496 
constitute a quorum of the Commission, but a lesser 
number of members may hold hearings. 
(b) DUTIES OF THE COMMISSION.— 
(1) IN GENERAL.—The Commission shall— 
(A) monitor and report on the implementa-
tion of this Act; and 
(B) investigate, monitor, and report on 
progress towards health equity and the elimi-
nation of health disparities. 
(2) 
ANNUAL
REPORT.—The 
Commission 
shall— 
(A) submit to the President and Congress 
at least one report annually on health equity 
and health disparities; and 
(B) include in such report— 
(i) a description of actions taken by 
the Department of Health and Human 
Services and any other Federal agency re-
lated to health equity or health disparities; 
and 
(ii) recommendations on ensuring eq-
uitable health care and eliminating health 
disparities. 
(c) POWERS.— 
(1) HEARINGS.— 
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497 
(A) IN GENERAL.—The Commission or, at 
the direction of the Commission, any sub-
committee or member of the Commission, may, 
for the purpose of carrying out this section, as 
the Commission or the subcommittee or mem-
ber considers advisable— 
(i) hold such hearings, meet and act 
at such times and places, take such testi-
mony, receive such evidence, and admin-
ister such oaths; and 
(ii) require, by subpoena or otherwise, 
the attendance and testimony of such wit-
nesses and the production of such books, 
records, correspondence, memoranda, pa-
pers, documents, tapes, and materials. 
(B) 
LIMITATION
ON
HEARINGS.—The 
Commission may hold a hearing under subpara-
graph (A)(i) only if the hearing is approved— 
(i) by a majority of the members of 
the Commission appointed under sub-
section (a)(2)(B); or 
(ii) by a majority of such members 
present at a meeting when a quorum is 
present. 
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498 
(2) ISSUANCE
AND
ENFORCEMENT
OF
SUB-
POENAS.— 
(A) ISSUANCE.—A subpoena issued under 
paragraph (1) shall— 
(i) bear the signature of the Chair-
person of the Commission; and 
(ii) be served by any person or class 
of persons designated by the Chairperson 
for that purpose. 
(B) ENFORCEMENT.—In the case of contu-
macy or failure to obey a subpoena issued 
under paragraph (1), the United States district 
court for the district in which the subpoenaed 
person resides, is served, or may be found may 
issue an order requiring the person to appear at 
any designated place to testify or to produce 
documentary or other evidence. 
(C) NONCOMPLIANCE.—Any failure to 
obey the order of the court may be punished by 
the court as a contempt of court. 
(3) WITNESS ALLOWANCES AND FEES.— 
(A) IN GENERAL.—Section 1821 of title 
28, United States Code, shall apply to a witness 
requested or subpoenaed to appear at a hearing 
of the Commission. 
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499 
(B) EXPENSES.—The per diem and mile-
age allowances for a witness shall be paid from 
funds available to pay the expenses of the Com-
mission. 
(4) POSTAL SERVICES.—The Commission may 
use the United States mails in the same manner and 
under the same conditions as other agencies of the 
Federal Government. 
(5) GIFTS.—The Commission may accept, use, 
and dispose of gifts or donations of services or prop-
erty. 
(d) ADMINISTRATIVE PROVISIONS.— 
(1) STAFF.— 
(A) DIRECTOR.—There shall be a full-time 
staff director for the Commission who shall— 
(i) serve as the administrative head of 
the Commission; and 
(ii) be appointed by the Chairperson 
with the concurrence of the Vice Chair-
person. 
(B) OTHER
PERSONNEL.—The Commis-
sion may— 
(i) appoint such other personnel as it 
considers advisable, subject to the provi-
sions of title 5, United States Code, gov-
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500 
erning appointments in the competitive 
service, and the provisions of chapter 51 
and subchapter III of chapter 53 of that 
title relating to classification and General 
Schedule pay rates; and 
(ii) may procure temporary and inter-
mittent services under section 3109(b) of 
title 5, United States Code, at rates for in-
dividuals not in excess of the daily equiva-
lent paid for positions at the maximum 
rate for GS–15 of the General Schedule 
under section 5332 of title 5, United 
States Code. 
(2) COMPENSATION OF MEMBERS.— 
(A) 
NON-FEDERAL
EMPLOYEES.—Each 
member of the Commission who is not an offi-
cer or employee of the Federal Government 
shall be compensated at a rate equal to the 
daily equivalent of the annual rate of basic pay 
prescribed for level IV of the Executive Sched-
ule under section 5315 of title 5, United States 
Code, for each day (including travel time) dur-
ing which the member is engaged in the per-
formance of the duties of the Commission. 
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501 
(B) FEDERAL EMPLOYEES.—Each member 
of the Commission who is an officer or em-
ployee of the Federal Government shall serve 
without compensation in addition to the com-
pensation received for the services of the mem-
ber as an office or employee of the Federal 
Government. 
(C) TRAVEL EXPENSES.—A member of the 
Commission shall be allowed travel expenses, in-
cluding per diem in lieu of subsistence, at rates 
authorized for an employee of an agency under 
subchapter I of chapter 57 of title 5, United 
States Code, while away from the home or reg-
ular place of business of the member in the per-
formance of the duties of the Commission. 
(3) COOPERATION.—The Commission may se-
cure directly from any Federal department or agency 
such information as the Commission considers nec-
essary to carry out this Act. Upon request of the 
Chairman of the Commission, the head of such de-
partment or agency shall furnish such information to 
the Commission. 
(e) PERMANENT COMMISSION.—Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall not 
apply to the Commission. 
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502 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated for fiscal year 2022 and 
each fiscal year thereafter such sums as may be necessary 
to carry out the duties of the Commission. 
SEC. 4508. GRANTS FOR HOSPITALS TO PROMOTE EQUI-
TABLE HEALTH CARE AND OUTCOMES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall award grants to hospitals to promote 
equitable health care treatment and services, and reduce 
disparities in care and outcomes. 
(b) CONSULTATION.—In establishing the criteria for 
grants under this section and evaluating applications for 
such grants, the Secretary shall consult with the Director 
for Civil Rights and Health Equity of the Department of 
Health and Human Services. 
(c) USE OF FUNDS.—A hospital shall use funds re-
ceived from a grant under this section to establish or ex-
pand programs to provide equitable health care to all pa-
tients and to ensure equitable health care outcomes. Such 
uses may include— 
(1) providing explicit and implicit bias training 
to medical providers and staff; 
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503 
(2) providing translation or interpretation serv-
ices for patients; 
(3) recruiting and training a diverse workforce; 
(4) tracking data related to care and outcomes; 
and 
(5) training on cultural sensitivity. 
(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to hospitals that 
have received disproportionate share hospital payments 
under section 1886(r) of the Social Security Act (42 
U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 
1396r–4) with respect to fiscal year 2021. 
(e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 
under this section shall be used to supplement, not sup-
plant, any nongovernment efforts, or other Federal, State, 
or local funds provided to a recipient. 
(f) EQUITABLE HEALTH CARE DEFINED.—The term 
‘‘equitable health care’’ has the meaning given such term 
in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu-
rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 
added by section 4(a). 
(g) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2022 through 2027. 
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504 
Subtitle G—Investing in Equity 
SEC. 4601. DEFINITIONS. 
In this subtitle: 
(1) ADVISORY COUNCIL.—The term ‘‘Advisory 
Council’’ means the Pay for Equity Council con-
vened under section 4603. 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(3) STRATEGY.—The term ‘‘Strategy’’ means 
the Pay for Equity Strategy set forth under section 
4602. 
SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY. 
(a) IN GENERAL.—The Secretary, in consultation 
with the heads of other appropriate Federal agencies, shall 
develop jointly with the Advisory Council and submit to 
the Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce and the Committee on 
Ways and Means of the House of Representatives, and 
make publicly available on the internet website of the De-
partment of Health and Human Services, a Pay for Eq-
uity Strategy. 
(b) CONTENTS.—The Strategy shall establish goals 
for Federal programs, including those authorized under ti-
tles XVIII and XIX of the Social Security Act, to 
incentivize health equity, which may include at least— 
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505 
(1) incorporating measures of equity into all 
payment models by 2025; 
(2) tying a percentage of reimbursement in 
value-based payment models to equity measure per-
formance by 2028; and 
(3) increasing the number of safety net pro-
viders participating in value-based payment by a set 
percentage by 2030. 
(c) DUTIES OF THE SECRETARY.—The Secretary, in 
carrying out subsection (a), shall oversee the following: 
(1) Collecting and making publicly available in-
formation submitted by the Advisory Council. 
(2) Coordinating and assessing existing Federal 
Government programs and activities to assess capac-
ity to meet equity goals. 
(3) Providing technical assistance, as appro-
priate, such as disseminating identified best prac-
tices and information sharing based on reports de-
veloped as a result of this subtitle. 
(d) INITIAL STRATEGY; UPDATES.—The Secretary 
shall— 
(1) not later than 18 months after the date of 
enactment of this Act, develop, publish, and submit 
to the Committee on Finance of the Senate and the 
Committee on Energy and Commerce and the Com-
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506 
mittee on Ways and Means of the House of Rep-
resentatives the strategy outlined in subsection (a); 
and 
(2) biennially update, publish, and submit to 
Congress an updated strategy to— 
(A) reflect new developments, challenges, 
opportunities, and solutions; and 
(B) review progress and, based on the re-
sults of such review, recommend priority actions 
for improving the implementation of such rec-
ommendations, as appropriate. 
(e) PROCESS FOR PUBLIC INPUT.—The Secretary 
shall establish a process for public input to inform the de-
velopment of, and updates to, the Strategy, including a 
process for the public to submit recommendations to the 
Advisory Council and an opportunity for public comment 
on the proposed Strategy. 
SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL. 
(a) CONVENING.—The Secretary shall convene a Pay 
for Equity Advisory Council to advise and provide rec-
ommendations, including identified best practices, to the 
Secretary on the Pay for Equity Strategy. 
(b) MEMBERSHIP.— 
(1) IN GENERAL.—The members of the Advi-
sory Council shall consist of— 
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507 
(A) the appointed members under para-
graph (2); and 
(B) the Federal members under paragraph 
(3). 
(2) APPOINTED MEMBERS.—In addition to the 
Federal members under paragraph (3), the Sec-
retary shall appoint not more than 15 voting mem-
bers of the Advisory Council who are not representa-
tives of Federal departments or agencies and who 
shall include at least 1 representative of each of the 
following: 
(A) Beneficiaries of Medicare and Med-
icaid. 
(B) Safety net health care providers. 
(C) Value-based payment experts. 
(D) Other members with expertise and 
lived experience the Secretary deems appro-
priate. 
(3) FEDERAL MEMBERS.—The Federal mem-
bers of the Advisory Council, who shall be nonvoting 
members, shall consist of the following: 
(A) The Administrator of the Centers for 
Medicare & Medicaid Services (or the Adminis-
trator’s designee). 
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508 
(B) The Administrator of the Health Re-
sources and Services Administration. 
(4) DIVERSE
REPRESENTATION.—The Sec-
retary shall ensure that the membership of the Advi-
sory Council reflects the diversity of individuals im-
pacted by Federal health payment programs. 
(c) MEETINGS.—The Advisory Council shall meet 
quarterly during the 1-year period beginning on the date 
of enactment of this Act and at least 3 times during each 
year thereafter. Meetings of the Advisory Council shall be 
open to the public. 
TITLE V—IMPROVING HEALTH 
OUTCOMES 
FOR 
WOMEN, 
CHILDREN, AND FAMILIES 
Subtitle A—In General 
SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280h et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Administrator of the Health Resources 
and Services Administration and other Federal officials 
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509 
determined appropriate by the Secretary, is authorized to 
award grants to eligible entities— 
‘‘(1) to promote health for medically under-
served communities, with preference given to 
projects that benefit racial and ethnic minority 
women, racial and ethnic minority children, adoles-
cents, and lesbian, gay, bisexual, transgender, queer, 
nonbinary, gender-nonconforming, or questioning 
communities; and 
‘‘(2) to strengthen health outreach initiatives in 
medically underserved communities, including lin-
guistically isolated populations. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support the activities of 
community health workers, including such activities— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate and provide outreach in a com-
munity setting regarding health problems prevalent 
among medically underserved communities, and es-
pecially among racial and ethnic minority women, 
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510 
racial and ethnic minority children, adolescents, and 
lesbian, gay, bisexual, transgender, queer, nonbinary, 
gender-nonconforming, or questioning communities; 
‘‘(3) to educate and provide experiential learn-
ing opportunities and target risk factors and healthy 
behaviors that impede or contribute to achieving 
positive health outcomes, including— 
‘‘(A) healthy nutrition; 
‘‘(B) physical activity; 
‘‘(C) overweight or obesity; 
‘‘(D) tobacco use, including the use of e- 
cigarettes and vaping; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) sexual health; 
‘‘(H) mental health; 
‘‘(I) musculoskeletal health and arthritis; 
‘‘(J) prenatal and postnatal care; 
‘‘(K) dental and oral health; 
‘‘(L) understanding informed consent; 
‘‘(M) stigma; and 
‘‘(N) environmental hazards; 
‘‘(4) to promote community wellness and aware-
ness; and 
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511 
‘‘(5) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that, with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides in-language training and 
supervision to community health workers to en-
able such workers to provide authorized pro-
gram activities in (at least) the most commonly 
used languages within a particular geographic 
region; 
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512 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide culturally com-
petent services in the linguistic context most 
appropriate for the individuals served by the 
program; 
‘‘(E) contain a plan to document and dis-
seminate project descriptions and results to 
other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services, as the 
Secretary determines to be appropriate, 
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513 
which may include transportation and 
translation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas 
that— 
‘‘(A)(i) have a high percentage of residents 
who are uninsured or underinsured (if the tar-
geted geographic area is located in a State that 
has elected to make medical assistance available 
under section 1902(a)(10)(A)(i)(VIII) of the 
Social Security Act to individuals described in 
such section); 
‘‘(ii) have a high percentage of under-
insured residents in a particular geographic 
area (if the targeted geographic area is located 
in a State that has not so elected); or 
‘‘(iii) have a high number of households ex-
periencing extreme poverty; and 
‘‘(B) have a high percentage of families for 
whom English is not their primary language or 
including smaller limited English-proficient 
communities within the region that are not oth-
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514 
erwise reached by linguistically appropriate 
health services; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE-
NESS.—The Secretary shall establish guidelines for ensur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for ensuring the cost effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
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515 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of these programs on 
the health outcomes of the community resi-
dents. 
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516 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
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517 
‘‘(F) by taking into consideration the 
needs of the communities served, including the 
prevalence rates of risk factors that impede 
achieving positive healthy outcomes among 
pregnant, birthing, and postpartum people and 
children, especially among racial and ethnic mi-
nority pregnant, birthing, and postpartum peo-
ple and children; and 
‘‘(G) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation that serves a population. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
Tribal government (including a federally recog-
nized Tribe or Alaska Native village); or 
‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
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518 
derserved population, as defined by section 
330(b)(3); 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332; and 
‘‘(C) that includes populations that are lin-
guistically isolated, such as geographic areas 
with a shortage of health professionals able to 
provide linguistically appropriate services. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2023 through 2027.’’. 
Subtitle B—Pregnancy Screening 
SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE 
DEMONSTRATION PROGRAM. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended by section 
5203(c)(6), is further amended by adding at the end the 
following: 
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‘‘SEC. 399V–8. PREGNANCY INTENTION SCREENING INITIA-
TIVE DEMONSTRATION PROGRAM. 
‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 
acting through the Director of the Centers for Disease 
Control and Prevention, shall establish a demonstration 
program to facilitate the clinical adoption of pregnancy in-
tention screening initiatives by health care and social serv-
ices providers. 
‘‘(b) GRANTS.—The Secretary may carry out the 
demonstration program through awarding grants to eligi-
ble entities to implement pregnancy intention screening 
initiatives, collect data, and evaluate such initiatives. 
