,,ii #aaith ,,congress #ast ,session ,s4 #cbgd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #bj1 #bjbe,ms4 ,alsobrooks 7for herself1 ,ms4 ,baldwin1 ,mr4 ,blumenthal1 ,ms4 ,cortez ,masto1 ,mr4 ,fetterman1 ,mrs4 ,gillibrand1 ,mr4 ,king1 ,ms4 ,klobuchar1 ,mr4 ,merkley1 ,mrs4 ,murray1 ,mr4 ,van ,hollen1 ,mr4 ,booker1 ,ms4 ,duckworth1 and ,mr4 ,kaine7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to provide for a special enrollment period for pregnant women1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,healthy ,maternity and ,obstetric ,medicine ,act or the ,healthy ,,mom ,act4 #b4 ,findings2 purpose 7a7 ,findings ,congress finds the following3 7#a7 ,pregnancy is a significant life event for millions of women in the ,united ,states each year4 7#b7 ,for more than #cj years1 our ,nation1 through the ,medicaid program1 has recognized that pregnant women need immediate access to affordable care1 and has allowed women who meet income-eligibility requirements to enroll in ,medicaid coverage when they become pregnant4 7#c7 ,congress recognized the central importance of maternity coverage by classifying maternity and newborn care as one of the ten essential health benefits that must now be covered on most individual and small group health insurance plans under section #acjb7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a774 7#d7 ,congress has also recognized the significant challenge of maternal mortality and the need to eliminate disparities in maternal health outcomes for pregnancy-related and pregnancy-associated deaths1 and to improve health outcomes for both mothers and babies through passage of the ,preventing ,maternal ,deaths ,act of #bjah 7,public ,law #aae-cdd74 7#e7 ,access to comprehensive maternity coverage allows women to access important pregnancy-related care1 which is demonstrated to improve health outcomes for women and newborns and reduce financial costs for both consumers and insurers4 7#f7 ,uninsured women1 women with grandfathered and transitional health plans1 self-funded student health plans1 and catastrophic and high-deductible health plans may lack access to comprehensive and affordable maternity coverage4 7#g7 ,employer health plans that exclude dependent daughters from maternity coverage leave young women without coverage for their pregnancy1 even though ,federal law has long held that treating pregnancy differently than other conditions is sex-based discrimination4 7#h7 ,a special enrollment period is especially important for young adults1 who are at high risk for unintended pregnancies1 yet young adults are frequently enrolled in catastrophic coverage1 which often has fewer benefits1 more restrictions1 and higher deductibles4 7#i7 ,this coverage would be an equalizer for communities of color4 ,the maternal mortality rate varies drastically by race and ethnicity1 and where a woman lives4 ,the rising maternal mortality rate in the ,united ,states is driven predominantly by the disproportionately high ,african-,american maternal mortality rate1 which is four times more than the rate for ,white women4 7#aj7 ,according to the ,centers for ,disease ,control and ,prevention1 about #gjj women die each year in the ,united ,states from pregnancy-related complications4 ,black and ,american ,indian_/,alaska ,native women are about three times more likely to die from a pregnancy-related cause than ,white women4 7#aa7 ,data demonstrates that #c in #e pregnancy related deaths could be prevented4 ,improving access to care is one way to help prevent deaths1 regardless of race or ethnicity4 7#ab7 ,timely maternity care improves the health of pregnant women1 as well as birth outcomes and the health of babies throughout their lifetimes4 ,pregnancy-related maternal mortality is three to four times higher among women who receive no maternity care compared to women who do4 ,regular maternity care can detect or mitigate serious pregnancy-related health complications1 including preeclampsia1 placental abruption1 complications from diabetes1 complications from heart disease1 and ,graves' disease1 all of which can result in morbidity or mortality for the mother or newborn4 7#ac7 ,the ,centers for ,disease ,control and ,prevention reports that more than half of all maternal deaths occur at delivery or in the first postpartum year1 whereas just more than one-third of pregnancy-related or pregnancy-associated deaths occur while a person is still pregnant4 ,yet1 for women eligible for the ,medicaid program on the basis of pregnancy1 such ,medicaid coverage lapses at the end of the month on which the #fjth postpartum day lands4 7#ad7 ,timely maternity care and adequate postpartum care can reduce short- and long-term health care costs4 ,if a woman does not have access to affordable maternity care during her pregnancy1 and she or her newborn experiences pregnancy complications that result in health problems after birth1 their insurer may end up paying much higher costs than if the insurer had covered the woman's maternity care during her pregnancy4 ,intensive maternity care can reduce hospital and neonatal intensive care unit admissions among infants1 resulting in cost savings of #a1gfh to #e1efj per birth4 ,for women with high-risk pregnancies1 intensive maternity care saves #a4cg for every #a invested in maternity care4 7b7 ,purpose ,the purpose of this ,act is to protect the health of women and newborns by ensuring that all women eligible for coverage through the ,exchanges established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and women eligible for other individual or group health plan coverage can access affordable health coverage during their pregnancy4 #c4 ,providing for a special enrollment period for pregnant individuals 7a7 ,public ,health ,service ,act ,section #bgjb7;b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#a7;b77#b77 is amended by inserting 1 including a special enrollment period for pregnant individuals1 beginning on the date on which the pregnancy is reported to the health insurance issuer before the period at the end4 7b7 ,patient ,protection and ,affordable ,care ,act ,section #acaa7;c77#f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 is amended-- 7#a7 in subparagraph 7,c71 by striking and at the end2 7#b7 by redesignating subparagraph 7,d7 as subparagraph 7,e72 and 7#c7 by inserting after subparagraph 7,c7 the following3 7,d7 a special enrollment period for pregnant individuals1 beginning on the date on which the pregnancy is reported to the ,exchange2 and 4 7c7 ,internal ,revenue ,code ,section #ihja7;f7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following3 7#d7 ,for pregnant individuals 7,a7 ,in general ,a group health plan shall permit an employee who is eligible1 but not enrolled1 for coverage under the terms of the plan 7or a dependent of such an employee if the dependent is eligible1 but not enrolled1 for coverage under such terms7 to enroll for coverage under the terms of the plan upon pregnancy1 with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or the pregnancy is confirmed by a health care provider4 7,b7 ,regulations ,the ,secretary shall promulgate regulations with respect to the special enrollment period under subparagraph 7,a71 including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage4 4 7d7 ,,erisa ,section #gja7;f7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha7;f77 is amended by adding at the end the following3 7#d7 ,for pregnant individuals 7,a7 ,in general ,a group health plan or health insurance issuer in connection with a group health plan shall permit an employee who is eligible1 but not enrolled1 for coverage under the terms of the plan 7or a dependent of such an employee if the dependent is eligible1 but not enrolled1 for coverage under such terms7 to enroll for coverage under the terms of the plan upon pregnancy1 with the special enrollment period beginning on the date on which the pregnancy is reported to the group health plan or health insurance issuer or the pregnancy is confirmed by a health care provider4 7,b7 ,regulations ,the ,secretary shall promulgate regulations with respect to the special enrollment period under subparagraph 7,a71 including establishing a time period for pregnant individuals to enroll in coverage and effective date of such coverage4 4 7e7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjbg4 #d4 ,coverage of maternity care for dependent children 7a7 ,public ,health ,service ,act ,section #bgii;,a-#g of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aag7 is amended by adding at the end the following3 7d7 ,coverage of maternity care ,a group health plan1 or health insurance issuer offering group or individual health insurance coverage1 that provides coverage for dependents shall ensure that such plan or coverage includes coverage for maternity care associated with pregnancy1 childbirth1 and postpartum care for all participants1 beneficiaries1 and enrollees1 including dependents1 including coverage of labor and delivery4 ,such coverage shall be provided to all pregnant dependents regardless of age4 4 7b7 ,,erisa ,section #gbb of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahek7 is amended by adding at the end the following3 7d7 ,coverage of maternity care ,a group health plan1 or health insurance issuer offering group health insurance coverage1 that provides coverage for dependents shall ensure that such plan or coverage includes coverage for maternity care associated with pregnancy1 childbirth1 and postpartum care for all participants1 beneficiaries1 and enrollees1 including dependents1 including coverage of labor and delivery4 ,such coverage shall be provided to all pregnant dependents regardless of age4 4 7c7 ,internal ,revenue ,code ,section #ihbb of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following3 7d7 ,coverage of maternity care ,a group health plan that provides coverage for dependents shall ensure that such plan includes coverage for maternity care associated with pregnancy1 childbirth1 and postpartum care for all participants and beneficiaries1 including dependents1 including coverage of labor and delivery4 ,such coverage shall be provided to all pregnant dependents regardless of age4 4 7d7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after ,january #a1 #bjbg4 #e4 ,federal employee health benefit plans 7a7 ,coverage of pregnancy 7#a7 ,in general ,the ,director of the ,office of ,personnel ,management shall issue such regulations as are necessary to ensure that pregnancy is considered a change in family status and a qualifying life event for an individual who is eligible to enroll1 but is not