Optimizing Postpartum Outcomes Act of 2025
- Bill Number
- H.R. 4074
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-23: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-06-19T08:06:29Z
AI-Generated Summary
Purpose
The Optimizing Postpartum Outcomes Act of 2025 aims to improve access to pelvic health services for women during pregnancy and the postpartum period (defined as the longer of the lactation period or six months after pregnancy ends) under Medicaid and the Children's Health Insurance Program (CHIP). It focuses on guiding coverage, addressing gaps in services, and raising awareness through education and training to support better maternal health outcomes.
Key Provisions
- Guidance from the Secretary of Health and Human Services (HHS): Within one year of enactment, HHS must issue guidance for states on covering "covered pelvic health services" (pelvic floor examinations and pelvic health physical therapy) under Medicaid state plans (or waivers) and CHIP plans (or waivers). The guidance covers:
- Best practices from states using innovative or evidence-based payment models to boost access to these services.
- Recommendations for financing options, including Medicaid funds and CHIP Health Services Initiative funds.
- Technical assistance to state agencies on flexibilities and incentives for screening, referrals, and access to services.
- Suggested medical terms and diagnosis codes (like those from the International Classification of Diseases, or ICD, system) to identify pelvic floor issues.
- Government Accountability Office (GAO) Study: Within one year of enactment, the GAO must study and report to Congress on coverage gaps for postpartum pelvic health services under Medicaid and other postpartum services for women who received Medicaid during pregnancy.
- Postpartum Pelvic Health Education Campaign: Adds a new section (317L-2) to the Public Health Service Act, requiring HHS (through the Centers for Disease Control and Prevention, or CDC, in collaboration with the Health Resources and Services Administration, or HRSA, and others) to:
- Train health professionals on pelvic floor examinations (assessments of pelvic health, including external checks of posture, muscles, and movement, plus internal exams if needed) and the benefits of pelvic health physical therapy (personalized therapy plans to improve pelvic function, mobility, and manage pain or conditions).
- Educate postpartum women on the importance of pelvic floor exams, how to get referrals, what the exams involve, the benefits of physical therapy, and how to access it.
- Authorizes $2 million annually for fiscal years 2026 through 2030 to fund this program.
- Definitions:
- Pelvic floor examination: An assessment for conditions like urinary, bowel, or sexual dysfunction, including external and, if necessary, internal checks.
- Pelvic health physical therapy: Evidence-based therapy by specialists to address pelvic issues, prevent injury, and manage chronic conditions.
- Pelvic health-related condition: Includes urinary or bowel problems, muscle or sexual issues, cancer recovery, and pregnancy-related states.
Significant Changes to Existing Law
- Directs new HHS guidance on Medicaid and CHIP coverage, which builds on but does not mandate changes to existing state plans—states retain flexibility in implementation.
- Adds a dedicated education and training program to the Public Health Service Act, introducing specific requirements for pelvic health awareness that were not previously outlined in federal law.
- Requires a GAO study on coverage gaps, creating a formal mechanism for federal oversight of postpartum services under Medicaid, without altering eligibility or funding structures directly.
Potential Impacts
- Government Agencies: HHS, CDC, and HRSA will need to develop and distribute guidance, conduct education campaigns, and coordinate with states, potentially increasing administrative workload but providing tools for better program alignment. The GAO study could inform future policy adjustments.
- Citizens: Postpartum women, especially low-income or pregnant individuals enrolled in Medicaid or CHIP, may gain easier access to pelvic health screenings and therapy, potentially reducing long-term health issues like incontinence or pain. Health professionals will receive training to improve care quality.
- International Relations: No direct impacts, as the bill focuses on domestic health programs.
Main Stakeholders Affected
- Postpartum Women: Primary beneficiaries, particularly those using Medicaid or CHIP, who may experience improved health outcomes and awareness of pelvic issues.
- State Agencies: Medicaid and CHIP administrators responsible for implementing guidance, payment models, and screening incentives.
- Health Professionals: Doctors, therapists, and associations involved in prenatal/postpartum care, who will receive training and resources for better service delivery.
- Federal Agencies: HHS (including CMS for guidance), CDC, HRSA, and GAO, tasked with oversight, education, and reporting.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances federal support for maternal health without imposing unfunded mandates on states, respecting federalism by offering guidance and flexibilities rather than strict requirements. Aligns with existing Medicaid/CHIP frameworks for optional services.
- Constitutional: No apparent conflicts; it promotes public health under Congress's spending power and does not infringe on individual rights.
- Political: Could advance bipartisan maternal health priorities by addressing postpartum care gaps, potentially influencing state-level policies and future funding debates, but relies on voluntary state adoption for full effect.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (37)
Rep. Trahan, Lori [D-MA-3], Rep. Tonko, Paul [D-NY-20], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Quigley, Mike [D-IL-5], Rep. Bonamici, Suzanne [D-OR-1], Rep. Cohen, Steve [D-TN-9], Rep. Gottheimer, Josh [D-NJ-5], Rep. Carter, Earl L. "Buddy" [R-GA-1], Rep. Riley, Josh [D-NY-19], Rep. Davis, Donald G. [D-NC-1], Rep. Lawler, Michael [R-NY-17], Rep. Hill, J. French [R-AR-2], Rep. Sherrill, Mikie [D-NJ-11], Rep. Crow, Jason [D-CO-6], Rep. Vindman, Eugene Simon [D-VA-7], Rep. McClain Delaney, April [D-MD-6], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Nunn, Zachary [R-IA-3], Rep. Lieu, Ted [D-CA-36], Rep. Tokuda, Jill N. [D-HI-2], Rep. Kim, Young [R-CA-40], Rep. Magaziner, Seth [D-RI-2], Rep. Ross, Deborah K. [D-NC-2], Rep. McBride, Sarah [D-DE-At Large], Rep. Gillen, Laura [D-NY-4], Rep. Thanedar, Shri [D-MI-13], Rep. Pingree, Chellie [D-ME-1], Rep. Soto, Darren [D-FL-9], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Carson, André [D-IN-7], Rep. Neguse, Joe [D-CO-2], Rep. Himes, James A. [D-CT-4], Rep. Meuser, Daniel [R-PA-9], Rep. Mackenzie, Ryan [R-PA-7], Rep. Adams, Alma S. [D-NC-12], Rep. Johnson, Julie [D-TX-32], Rep. Fitzpatrick, Brian K. [R-PA-1]
Recent Actions
- 2025-06-23: Referred to the House Committee on Energy and Commerce.
- 2025-06-23: Introduced in House
- 2025-06-23: Introduced in House
Bill Versions
- Optimizing Postpartum Outcomes Act of 2025 — issued 2025-06-23 — PDF (7 pages)