‘‘(c) ELIGIBLE ENTITIES.—To be eligible to seek a 
grant under this section, an entity shall— 
‘‘(1) 
provide 
non-directive, 
comprehensive, 
medically accurate information; and 
‘‘(2) be a community-based organization, vol-
untary health organization, public health depart-
ment, community health center, or other interested 
public or private primary, behavioral, or other health 
care or social service provider or organization. 
‘‘(d) PREGNANCY INTENTION SCREENING INITIA-
TIVE.—For purposes of this section, the term ‘pregnancy 
intention screening initiative’ means any initiative by an 
eligible entity to routinely screen people with respect to 
their pregnancy intentions and goals to either prevent un-
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intended pregnancies or improve the likelihood of healthy 
pregnancies, in order to better provide health care that 
meets the contraceptive or pre-pregnancy needs and goals 
of such people. 
‘‘(e) EVALUATION.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall, by grant or contract, 
and after consultation as described in paragraph (2), 
conduct an evaluation of the demonstration pro-
gram, with respect to pregnancy intention screening 
initiatives, conducted under this section. Such eval-
uation shall include: 
‘‘(A) Assessment of the implementation of 
pregnancy intention screening protocols among 
a diverse group of patients and providers, in-
cluding collecting data on the experiences and 
outcomes for diverse patient populations in a 
variety of clinical settings. 
‘‘(B) Analysis of outcome measures that 
will facilitate effective and widespread adoption 
of such protocols by health care providers for 
inquiring about and responding to pregnancy 
goals of people with both contraceptive and pre- 
pregnancy care. 
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‘‘(C) Consideration of health inequities 
among the population served. 
‘‘(D) Assessment of the equitable and vol-
untary application of such initiatives to minor-
ity and medically underserved communities. 
‘‘(E) Assessment of the training, capacity, 
and ongoing technical assistance needed for 
providers to effectively implement such preg-
nancy intention screening protocols. 
‘‘(F) Assessment of whether referral sys-
tems for selected protocols follow evidence-based 
standards that ensure access to comprehensive 
health services and appropriate follow-up care. 
‘‘(G) Measuring through rigorous methods 
the effect of such initiatives on key health out-
comes. 
‘‘(2) CONSULTATION WITH INDEPENDENT, EX-
PERT ADVISORY PANEL.—In conducting the evalua-
tion under paragraph (1), the Director of the Cen-
ters for Disease Control and Prevention shall consult 
with physicians, physician assistants, advanced prac-
tice registered nurses, nurse midwives, and other 
health care providers who specialize in women’s 
health, and other experts in public health, clinical 
practice, program evaluation, and research. 
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‘‘(3) REPORT.—Not later than one year after 
the last day of the demonstration program under 
this section, the Director of the Centers for Disease 
Control and Prevention shall— 
‘‘(A) submit to Congress a report on the 
results of the evaluation conducted under para-
graph (1); and 
‘‘(B) make the report publicly available. 
‘‘(f) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
To carry out this section, there is authorized to be 
appropriated $10,000,000 for each of fiscal years 
2023 through 2027. 
‘‘(2) LIMITATION.—Not more than 20 percent 
of funds appropriated to carry out this section pur-
suant to paragraph (1) for a fiscal year may be used 
for purposes of the evaluation under subsection 
(e).’’. 
SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 
AND AWARENESS. 
(a) IN GENERAL.—The Secretary shall establish and 
implement a birth defects prevention and public awareness 
program, consisting of the activities described in sub-
sections (c) and (d). 
(b) DEFINITIONS.—In this section: 
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(1) MATERNAL.—The term ‘‘maternal’’ refers 
to people who are pregnant or breastfeeding. 
(2) PREGNANCY AND BREASTFEEDING INFOR-
MATION
SERVICES.—The term ‘‘pregnancy and 
breastfeeding information services’’ includes only— 
(A) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during pregnancy 
or breastfeeding that may be associated with 
birth defects, health risks to a breastfed infant, 
or other health risks, such as exposures to 
medications, chemicals, infections, foodborne 
pathogens, illnesses, nutrition, lifestyle, or 
climate- and weather-related factors; 
(B) the provision of accurate, evidence- 
based information weighing risks of exposures 
during breastfeeding against the benefits of 
breastfeeding; and 
(C) the provision of information described 
in subparagraph (A), (B), or (C) through coun-
selors, websites, fact sheets, telephonic or elec-
tronic communication, community outreach ef-
forts, or other appropriate means. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services, acting 
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through the Director of the Centers for Disease 
Control and Prevention. 
(c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 
subsection (a), the Secretary shall conduct or support a 
nationwide media campaign to increase awareness among 
health care providers and at-risk populations about preg-
nancy and breastfeeding information services. 
(d) GRANTS FOR PREGNANCY AND BREASTFEEDING 
INFORMATION SERVICES.— 
(1) IN GENERAL.—In carrying out subsection 
(a), the Secretary shall award grants to State or re-
gional agencies or organizations for any of the fol-
lowing: 
(A) INFORMATION SERVICES.—The provi-
sion of, or campaigns to increase awareness 
about, pregnancy and breastfeeding information 
services. 
(B) SURVEILLANCE AND RESEARCH.—The 
conduct or support of— 
(i) surveillance of or research on— 
(I) maternal exposures and ma-
ternal health conditions that may in-
fluence the risk of birth defects, pre-
maturity, or other adverse pregnancy 
outcomes; and 
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(II) maternal exposures that may 
influence health risks to a breastfed 
infant; or 
(ii) networking to facilitate surveil-
lance or research described in this sub-
paragraph. 
(2) PREFERENCE FOR CERTAIN STATES.—The 
Secretary, in making any grant under this sub-
section, shall give preference to States, otherwise 
equally 
qualified, 
that 
have 
pregnancy 
and 
breastfeeding information services in place. 
(3) MATCHING
FUNDS.—The Secretary may 
only award a grant under this subsection to a State 
or regional agency or organization that agrees, with 
respect to the costs to be incurred in carrying out 
the grant activities, to make available (directly or 
through donations from public or private entities) 
non-Federal funds toward such costs in an amount 
equal to not less than 25 percent of the amount of 
the grant. 
(4) COORDINATION.—The Secretary shall en-
sure that activities funded through a grant under 
this subsection are coordinated, to the maximum ex-
tent practicable, with other birth defects prevention 
and environmental health activities of the Federal 
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526 
Government, including with respect to pediatric envi-
ronmental health specialty units and children’s envi-
ronmental health centers. 
(e) EVALUATION.—The Secretary shall provide for an 
evaluation of pregnancy and breastfeeding information 
services carried out by States to identify efficient and ef-
fective models of— 
(1) providing information; 
(2) raising awareness and increasing knowledge 
about birth defects prevention measures and tar-
geting education to at-risk groups; 
(3) modifying risk behaviors; or 
(4) other outcome measures as determined ap-
propriate by the Secretary. 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated— 
(1) $5,000,000 for fiscal year 2023; 
(2) $6,000,000 for fiscal year 2024; 
(3) $7,000,000 for fiscal year 2025; 
(4) $8,000,000 for fiscal year 2026; and 
(5) $9,000,000 for fiscal year 2027. 
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Subtitle C—Pregnancy-Related 
Care 
SEC. 5201. MOTHERS AND OFFSPRING MORTALITY AND 
MORBIDITY AWARENESS. 
(a) IMPROVING FEDERAL EFFORTS WITH RESPECT 
TO PREVENTION OF MATERNAL MORTALITY.— 
(1) TECHNICAL ASSISTANCE FOR STATES WITH 
RESPECT TO REPORTING MATERNAL MORTALITY.— 
Not later than one year after the date of enactment 
of this Act, the Director of the Centers for Disease 
Control and Prevention (referred to in this section 
as the ‘‘Director’’), in consultation with the Admin-
istrator of the Health Resources and Services Ad-
ministration, shall provide technical assistance to 
States that elect to report comprehensive data on 
maternal mortality and factors relating to such mor-
tality (including oral and mental health), intimate 
partner violence, and breastfeeding health informa-
tion, for the purpose of encouraging uniformity in 
the reporting of such data and to encourage the 
sharing of such data among the respective States. 
(2) BEST
PRACTICES
RELATING
TO
PREVEN-
TION OF MATERNAL MORTALITY.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act— 
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(i) the Director, in consultation with 
relevant patient and provider groups, shall 
issue best practices to State maternal mor-
tality review committees on how best to 
identify and review maternal mortality 
cases, taking into account any data made 
available by States relating to maternal 
mortality, including data on oral, mental, 
and breastfeeding health, and utilization of 
any emergency services; and 
(ii) the Director, working in collabora-
tion with the Health Resources and Serv-
ices Administration, shall issue best prac-
tices to hospitals, State professional society 
groups, and perinatal quality collaboratives 
on how best to prevent maternal mortality. 
(B) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this 
paragraph, there is authorized to be appro-
priated $5,000,000 for each of fiscal years 
2023 through 2027. 
(3) ALLIANCE FOR INNOVATION ON MATERNAL 
HEALTH GRANT PROGRAM.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
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retary of Health and Human Services, acting 
through the Associate Administrator of the Ma-
ternal and Child Health Bureau of the Health 
Resources and Services Administration (re-
ferred to in this paragraph as the ‘‘Secretary’’), 
shall establish a grant program to be known as 
the Alliance for Innovation on Maternal Health 
Grant Program (referred to in this subsection 
as ‘‘AIM’’) under which the Secretary shall 
award grants to eligible entities for the purpose 
of— 
(i) directing widespread adoption and 
implementation of maternal safety bundles 
through collaborative State-based teams; 
and 
(ii) collecting and analyzing process, 
structure, and outcome data to drive con-
tinuous improvement in the implementa-
tion of such safety bundles by such State- 
based teams with the ultimate goal of 
eliminating preventable maternal mortality 
and severe maternal morbidity in the 
United States. 
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(B) ELIGIBLE ENTITIES.—In order to be 
eligible for a grant under subparagraph (A), an 
entity shall— 
(i) submit to the Secretary an applica-
tion at such time, in such manner, and 
containing such information as the Sec-
retary may require; and 
(ii) demonstrate in such application 
that the entity is an interdisciplinary, 
multi-stakeholder, 
national 
organization 
with a national data-driven maternal safety 
and quality improvement initiative based 
on implementation approaches that have 
been proven to improve maternal safety 
and outcomes in the United States. 
(C) USE
OF
FUNDS.—An eligible entity 
that receives a grant under subparagraph (A) 
shall use such grant funds— 
(i) to develop and implement, through 
a robust, multi-stakeholder process, mater-
nal safety 
bundles 
to 
assist 
States, 
perinatal quality collaboratives, and health 
care systems in aligning national, State, 
and hospital-level quality improvement ef-
forts to improve maternal health outcomes, 
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531 
specifically the reduction of maternal mor-
tality and severe maternal morbidity; 
(ii) to ensure, in developing and im-
plementing maternal safety bundles under 
clause (i), that such maternal safety bun-
dles— 
(I) satisfy the quality improve-
ment needs of a State, perinatal qual-
ity collaborative, or health care system 
by factoring in the results and find-
ings of relevant data reviews, such as 
reviews conducted by a State maternal 
mortality review committee; and 
(II) address topics which may in-
clude— 
(aa) information on evi-
dence-based practices to improve 
the quality and safety of mater-
nal health care in hospitals and 
other health care settings of a 
State or health care system, in-
cluding by addressing topics com-
monly associated with health 
complications or risks related to 
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532 
prenatal care, labor care, birth-
ing, and postpartum care; 
(bb) best practices for im-
proving maternal health care 
based on data findings and re-
views conducted by a State ma-
ternal mortality review committee 
that address topics of relevance 
to 
common 
complications 
or 
health risks related to prenatal 
care, labor care, birthing, and 
postpartum care; 
(cc) information on address-
ing determinants of health that 
impact maternal health outcomes 
for people before, during, and 
after pregnancy; 
(dd) obstetric hemorrhage; 
(ee) 
obstetric 
and 
postpartum care for people with 
substance use disorders, includ-
ing opioid use disorder; 
(ff) maternal cardiovascular 
system; 
(gg) maternal mental health; 
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(hh) postpartum care basics 
for maternal safety; 
(ii) reduction of peripartum 
racial and ethnic inequities; 
(jj) reduction of primary 
caesarean birth; 
(kk) severe hypertension in 
pregnancy; 
(ll) severe maternal mor-
bidity reviews; 
(mm) support after a severe 
maternal morbidity event; 
(nn) thromboembolism; 
(oo) optimization of support 
for breastfeeding; 
(pp) maternal oral health; 
and 
(qq) intimate partner vio-
lence; and 
(iii) to provide ongoing technical as-
sistance at the national and State levels to 
support implementation of maternal safety 
bundles under clause (i). 
(D) MATERNAL
SAFETY
BUNDLE
DE-
FINED.—For purposes of this paragraph, the 
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term ‘‘maternal safety bundle’’ means standard-
ized, evidence-informed processes for maternal 
health care. 
(E) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this 
paragraph, there is authorized to be appro-
priated $10,000,000 for each of fiscal years 
2023 through 2027. 
(4) FUNDING
FOR
STATE-BASED
PERINATAL 
QUALITY COLLABORATIVES DEVELOPMENT AND SUS-
TAINABILITY.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (referred 
to in this paragraph as the ‘‘Secretary’’), acting 
through the Division of Reproductive Health of 
the Centers for Disease Control and Prevention, 
shall establish a grant program to be known as 
the State-Based Perinatal Quality Collaborative 
grant program under which the Secretary 
awards grants to eligible entities for the pur-
pose of development and sustainability of 
perinatal quality collaboratives in every State, 
the District of Columbia, and eligible terri-
tories, in order to measurably improve perinatal 
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535 
care and perinatal health outcomes for preg-
nant and postpartum people and their infants. 
(B) GRANT
AMOUNTS.—Grants awarded 
under this paragraph shall be in amounts not to 
exceed $250,000 per year, for the duration of 
the grant period. 
(C) STATE-BASED
PERINATAL
QUALITY 
COLLABORATIVE
DEFINED.—For purposes of 
this paragraph, the term ‘‘State-based perinatal 
quality collaborative’’ means a network of teams 
that— 
(i) is multidisciplinary in nature and 
includes the full range of perinatal and 
maternity care providers; 
(ii) works to improve measurable out-
comes for maternal and infant health by 
advancing evidence-informed clinical prac-
tices using quality improvement principles; 
(iii) works with hospital-based or out-
patient facility-based clinical teams, ex-
perts, and stakeholders, including patients 
and families, to spread best practices and 
optimize resources to improve perinatal 
care and outcomes; 
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(iv) employs strategies that include 
the use of the collaborative learning model 
to provide opportunities for hospitals and 
clinical teams to collaborate on improve-
ment strategies, rapid-response data to 
provide timely feedback to hospital and 
other clinical teams to track progress, and 
quality improvement science to provide 
support and coaching to hospital and clin-
ical teams; 
(v) has the goal of improving popu-
lation-level outcomes in maternal and in-
fant health; and 
(vi) has the goal of improving out-
comes of all birthing people, through the 
coordination, integration, and collaboration 
across birth settings. 
(D) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this 
paragraph, there is authorized to be appro-
priated $14,000,000 per year for each of fiscal 
years 2023 through 2027. 
