H.R. 4074 — Optimizing Postpartum Outcomes Act of 2025

This section directs the Secretary of Health and Human Services, not later than one year after enactment, to issue guidance to states on Medicaid and Children's Health Insurance Program (CHIP) coverage of covered pelvic health services—defined as pelvic floor examinations and pelvic health physical therapy—furnished during the prenatal or postpartum period, defined as the longer of the lactation period or six months following pregnancy. The guidance must include (1) best practices from states on innovative or evidence-based payment models to increase access; (2) recommendations on financing options under Medicaid and CHIP, including CHIP Health Services Initiative funds; (3) technical assistance on flexibilities and incentives for screening, referral, and access; and (4) suggested terminology and diagnosis codes (e.g., International Classification of Diseases codes) for pelvic floor dysfunction and disorders. This section also directs the Comptroller General, not later than one year after enactment, to conduct a study on gaps in Medicaid coverage of postpartum pelvic health services and other postpartum services for women enrolled during pregnancy, and to submit a report to Congress.

This section establishes a postpartum pelvic health education campaign to be carried out by the Centers for Disease Control and Prevention (CDC), in collaboration with the Health Resources and Services Administration (HRSA) and other agencies and in consultation with health professional associations. The campaign (1) educates and trains health professionals on pelvic floor examinations (i.e., external evaluations of posture, joints, muscles, movement, and pelvic floor palpation/observation, plus internal vaginal/rectal exams if clinically necessary to assess tone, strength, control, fascia, and organ position) and the benefits of pelvic health physical therapy (i.e., evidence-based plans by pelvic health physical therapists to improve pelvic floor anatomy, mobility, injury recovery/prevention, and pain/chronic condition management); and (2) educates postpartum women on the importance of, access to (including referrals), and procedures for such examinations and physical therapy for pelvic health related conditions (e.g., urinary/bowel/musculoskeletal/sexual dysfunction, cancer rehabilitation, pre-partum conditions). Authorizes $2 million for each of FY2026 through FY2030.