( ?is ,act4 #f4 ,cont9uation ( ,m$icaid income eligibility /&>d = pregnant individuals & infants ,section #aijb7l77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77#b77;,a77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ & n m ?an #ahe p]c5t2 7#b7 9 clause 7ii7-- 7,a7 9 subclause 7,i71 by /rik+ & aft] ! comma2 7,b7 9 subclause 7,,ii71 by /rik+ ! p]iod at ! end & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+3 7,,iii7 ,janu>y #a1 #bjbe1 is ! p]c5tage provid$ "u clause 7v74 2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7v7 ,! p]c5tage provid$ "u clause 7ii7 = m$ical assi/ance provid$ on or aft] ,janu>y #a1 #bjbe1 ) respect to individuals describ$ 9 subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7 %all n be less ?an-- 7,i7 ! p]c5tage specifi$ = su* individuals by ! ,/ate 9 an am5dm5t to its ,/ate plan 7:e!r approv$ or n7 z ( ,janu>y #a1 #bjbe2 or 7,,ii7 if no su* p]c5tage is specifi$ z ( ,janu>y #a1 #bjbe1 ! p]c5tage e/abli%$ = su* individuals "u ! ,/ate's au?oriz+ legislation or provid$ = "u ! ,/ate's appropriations z ( t date4 4 #g4 ,requir+ & mak+ p]man5t #ab-mon? cont9u\s cov]age = pregnant & po/p>tum individuals "u ,m$icaid & ,,*ip 7a7 ,m$icaid ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#hf71 by /rik+ & at ! end2 7,b7 9 p>agraph 7#hg71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] p>agraph 7#hg7 ! foll[+ new p>agraph3 7#hh7 provide t ! ,/ate plan is 9 compliance ) subsection 7e77#af74 2 & 7#b7 9 subsection 7e77#af71 z add$ by section #ihab ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,p4,l4 #aag-b7-- 7,a7 9 subp>agraph 7,a71 by /rik+ ,at ! option ( ! ,/ate1 ! ,/ate plan 7or waiv] ( su* ,/ate plan7 may provide & ins]t+ ,a ,/ate plan 7or waiv] ( su* ,/ate plan7 %all provide2 7,b7 9 subp>agraph 7,b71 9 ! matt] prec$+ clause 7i71 by /rik+ by a ,/ate mak+ an election "u ?is p>agraph & ins]t+ "u a ,/ate plan 7or a waiv] ( su* ,/ate plan72 & 7,c7 by /rik+ subp>agraph 7,c74 7b7 ,,*ip 7#a7 ,9 g5]al ,section #bajg7;e77#a77;,j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77;,j771 z ins]t$ by section #ihbb ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,p4,l4 #aag-b71 is am5d$ to read z foll[s3 7,j7 ,p>agraphs 7#e7 & 7#af7 ( section #aijb7;e7 7relat+ to ! requirem5t to provide m$ical assi/ance "u ! ,/ate plan or waiv] consi/+ ( full b5efits dur+ pregnancy & ?r\gh\t ! #ab-mon? po/p>tum p]iod "u title ,,xix7 su* t ! provision ( assi/ance "u ! ,/ate *ild heal? plan or waiv] = t>get$ l[-income *ildr5 or t>get$ l[-income pregnant wom5 dur+ pregnancy & ! #ab-mon? po/p>tum p]iod %all be requir$ & %all include cov]age ( all items or s]vices provid$ to a t>get$ l[-income *ild or t>get$ l[-income pregnant woman 7z applicable7 "u ! ,/ate *ild heal? plan or waiv]74 4 7#b7 ,con=m+ ,section #baab7;d77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a771 z ins]t$ by section #ihbb ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,p4,l4 #aag-b71 is am5d$ by /rik+ ! mon? 9 :i* ! #fj-;day p]iod & all t foll[s ?r\gh pursuant to section #bajg7;e77#a714 7c7 ,con=m+ am5dm5ts 7#a7 ,section #ihab7;b7 ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,p4,l4 #aag-b7 is am5d$ to read z foll[s3 7b7 ,effective date 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! am5dm5t made by subsection 7a7 %all apply ) respect to s]vices furni%$ on or aft] ! #a/ day ( ! #a/ fiscal ye> qu>t] t beg9s "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 9 ord] = ! respective plan to meet any requirem5t impos$ by am5dm5ts made by ?is section1 ! plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* an additional requirem5t be=e ! fir/ day ( ! fir/ fiscal ye> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session %all be consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 4 7#b7 ,section #ihbb7;b7 ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,p4,l4 #aag-b7 is am5d$ to read z foll[s3 7b7 ,effective date 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! am5dm5ts made by subsection 7a71 %all apply ) respect to s]vices furni%$ on or aft] ! #a/ day ( ! #a/ fiscal ye> qu>t] t beg9s "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 7#b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate *ild heal? plan "u title ,,xxi ( ! ,social ,security ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 9 ord] = ! plan to meet any requirem5t impos$ by am5dm5ts made by ?is section1 ! respective plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* an additional requirem5t be=e ! fir/ day ( ! fir/ fiscal ye> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session %all be consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 4 7d7 ,effective date ,! am5dm5ts made by subsections 7a7 & 7c77#a7 %all take effect z if includ$ 9 ! enactm5t ( section #ihab ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,p4,l4 #aag-b74 ,! am5dm5ts made by subsections 7b7 & 7c77#b7 %all take effect z if includ$ 9 ! enactm5t ( section #ihbb ( su* ,act4 #h4 ,relation%ip to o!r laws ,no?+ 9 ?is ,act 7or an am5dm5t made by ?is ,act7 %all be con/ru$ to invalidate or limit ! rem$ies1 rights1 & proc$ures ( any ,f$]al law or ! law ( any ,/ate or political subdivision ( any ,/ate or jurisdiction t provides great] or equal protection = enrollees 9 a gr\p heal? plan or gr\p or individual heal? insurance (f]$ by a heal? insurance issu]4