(5) EXPANSION OF MEDICAID AND CHIP COV-
ERAGE
FOR
PREGNANT
AND
POSTPARTUM
PEO-
PLE.— 
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537 
(A) 
REQUIRING
COVERAGE
OF
ORAL 
HEALTH
SERVICES
FOR
PREGNANT
AND 
POSTPARTUM PEOPLE.— 
(i) MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is 
amended— 
(I) in subsection (a)(4)— 
(aa) by redesignating sub-
paragraphs (E) and (F) as sub-
paragraphs (F) and (G), respec-
tively; 
(bb) by striking ‘‘; and (F)’’ 
and inserting ‘‘; (F)’’; 
(cc) by inserting ‘‘; and (G) 
oral health services for pregnant 
and postpartum people (as de-
fined in subsection (ii))’’ before 
the semicolon at the end; and 
(II) by adding at the end the fol-
lowing new subsection: 
‘‘(jj) ORAL HEALTH SERVICES FOR PREGNANT AND 
POSTPARTUM PEOPLE.— 
‘‘(1) IN GENERAL.—For purposes of this title, 
the term ‘oral health services for pregnant and 
postpartum people’ means dental services necessary 
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to prevent disease and promote oral health, restore 
oral structures to health and function, and treat 
emergency conditions that are furnished to a person 
during pregnancy (or during the 1-year period be-
ginning on the last day of the pregnancy). 
‘‘(2) COVERAGE
REQUIREMENTS.—To satisfy 
the requirement to provide oral health services for 
pregnant and postpartum people, a State shall pro-
vide coverage for preventive, diagnostic, periodontal, 
and restorative care consistent with recommenda-
tions for perinatal oral health care and dental care 
during pregnancy from the American Academy of 
Pediatric Dentistry and the American College of Ob-
stetricians and Gynecologists.’’. 
(ii) CHIP.—Section 2103(c)(6)(A) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(c)(6)(A)) is amended by inserting 
‘‘or a targeted low-income pregnant per-
son’’ after ‘‘targeted low-income child’’. 
(B) EXTENDING MEDICAID COVERAGE FOR 
PREGNANT
AND
POSTPARTUM
PEOPLE.—Sec-
tion 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended— 
(i) in subsection (e)— 
(I) in paragraph (5)— 
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539 
(aa) by inserting ‘‘(including 
oral health services for pregnant 
and postpartum people (as de-
fined in section 1905(jj)))’’ after 
‘‘postpartum medical assistance 
under the plan’’; and 
(bb) by striking ‘‘60-day’’ 
and inserting ‘‘1-year’’; and 
(II) in paragraph (6), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’; and 
(ii) in subsection (l)(1)(A), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’. 
(C) EXTENDING MEDICAID COVERAGE FOR 
LAWFUL RESIDENTS.—Section 1903(v)(4)(A)(i) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(v)(4)(A)(i)) is amended by striking ‘‘60- 
day’’ and inserting ‘‘1-year’’. 
(D) EXTENDING
CHIP
COVERAGE
FOR 
PREGNANT
AND
POSTPARTUM
PEOPLE.—Sec-
tion 2112(d)(2)(A) of the Social Security Act 
(42 U.S.C. 1397ll(d)(2)(A)) is amended by 
striking ‘‘60-day’’ and inserting ‘‘1-year’’. 
(E) MAINTENANCE OF EFFORT.— 
(i) MEDICAID.—Section 1902(l) of the 
Social Security Act (42 U.S.C. 1396a(l)) is 
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540 
amended by adding at the end the fol-
lowing new paragraph: 
‘‘(5) During the period that begins on the date of 
enactment of this paragraph and ends on the date that 
is five years after such date of enactment, as a condition 
for receiving any Federal payments under section 1903(a) 
for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to people who 
are eligible for medical assistance under the State plan 
or under a waiver of such plan on the basis of being preg-
nant or having been pregnant, eligibility standards, meth-
odologies, or procedures under the State plan or waiver 
that are more restrictive than the eligibility standards, 
methodologies, or procedures, respectively, under such 
plan or waiver that are in effect on the date of enactment 
of this paragraph.’’. 
(ii) CHIP.—Section 2105(d) of the 
Social Security Act (42 U.S.C. 1397ee(d)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) IN
ELIGIBILITY
STANDARDS
FOR
TAR-
GETED
LOW-INCOME
PREGNANT
PEOPLE.—During 
the period that begins on the date of enactment of 
this paragraph and ends on the date that is five 
years after such date of enactment, as a condition 
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541 
of receiving payments under subsection (a) and sec-
tion 1903(a), a State that elects to provide assist-
ance to people on the basis of being pregnant (in-
cluding pregnancy-related assistance provided to tar-
geted low-income pregnant people (as defined in sec-
tion 2112(d)), pregnancy-related assistance provided 
to people who are eligible for such assistance 
through application of section 1902(v)(4)(A)(i) 
under section 2107(e)(1), or any other assistance 
under the State child health plan (or a waiver of 
such plan) which is provided to people on the basis 
of being pregnant) shall not have in effect, with re-
spect to such people, eligibility standards, meth-
odologies, or procedures under such plan (or waiver) 
that are more restrictive than the eligibility stand-
ards, methodologies, or procedures, respectively, 
under such plan (or waiver) that are in effect on the 
date of enactment of this paragraph.’’. 
(F) INFORMATION
ON
BENEFITS.—The 
Secretary of Health and Human Services shall 
make publicly available on the internet website 
of the Department of Health and Human Serv-
ices, information regarding benefits available to 
pregnant and postpartum people and under the 
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542 
Medicaid program and the Children’s Health 
Insurance Program, including information on— 
(i) benefits that States are required to 
provide to pregnant and postpartum people 
under such programs; 
(ii) optional benefits that States may 
provide to pregnant and postpartum people 
under such programs; and 
(iii) the availability of different kinds 
of benefits for pregnant and postpartum 
people, including oral health and mental 
health benefits, under such programs. 
(G) FEDERAL FUNDING FOR COST OF EX-
TENDED MEDICAID AND CHIP COVERAGE FOR 
POSTPARTUM PEOPLE.— 
(i) MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d), as 
amended by subparagraph (A), is further 
amended— 
(I) in subsection (b), by striking 
‘‘and (ii)’’ and inserting ‘‘(ii), and 
(kk)’’; and 
(II) by adding at the end the fol-
lowing: 
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543 
‘‘(kk) INCREASED FMAP FOR EXTENDED MEDICAL 
ASSISTANCE
FOR
POSTPARTUM
PEOPLE.—Notwith-
standing subsection (b), the Federal medical assistance 
percentage for a State, with respect to amounts expended 
by such State for medical assistance for a person who is 
eligible for such assistance on the basis of being pregnant 
or having been pregnant that is provided during the period 
that begins on the 60th day after the last day of their 
pregnancy (including any such assistance provided during 
the month in which such period ends), shall be equal to— 
‘‘(1) 100 percent for the first 20 calendar quar-
ters during which this subsection is in effect; and 
‘‘(2) 90 percent for calendar quarters there-
after.’’. 
(ii) CHIP.—Section 2105(c) of the 
Social Security Act (42 U.S.C. 1397ee(c)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(13) ENHANCED
PAYMENT
FOR
EXTENDED 
ASSISTANCE
PROVIDED
TO
PREGNANT
PEOPLE.— 
Notwithstanding 
subsection 
(b), 
the 
enhanced 
FMAP, with respect to payments under subsection 
(a) for expenditures under the State child health 
plan (or a waiver of such plan) for assistance pro-
vided under the plan (or waiver) to a person who is 
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544 
eligible for such assistance on the basis of being 
pregnant (including pregnancy-related assistance 
provided to a targeted low-income pregnant person 
(as defined in section 2112(d)), pregnancy-related 
assistance provided to a person who is eligible for 
such assistance through application of section 
1902(v)(4)(A)(i) under section 2107(e)(1), or any 
other assistance under the plan (or waiver) provided 
to a person who is eligible for such assistance on the 
basis of being pregnant) during the 305-day period 
that begins on the 60th day after the last day of her 
pregnancy (including any such assistance provided 
during the month in which such period ends), shall 
be equal to— 
‘‘(A) 100 percent for the first 20 calendar 
quarters during which this paragraph is in ef-
fect; and 
‘‘(B) 90 percent for calendar quarters 
thereafter.’’. 
(H) GUIDANCE
ON
STATE
OPTIONS
FOR 
MEDICAID
COVERAGE
OF
DOULA
SERVICES.— 
Not later than 1 year after the date of the en-
actment of this Act, the Secretary of Health 
and Human Services, acting through the Ad-
ministrator of the Centers for Medicare & Med-
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545 
icaid Services, shall issue guidance for the 
States concerning options for Medicaid coverage 
and payment for support services provided by 
doulas. 
(I) EFFECTIVE DATE.— 
(i) IN
GENERAL.—Subject to clause 
(ii), the amendments made by this para-
graph shall take effect on the first day of 
the first calendar quarter that begins on or 
after the date that is one year after the 
date of enactment of this Act. 
(ii) EXCEPTION FOR STATE LEGISLA-
TION.—In the case of a State plan under 
title XIX of the Social Security Act or a 
State child health plan under title XXI of 
such Act that the Secretary of Health and 
Human Services determines requires State 
legislation in order for the respective plan 
to meet any requirement imposed by 
amendments made by this paragraph, 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 be-
fore the first day of the first calendar 
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546 
quarter beginning after the close of the 
first regular session of the State legislature 
that begins after the date of enactment of 
this Act. For purposes of the previous sen-
tence, in the case of a State that has a 2- 
year legislative session, each year of the 
session shall be considered to be a separate 
regular session of the State legislature. 
(6) REGIONAL
CENTERS
OF
EXCELLENCE.— 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended by section 
5101, is further amended by adding at the end the 
following new section: 
‘‘SEC. 399V–9. REGIONAL CENTERS OF EXCELLENCE AD-
DRESSING IMPLICIT BIAS AND CULTURAL 
COMPETENCY IN PATIENT-PROVIDER INTER-
ACTIONS EDUCATION. 
‘‘(a) IN GENERAL.—Not later than one year after the 
date of enactment of this section, the Secretary, in con-
sultation with such other agency heads as the Secretary 
determines appropriate, shall award cooperative agree-
ments for the establishment or support of regional centers 
of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider inter-
actions education for the purpose of enhancing and im-
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547 
proving how health care professionals are educated in im-
plicit bias and delivering culturally competent health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper-
ative agreement under subsection (a), an entity shall— 
‘‘(1) be a public or other nonprofit entity speci-
fied by the Secretary that provides educational and 
training opportunities for students and health care 
professionals, which may be a health system, teach-
ing hospital, community health center, medical 
school, school of public health, school of nursing, 
dental school, social work school, school of profes-
sional psychology, or any other health professional 
school or program at an institution of higher edu-
cation (as defined in section 101 of the Higher Edu-
cation Act of 1965) focused on the prevention, treat-
ment, or recovery of health conditions that con-
tribute to maternal mortality and the prevention of 
maternal mortality and severe maternal morbidity; 
‘‘(2) demonstrate community engagement and 
participation, such as through partnerships with 
home visiting and case management programs; 
‘‘(3) demonstrate engagement with groups en-
gaged in the implementation of health care profes-
sional training in implicit bias and delivering cul-
turally competent care, such as departments of pub-
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548 
lic health, perinatal quality collaboratives, hospital 
systems, and health care professional groups, in 
order to obtain input on resources needed for effec-
tive implementation strategies; and 
‘‘(4) provide to the Secretary such information, 
at such time and in such manner, as the Secretary 
may require. 
‘‘(c) DIVERSITY.—In awarding a cooperative agree-
ment under subsection (a), the Secretary shall take into 
account any regional differences among eligible entities 
and make an effort to ensure geographic diversity among 
award recipients. 
‘‘(d) DISSEMINATION OF INFORMATION.— 
‘‘(1) PUBLIC
AVAILABILITY.—The Secretary 
shall make publicly available on the internet website 
of the Department of Health and Human Services 
information submitted to the Secretary under sub-
section (b)(3). 
‘‘(2) EVALUATION.—The Secretary shall evalu-
ate each regional center of excellence established or 
supported pursuant to subsection (a) and dissemi-
nate the findings resulting from each such evalua-
tion to the appropriate public and private entities. 
‘‘(3) DISTRIBUTION.—The Secretary shall share 
evaluations and overall findings with State depart-
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549 
ments of health and other relevant State level offices 
to inform State and local best practices. 
‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec-
tion, the term ‘maternal mortality’ means death of a per-
son that occurs during pregnancy or within the one-year 
period following the end of such pregnancy. 
‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—For 
purposes of carrying out this section, there is authorized 
to be appropriated $5,000,000 for each of fiscal years 
2023 through 2027.’’. 
(7) SPECIAL SUPPLEMENTAL NUTRITION PRO-
GRAM FOR PEOPLE, INFANTS, AND CHILDREN.—Sec-
tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 
1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 
(A) by striking the clause designation and 
heading and all that follows through ‘‘A State’’ 
and inserting the following: 
‘‘(ii) PREGNANT
AND
POSTPARTUM 
PEOPLE.— 
‘‘(I) BREASTFEEDING PEOPLE.— 
A State’’; 
(B) in subclause (I) (as so designated), by 
striking ‘‘1 year’’ and all that follows through 
‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 
and 
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550 
(C) by adding at the end the following: 
‘‘(II) POSTPARTUM
PEOPLE.—A 
State 
may 
elect 
to 
certify 
a 
postpartum person for a period of 2 
years.’’. 
(8) DEFINITIONS.—In this subsection: 
(A) MATERNAL
MORTALITY.—The term 
‘‘maternal mortality’’ means death of a person 
that occurs during pregnancy or within the one- 
year period following the end of such preg-
nancy. 
(B) PREGNANCY
RELATED
DEATH.—The 
term ‘‘pregnancy related death’’ includes the 
death of a person during pregnancy or within 
one year of the end of pregnancy from a preg-
nancy complication, a chain of events initiated 
by pregnancy, or the aggravation of an unre-
lated condition by the physiologic effects of 
pregnancy. 
(C) SEVERE MATERNAL MORBIDITY.—The 
term ‘‘severe maternal morbidity’’ includes un-
expected outcomes of labor and delivery that re-
sult in significant short-term or long-term con-
sequences to a person’s health. 
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551 
(b) INCREASE IN TAX ON CERTAIN TOBACCO PROD-
UCTS AND IMPOSITION OF TAX ON NICOTINE.— 
(1) INCREASING TAX ON CIGARETTES.— 
(A) 
SMALL
CIGARETTES.—Section 
5701(b)(1) of the Internal Revenue Code of 
1986 is amended by striking ‘‘$50.33’’ and in-
serting ‘‘$100.66’’. 
(B) 
LARGE
CIGARETTES.—Section 
5701(b)(2) of the Internal Revenue Code of 
1986 is amended by striking ‘‘$105.69’’ and in-
serting ‘‘$211.39’’. 
(2) TAX PARITY FOR SMALL CIGARS.—Section 
5701(a)(1) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘$50.33’’ and inserting 
‘‘$100.66’’. 
(3) TAX PARITY FOR LARGE CIGARS.—Section 
5701(a)(2) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘52.75 percent’’ and all that 
follows through the period and inserting ‘‘$49.56 per 
pound and a proportionate tax at the like rate on all 
fractional parts of a pound but not less than 10.06 
cents per cigar.’’. 
(4) TAX PARITY FOR SMOKELESS TOBACCO.— 
(A) Section 5701(e) of the Internal Rev-
enue Code of 1986 is amended— 
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552 
(i) in paragraph (1), by striking 
‘‘$1.51’’ and inserting ‘‘$26.84’’; 
(ii) in paragraph (2), by striking 
‘‘50.33 cents’’ and inserting ‘‘$10.70’’; and 
(iii) by adding at the end the fol-
lowing new paragraph: 
‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE 
SINGLE-USE
UNITS.—On discrete single-use units, 
$100 per thousand.’’. 
(B) Section 5702(m) of the Internal Rev-
enue Code of 1986 is amended— 
(i) in paragraph (1), by striking ‘‘or 
chewing tobacco’’ and inserting ‘‘, chewing 
tobacco, or discrete single-use unit’’; 
(ii) in paragraphs (2) and (3), by in-
serting ‘‘and that is not a discrete single- 
use unit’’ before the period at the end of 
each such paragraph; and 
(iii) by adding at the end the fol-
lowing new paragraph: 
‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 
‘discrete single-use unit’ means any product con-
taining tobacco that— 
‘‘(A) is not intended to be smoked, and 
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553 
‘‘(B) is in the form of a lozenge, tablet, 
pill, pouch, dissolvable strip, or other discrete 
single-use or single-dose unit.’’. 
