119-hr4074

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4074 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4074

To direct the Secretary of Health and Human Services to issue guidance 
 on coverage under the Medicaid program under title XIX of the Social 
 Security Act of certain pelvic health services furnished during the 
 postpartum period, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 23, 2025

Mr. Bacon (for himself and Mrs. Trahan) introduced the following bill; 
 which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

 A BILL

To direct the Secretary of Health and Human Services to issue guidance 
 on coverage under the Medicaid program under title XIX of the Social 
 Security Act of certain pelvic health services furnished during the 
 postpartum period, 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 ``Optimizing Postpartum Outcomes Act 
of 2025''.

SEC. 2. CMS GUIDANCE.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
issue guidance on coverage under State plans (or waivers of such plans) 
under the Medicaid program under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) or State child health plans (or waivers of 
such plans) under the Children's Health Insurance Program under title 
XXI of such Act (42 U.S.C. 1397aa et seq.) of covered pelvic health 
services furnished during the prenatal or postpartum period. Such 
guidance shall include--

    (1) best practices from States with respect to innovative 
 or evidenced-based payment models to increase access to covered 
 pelvic health services;

    (2) recommendations for States on available financing 
 options under--
        (A) the Medicaid program under title XIX of such 
 Act (42 U.S.C. 1396 et seq.); and
        (B) the Children's Health Insurance Program under 
 title XXI of such Act (42 U.S.C. 1397aa et seq.), 
 specifically funds made available through a Children's 
 Health Insurance Program Health Services Initiative;

    (3) guidance and technical assistance to State agencies 
 responsible for administering State plans (or waivers of such 
 plans) under the Medicaid program under title XIX of the Social 
 Security Act (42 U.S.C. 1396 et seq.) regarding additional 
 flexibilities and incentives related to screening and referral 
 for, and access to, covered pelvic health services; and

    (4) guidance regarding suggested terminology and diagnosis 
 codes, such as the International Classification of Diseases 
 code set, to identify women with pelvic floor dysfunction and 
 disorders.

    (b) GAO Study.--Not later than 1 year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a study on, and submit to Congress a report that 
addresses, gaps in coverage for--

    (1) covered pelvic health services under State plans (or 
 waivers of such plans) under the Medicaid program under title 
 XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for 
 postpartum women; and

    (2) other services for postpartum women who received 
 medical assistance under a State plan (or a waiver of such 
 plan) under the Medicaid program under title XIX of the Social 
 Security Act (42 U.S.C. 1396 et seq.) during their pregnancy.
            (c) === Definitions. ===
-In this section:

    (1) The term ``postpartum period'' means the longer of the 
 period of lactation or the 6-month period beginning on the last 
 day of a woman's pregnancy.

    (2) The term ``covered pelvic health services'' means--
        (A) pelvic floor examinations (as defined in 
 

section 317L-2 of the Public Health Service Act, as 
 added by 

section 2 of this Act); and
        (B) pelvic health physical therapy (as defined in 
 such 

section 317L-2).

SEC. 3. POSTPARTUM PELVIC HEALTH EDUCATION CAMPAIGN.

 Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after 

section 317L-1 (42 U.S.C. 247b-
13a) the following:

``

SEC. 317L-2. POSTPARTUM PELVIC HEALTH EDUCATION CAMPAIGN.

 ``

    (a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, in collaboration with 
the Administrator of the Health Resources and Services Administration 
and the heads of other agencies, and in consultation with appropriate 
health professional associations, shall develop and carry out a 
program--
 ``

    (1) to educate and train health professionals on pelvic 
 floor examinations and the benefits of pelvic health physical 
 therapy; and
 ``

    (2) to educate postpartum women on--
 ``
        (A) with respect to pelvic floor examinations--
 ``
            (i) the importance of such examinations 
 during the postpartum period;
 ``
            (ii) how to obtain such an examination, 
 including information relating to obtaining 
 referrals; and
 ``
            (iii) what is involved in such an 
 examination; and
 ``
        (B) with respect to pelvic health physical 
 therapy--
 ``
            (i) the benefits of, and availability of 
 such physical therapy; and
 ``
            (ii) how to obtain a referral for such 
 physical therapy.
 ``

    (b) 

=== Definitions. ===
-In this section:
 ``

    (1) The term `pelvic floor examination' means an 
 examination to assess a patient for pelvic health related 
 conditions that is composed of--
 ``
        (A) an external evaluation that includes analysis 
 of posture, joint integrity, muscle performance, 
 quality of movement, and palpation and observation of 
 the pelvic floor; and
 ``
        (B) if deemed necessary based on the health care 
 professional's clinical reasoning, an internal vaginal 
 or rectal examination, or both, to gather relevant 
 information about the tone, strength, control, ability 
 to contract and relax the muscles of the pelvic floor 
 individually and together, the condition of the 
 surrounding fascia, and the position of the organs.
 ``

    (2) The term `pelvic health physical therapy' means a 
 personalized physical therapy plan implemented by a pelvic 
 health physical therapist, after performing a pelvic floor 
 examination and making a diagnosis, that is based on best 
 available evidence to improve the patient condition, with 
 respect to the anatomy of the pelvic floor, improve mobility, 
 recover from injury, prevent future injury, and manage pain and 
 chronic conditions.
 ``

    (3) The term `pelvic health related condition' includes 
 urinary dysfunction, bowel dysfunction, musculoskeletal 
 dysfunction, sexual dysfunction, cancer-related rehabilitation, 
 and the pre-partum state and pre-partum conditions.
 ``
            (c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $2,000,000 for each of fiscal 
years 2026 through 2030.''.
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