S. 4913 — MOMMIES Act

This section extends continuous Medicaid and CHIP eligibility for pregnant and postpartum individuals to a 1-year period beginning on the last day of pregnancy (from 60 days), or longer at state option. It requires states to provide full benefits equivalent to those available to individuals described in section 1902(a)(10)(A)(i) during pregnancy and the extended postpartum period. It also mandates Medicaid and CHIP coverage of oral health services for these individuals, including at minimum preventive, diagnostic, periodontal, and restorative care consistent with specified professional recommendations.

This section establishes a maternity care home demonstration project under which the Secretary provides grants to at least 10 States to implement or expand maternity care home models for eligible pregnant and postpartum individuals enrolled in Medicaid or CHIP. The project aims to improve maternity and infant care outcomes, birth equity, and health equity for specified underserved populations while reducing maternal morbidity, mortality, and related disparities.

This section reapplies the Medicare payment rate floor to primary care services furnished under Medicaid, requiring states to pay at least 100 percent of the applicable Medicare rate (or the 2009 conversion factor rate if higher) for services provided by specified providers beginning the first month after enactment of the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act. It expands the providers subject to the floor to include physicians with a primary specialty in obstetrics and gynecology, advanced practice clinicians supervised by qualifying physicians or other clinicians, rural health clinics, federally qualified health centers, title X health centers, and midwives working under state law, while excluding emergency department services. It also requires Medicaid managed care contracts to ensure equivalent payments and documentation of compliance.

This section requires the Medicaid and CHIP Payment and Access Commission to publish a report within one year on doula services coverage under State Medicaid programs, including current offerings by type, credentialing requirements, enrollment and payment data, barriers to coverage, strategies to recruit and sustain a diverse workforce, and recommendations for legislative and administrative actions to improve access and doula compensation. It also directs the Centers for Medicare & Medicaid Services to issue guidance to States within one year after the report on options for covering doula services, best practices for sustainable reimbursement, and methods to expand access, including for community-based doulas.

This section directs the Comptroller General to submit a report to Congress within one year of enactment on State Medicaid programs' use of telehealth to increase access to maternity care. The report must cover the number of states using such telehealth, common program characteristics and differences in maternal health outcomes, comparisons of demographics, health outcomes, services, devices, quality, patient satisfaction, spending impacts, and COVID-19 effects for telehealth versus in-person care, barriers to use, and recommendations for legislative and administrative actions.