(5) TAX PARITY FOR PIPE TOBACCO.—Section 
5701(f) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘$2.8311 cents’’ and inserting 
‘‘$49.56’’. 
(6) TAX
PARITY
FOR
ROLL-YOUR-OWN
TO-
BACCO.—Section 5701(g) of the Internal Revenue 
Code of 1986 is amended by striking ‘‘$24.78’’ and 
inserting ‘‘$49.56’’. 
(7) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO 
AND
CERTAIN
PROCESSED
TOBACCO.—Section 
5702(o) of the Internal Revenue Code of 1986 is 
amended by inserting ‘‘, and includes processed to-
bacco that is removed for delivery or delivered to a 
person other than a person with a permit provided 
under section 5713, but does not include removals of 
processed tobacco for exportation’’ after ‘‘wrappers 
thereof’’. 
(8) IMPOSITION OF TAX ON NICOTINE FOR USE 
IN VAPING, ETC.— 
(A) IN GENERAL.—Section 5701 of the In-
ternal Revenue Code of 1986 is amended by re-
designating subsection (h) as subsection (i) and 
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554 
by inserting after subsection (g) the following 
new subsection: 
‘‘(h) NICOTINE.—On taxable nicotine, manufactured 
in or imported into the United States, there shall be im-
posed a tax equal to the dollar amount specified in section 
5701(b)(1) per 1,810 milligrams of nicotine (and a pro-
portionate tax at the like rate on any fractional part there-
of).’’. 
(B) TAXABLE NICOTINE.—Section 5702 of 
the Internal Revenue Code of 1986 is amended 
by adding at the end the following new sub-
section: 
‘‘(q) TAXABLE NICOTINE.— 
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this subsection, the term ‘taxable nicotine’ 
means any nicotine which has been extracted, con-
centrated, or synthesized. 
‘‘(2) EXCEPTION FOR PRODUCTS APPROVED BY 
FOOD
AND
DRUG
ADMINISTRATION.—Such term 
shall not include any nicotine if the manufacturer or 
importer thereof demonstrates to the satisfaction of 
the Secretary of Health and Human Services that 
such nicotine will be used in— 
‘‘(A) a drug— 
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555 
‘‘(i) that is approved under section 
505 of the Federal Food, Drug, and Cos-
metic Act or licensed under section 351 of 
the Public Health Service Act; or 
‘‘(ii) for which an investigational use 
exemption has been authorized under sec-
tion 505(i) of the Federal Food, Drug, and 
Cosmetic Act or under section 351(a) of 
the Public Health Service Act; or 
‘‘(B) a combination product (as described 
in section 503(g) of the Federal Food, Drug, 
and Cosmetic Act), the constituent parts of 
which were approved or cleared under section 
505, 510(k), or 515 of such Act. 
‘‘(3) COORDINATION WITH TAXATION OF OTHER 
TOBACCO
PRODUCTS.—Tobacco products meeting 
the definition of cigars, cigarettes, smokeless to-
bacco, pipe tobacco, and roll-your-own tobacco in 
this section shall be classified and taxed as such de-
spite any concentration of the nicotine inherent in 
those products or any addition of nicotine to those 
products during the manufacturing process. 
‘‘(4) REGULATIONS.—The Secretary shall pre-
scribe such regulations or other guidance as is nec-
essary or appropriate to carry out the purposes of 
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556 
this subsection, including regulations or other guid-
ance for coordinating the taxation of tobacco prod-
ucts and taxable nicotine to protect revenue and pre-
vent double taxation.’’. 
(C) TAXABLE NICOTINE TREATED AS A TO-
BACCO PRODUCT.—Section 5702(c) of the In-
ternal Revenue Code of 1986 is amended by 
striking ‘‘and roll-your-own tobacco’’ and in-
serting ‘‘roll-your-own tobacco, and taxable nic-
otine’’. 
(D) MANUFACTURER OF TAXABLE NICO-
TINE.—Section 5702 of the Internal Revenue 
Code of 1986, as amended by subparagraph 
(B), is amended by adding at the end the fol-
lowing new subsection: 
‘‘(r) MANUFACTURER OF TAXABLE NICOTINE.— 
‘‘(1) IN GENERAL.—Any person who extracts, 
concentrates, or synthesizes nicotine shall be treated 
as a manufacturer of taxable nicotine (and as manu-
facturing such taxable nicotine). 
‘‘(2) APPLICATION
OF
RULES
RELATED
TO 
MANUFACTURERS
OF
TOBACCO
PRODUCTS.—Any 
reference to a manufacturer of tobacco products, or 
to manufacturing tobacco products, shall be treated 
as including a reference to a manufacturer of tax-
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557 
able nicotine, or to manufacturing taxable nicotine, 
respectively.’’. 
(9) REPEAL OF SPECIAL RULES FOR DETER-
MINING PRICE OF CIGARS.—Section 5702 of the In-
ternal Revenue Code of 1986 is amended by striking 
subsection (l). 
(10) FLOOR STOCKS TAXES.— 
(A) IMPOSITION OF TAX.—On covered to-
bacco products, and cigarette papers and tubes, 
manufactured in or imported into the United 
States which are removed before the tax in-
crease date and held on such date for sale by 
any person, there is hereby imposed a tax in an 
amount equal to the excess of— 
(i) the tax which would be imposed 
under section 5701 of the Internal Rev-
enue Code of 1986 on the article if the ar-
ticle had been removed on such date; over 
(ii) the prior tax (if any) imposed 
under section 5701 of such Code on such 
article. 
(B) COVERED TOBACCO PRODUCTS.—For 
purposes of this paragraph, the term ‘‘covered 
tobacco products’’ means any tobacco product 
other than— 
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558 
(i) 
cigars 
described 
in 
section 
5701(a)(2) of the Internal Revenue Code 
of 1986; 
(ii) discrete single-use units (as de-
fined in section 5702(m)(4) of such Code, 
as amended by this subsection); and 
(iii) taxable nicotine (as defined in 
section 5702(q) of such Code, as amended 
by this subsection). 
(C) CREDIT AGAINST TAX.—Each person 
shall be allowed as a credit against the taxes 
imposed by subparagraph (A) an amount equal 
to the lesser of $1,000 or the amount of such 
taxes. For purposes of the preceding sentence, 
all persons treated as a single employer under 
subsection (b), (c), (m), or (o) of section 414 of 
the Internal Revenue Code of 1986 shall be 
treated as 1 person for purposes of this sub-
paragraph. 
(D) LIABILITY FOR TAX AND METHOD OF 
PAYMENT.— 
(i) LIABILITY FOR TAX.—The person 
referred to in subparagraph (A) shall be 
liable for the tax imposed by such subpara-
graph. 
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559 
(ii) METHOD OF PAYMENT.—The tax 
imposed by subparagraph (A) shall be paid 
in such manner as the Secretary may pro-
vide. 
(E) 
ARTICLES
IN
FOREIGN
TRADE 
ZONES.— 
(i) IN
GENERAL.—Notwithstanding 
the Act of June 18, 1934 (commonly 
known as the Foreign Trade Zone Act, 48 
Stat. 998, 19 U.S.C. 81a et seq.) or any 
other provision of law, any covered tobacco 
products, or cigarette papers and tubes, 
which are located in a foreign trade zone 
on the tax increase date, shall be subject 
to the tax imposed by subparagraph (A) 
if— 
(I) internal revenue taxes have 
been determined, or customs duties 
liquidated, with respect to such article 
before such date pursuant to a re-
quest made under the 1st proviso of 
section 3(a) of such Act; or 
(II) such article is held on such 
date under the supervision of an offi-
cer of the United States Customs and 
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560 
Border Protection of the Department 
of Homeland Security pursuant to the 
2d proviso of such section 3(a). 
(F) TAX INCREASE DATE.—For purposes 
of this paragraph, the term ‘‘tax increase date’’ 
means the first day of the first calendar quarter 
described in paragraph (11)(A). 
(G) 
CERTAIN
OTHER
DEFINITIONS.— 
Terms used in this paragraph which are also 
used in section 5702 of the Internal Revenue 
Code of 1986 shall have the same meaning as 
when used in such section. 
(11) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Except as otherwise 
provided in this paragraph, the amendments 
made by this subsection shall apply to articles 
removed in calendar quarters beginning after 
the date of the enactment of this Act. 
(B) DELAYED EFFECTIVE DATE FOR CER-
TAIN
PRODUCTS.—The amendments made by 
paragraphs (3), (4)(A)(iii), (4)(B), and (8) 
shall apply to articles removed in calendar 
quarters beginning after the date which is 180 
days after the date of the enactment of this 
Act. 
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561 
(12) TRANSITION RULE FOR PERMIT AND BOND 
REQUIREMENTS.—A person which is lawfully en-
gaged in business as a manufacturer or importer of 
taxable nicotine (within the meaning of subchapter 
A of chapter 52 of the Internal Revenue Code of 
1986, as amended by this subsection) on the date of 
the enactment of this Act, first becomes subject to 
the requirements of subchapter B of chapter 52 of 
such Code by reason of the amendments made by 
this subsection, and submits an application under 
such subchapter B to engage in such business not 
later than 90 days after the date of the enactment 
of this Act, shall not be denied the right to carry on 
such business by reason of such requirements before 
final action on such application. 
SEC. 5202. MOMMIES. 
(a) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Comp-
troller General of the United States shall submit to 
Congress a report on the gaps in coverage with re-
spect to— 
(A) pregnant individuals enrolled under a 
State plan (or waiver of such plan) under title 
XIX of the Social Security Act (42 U.S.C. 1396 
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562 
et seq.) and the Children’s Health Insurance 
Program under title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.); and 
(B) postpartum individuals enrolled under 
a State plan (or waiver of such plan) under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) and the Children’s Health Insurance 
Program under title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) who received as-
sistance under either such program during their 
pregnancy. 
(2) CONTENT
OF
REPORT.—The report re-
quired under this paragraph shall include the fol-
lowing: 
(A) Information about the abilities and 
successes of State Medicaid agencies in deter-
mining whether pregnant and postpartum indi-
viduals are eligible under another insurance af-
fordability program, and in transitioning any 
such individuals who are so eligible to coverage 
under such a program at the end of their period 
of eligibility for medical assistance, pursuant to 
section 435.1200 of the title 42, Code of Fed-
eral Regulations (as in effect on September 1, 
2018). 
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563 
(B) Information on factors contributing to 
gaps in coverage that disproportionately impact 
underserved populations, including low-income 
individuals, Black, Indigenous, and other indi-
viduals of color, individuals who reside in a 
health professional shortage area (as defined in 
section 332(a)(1)(A) of the Public Health Serv-
ice Act (42 U.S.C. 254e(a)(1)(A))) or individ-
uals who are members of a medically under-
served population (as defined by section 
330(b)(3) 
of 
such 
Act 
(42 
U.S.C. 
254b(b)(3)(A))). 
(C) Recommendations for addressing and 
reducing such gaps in coverage. 
(D) Such other information as the Comp-
troller General deems necessary. 
(3) DATA DISAGGREGATION.—To the greatest 
extent possible, the Comptroller General shall 
disaggregate data presented in the report, including 
by age, gender identity, race, ethnicity, income level, 
and other demographic factors. 
(b) MATERNITY
CARE
HOME
DEMONSTRATION 
PROJECT.—Title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) is amended by inserting the following 
new section after section 1947: 
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564 
‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 
PROJECT. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of the enactment of this section, the Secretary shall 
establish a demonstration project (in this section referred 
to as the ‘demonstration project’) under which the Sec-
retary shall provide grants to States to enter into arrange-
ments with eligible entities to implement or expand a ma-
ternity care home model for eligible individuals. 
‘‘(b) GOALS
OF DEMONSTRATION PROJECT.—The 
goals of the demonstration project are the following: 
‘‘(1) To improve— 
‘‘(A) maternity and infant care outcomes; 
‘‘(B) birth equity; 
‘‘(C) health equity for— 
‘‘(i) Black, Indigenous, and other peo-
ple of color; 
‘‘(ii) 
lesbian, 
gay, 
bisexual, 
transgender, queer, non-binary, and gender 
nonconfirming individuals; 
‘‘(iii) people with disabilities; and 
‘‘(iv) other underserved populations; 
‘‘(D) communication by maternity, infant 
care, and social services providers; 
‘‘(E) integration of perinatal support serv-
ices, including community health workers, 
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565 
doulas, social workers, public health nurses, 
peer lactation counselors, lactation consultants, 
childbirth educators, peer mental health work-
ers, and others, into health care entities and or-
ganizations; 
‘‘(F) care coordination between maternity, 
infant care, oral health services, and social serv-
ices providers within the community; 
‘‘(G) the quality and safety of maternity 
and infant care; 
‘‘(H) the experience of individuals receiv-
ing maternity care, including by increasing the 
ability of an individual to develop and follow 
their own birthing plans; and 
‘‘(I) access to adequate prenatal and 
postpartum care, including— 
‘‘(i) prenatal care that is initiated in 
a timely manner; 
‘‘(ii) not fewer than 5 post-pregnancy 
visits to a maternity care provider; and 
‘‘(iii) interpregnancy care. 
‘‘(2) To provide coordinated, evidence-based, re-
spectful, culturally and linguistically appropriate, 
and person-centered maternity care management. 
‘‘(3) To decrease— 
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566 
‘‘(A) severe and preventable maternal mor-
bidity and maternal mortality; 
‘‘(B) overall health care spending; 
‘‘(C) unnecessary emergency department 
visits; 
‘‘(D) inequities in maternal and infant care 
outcomes, including racial, economic, disability, 
gender-based, and geographical inequities; 
‘‘(E) racial, gender, economic, and other 
discrimination among health care professionals; 
‘‘(F) racism, discrimination, disrespect, 
and abuse in maternity care settings; 
‘‘(G) the rate of cesarean deliveries for 
low-risk pregnancies; 
‘‘(H) the rate of pre-term births and in-
fants born with low birth weight; and 
‘‘(I) the rate of avoidable maternal and 
newborn hospitalizations and admissions to in-
tensive care units. 
‘‘(c) CONSULTATION.—In designing and imple-
menting the demonstration project the Secretary shall 
consult with stakeholders, including— 
‘‘(1) States; 
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567 
‘‘(2) organizations representing relevant health 
care professionals, including oral health services pro-
fessionals; 
‘‘(3) organizations, particularly reproductive 
justice and birth justice organizations led by people 
of color, that represent consumers of maternal 
health care, including consumers of maternal health 
care who are disproportionately impacted by poor 
maternal health outcomes; 
‘‘(4) representatives with experience imple-
menting other maternity care home models, includ-
ing representatives from the Center for Medicare 
and Medicaid Innovation; 
‘‘(5) community-based health care professionals, 
including doulas, lactation consultants, and other 
stakeholders; 
‘‘(6) experts in promoting health equity and 
combating racial bias in health care settings; and 
‘‘(7) Black, Indigenous, and other maternal 
health care consumers of color who have experienced 
severe maternal morbidity. 
‘‘(d) APPLICATION AND SELECTION OF STATES.— 
‘‘(1) IN GENERAL.—A State seeking to partici-
pate in the demonstration project shall submit an 
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568 
application to the Secretary at such time and in 
such manner as the Secretary shall require. 
‘‘(2) SELECTION OF STATES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
select at least 10 States to participate in the 
demonstration project. 
‘‘(B) SELECTION REQUIREMENTS.—In se-
lecting States to participate in the demonstra-
tion project, the Secretary shall— 
‘‘(i) ensure that there is geographic 
and regional diversity in the areas in which 
activities will be carried out under the 
project; 
‘‘(ii) ensure that States with signifi-
cant inequities in maternal and infant 
health outcomes, including severe maternal 
morbidity, and other inequities based on 
race, income, or access to maternity care, 
are included; and 
‘‘(iii) ensure that at least 1 territory 
is included. 
