181 
1817 of the Social Security Act (42 U.S.C. 1395i)) and 
the Federal Supplementary Medical Insurance Trust 
Fund (as described in section 1841 of such Act (42 U.S.C. 
1395t)), in such proportions as determined appropriate by 
the Secretary, to the Social Security Administration, of 
$30,000,000, to remain available until expended, for pur-
poses of carrying out the amendments made by this sec-
tion. 
(d) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by this 
section by program instruction or otherwise. 
SEC. 502. SPECIAL ENROLLMENT PERIOD THROUGH EX-
CHANGES; FEDERAL EXCHANGE OUTREACH 
AND EDUCATIONAL ACTIVITIES. 
(a) SPECIAL ENROLLMENT PERIOD THROUGH EX-
CHANGES.—Section 1311(c) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031(c)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking at 
the end the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(E) subject to subparagraph (B) of para-
graph (8), the special enrollment period de-
scribed in subparagraph (A) of such para-
graph.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
TAIN PUBLIC HEALTH EMERGENCY.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
subject to subparagraph (B), require an Ex-
change to provide— 
‘‘(i) for a special enrollment period 
during the emergency period described in 
section 1135(g)(1)(B) of the Social Secu-
rity Act— 
‘‘(I) which shall begin on the 
date that is one week after the date of 
the enactment of this paragraph and 
which, in the case of an Exchange es-
tablished or operated by the Secretary 
within a State pursuant to section 
1321(c), shall be an 8-week period; 
and 
‘‘(II) during which any individual 
who is otherwise eligible to enroll in a 
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183 
qualified health plan through the Ex-
change may enroll in such a qualified 
health plan; and 
‘‘(ii) that, in the case of an individual 
who enrolls in a qualified health plan 
through the Exchange during such enroll-
ment period, the coverage period under 
such plan shall begin, at the option of the 
individual, on April 1, 2020, or on the first 
day of the month following the day the in-
dividual selects a plan through such special 
enrollment period. 
‘‘(B) EXCEPTION.—The requirement of 
subparagraph (A) shall not apply to a State-op-
erated or State-established Exchange if such 
Exchange, prior to the date of the enactment of 
this paragraph, established or otherwise pro-
vided for a special enrollment period to address 
access to coverage under qualified health plans 
offered through such Exchange during the 
emergency 
period 
described 
in 
section 
1135(g)(1)(B) of the Social Security Act.’’. 
(b) FEDERAL EXCHANGE OUTREACH
AND EDU-
CATIONAL ACTIVITIES.—Section 1321(c) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18041(c)) 
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is amended by adding at the end the following new para-
graph: 
‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
TIES.— 
‘‘(A) IN GENERAL.—In the case of an Ex-
change established or operated by the Secretary 
within a State pursuant to this subsection, the 
Secretary shall carry out outreach and edu-
cational activities for purposes of informing po-
tential enrollees in qualified health plans offered 
through the Exchange of the availability of cov-
erage under such plans and financial assistance 
for coverage under such plans. Such outreach 
and educational activities shall be provided in a 
manner that is culturally and linguistically ap-
propriate to the needs of the populations being 
served by the Exchange (including hard-to- 
reach populations, such as racial and sexual mi-
norities, limited English proficient populations, 
and young adults). 
‘‘(B) LIMITATION ON USE OF FUNDS.—No 
funds appropriated under this paragraph shall 
be used for expenditures for promoting non- 
ACA compliant health insurance coverage. 
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‘‘(C) NON-ACA COMPLIANT
HEALTH
IN-
SURANCE
COVERAGE.—For purposes of sub-
paragraph (B): 
‘‘(i) The term ‘non-ACA compliant 
health insurance coverage’ means health 
insurance coverage, or a group health plan, 
that is not a qualified health plan. 
‘‘(ii) Such term includes the following: 
‘‘(I) An association health plan. 
‘‘(II) Short-term limited duration 
insurance. 
‘‘(D) FUNDING.—There are appropriated, 
out of any funds in the Treasury not otherwise 
appropriated, $25,000,000, to remain available 
until expended— 
‘‘(i) to carry out this paragraph; and 
‘‘(ii) at the discretion of the Sec-
retary, to carry out section 1311(i), with 
respect to an Exchange established or op-
erated by the Secretary within a State pur-
suant to this subsection.’’. 
(c) IMPLEMENTATION.—The Secretary of Health and 
Human Services may implement the provisions of (includ-
ing amendments made by) this section through subregu-
latory guidance, program instruction, or otherwise. 
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SEC. 503. MOMMA’S ACT. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Mothers and Offspring Mortality and Morbidity Aware-
ness Act’’ or the ‘‘MOMMA’s Act’’. 