enrolled1 in a health benefit plan under chapter #hi of title #e1 ,united ,states ,code4 7#b7 ,effective date ,the requirement in paragraph 7#a7 shall apply with respect to any contract entered into under section #hijb of title #e1 ,united ,states ,code1 on or after the date that is #a year after the date of enactment of this ,act4 7b7 ,designating certain ,,fehbp-,related services as excepted services under the ,anti-,deficiency ,act 7#a7 ,in general ,section #hije of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7j7 ,any services by an officer or employee under this chapter relating to enrolling individuals in a health benefits plan under this chapter1 or changing the enrollment of an individual already so enrolled due to an event described in section #e7;a77#a7 of the ,healthy ,,mom ,act1 shall be deemed1 for purposes of section #acdb of title #ca1 services for emergencies involving the safety of human life or the protection of property4 4 7#b7 ,application ,the amendment made by paragraph 7#a7 shall apply to any lapse in appropriations beginning on or after the date of enactment of this ,act4 #f4 ,continuation of ,medicaid income eligibility standard for pregnant individuals and infants ,section #aijb7l77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77#b77;,a77 is amended-- 7#a7 in clause 7i71 by striking and not more than #ahe percent2 7#b7 in clause 7ii7-- 7,a7 in subclause 7,i71 by striking and after the comma2 7,b7 in subclause 7,,ii71 by striking the period at the end and inserting 1 and2 and 7,c7 by adding at the end the following3 7,,iii7 ,january #a1 #bjbg1 is the percentage provided under clause 7v74 2 and 7#c7 by adding at the end the following new clause3 7v7 ,the percentage provided under clause 7ii7 for medical assistance provided on or after ,january #a1 #bjbg1 with respect to individuals described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 shall not be less than-- 7,i7 the percentage specified for such individuals by the ,state in an amendment to the ,state plan under this title 7whether approved or not7 as of ,january #a1 #bjbe2 or 7,,ii7 if no such percentage is specified as of ,january #a1 #bjbe1 the percentage established for such individuals under the ,state's authorizing legislation or provided for under the ,state's appropriations as of that date4 4 #g4 ,requiring and making permanent #ab-month continuous coverage for pregnant and postpartum individuals under ,medicaid and ,,chip 7a7 ,medicaid ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#hh77;,b77iii71 by striking and at the end2 7,b7 in paragraph 7#hi71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hi7 the following new paragraph3 7#ij7 provide that the ,state plan is in compliance with subsection 7e77#af74 2 and 7#b7 in subsection 7e77#af7-- 7,a7 in subparagraph 7,a71 by striking ,at the option of the ,state1 the ,state plan 7or waiver of such ,state plan7 may provide1 and inserting ,a ,state plan 7or waiver of such ,state plan7 shall provide2 7,b7 in subparagraph 7,b71 in the matter preceding clause 7i71 by striking by a ,state making an election under this paragraph and inserting under a ,state plan 7or a waiver of such ,state plan72 and 7,c7 by striking subparagraph 7,c74 7b7 ,,chip 7#a7 ,in general ,section #bajg7;e77#a77,k7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77,k77 is amended to read as follows3 7,k7 ,paragraphs 7#e7 and 7#af7 of section #aijb7;e7 7relating to the requirement to provide medical assistance under the ,state plan or waiver consisting of full benefits during pregnancy and throughout the #ab-month postpartum period under title ,,xix7 such that the provision of assistance under the ,state child health plan or waiver for targeted low-income children or targeted low-income pregnant women during pregnancy and the #ab-month postpartum period shall be required and shall include coverage of all items or services provided to a targeted low-income child or targeted low-income pregnant woman 7as applicable7 under the ,state child health plan or waiver4 4 7#b7 ,conforming ,section #baab7;d77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is amended by striking the month in which the #fj-;day period and all that follows through pursuant to section #bajg7;e77#a714 7c7 ,effective date 7#a7 ,in general ,subject to paragraph 7#b71 the amendments made by this section shall apply with respect to services furnished on or after the date that is #a year after the date of the enactment of this ,act4 7#b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a ,state child health plan under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;ee et seq47 that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the plan to meet any requirement imposed by amendments made by this section1 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 enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 #h4 ,relationship to other laws ,nothing in this ,act 7or an amendment made by this ,act7 shall be construed to invalidate or limit the remedies1 rights1 and procedures of any ,federal law or the law of any ,state or political subdivision of any ,state or jurisdiction that provides greater or equal protection for enrollees in a group health plan or group or individual health insurance offered by a health insurance issuer4