‘‘(e) GRANTS.— 
‘‘(1) IN
GENERAL.—From amounts appro-
priated under subsection (l), the Secretary shall 
award 1 grant for each year of the demonstration 
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569 
project to each State that is selected to participate 
in the demonstration project. 
‘‘(2) USE OF GRANT FUNDS.—A State may use 
funds received under this section to— 
‘‘(A) award grants or make payments to 
eligible entities as part of an arrangement de-
scribed in subsection (f)(2); 
‘‘(B) provide financial incentives to health 
care professionals, including community-based 
health care workers and community-based 
doulas, who participate in the State’s maternity 
care home model; 
‘‘(C) provide adequate training for health 
care professionals, including community-based 
health care workers, doulas, and care coordina-
tors, who participate in the State’s maternity 
care home model, which may include training 
for cultural humility and antiracism, racial bias, 
health equity, reproductive and birth justice, 
trauma-informed care, home visiting skills, and 
respectful communication and listening skills, 
particularly in regards to maternal health; 
‘‘(D) pay for personnel and administrative 
expenses associated with designing, imple-
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570 
menting, and operating the State’s maternity 
care home model; 
‘‘(E) pay for items and services that are 
furnished under the State’s maternity care 
home model and for which payment is otherwise 
unavailable under this title; 
‘‘(F) pay for services and materials to en-
sure culturally and linguistically appropriate 
communication, including— 
‘‘(i) language services such as inter-
preters and translation of written mate-
rials; and 
‘‘(ii) development of culturally and lin-
guistically appropriate materials; and aux-
iliary aids and services; and 
‘‘(G) pay for other costs related to the 
State’s maternity care home model, as deter-
mined by the Secretary. 
‘‘(3) GRANT
FOR
NATIONAL
INDEPENDENT 
EVALUATOR.— 
‘‘(A) IN
GENERAL.—From the amounts 
appropriated under subsection (l), prior to 
awarding any grants under paragraph (1), the 
Secretary shall enter into a contract with a na-
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571 
tional external entity to create a single, uniform 
process to— 
‘‘(i) ensure that States that receive 
grants under paragraph (1) comply with 
the requirements of this section; and 
‘‘(ii) evaluate the outcomes of the 
demonstration project in each participating 
State. 
‘‘(B) ANNUAL REPORT.—The contract de-
scribed in subparagraph (A) shall require the 
national external entity to submit to the Sec-
retary— 
‘‘(i) a yearly evaluation report for 
each year of the demonstration project; 
and 
‘‘(ii) a final impact report after the 
demonstration project has concluded. 
‘‘(C) SECRETARY’S AUTHORITY.—Nothing 
in this paragraph shall prevent the Secretary 
from making a determination that a State is 
not in compliance with the requirements of this 
section without the national external entity 
making such a determination. 
‘‘(f) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 
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572 
‘‘(1) IN GENERAL.—As a condition of receiving 
a grant under this section, a State shall enter into 
an arrangement with one or more eligible entities 
that meets the requirements of paragraph (2). 
‘‘(2) ARRANGEMENTS
WITH
ELIGIBLE
ENTI-
TIES.—Under an arrangement between a State and 
an eligible entity under this subsection, the eligible 
entity shall perform the following functions, with re-
spect to eligible individuals enrolled with the entity 
under the State’s maternity care home model— 
‘‘(A) provide culturally and linguistically 
appropriate congruent care, which may include 
prenatal care, family planning services, medical 
care, mental and behavioral care, postpartum 
care, and oral health services to such eligible in-
dividuals through a team of health care profes-
sionals, which may include obstetrician-gyne-
cologists, maternal-fetal medicine specialists, 
family physicians, primary care providers, oral 
health providers, physician assistants, advanced 
practice registered nurses such as nurse practi-
tioners and certified nurse midwives, certified 
midwives, certified professional midwives, phys-
ical therapists, social workers, traditional and 
community-based doulas, lactation consultants, 
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573 
childbirth educators, community health workers, 
peer mental health supporters, and other health 
care professionals; 
‘‘(B) conduct a risk assessment of each 
such eligible individual to determine if their 
pregnancy is high or low risk, and establish a 
tailored pregnancy care plan, which takes into 
consideration the individual’s own preferences 
and pregnancy care and birthing plans and de-
termines the appropriate support services to re-
duce the individual’s medical, social, and envi-
ronmental risk factors, for each such eligible in-
dividual based on the results of such risk as-
sessment; 
‘‘(C) assign each such eligible individual to 
a culturally and linguistically appropriate care 
coordinator, which may be a nurse, social work-
er, traditional or community-based doula, com-
munity health worker, midwife, or other health 
care provider, who is responsible for ensuring 
that such eligible individual receives the nec-
essary medical care and connections to essential 
support services; 
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574 
‘‘(D) provide, or arrange for the provision 
of, essential support services, such as services 
that address— 
‘‘(i) food access, nutrition, and exer-
cise; 
‘‘(ii) smoking cessation; 
‘‘(iii) substance use disorder and ad-
diction treatment; 
‘‘(iv) anxiety, depression, trauma, and 
other mental and behavioral health issues; 
‘‘(v) breast feeding, chestfeeding, or 
other infant feeding options supports, initi-
ation, continuation, and duration; 
‘‘(vi) stable, affordable, safe, and 
healthy housing; 
‘‘(vii) transportation; 
‘‘(viii) intimate partner violence; 
‘‘(ix) community and police violence; 
‘‘(x) home visiting services; 
‘‘(xi) childbirth and newborn care edu-
cation; 
‘‘(xii) oral health education; 
‘‘(xiii) continuous labor support; 
‘‘(xiv) group prenatal care; 
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575 
‘‘(xv) family planning and contracep-
tive care and supplies; and 
‘‘(xvi) affordable child care; 
‘‘(E) as appropriate, facilitate connections 
to a usual primary care provider, which may be 
a reproductive health care provider; 
‘‘(F) refer to guidelines and opinions of 
medical associations when determining whether 
an elective delivery should be performed on an 
eligible individual before 39 weeks of gestation; 
‘‘(G) provide such eligible individual with 
evidence-based and culturally and linguistically 
appropriate education and resources to identify 
potential warning signs of pregnancy and 
postpartum complications and when and how to 
obtain medical attention; 
‘‘(H) provide, or arrange for the provision 
of, culturally and linguistically appropriate 
pregnancy and postpartum health services, in-
cluding family planning counseling and services, 
to eligible individuals; 
‘‘(I) track and report postpartum health 
and birth outcomes of such eligible individuals 
and their children; 
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576 
‘‘(J) ensure that care is person-centered, 
culturally and linguistically appropriate, and 
patient-led, including by engaging eligible indi-
viduals in their own care, including through 
communication and education; and 
‘‘(K) ensure adequate training for appro-
priately serving the population of individuals el-
igible for medical assistance under the State 
plan (or waiver of such plan), including through 
reproductive justice, birth justice, birth equity, 
and anti-racist frameworks, home visiting skills, 
and knowledge of social services. 
‘‘(g) TERM
OF DEMONSTRATION PROJECT.—The 
Secretary shall conduct the demonstration project for a 
period of 5 years. 
‘‘(h) REPORT.—Not later than 18 months after the 
date of the enactment of this section and annually there-
after for each year of the demonstration project term, the 
Secretary shall submit a report to Congress on the results 
of the demonstration project, including— 
‘‘(1) the results of the final report of the na-
tional external entity required under subsection 
(e)(3)(B)(ii); and 
‘‘(2) recommendations on whether the model 
studied in the demonstration project should be con-
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577 
tinued or more widely adopted, including by private 
health plans. 
‘‘(i) WAIVER AUTHORITY.—To the extent that the 
Secretary determines necessary in order to carry out the 
demonstration project, the Secretary may waive section 
1902(a)(1) (relating to statewideness) and section 
1902(a)(10)(B) (relating to comparability). 
‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 
establish a process to provide technical assistance to 
States that are awarded grants under this section and to 
eligible entities and other providers participating in a 
State maternity care home model funded by such a grant. 
‘‘(k) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means an entity or organization that provides 
medically accurate, comprehensive maternity services 
to individuals who are eligible for medical assistance 
under a State plan under this title or a waiver of 
such a plan, and may include: 
‘‘(A) A freestanding birth center. 
‘‘(B) An entity or organization receiving 
assistance under section 330 of the Public 
Health Service Act. 
‘‘(C) A federally qualified health center. 
‘‘(D) A rural health clinic. 
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578 
‘‘(E) A health facility operated by an In-
dian tribe or tribal organization (as those terms 
are defined in section 4 of the Indian Health 
Care Improvement Act). 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means a pregnant individual or a for-
merly pregnant individual during the 1-year period 
beginning on the last day of the pregnancy, or such 
longer period beginning on such day as a State may 
elect, who is— 
‘‘(A) enrolled in a State plan under this 
title, a waiver of such a plan, or a State child 
health plan under title XXI; and 
‘‘(B) a patient of an eligible entity which 
has entered into an arrangement with a State 
under subsection (g). 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary, for 
each of fiscal years 2023 through 2030, such sums as may 
be necessary to carry out this section.’’. 
(c) REAPPLICATION OF MEDICARE PAYMENT RATE 
FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER 
MEDICAID
AND
INCLUSION
OF
ADDITIONAL
PRO-
VIDERS.— 
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579 
(1) REAPPLICATION OF PAYMENT FLOOR; ADDI-
TIONAL PROVIDERS.— 
(A) IN GENERAL.—Section 1902(a)(13) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(13)) is amended— 
(i) in subparagraph (B), by striking ‘‘; 
and’’ and inserting a semicolon; 
(ii) in subparagraph (C), by striking 
the semicolon and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) payment for primary care services (as 
defined in subsection (jj)(1)) furnished in the 
period that begins on the first day of the first 
month that begins after the date of enactment 
of this subparagraph by a provider described in 
subsection (jj)(2)— 
‘‘(i) at a rate that is not less than 100 
percent of the payment rate that applies to 
such services and the provider of such 
services under part B of title XVIII (or, if 
greater, the payment rate that would be 
applicable under such part if the conver-
sion factor under section 1848(d) for the 
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580 
year were the conversion factor under such 
section for 2009); 
‘‘(ii) in the case of items and services 
that are not items and services provided 
under such part, at a rate to be established 
by the Secretary; and 
‘‘(iii) in the case of items and services 
that are furnished in rural areas (as de-
fined in section 1886(d)(2)(D)), health 
professional shortage areas (as defined in 
section 332(a)(1)(A) of the Public Health 
Service Act (42 U.S.C. 254e(a)(1)(A))), or 
medically underserved areas (according to 
a designation under section 330(b)(3)(A) 
of the Public Health Service Act (42 
U.S.C. 254b(b)(3)(A))), at the rate other-
wise applicable to such items or services 
under clause (i) or (ii) increased, at the 
Secretary’s discretion, by not more than 25 
percent;’’. 
(B) CONFORMING AMENDMENTS.— 
(i) Section 1902(a)(13)(C) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396a(a)(13)(C)) is amended by striking 
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581 
‘‘subsection (jj)’’ and inserting ‘‘subsection 
(jj)(1)’’. 
(ii) Section 1905(dd) of the Social Se-
curity Act (42 U.S.C. 1396d(dd)) is 
amended— 
(I) 
by 
striking 
‘‘Notwith-
standing’’ and inserting the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
(II) 
by 
striking 
‘‘section 
1902(a)(13)(C)’’ and inserting ‘‘sub-
paragraph 
(C) 
of 
section 
1902(a)(13)’’; 
(III) by inserting ‘‘or for services 
described in subparagraph (D) of sec-
tion 1902(a)(13) furnished during an 
additional period specified in para-
graph (2),’’ after ‘‘2015,’’; 
(IV) by striking ‘‘under such sec-
tion’’ and inserting ‘‘under subpara-
graph 
(C) 
or 
(D) 
of 
section 
1902(a)(13), as applicable’’; and 
(V) by adding at the end the fol-
lowing: 
‘‘(2) ADDITIONAL PERIODS.—For purposes of 
paragraph (1), the following are additional periods: 
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582 
‘‘(A) The period that begins on the first 
day of the first month that begins after the 
date of enactment of this paragraph.’’. 
(2) 
IMPROVED
TARGETING
OF
PRIMARY 
CARE.—Section 1902(jj) of the Social Security Act 
(42 U.S.C. 1396a(jj)) is amended— 
(A) by redesignating paragraphs (1) and 
(2) as clauses (i) and (ii), respectively, and re-
aligning the left margins accordingly; 
(B) by striking ‘‘For purposes of sub-
section (a)(13)(C)’’ and inserting the following: 
‘‘(1) IN GENERAL.— 
‘‘(A) DEFINITION.—For purposes of sub-
paragraphs (C) and (D) of subsection (a)(13)’’; 
and 
(C) by inserting after clause (ii) (as so re-
designated) the following: 
‘‘(B) EXCLUSIONS.—Such term does not 
include any services described in subparagraph 
(A) or (B) of paragraph (1) if such services are 
provided in an emergency department of a hos-
pital. 
‘‘(2) ADDITIONAL
PROVIDERS.—For purposes 
of subparagraph (D) of subsection (a)(13), a pro-
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583 
vider described in this paragraph is any of the fol-
lowing: 
‘‘(A) A physician with a primary specialty 
designation of family medicine, general internal 
medicine, or pediatric medicine, or obstetrics 
and gynecology. 
‘‘(B) An advanced practice clinician, as de-
fined by the Secretary, that works under the 
supervision of— 
‘‘(i) a physician that satisfies the cri-
teria specified in subparagraph (A); 
‘‘(ii) a nurse practitioner or a physi-
cian assistant (as such terms are defined 
in section 1861(aa)(5)(A)) who is working 
in accordance with State law; or 
‘‘(iii) or a certified nurse-midwife (as 
defined in section 1861(gg)) or a certified 
professional midwife who is working in ac-
cordance with State law. 
‘‘(C) A rural health clinic, federally quali-
fied health center, health center that receives 
funding under title X of the Public Health 
Service Act, or other health clinic that receives 
reimbursement on a fee schedule applicable to 
a physician. 
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584 
‘‘(D) An advanced practice clinician super-
vised by a physician described in subparagraph 
(A), another advanced practice clinician, or a 
certified nurse-midwife. 
‘‘(E) A midwife who is working in accord-
ance with State law.’’. 
(3) ENSURING
PAYMENT
BY
MANAGED
CARE 
ENTITIES.— 
(A) IN GENERAL.—Section 1903(m)(2)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(m)(2)(A)) is amended— 
(i) in clause (xii), by striking ‘‘and’’ 
after the semicolon; 
(ii) by realigning the left margin of 
clause (xiii) so as to align with the left 
margin of clause (xii) and by striking the 
period at the end of clause (xiii) and in-
serting ‘‘; and’’; and 
(iii) by inserting after clause (xiii) the 
following: 
‘‘(xiv) such contract provides that (I) payments 
to providers specified in section 1902(a)(13)(D) for 
primary care services (as defined in section 1902(jj)) 
that are furnished during a year or period (as speci-
fied 
in 
section 
1902(a)(13)(D) 
and 
section 
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585 
1905(dd)) are at least equal to the amounts set 
forth and required by the Secretary by regulation; 
(II) the entity shall, upon request, provide docu-
mentation to the State, sufficient to enable the State 
and the Secretary to ensure compliance with sub-
clause (I); and (III) the Secretary shall approve pay-
ments described in subclause (I) that are furnished 
through an agreed upon capitation, partial capita-
tion, or other value-based payment arrangement if 
the capitation, partial capitation, or other value- 
based payment arrangement is based on a reason-
able methodology and the entity provides docu-
mentation to the State sufficient to enable the State 
and the Secretary to ensure compliance with sub-
clause (I).’’. 
(B) CONFORMING
AMENDMENT.—Section 
1932(f) of the Social Security Act (42 U.S.C. 