(b) FINDINGS.—Congress finds the following: 
(1) Every year, across the United States, 
4,000,000 women give birth, about 700 women suf-
fer fatal complications during pregnancy, while giv-
ing birth or during the postpartum period, and 
70,000 women suffer near-fatal, partum-related 
complications. 
(2) The maternal mortality rate is often used as 
a proxy to measure the overall health of a popu-
lation. While the infant mortality rate in the United 
States has reached its lowest point, the risk of death 
for women in the United States during pregnancy, 
childbirth, or the postpartum period is higher than 
such risk in many other developed nations. The esti-
mated maternal mortality rate (per 100,000 live 
births) for the 48 contiguous States and Wash-
ington, DC increased from 18.8 percent in 2000 to 
23.8 percent in 2014 to 26.6 percent in 2018. This 
estimated rate is on par with such rate for under-
developed nations such as Iraq and Afghanistan. 
(3) International studies estimate the 2015 ma-
ternal mortality rate in the United States as 26.4 
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per 100,000 live births, which is almost twice the 
2015 World Health Organization estimation of 14 
per 100,000 live births. 
(4) It is estimated that more than 60 percent 
of maternal deaths in the United States are prevent-
able. 
(5) According to the Centers for Disease Con-
trol and Prevention, the maternal mortality rate var-
ies drastically for women by race and ethnicity. 
There are 12.7 deaths per 100,000 live births for 
White women, 43.5 deaths per 100,000 live births 
for African-American women, and 14.4 deaths per 
100,000 live births for women of other ethnicities. 
While maternal mortality disparately impacts Afri-
can-American women, this urgent public health crisis 
traverses race, ethnicity, socioeconomic status, edu-
cational background, and geography. 
(6) African-American women are 3 to 4 times 
more likely to die from causes related to pregnancy 
and childbirth compared to non-Hispanic White 
women. 
(7) The findings described in paragraphs (1) 
through (6) are of major concern to researchers, 
academics, members of the business community, and 
providers across the obstetrical continuum rep-
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resented by organizations such as March of Dimes; 
the Preeclampsia Foundation; the American College 
of Obstetricians and Gynecologists; the Society for 
Maternal-Fetal Medicine; the Association of Wom-
en’s Health, Obstetric, and Neonatal Nurses; the 
California Maternal Quality Care Collaborative; 
Black Women’s Health Imperative; the National 
Birth Equity Collaborative; Black Mamas Matter Al-
liance; EverThrive Illinois; the National Association 
of Certified Professional Midwives; PCOS Challenge: 
The National Polycystic Ovary Syndrome Associa-
tion; and the American College of Nurse Midwives. 
(8) Hemorrhage, cardiovascular and coronary 
conditions, cardiomyopathy, infection, embolism, 
mental health conditions, preeclampsia and eclamp-
sia, polycystic ovary syndrome, infection and sepsis, 
and anesthesia complications are the predominant 
medical causes of maternal-related deaths and com-
plications. Most of these conditions are largely pre-
ventable or manageable. 
(9) Oral health is an important part of 
perinatal health. Reducing bacteria in a woman’s 
mouth during pregnancy can significantly reduce her 
risk of developing oral diseases and spreading decay- 
causing bacteria to her baby. Moreover, some evi-
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dence suggests that women with periodontal disease 
during pregnancy could be at greater risk for poor 
birth outcomes, such as preeclampsia, pre-term 
birth, and low-birth weight. Furthermore, a woman’s 
oral health during pregnancy is a good predictor of 
her newborn’s oral health, and since mothers can 
unintentionally spread oral bacteria to their babies, 
putting their children at higher risk for tooth decay, 
prevention efforts should happen even before chil-
dren are born, as a matter of pre-pregnancy health 
and prenatal care during pregnancy. 
(10) The United States has not been able to 
submit a formal maternal mortality rate to inter-
national data repositories since 2007. Thus, no offi-
cial maternal mortality rate exists for the United 
States. There can be no maternal mortality rate 
without streamlining maternal mortality-related data 
from the State level and extrapolating such data to 
the Federal level. 
(11) In the United States, death reporting and 
analysis is a State function rather than a Federal 
process. States report all deaths—including mater-
nal deaths—on a semi-voluntary basis, without 
standardization across States. While the Centers for 
Disease Control and Prevention has the capacity and 
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system for collecting death-related data based on 
death certificates, these data are not sufficiently re-
ported by States in an organized and standard for-
mat across States such that the Centers for Disease 
Control and Prevention is able to identify causes of 
maternal death and best practices for the prevention 
of such death. 