1396u–2(f)) is amended— 
(i) 
by 
striking 
‘‘section 
1902(a)(13)(C)’’ 
and 
inserting 
‘‘sub-
sections 
(C) 
and 
(D) 
of 
section 
1902(a)(13)’’; and 
(ii) by inserting ‘‘, and clause (xiv) of 
section 1903(m)(2)(A)’’ before the period. 
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586 
(d) MACPAC REPORT AND CMS GUIDANCE ON IN-
CREASING ACCESS TO DOULA SERVICES FOR MEDICAID 
BENEFICIARIES.— 
(1) MACPAC REPORT.— 
(A) IN GENERAL.—Not later than 1 year 
after the date of the enactment of this Act, the 
Medicaid and CHIP Payment and Access Com-
mission (referred to in this subsection as 
‘‘MACPAC’’) shall publish a report on the cov-
erage of doula services under State Medicaid 
programs, which shall at a minimum include 
the following: 
(i) Information about coverage for 
doula services under State Medicaid pro-
grams that currently provide coverage for 
such care, including the type of doula serv-
ices offered (such as prenatal, labor and 
delivery, postpartum support, and also 
community-based and traditional doula 
services). 
(ii) An analysis of barriers to covering 
doula services under State Medicaid pro-
grams. 
(iii) An identification of effective 
strategies to increase the use of doula serv-
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587 
ices in order to provide better care and 
achieve better maternal and infant health 
outcomes, including strategies that States 
may use to recruit, train, and certify a di-
verse doula workforce, particularly from 
underserved communities, communities of 
color, and communities facing linguistic or 
cultural barriers. 
(iv) Recommendations for legislative 
and administrative actions to increase ac-
cess to doula services in State Medicaid 
programs, including actions that ensure 
doulas may earn a living wage that ac-
counts for their time and costs associated 
with providing care and community-based 
doula program administration and oper-
ation. 
(B) STAKEHOLDER
CONSULTATION.—In 
developing the report required under subpara-
graph (A), MACPAC shall consult with relevant 
stakeholders, including— 
(i) States; 
(ii) organizations, especially reproduc-
tive justice and birth justice organizations 
led by people of color, representing con-
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588 
sumers of maternal health care, including 
those that are disproportionately impacted 
by poor maternal health outcomes; 
(iii) organizations and individuals rep-
resenting doulas, including community- 
based doula programs and those who serve 
underserved communities, including com-
munities of color, and communities facing 
linguistic or cultural barriers; 
(iv) organizations representing health 
care providers; and 
(v) Black, Indigenous, and other ma-
ternal health care consumers of color who 
have experienced severe maternal mor-
bidity. 
(2) CMS GUIDANCE.— 
(A) IN GENERAL.—Not later than 1 year 
after the date that MACPAC publishes the re-
port required under paragraph (1)(A), the Ad-
ministrator of the Centers for Medicare & Med-
icaid Services shall issue guidance to States on 
increasing access to doula services under Med-
icaid. Such guidance shall at a minimum in-
clude— 
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589 
(i) options for States to provide med-
ical assistance for doula services under 
State Medicaid programs; 
(ii) best practices for ensuring that 
doulas, including community-based doulas, 
receive reimbursement for doula services 
provided under a State Medicaid program, 
at a level that allows doulas to earn a liv-
ing wage that accounts for their time and 
costs associated with providing care and 
community-based doula program adminis-
tration; and 
(iii) best practices for increasing ac-
cess to doula services, including services 
provided 
by 
community-based 
doulas, 
under State Medicaid programs. 
(B) STAKEHOLDER
CONSULTATION.—In 
developing the guidance required under sub-
paragraph (A), the Administrator of the Cen-
ters for Medicare & Medicaid Services shall con-
sult with MACPAC and other relevant stake-
holders, including— 
(i) State Medicaid officials; 
(ii) organizations representing con-
sumers of maternal health care, including 
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590 
those that are disproportionately impacted 
by poor maternal health outcomes; 
(iii) organizations representing doulas, 
including community-based doulas and 
those who serve underserved communities, 
such as communities of color and commu-
nities facing linguistic or cultural barriers; 
and 
(iv) organizations representing med-
ical professionals. 
(e) GAO REPORT ON STATE MEDICAID PROGRAMS’ 
USE OF TELEHEALTH TO INCREASE ACCESS TO MATER-
NITY CARE.—Not later than 1 year after the date of the 
enactment of this Act, the Comptroller General of the 
United States shall submit a report to Congress on State 
Medicaid programs’ use of telehealth to increase access to 
maternity care. Such report shall include the following: 
(1) The number of State Medicaid programs 
that utilize telehealth that increases access to mater-
nity care. 
(2) With respect to State Medicaid programs 
that utilize telehealth that increases access to mater-
nity care, information about— 
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591 
(A) common characteristics of such pro-
grams’ approaches to utilizing telehealth that 
increases access to maternity care; 
(B) differences in States’ approaches to 
utilizing telehealth to improve access to mater-
nity care, and the resulting differences in State 
maternal health outcomes, as determined by 
factors described in subsection (C); and 
(C) when compared to patients who receive 
maternity care in-person, what is known 
about— 
(i) the demographic characteristics, 
such as race, ethnicity, sex, sexual orienta-
tion, gender identity, disability status, age, 
and preferred language of the individuals 
enrolled in such programs who use tele-
health to access maternity care; 
(ii) health outcomes for such individ-
uals, including frequency of mortality and 
severe morbidity, as compared to individ-
uals with similar characteristics who did 
not use telehealth to access maternity care; 
(iii) the services provided to individ-
uals through telehealth, including family 
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592 
planning services, mental health care serv-
ices, and oral health services; 
(iv) the devices and equipment pro-
vided to individuals for remote patient 
monitoring and telehealth, including blood 
pressure monitors and blood glucose mon-
itors; 
(v) the quality of maternity care pro-
vided through telehealth, including whether 
maternity care provided through telehealth 
is culturally and linguistically appropriate; 
(vi) the level of patient satisfaction 
with maternity care provided through tele-
health to individuals enrolled in State Med-
icaid programs; 
(vii) the impact of utilizing telehealth 
to increase access to maternity care on 
spending, cost savings, access to care, and 
utilization of care under State Medicaid 
programs; and 
(viii) the accessibility and effectiveness 
of telehealth for maternity care during the 
COVID–19 pandemic. 
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593 
(3) An identification and analysis of the bar-
riers to using telehealth to increase access to mater-
nity care under State Medicaid programs. 
(4) Recommendations for such legislative and 
administrative actions related to increasing access to 
telehealth maternity services under Medicaid as the 
Comptroller General deems appropriate. 
SEC. 5203. JUSTICE FOR INCARCERATED MOMS. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) the respect and proper care that birthing 
people deserve is inclusive; and 
(2) regardless of race, ethnicity, gender iden-
tity, sexual orientation, religion, marital status, fa-
milial status, socioeconomic status, immigration sta-
tus, incarceration status, or disability, all deserve 
dignity. 
(b) ENDING THE SHACKLING OF PREGNANT INDI-
VIDUALS.— 
(1) IN GENERAL.—Beginning on the date that 
is 6 months after the date of enactment of this Act, 
and annually thereafter, in each State that receives 
a grant under subpart 1 of part E of title I of the 
Omnibus Crime Control and Safe Streets Act of 
1968 (34 U.S.C. 10151 et seq.) (commonly referred 
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594 
to as the ‘‘Edward Byrne Memorial Justice Grant 
Program’’) and that does not have in effect through-
out the State for such fiscal year laws restricting the 
use of restraints on pregnant individuals in prison 
that are substantially similar to the rights, proce-
dures, requirements, effects, and penalties set forth 
in section 4322 of title 18, United States Code, the 
amount of such grant that would otherwise be allo-
cated to such State under such subpart for the fiscal 
year shall be decreased by 25 percent. 
(2) REALLOCATION.—Amounts not allocated to 
a State for failure to comply with paragraph (1) 
shall be reallocated in accordance with subpart 1 of 
part E of title I of the Omnibus Crime Control and 
Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) 
to States that have complied with such paragraph. 
(c) CREATING MODEL PROGRAMS FOR THE CARE OF 
INCARCERATED INDIVIDUALS
IN
THE PRENATAL
AND 
POSTPARTUM PERIODS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Attorney Gen-
eral, acting through the Director of the Bureau of 
Prisons (in this subsection referred to as the ‘‘Direc-
tor’’), shall establish, in not fewer than 6 Bureau of 
Prisons facilities, programs to optimize maternal 
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595 
health outcomes for pregnant and postpartum indi-
viduals incarcerated in such facilities. The Attorney 
General shall establish such programs in consulta-
tion with stakeholders such as— 
(A) relevant community-based organiza-
tions, particularly organizations that represent 
incarcerated and formerly incarcerated individ-
uals and organizations that seek to improve ma-
ternal health outcomes for pregnant and 
postpartum individuals from racial and ethnic 
minority groups; 
(B) relevant organizations representing pa-
tients, with a particular focus on patients from 
racial and ethnic minority groups; 
(C) organizations representing maternity 
care providers and maternal health care edu-
cation programs; 
(D) perinatal health workers; and 
(E) researchers and policy experts in fields 
related to maternal health care for incarcerated 
individuals. 
(2) START DATE.—Each selected facility shall 
begin facility programs not later than 18 months 
after the date of enactment of this Act. 
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596 
(3) FACILITY PRIORITY.—In carrying out para-
graph (1), the Director shall give priority to a facil-
ity based on— 
(A) 
the 
number 
of 
pregnant 
and 
postpartum individuals incarcerated in such fa-
cility and, among such individuals, the number 
of pregnant and postpartum individuals from 
racial and ethnic minority groups; and 
(B) the extent to which the leaders of such 
facility have demonstrated a commitment to de-
veloping exemplary programs for pregnant and 
postpartum individuals incarcerated in such fa-
cility. 
(4) PROGRAM
DURATION.—The programs es-
tablished under this subsection shall be for a 5-year 
period. 
(5) PROGRAMS.—Bureau of Prisons facilities 
selected by the Director shall establish programs for 
pregnant and postpartum incarcerated individuals, 
and such programs may— 
(A) provide access to perinatal health 
workers 
from 
pregnancy 
through 
the 
postpartum period; 
(B) provide access to healthy foods and 
counseling on nutrition, recommended activity 
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597 
levels, and safety measures throughout preg-
nancy; 
(C) train correctional officers to ensure 
that pregnant incarcerated individuals receive 
safe and respectful treatment; 
(D) train medical personnel to ensure that 
pregnant incarcerated individuals receive trau-
ma-informed, culturally congruent care that 
promotes the health and safety of the pregnant 
individuals; 
(E) provide counseling and treatment for 
individuals who have suffered from— 
(i) diagnosed mental or behavioral 
health conditions, including trauma and 
substance use disorders; 
(ii) trauma or violence, including do-
mestic violence; 
(iii) human immunodeficiency virus; 
(iv) sexual abuse; 
(v) pregnancy or infant loss; or 
(vi) chronic conditions; 
(F) provide evidence-based pregnancy and 
childbirth education, parenting support, and 
other relevant forms of health literacy; 
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598 
(G) provide clinical education opportunities 
to maternity care providers in training to ex-
pand pathways into maternal health care ca-
reers serving incarcerated individuals; 
(H) offer opportunities for postpartum in-
dividuals to maintain contact with the individ-
ual’s newborn child to promote bonding, includ-
ing enhanced visitation policies, access to prison 
nursery programs, or breastfeeding support; 
(I) provide reentry assistance, particularly 
to— 
(i) ensure access to health insurance 
coverage and transfer of health records to 
community providers if an incarcerated in-
dividual exits the criminal justice system 
during such individual’s pregnancy or in 
the postpartum period; and 
(ii) connect individuals exiting the 
criminal justice system during pregnancy 
or in the postpartum period to community- 
based resources, such as referrals to health 
care providers, substance use disorder 
treatments, and social services that ad-
dress social determinants of maternal 
health; or 
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599 
(J) establish partnerships with local public 
entities, private community entities, community- 
based organizations, Indian Tribes and tribal 
organizations (as such terms are defined in sec-
tion 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5304)), 
and urban Indian organizations (as such term 
is defined in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603)) to es-
tablish or expand pretrial diversion programs as 
an alternative to incarceration for pregnant and 
postpartum individuals, including— 
(i) evidence-based childbirth education 
or parenting classes; 
(ii) prenatal health coordination; 
(iii) family and individual counseling; 
(iv) evidence-based screenings, edu-
cation, and, as needed, treatment for men-
tal and behavioral health conditions, in-
cluding drug and alcohol treatments; 
(v) family case management services; 
(vi) domestic violence education and 
prevention; 
(vii) physical and sexual abuse coun-
seling; and 
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600 
(viii) programs to address social de-
terminants of health such as employment, 
housing, education, transportation, and nu-
trition. 
(6) IMPLEMENTATION AND REPORTING.—A se-
lected facility shall be responsible for— 
(A) implementing programs, which may in-
clude the programs described in paragraph (5); 
and 
(B) not later than 3 years after the date 
of enactment of this Act, and 6 years after the 
date of enactment of this Act, reporting results 
of the programs to the Director, including in-
formation describing— 
(i) relevant quantitative indicators of 
success in improving the standard of care 
and health outcomes for pregnant and 
postpartum incarcerated individuals in the 
facility, including data stratified by race, 
ethnicity, sex, gender, age, geography, dis-
ability status, the category of the criminal 
charge against such individual, rates of 
pregnancy-related deaths, pregnancy-asso-
ciated deaths, cases of infant mortality and 
morbidity, rates of pre-term births and 
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601 
low-birthweight births, cases of severe ma-
ternal morbidity, cases of violence against 
pregnant or postpartum individuals, diag-
noses of maternal mental or behavioral 
health conditions, and other such informa-
tion as appropriate; 
(ii) relevant qualitative and quan-
titative evaluations from pregnant and 
postpartum incarcerated individuals who 
participated in such programs, including 
measures of patient-reported experience of 
care; and 
(iii) strategies to sustain such pro-
grams after fiscal year 2027 and expand 
such programs to other facilities. 
(7) REPORT.—Not later than 6 years after the 
date of enactment of this Act, the Director shall 
submit to the Attorney General and to the Congress 
a report describing the results of the programs fund-
ed under this subsection. 
(8) OVERSIGHT.—Not later than 1 year after 
the date of enactment of this Act, the Attorney Gen-
eral shall award a contract to an independent orga-
nization or independent organizations to conduct 
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602 
oversight of the programs described in paragraph 
(5). 
(9) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection $10,000,000 for each of fiscal years 
2023 through 2027. 
(d) GRANT
PROGRAM
TO
IMPROVE
MATERNAL 
HEALTH OUTCOMES FOR INDIVIDUALS IN STATE AND 
LOCAL PRISONS AND JAILS.— 
(1) ESTABLISHMENT.—Not later than 1 year 
after the date of enactment of this section, the At-
torney General, acting through the Director of the 
Bureau of Justice Assistance (in this subsection re-
ferred to as the ‘‘Director’’), shall award Justice for 
Incarcerated Moms grants to States to establish or 
expand programs in State and local prisons and jails 
for pregnant and postpartum incarcerated individ-
uals. The Attorney General shall award such grants 
in consultation with stakeholders such as— 
(A) relevant community-based organiza-
tions, particularly organizations that represent 
incarcerated and formerly incarcerated individ-
uals and organizations that seek to improve ma-
ternal health outcomes for pregnant and 
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603 
postpartum individuals from racial and ethnic 
minority groups; 
(B) relevant organizations representing pa-
tients, with a particular focus on patients from 
racial and ethnic minority groups; 
(C) organizations representing maternity 
care providers and maternal health care edu-
cation programs; 
(D) perinatal health workers; and 
(E) researchers and policy experts in fields 
related to maternal health care for incarcerated 
individuals. 
(2) APPLICATIONS.—Each applicant for a grant 
under this subsection shall submit to the Director an 
application at such time, in such manner, and con-
taining such information as the Director may re-
quire. 
(3) USE OF FUNDS.—A State that is awarded 
a grant under this subsection shall use such grant 
to establish or expand programs for pregnant and 
postpartum incarcerated individuals, and such pro-
grams may— 
(A) provide access to perinatal health 
workers 
from 
pregnancy 
through 
the 
postpartum period; 
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604 
(B) provide access to healthy foods and 
counseling on nutrition, recommended activity 
levels, and safety measures throughout preg-
nancy; 
(C) train correctional officers to ensure 
that pregnant incarcerated individuals receive 
safe and respectful treatment; 
(D) train medical personnel to ensure that 
pregnant incarcerated individuals receive trau-
ma-informed, culturally congruent care that 
promotes the health and safety of the pregnant 
individuals; 
(E) provide counseling and treatment for 
individuals who have suffered from— 
(i) diagnosed mental or behavioral 
health conditions, including trauma and 
substance use disorders; 
(ii) trauma or violence, including do-
mestic violence; 
(iii) human immunodeficiency virus; 
(iv) sexual abuse; 
(v) pregnancy or infant loss; or 
(vi) chronic conditions; 
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605 
(F) provide evidence-based pregnancy and 
childbirth education, parenting support, and 
other relevant forms of health literacy; 
(G) provide clinical education opportunities 
to maternity care providers in training to ex-
pand pathways into maternal health care ca-
reers serving incarcerated individuals; 
(H) offer opportunities for postpartum in-
dividuals to maintain contact with the individ-
ual’s newborn child to promote bonding, includ-
ing enhanced visitation policies, access to prison 
nursery programs, or breastfeeding support; 
(I) provide reentry assistance, particularly 
to— 
(i) ensure access to health insurance 
coverage and transfer of health records to 
community providers if an incarcerated in-
dividual exits the criminal justice system 
during such individual’s pregnancy or in 
the postpartum period; and 
(ii) connect individuals exiting the 
criminal justice system during pregnancy 
or in the postpartum period to community- 
based resources, such as referrals to health 
care providers, substance use disorder 
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606 
treatments, and social services that ad-
dress social determinants of maternal 
health; or 
(J) establish partnerships with local public 
entities, private community entities, community- 
based organizations, Indian Tribes and tribal 
organizations (as such terms are defined in sec-
tion 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5304)), 
and urban Indian organizations (as such term 
is defined in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603)) to es-
tablish or expand pretrial diversion programs as 
an alternative to incarceration for pregnant and 
postpartum individuals, including— 
(i) evidence-based childbirth education 
or parenting classes; 
(ii) prenatal health coordination; 
(iii) family and individual counseling; 
(iv) evidence-based screenings, edu-
cation, and, as needed, treatment for men-
tal and behavioral health conditions, in-
cluding drug and alcohol treatments; 
(v) family case management services; 
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607 
(vi) domestic violence education and 
prevention; 
(vii) physical and sexual abuse coun-
seling; and 
(viii) programs to address social de-
terminants of health such as employment, 
housing, education, transportation, and nu-
trition. 
(4) PRIORITY.—In awarding grants under this 
subsection, the Director shall give priority to appli-
cants based on— 
(A) 
the 
number 
of 
pregnant 
and 
postpartum individuals incarcerated in the 
State and, among such individuals, the number 
of pregnant and postpartum individuals from 
racial and ethnic minority groups; and 
(B) the extent to which the State has dem-
onstrated a commitment to developing exem-
plary programs for pregnant and postpartum 
individuals incarcerated in the prisons and jails 
in such State. 
(5) GRANT DURATION.—A grant awarded under 
this subsection shall be for a 5-year period. 
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608 
(6) IMPLEMENTING AND REPORTING.—A State 
that receives a grant under this subsection shall be 
responsible for— 
(A) implementing the program funded by 
the grant; and 
(B) not later than 3 years after the date 
of enactment of this section, and 6 years after 
the date of enactment of this section, reporting 
results of such program to the Attorney Gen-
eral, including information describing— 
(i) relevant quantitative indicators of 
the program’s success in improving the 
standard of care and health outcomes for 
pregnant and postpartum incarcerated in-
dividuals in the facility, including data 
stratified by race, ethnicity, sex, gender, 
age, geography, disability status, category 
of the criminal charge against such indi-
vidual, incidence rates of pregnancy-related 
deaths, pregnancy-associated deaths, cases 
of infant mortality and morbidity, rates of 
pre-term births and low-birthweight births, 
cases of severe maternal morbidity, cases 
of violence against pregnant or postpartum 
individuals, diagnoses of maternal mental 
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609 
or behavioral health conditions, and other 
such information as appropriate; 
(ii) relevant qualitative and quan-
titative evaluations from pregnant and 
postpartum incarcerated individuals who 
participated in such programs, including 
measures of patient-reported experience of 
care; and 
(iii) strategies to sustain such pro-
grams beyond the duration of the grant 
and expand such programs to other facili-
ties. 
(7) REPORT.—Not later than 6 years after the 
date of enactment of this Act, the Attorney General 
shall submit to the Congress a report describing the 
results of such grant programs. 
(8) OVERSIGHT.—Not later than 1 year after 
the date of enactment of this Act, the Attorney Gen-
eral shall award a contract to an independent orga-
nization or independent organizations to conduct 
oversight of the programs described in paragraph 
(3). 
(9) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
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610 
this subsection $10,000,000 for each of fiscal years 
2023 through 2027. 
(e) GAO REPORT.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this section, the Comp-
troller General of the United States shall submit to 
the Congress a report on adverse maternal and in-
fant health outcomes among incarcerated individuals 
and infants born to such individuals, with a par-
ticular focus on racial and ethnic inequities in ma-
ternal and infant health outcomes for incarcerated 
individuals. 
(2) CONTENTS
OF
REPORT.—The report de-
scribed in this subsection shall include— 
(A) to the extent practicable— 
(i) the number of pregnant individuals 
who are incarcerated in Bureau of Prisons 
facilities; 
(ii) the number of incarcerated indi-
viduals, including those incarcerated in 
Federal, State, and local correctional facili-
ties, who have experienced a pregnancy-re-
lated death, pregnancy-associated death, or 
the death of an infant in the most recent 
10 years of available data; 
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611 
(iii) the number of cases of severe ma-
ternal morbidity among incarcerated indi-
viduals, including those incarcerated in 
Federal, State, and local detention facili-
ties, in the most recent 10 years of avail-
able data; 
(iv) the number of pre-term and low- 
birthweight births of infants born to incar-
cerated individuals, including those incar-
cerated in Federal, State, and local correc-
tional facilities, in the most recent 10 
years of available data; and 
(v) statistics on the racial and ethnic 
inequities in maternal and infant health 
outcomes and severe maternal morbidity 
rates among incarcerated individuals, in-
cluding those incarcerated in Federal, 
State, and local detention facilities; 
(B) in the case that the Comptroller Gen-
eral of the United States is unable determine 
the information required in clauses (i) through 
(iii) of subparagraph (A), an assessment of the 
barriers to determining such information and 
recommendations for improvements in tracking 
maternal health outcomes among incarcerated 
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612 
individuals, including those incarcerated in Fed-
eral, State, and local detention facilities; 
(C) causes of adverse maternal health out-
comes that are unique to incarcerated individ-
uals, including those incarcerated in Federal, 
State, and local detention facilities; 
(D) causes of adverse maternal health out-
comes and severe maternal morbidity that are 
unique to incarcerated individuals from racial 
and ethnic minority groups; 
(E) recommendations to reduce maternal 
mortality and severe maternal morbidity among 
incarcerated individuals and to address racial 
and ethnic inequities in maternal health out-
comes for incarcerated individuals in Bureau of 
Prisons facilities and State and local prisons 
and jails; and 
(F) such other information as may be ap-
propriate to reduce the occurrence of adverse 
maternal health outcomes among incarcerated 
individuals and to address racial and ethnic in-
equities in maternal health outcomes for such 
individuals. 
(f) MACPAC REPORT.— 
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613 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this section, the Medicaid 
and CHIP Payment and Access Commission (re-
ferred to in this subsection as ‘‘MACPAC’’) shall 
publish a report on the implications of pregnant and 
postpartum incarcerated individuals being ineligible 
for medical assistance under a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) that contains the information described in 
paragraph (2). 
(2) INFORMATION DESCRIBED.—For purposes 
of paragraph (1), the information described in this 
paragraph includes— 
(A) information on the effect of ineligibility 
for medical assistance under a State plan under 
title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) on maternal health outcomes for 
pregnant and postpartum incarcerated individ-
uals, concentrating on the effects of such ineli-
gibility for pregnant and postpartum individuals 
from racial and ethnic minority groups; and 
(B) the potential implications on maternal 
health outcomes resulting from suspending eli-
gibility for medical assistance under a State 
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614 
plan under such title of such Act when a preg-
nant or postpartum individual is incarcerated. 
(g) DEFINITIONS.—In this section: 
(1) CULTURALLY CONGRUENT.—The term ‘‘cul-
turally congruent’’, with respect to care or maternity 
care, means care that is in agreement with the pre-
ferred cultural values, beliefs, worldview, language, 
and practices of the health care consumer and other 
stakeholders. 
(2) MATERNITY
CARE
PROVIDER.—The term 
‘‘maternity care provider’’ means a health care pro-
vider who— 
(A) is a physician, physician assistant, 
midwife who meets at a minimum the inter-
national definition of the midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
Midwives, nurse practitioner, or clinical nurse 
specialist; and 
(B) has a focus on maternal or perinatal 
health. 
(3) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means a death occurring during or 
within a one-year period after pregnancy, caused by 
pregnancy-related or childbirth complications, in-
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615 
cluding a suicide, overdose, or other death resulting 
from a mental health or substance use disorder at-
tributed to or aggravated by pregnancy-related or 
childbirth complications. 
(4) PERINATAL HEALTH WORKER.—The term 
‘‘perinatal health worker’’ means a doula, commu-
nity health worker, peer supporter, breastfeeding 
and lactation educator or counselor, nutritionist or 
dietitian, childbirth educator, social worker, home 
visitor, language interpreter, or navigator. 
(5) POSTPARTUM AND POSTPARTUM PERIOD.— 
The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 
refer to the 1-year period beginning on the last day 
of the pregnancy of an individual. 
(6) 
PREGNANCY-ASSOCIATED
DEATH.—The 
term ‘‘pregnancy-associated death’’ means a death of 
a pregnant or postpartum individual, by any cause, 
that occurs during, or within 1 year following, the 
individual’s pregnancy, regardless of the outcome, 
duration, or site of the pregnancy. 
(7) PREGNANCY-RELATED
DEATH.—The term 
‘‘pregnancy-related death’’ means a death of a preg-
nant or postpartum individual that occurs during, or 
within 1 year following, the individual’s pregnancy, 
from a pregnancy complication, a chain of events 
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616 
initiated by pregnancy, or the aggravation of an un-
related condition by the physiologic effects of preg-
nancy. 
(8) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘‘racial and ethnic minority group’’ has the 
meaning given such term in section 1707(g)(1) of 
the Public Health Service Act (42 U.S.C. 300u– 
6(g)(1)). 
(9) SEVERE MATERNAL MORBIDITY.—The term 
‘‘severe maternal morbidity’’ means a health condi-
tion, including mental health conditions and sub-
stance use disorders, attributed to or aggravated by 
pregnancy or childbirth that results in significant 
short-term or long-term consequences to the health 
of the individual who was pregnant. 
(10) SOCIAL
DETERMINANTS
OF
MATERNAL 
HEALTH DEFINED.—The term ‘‘social determinants 
of maternal health’’ means non-clinical factors that 
impact maternal health outcomes, including— 
(A) economic factors, which may include 
poverty, employment, food security, support for 
and access to lactation and other infant feeding 
options, housing stability, and related factors; 
(B) neighborhood factors, which may in-
clude quality of housing, access to transpor-
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617 
tation, access to child care, availability of 
healthy foods and nutrition counseling, avail-
ability of clean water, air and water quality, 
ambient temperatures, neighborhood crime and 
violence, access to broadband, and related fac-
tors; 
(C) social and community factors, which 
may include systemic racism, gender discrimi-
nation or discrimination based on other pro-
tected classes, workplace conditions, incarcer-
ation, and related factors; 
(D) household factors, which may include 
ability to conduct lead testing and abatement, 
car seat installation, indoor air temperatures, 
and related factors; 
(E) education access and quality factors, 
which may include educational attainment, lan-
guage and literacy, and related factors; and 
(F) health care access factors, including 
health insurance coverage, access to culturally 
congruent health care services, providers, and 
non-clinical support, access to home visiting 
services, access to wellness and stress manage-
ment programs, health literacy, access to tele-
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618 
health and items required to receive telehealth 
services, and related factors. 
SEC. 5204. IMPACT TO SAVE MOMS ACT. 
(a) PERINATAL
CARE
ALTERNATIVE
PAYMENT 
MODEL DEMONSTRATION PROJECT.— 
(1) IN
GENERAL.—For the period of fiscal 
years 2023 through 2027, the Secretary of Health 
and Human Services (referred to in this subsection 
as the ‘‘Secretary’’), acting through the Adminis-
trator of the Centers for Medicare & Medicaid Serv-
ices, shall establish and implement, in accordance 
with the requirements of this subsection, a dem-
onstration project, to be known as the Perinatal 
Care Alternative Payment Model Demonstration 
Project (referred to in this subsection as the ‘‘Dem-
onstration Project’’), for purposes of allowing States 
to test payment models under their State plans 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and State child health plans 
under title XXI of such Act (42 U.S.C. 1397aa et 
seq.) with respect to maternity care provided to 
pregnant and postpartum individuals enrolled in 
such State plans and State child health plans. 
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619 
(2) COORDINATION.—In establishing the Dem-
onstration Project, the Secretary shall coordinate 
with stakeholders such as— 
(A) State Medicaid programs; 
(B) relevant organizations representing 
maternal health care providers; 
(C) relevant organizations representing pa-
tients, with a particular focus on individuals 
from demographic groups with disproportionate 
rates of adverse maternal health outcomes; 
(D) relevant community-based organiza-
tions, particularly organizations that seek to 
improve maternal health outcomes for individ-
uals from demographic groups with dispropor-
tionate rates of adverse maternal health out-
comes; 
(E) non-clinical perinatal health workers 
such as doulas, community health workers, peer 
supporters, certified lactation consultants, nu-
tritionists and dieticians, social workers, home 
visitors, and navigators; 
(F) relevant health insurance issuers; 
(G) hospitals, health systems, freestanding 
birth centers (as such term is defined in para-
graph (3)(B) of section 1905(l) of the Social 
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620 
Security Act (42 U.S.C. 1396d(l))), Federally- 
qualified health centers (as such term is defined 
in paragraph (2)(B) of such section), and rural 
health clinics (as such term is defined in section 
1861(aa) of such Act (42 U.S.C. 1395x(aa))); 
(H) researchers and policy experts in fields 
related to maternity care payment models; and 
(I) any other stakeholders as the Secretary 
determines appropriate, with a particular focus 
on stakeholders from demographic groups with 
disproportionate rates of adverse maternal 
health outcomes. 
(3) 
CONSIDERATIONS.—In 
establishing 
the 
Demonstration Project, the Secretary shall consider 
each of the following: 
(A) Findings from any evaluations of the 
Strong Start for Mothers and Newborns initia-
tive carried out by the Centers for Medicare & 
Medicaid Services, the Health Resources and 
Services Administration, and the Administra-
tion on Children and Families. 