(12) Vital statistics systems often underesti-
mate maternal mortality and are insufficient data 
sources from which to derive a full scope of medical 
and social determinant factors contributing to ma-
ternal deaths. While the addition of pregnancy 
checkboxes on death certificates since 2003 have 
likely improved States’ abilities to identify preg-
nancy-related deaths, they are not generally com-
pleted by obstetrical providers or persons trained to 
recognize pregnancy-related mortality. Thus, these 
vital forms may be missing information or may cap-
ture inconsistent data. Due to varying maternal 
mortality-related analyses, lack of reliability, and 
granularity in data, current maternal mortality 
informatics do not fully encapsulate the myriad med-
ical and socially determinant factors that contribute 
to such high maternal mortality rates within the 
United States compared to other developed nations. 
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Lack of standardization of data and data sharing 
across States and between Federal entities, health 
networks, and research institutions keep the Nation 
in the dark about ways to prevent maternal deaths. 
(13) Having reliable and valid State data ag-
gregated at the Federal level are critical to the Na-
tion’s ability to quell surges in maternal death and 
imperative for researchers to identify long-lasting 
interventions. 
(14) Leaders in maternal wellness highly rec-
ommend that maternal deaths be investigated at the 
State level first, and that standardized, streamlined, 
de-identified data regarding maternal deaths be sent 
annually to the Centers for Disease Control and Pre-
vention. Such data standardization and collection 
would be similar in operation and effect to the Na-
tional Program of Cancer Registries of the Centers 
for Disease Control and Prevention and akin to the 
Confidential Enquiry in Maternal Deaths Pro-
gramme in the United Kingdom. Such a maternal 
mortalities and morbidities registry and surveillance 
system would help providers, academicians, law-
makers, and the public to address questions con-
cerning the types of, causes of, and best practices to 
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thwart, pregnancy-related or pregnancy-associated 
mortality and morbidity. 
(15) The United Nations’ Millennium Develop-
ment Goal 5a aimed to reduce by 75 percent, be-
tween 1990 and 2015, the maternal mortality rate, 
yet this metric has not been achieved. In fact, the 
maternal mortality rate in the United States has 
been estimated to have more than doubled between 
2000 and 2014. Yet, because national data are not 
fully available, the United States does not have an 
official maternal mortality rate. 
(16) Many States have struggled to establish or 
maintain Maternal Mortality Review Committees 
(referred to in this section as ‘‘MMRC’’). On the 
State level, MMRCs have lagged because States have 
not had the resources to mount local reviews. State- 
level reviews are necessary as only the State depart-
ments of health have the authority to request med-
ical records, autopsy reports, and police reports crit-
ical to the function of the MMRC. 
(17) The United Kingdom regards maternal 
deaths as a health systems failure and a national 
committee of obstetrics experts review each maternal 
death or near-fatal childbirth complication. Such 
committee also establishes the predominant course of 
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maternal-related deaths from conditions such as 
preeclampsia. Consequently, the United Kingdom 
has been able to reduce its incidence of preeclampsia 
to less than one in 10,000 women—its lowest rate 
since 1952. 
(18) The United States has no comparable, co-
ordinated Federal process by which to review cases 
of maternal mortality, systems failures, or best prac-
tices. Many States have active MMRCs and leverage 
their work to impact maternal wellness. For exam-
ple, the State of California has worked extensively 
with their State health departments, health and hos-
pital systems, and research collaborative organiza-
tions, including the California Maternal Quality Care 
Collaborative and the Alliance for Innovation on Ma-
ternal Health, to establish MMRCs, wherein such 
State has determined the most prevalent causes of 
maternal mortality and recorded and shared data 
with providers and researchers, who have developed 
and implemented safety bundles and care protocols 
related to preeclampsia, maternal hemorrhage, and 
the like. In this way, the State of California has 
been able to leverage its maternal mortality review 
board system, generate data, and apply those data 
to effect changes in maternal care-related protocol. 
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To date, the State of California has reduced its ma-
ternal mortality rate, which is now comparable to 
the low rates of the United Kingdom. 
(19) Hospitals and health systems across the 
United States lack standardization of emergency ob-
stetrical protocols before, during, and after delivery. 
Consequently, many providers are delayed in recog-
nizing critical signs indicating maternal distress that 
quickly escalate into fatal or near-fatal incidences. 
Moreover, any attempt to address an obstetrical 
emergency that does not consider both clinical and 
public health approaches falls woefully under the 
mark of excellent care delivery. State-based maternal 
quality collaborative organizations, such as the Cali-
fornia Maternal Quality Care Collaborative or enti-
ties participating in the Alliance for Innovation on 
Maternal Health (AIM), have formed obstetrical pro-
tocols, tool kits, and other resources to improve sys-
tem care and response as they relate to maternal 
complications and warning signs for such conditions 
as 
maternal 
hemorrhage, 
hypertension, 
and 
preeclampsia. 
(20) The Centers for Disease Control and Pre-
vention reports that nearly half of all maternal 
deaths occur in the immediate postpartum period— 
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the 42 days following a pregnancy—whereas more 
than one-third of pregnancy-related or pregnancy-as-
sociated deaths occur while a person is still preg-
nant. Yet, for women eligible for the Medicaid pro-
gram on the basis of pregnancy, such Medicaid cov-
erage lapses at the end of the month on which the 
60th postpartum day lands. 
(21) The experience of serious traumatic 
events, such as being exposed to domestic violence, 
substance use disorder, or pervasive racism, can 
over-activate the body’s stress-response system. 
Known as toxic stress, the repetition of high-doses 
of cortisol to the brain, can harm healthy neuro-
logical development, which can have cascading phys-
ical and mental health consequences, as documented 
in the Adverse Childhood Experiences study of the 
Centers for Disease Control and Prevention. 
(22) A growing body of evidence-based research 
has shown the correlation between the stress associ-
ated with one’s race—the stress of racism—and 
one’s birthing outcomes. The stress of sex and race 
discrimination and institutional racism has been 
demonstrated to contribute to a higher risk of ma-
ternal mortality, irrespective of one’s gestational 
age, maternal age, socioeconomic status, or indi-
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vidual-level health risk factors, including poverty, 
limited access to prenatal care, and poor physical 
and mental health (although these are not nominal 
factors). African-American women remain the most 
at risk for pregnancy-associated or pregnancy-re-
lated 
causes 
of 
death. 
When 
it 
comes 
to 
preeclampsia, for example, which is related to obe-
sity, African-American women of normal weight re-
main the most at risk of dying during the perinatal 
period compared to non-African-American obese 
women. 
(23) The rising maternal mortality rate in the 
United States is driven predominantly by the dis-
proportionately high rates of African-American ma-
ternal mortality. 
(24) African-American women are 3 to 4 times 
more likely to die from pregnancy or maternal-re-
lated distress than are White women, yielding one of 
the greatest and most disconcerting racial disparities 
in public health. 
(25) Compared to women from other racial and 
ethnic 
demographics, 
African-American 
women 
across the socioeconomic spectrum experience pro-
longed, unrelenting stress related to racial and gen-
der discrimination, contributing to higher rates of 
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maternal mortality, giving birth to low-weight ba-
bies, and experiencing pre-term birth. Racism is a 
risk-factor for these aforementioned experiences. 
This cumulative stress often extends across the life 
course and is situated in everyday spaces where Afri-
can-American women establish livelihood. Structural 
barriers, lack of access to care, and genetic pre-
dispositions to health vulnerabilities exacerbate Afri-
can-American women’s likelihood to experience poor 
or fatal birthing outcomes, but do not fully account 
for the great disparity. 
(26) African-American women are twice as like-
ly to experience postpartum depression, and dis-
proportionately higher rates of preeclampsia com-
pared to White women. 
(27) Racism is deeply ingrained in United 
States systems, including in health care delivery sys-
tems between patients and providers, often resulting 
in disparate treatment for pain, irreverence for cul-
tural 
norms 
with 
respect 
to 
health, 
and 
dismissiveness. Research has demonstrated that pa-
tients respond more warmly and adhere to medical 
treatment plans at a higher degree with providers of 
the same race or ethnicity or with providers with 
great ability to exercise empathy. However, the pro-
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vider pool is not primed with many people of color, 
nor are providers (whether student-doctors in train-
ing or licensed practitioners) consistently required to 
undergo implicit bias, cultural competency, or empa-
thy training on a consistent, on-going basis. 
(c) 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, including oral, mental, and 
breastfeeding health information, 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 sub-
section, there is authorized to be appropriated 
$5,000,000 for each of fiscal years 2021 
through 2025. 
(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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200 
retary of Health and Human Services (referred 
to in this subsection as the ‘‘Secretary’’), acting 
through the Associate Administrator of the Ma-
ternal and Child Health Bureau of the Health 
Resources and Services Administration, 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 paragraph (1), an en-
tity 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 paragraph (1) shall 
use such grant funds— 
(i) to develop and implement, through 
a robust, multi-stakeholder process, mater-
nal safety bundles to assist States and 
health care systems in aligning national, 
State, and hospital-level quality improve-
ment efforts to improve maternal health 
outcomes, specifically the reduction of ma-
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