(B) Any alternative payment model that— 
(i) is designed to improve maternal 
health outcomes for racial and ethnic 
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621 
groups with disproportionate rates of ad-
verse maternal health outcomes; 
(ii) includes methods for stratifying 
patients by pregnancy risk level and, as 
appropriate, adjusting payments under 
such model to take into account pregnancy 
risk level; 
(iii) establishes evidence-based quality 
metrics for such payments; 
(iv) includes consideration of non-hos-
pital birth settings such as freestanding 
birth centers (as so defined); 
(v) includes consideration of social de-
terminants of health that are relevant to 
maternal health outcomes such as housing, 
transportation, nutrition, and other non- 
clinical factors that influence maternal 
health outcomes; or 
(vi) includes diverse maternity care 
teams that include— 
(I) maternity care providers, in-
cluding 
obstetrician-gynecologists, 
family physicians, physician assist-
ants, midwives who meet, at a min-
imum, the international definition of 
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622 
the term ‘‘midwife’’ and global stand-
ards for midwifery education (as es-
tablished by the International Confed-
eration of Midwives), and nurse prac-
titioners— 
(aa) 
from 
racially, 
eth-
nically, and professionally diverse 
backgrounds; 
(bb) with experience prac-
ticing in racially and ethnically 
diverse communities; or 
(cc) who have undergone 
trainings on racism, implicit bias, 
and explicit bias; and 
(II) non-clinical perinatal health 
workers such as doulas, community 
health workers, peer supporters, cer-
tified lactation consultants, nutrition-
ists and dieticians, social workers, 
home visitors, and navigators. 
(4) ELIGIBILITY.—To be eligible to participate 
in the Demonstration Project, a State shall submit 
an application to the Secretary at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
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623 
(5) EVALUATION.—The Secretary shall conduct 
an evaluation of the Demonstration Project to deter-
mine the impact of the Demonstration Project on— 
(A) maternal health outcomes, with data 
stratified by race, ethnicity, socioeconomic indi-
cators, and any other factors as the Secretary 
determines appropriate; 
(B) spending on maternity care by States 
participating in the Demonstration Project; 
(C) to the extent practicable, subjective 
measures of patient experience; and 
(D) any other areas of assessment that the 
Secretary determines relevant. 
(6) REPORT.—Not later than one year after the 
completion or termination date of the Demonstration 
Project, the Secretary shall submit to the Committee 
on Energy and Commerce, the Committee on Ways 
and Means, and the Committee on Education and 
Labor of the House of Representatives and the Com-
mittee on Finance and the Committee on Health, 
Education, Labor, and Pensions of the Senate, and 
make publicly available, a report containing— 
(A) the results of any evaluation conducted 
under paragraph (5); and 
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624 
(B) a recommendation regarding whether 
the Demonstration Project should be continued 
after fiscal year 2026 and expanded on a na-
tional basis. 
(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as are necessary to carry out this subsection. 
(8) DEFINITIONS.—In this subsection: 
(A) ALTERNATIVE PAYMENT MODEL.—The 
term ‘‘alternative payment model’’ has the 
meaning 
given 
such 
term 
in 
section 
1833(z)(3)(C) of the Social Security Act (42 
U.S.C. 1395l(z)(3)(C)). 
(B) PERINATAL.—The term ‘‘perinatal’’ 
means the period beginning on the day a person 
becomes pregnant and ending on the last day of 
the 1-year period beginning on the last day of 
such person’s pregnancy. 
(b) MACPAC REPORT.— 
(1) IN
GENERAL.—Not later than two years 
after the date of the enactment of this section, the 
Medicaid and CHIP Payment and Access Commis-
sion shall publish a report on issues relating to the 
continuity of coverage under State plans under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
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625 
seq.) and State child health plans under title XXI of 
such Act (42 U.S.C. 1397aa et seq.) for pregnant 
and postpartum individuals. Such report shall, at a 
minimum, include the following: 
(A) An assessment of any existing policies 
under such State plans and such State child 
health plans regarding presumptive eligibility 
for pregnant individuals while their application 
for enrollment in such a State plan or such a 
State child health plan is being processed. 
(B) An assessment of any existing policies 
under such State plans and such State child 
health plans regarding measures to ensure con-
tinuity of coverage under such a State plan or 
such a State child health plan for pregnant and 
postpartum individuals, including such individ-
uals who need to change their health insurance 
coverage 
during 
their 
pregnancy 
or 
the 
postpartum period following their pregnancy. 
(C) An assessment of any existing policies 
under such State plans and such State child 
health plans regarding measures to automati-
cally reenroll individuals who are eligible to en-
roll under such a State plan or such a State 
child health plan as a parent. 
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626 
(D) If determined appropriate by the Com-
mission, any recommendations for the Depart-
ment of Health and Human Services, or such 
State plans and such State child health plans, 
to ensure continuity of coverage under such a 
State plan or such a State child health plan for 
pregnant and postpartum people. 
(2) POSTPARTUM
DEFINED.—In this sub-
section, the term ‘‘postpartum’’ means the 1-year 
period beginning on the last day of a person’s preg-
nancy. 
SEC. 5205. PROTECTING MOMS AND BABIES AGAINST CLI-
MATE CHANGE. 
(a) GRANT PROGRAM TO PROTECT VULNERABLE 
MOTHERS
AND
BABIES
FROM
CLIMATE
CHANGE 
RISKS.— 
(1) IN
GENERAL.—Not later than 180 days 
after the date of the enactment of this section, the 
Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) shall estab-
lish a grant program (in this subsection referred to 
as the ‘‘Program’’) to protect vulnerable individuals 
from risks associated with climate change. 
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(2) GRANT AUTHORITY.—In carrying out the 
Program, the Secretary may award, on a competitive 
basis, grants to 10 covered entities. 
(3) APPLICATIONS.—To be eligible for a grant 
under the Program, a covered entity shall submit to 
the Secretary an application at such time, in such 
form, and containing such information as the Sec-
retary may require, which shall include, at a min-
imum, a description of the following: 
(A) Plans for the use of grant funds 
awarded under the Program and how patients 
and stakeholder organizations were involved in 
the development of such plans. 
(B) How such grant funds will be targeted 
to geographic areas that have disproportionately 
high levels of risks associated with climate 
change for vulnerable individuals. 
(C) How such grant funds will be used to 
address racial and ethnic inequities in— 
(i) adverse maternal and infant health 
outcomes; and 
(ii) exposure to risks associated with 
climate change for vulnerable individuals. 
(D) Strategies to prevent an initiative as-
sisted with such grant funds from causing— 
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(i) adverse environmental impacts; 
(ii) displacement of residents and 
businesses; 
(iii) rent and housing price increases; 
or 
(iv) disproportionate adverse impacts 
on racial and ethnic minority groups and 
other underserved populations. 
(4) SELECTION OF GRANT RECIPIENTS.— 
(A) TIMING.—Not later than 270 days 
after the date of the enactment of this Act, the 
Secretary shall select the recipients of grants 
under the Program. 
(B) CONSULTATION.—In selecting covered 
entities for grants under the Program, the Sec-
retary shall consult with— 
(i) representatives of stakeholder or-
ganizations; 
(ii) the Administrator of the Environ-
mental Protection Agency; 
(iii) the Administrator of the National 
Oceanic and Atmospheric Administration; 
and 
(iv) from the Department of Health 
and Human Services— 
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(I) the Deputy Assistant Sec-
retary for Minority Health; 
(II) the Administrator of the 
Centers for Medicare & Medicaid 
Services; 
(III) the Administrator of the 
Health Resources and Services Ad-
ministration; 
(IV) the Director of the National 
Institutes of Health; and 
(V) the Director of the Centers 
for Disease Control and Prevention. 
(C) PRIORITY.—In selecting a covered en-
tity to be awarded a grant under the Program, 
the Secretary shall give priority to covered enti-
ties that serve a county— 
(i) designated, or located in an area 
designated, as a nonattainment area pur-
suant to section 107 of the Clean Air Act 
(42 U.S.C. 7407) for any air pollutant for 
which air quality criteria have been issued 
under section 108(a) of such Act (42 
U.S.C. 7408(a)); 
(ii) with a level of vulnerability of 
moderate-to-high or higher, according to 
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630 
the Social Vulnerability Index of the Cen-
ters for Disease Control and Prevention; or 
(iii) with temperatures that pose a 
risk to human health, as determined by the 
Secretary, in consultation with the Admin-
istrator of the National Oceanic and At-
mospheric Administration and the Chair of 
the United States Global Change Research 
Program, based on the best available 
science. 
(D) LIMITATION.—A recipient of grant 
funds under the Program may not use such 
grant funds to serve a county that is served by 
any other recipient of a grant under the Pro-
gram. 
(5) USE OF FUNDS.—A covered entity awarded 
grant funds under the Program may only use such 
grant funds for the following: 
(A) Initiatives to identify risks associated 
with climate change for vulnerable individuals 
and to provide services and support to such in-
dividuals that address such risks, which may in-
clude— 
(i) training for health care providers, 
doulas, and other employees in hospitals, 
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birth centers, midwifery practices, and 
other health care practices that provide 
prenatal or labor and delivery services to 
vulnerable individuals on the identification 
of, and patient counseling relating to, risks 
associated with climate change for vulner-
able individuals; 
(ii) hiring, training, or providing re-
sources to community health workers and 
perinatal health workers who can help 
identify risks associated with climate 
change for vulnerable individuals, provide 
patient counseling about such risks, and 
carry out the distribution of relevant serv-
ices and support; 
(iii) enhancing the monitoring of risks 
associated with climate change for vulner-
able individuals, including by— 
(I) collecting data on such risks 
in specific census tracts, neighbor-
hoods, or other geographic areas; and 
(II) sharing such data with local 
health care providers, doulas, and 
other employees in hospitals, birth 
centers, 
midwifery 
practices, 
and 
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632 
other health care practices that pro-
vide prenatal or labor and delivery 
services to local vulnerable individuals; 
and 
(iv) providing vulnerable individuals— 
(I) air conditioning units, resi-
dential weatherization support, filtra-
tion systems, household appliances, or 
related items; 
(II) direct financial assistance; 
and 
(III) services and support, in-
cluding housing and transportation 
assistance, to prepare for or recover 
from extreme weather events, which 
may 
include 
floods, 
hurricanes, 
wildfires, 
droughts, 
and 
related 
events. 
(B) Initiatives to mitigate levels of and ex-
posure to risks associated with climate change 
for vulnerable individuals, which shall be based 
on the best available science and which may in-
clude initiatives to— 
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(i) develop, maintain, or expand urban 
or community forestry initiatives and tree 
canopy coverage initiatives; 
(ii) improve infrastructure, including 
buildings and paved surfaces; 
(iii) develop or improve community 
outreach networks to provide culturally 
and linguistically appropriate information 
and notifications about risks associated 
with climate change for vulnerable individ-
uals; and 
(iv) provide enhanced services to ra-
cial and ethnic minority groups and other 
underserved populations. 
(6) LENGTH OF AWARD.—A grant under this 
subsection shall be disbursed over 4 fiscal years. 
(7) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide technical assistance to a covered entity 
awarded a grant under the Program to support the 
development, implementation, and evaluation of ac-
tivities funded with such grant. 
(8) REPORTS TO SECRETARY.— 
(A) ANNUAL
REPORT.—For each fiscal 
year during which a covered entity is disbursed 
grant funds under the Program, such covered 
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entity shall submit to the Secretary a report 
that summarizes the activities carried out by 
such covered entity with such grant funds dur-
ing such fiscal year, which shall include a de-
scription of the following: 
(i) The involvement of stakeholder or-
ganizations in the implementation of initia-
tives assisted with such grant funds. 
(ii) Relevant health and environmental 
data, disaggregated, to the extent prac-
ticable, by race, ethnicity, gender, and 
pregnancy status. 
(iii) 
Qualitative 
feedback 
received 
from vulnerable individuals with respect to 
initiatives assisted with such grant funds. 
(iv) Criteria used in selecting the geo-
graphic areas assisted with such grant 
funds. 
(v) Efforts to address racial and eth-
nic inequities in adverse maternal and in-
fant health outcomes and in exposure to 
risks associated with climate change for 
vulnerable individuals. 
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(vi) Any negative and unintended im-
pacts of initiatives assisted with such grant 
funds, including— 
(I) adverse environmental im-
pacts; 
(II) displacement of residents 
and businesses; 
(III) rent and housing price in-
creases; and 
(IV) disproportionate adverse im-
pacts on racial and ethnic minority 
groups and other underserved popu-
lations. 
(vii) How the covered entity will ad-
dress and prevent any impacts described in 
clause (vi). 
(B) PUBLICATION.—Not later than 30 
days after the date on which a report is sub-
mitted under subparagraph (A), the Secretary 
shall publish such report on a public website of 
the Department of Health and Human Services. 
(9) REPORT TO CONGRESS.—Not later than the 
date that is 5 years after the date on which the Pro-
gram is established, the Secretary shall submit to 
Congress and publish on a public website of the De-
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636 
partment of Health and Human Services a report on 
the results of the Program, including the following: 
(A) Summaries of the annual reports sub-
mitted under paragraph (8). 
(B) Evaluations of the initiatives assisted 
with grant funds under the Program. 
(C) An assessment of the effectiveness of 
the Program in— 
(i) identifying risks associated with 
climate change for vulnerable individuals; 
(ii) providing services and support to 
such individuals; 
(iii) mitigating levels of and exposure 
to such risks; and 
(iv) addressing racial and ethnic in-
equities in adverse maternal and infant 
health outcomes and in exposure to such 
risks. 
(D) A description of how the Program 
could be expanded, including— 
(i) monitoring efforts or data collec-
tion that would be required to identify 
areas with high levels of risks associated 
with climate change for vulnerable individ-
uals; 
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637 
(ii) how such areas could be identified 
using the strategy developed under sub-
section (d); and 
(iii) recommendations for additional 
funding. 
(10) COVERED ENTITY DEFINED.—In this sub-
section, the term ‘‘covered entity’’ means a consor-
tium of organizations serving a county that— 
(A) shall include a community-based orga-
nization; and 
(B) may include— 
(i) another stakeholder organization; 
(ii) the government of such county; 
(iii) the governments of one or more 
municipalities within such county; 
(iv) a State or local public health de-
partment or emergency management agen-
cy; 
(v) a local health care practice, which 
may include a licensed and accredited hos-
pital, birth center, midwifery practice, or 
other health care practice that provides 
prenatal or labor and delivery services to 
vulnerable individuals; 
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1038 
health care and community-based settings to address 
mental health inequities among racial and ethnic mi-
nority groups. 
(b) CURRICULA; CORE COMPETENCIES.—Organiza-
tions receiving funds under subsection (a) may use the 
funds to engage in the following activities related to the 
development and dissemination of curricula or core com-
petencies described in subsection (a)(1): 
(1) Formation of committees or working groups 
comprised of experts from accredited health profes-
sions schools to identify core competencies relating 
to mental health inequities among racial and ethnic 
minority groups. 
(2) Planning of workshops in collaboration with 
community-based organizations and communities of 
color in national fora to directly facilitate public 
input, including input from communities of color 
with lived experience, into the educational needs as-
sociated with mental health inequities among racial 
and ethnic minority groups. 
(3) Dissemination and promotion of the use of 
curricula or core competencies in undergraduate and 
graduate health professions training programs na-
tionwide. 
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‘‘(1) the recruitment and retention of commu-
nity health workers or navigators to coordinate fam-
ily access to pediatric mental, emotional, and behav-
ioral health services; 
‘‘(2) training the pediatric mental, emotional, 
and behavioral health care workforce, relevant stake-
holders, and community members; 
‘‘(3) expanding evidence-based, integrated mod-
els of care for pediatric mental, emotional, and be-
havioral health services; 
‘‘(4) pediatric practice integration for the provi-
sion of pediatric mental, emotional, and behavioral 
health services; 
‘‘(5) addressing surge capacity for pediatric 
mental, emotional, and behavioral health needs; 
‘‘(6) providing pediatric mental, emotional, and 
behavioral health services to children as delivered by 
behavioral, emotional, and mental health profes-
sionals utilizing telehealth services; 
‘‘(7) establishing or maintaining initiatives to 
decompress emergency departments, including par-
tial hospitalization, step down residency programs, 
and intensive outpatient programs; 
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