408 
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 subsection, 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 
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 
is amended by adding at the end the following new 
section: 
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‘‘SEC. 399V–7. 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 and cultural com-
petency in patient-provider interactions education for the 
purpose of enhancing and improving how health care pro-
fessionals are educated in implicit bias and delivering cul-
turally 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, dental school, social 
work school, school of professional psychology, or 
any other health professional school or program at 
an institution of higher education (as defined in sec-
tion 101 of the Higher Education Act of 1965) fo-
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410 
cused on the prevention, treatment, or recovery of 
health conditions that contribute to maternal mor-
tality 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; and 
‘‘(3) 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-
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411 
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-
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 
woman 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 
2021 through 2025.’’. 
(7) SPECIAL SUPPLEMENTAL NUTRITION PRO-
GRAM FOR WOMEN, 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) WOMEN.— 
‘‘(I) BREASTFEEDING WOMEN.— 
A State’’; 
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412 
(B) in subclause (I) (as so designated), by 
striking ‘‘1 year’’ and all that follows through 
‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 
and 
(C) by adding at the end the following: 
‘‘(II) POSTPARTUM
WOMEN.—A 
State 
may 
elect 
to 
certify 
a 
postpartum woman for a period of 2 
years.’’. 
(8) DEFINITIONS.—In this section: 
(A) MATERNAL
MORTALITY.—The term 
‘‘maternal mortality’’ means death of a woman 
that occurs during pregnancy or within the one- 
year period following the end of such preg-
nancy. 
(B) 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 woman’s health. 
(d) INCREASING EXCISE TAXES ON CIGARETTES AND 
ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO-
BACCO PRODUCT TAX RATES.— 
(1) TAX
PARITY
FOR
ROLL-YOUR-OWN
TO-
BACCO.—Section 5701(g) of the Internal Revenue 
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413 
Code of 1986 is amended by striking ‘‘$24.78’’ and 
inserting ‘‘$49.56’’. 
(2) 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’’. 
(3) TAX PARITY FOR SMOKELESS TOBACCO.— 
(A) Section 5701(e) of the Internal Rev-
enue Code of 1986 is amended— 
(i) in paragraph (1), by striking 
‘‘$1.51’’ and inserting ‘‘$26.84’’; 
(ii) in paragraph (2), by striking 
‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE 
SINGLE-USE
UNITS.—On discrete single-use units, 
$100.66 per thousand.’’. 
(B) Section 5702(m) of such Code 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 ‘‘that is not a discrete single-use 
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414 
unit’’ before the period in each such para-
graph; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(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 
‘‘(B) is in the form of a lozenge, tablet, 
pill, pouch, dissolvable strip, or other discrete 
single-use or single-dose unit.’’. 
(4) TAX
PARITY
FOR
SMALL
CIGARS.—Para-
graph (1) of section 5701(a) of the Internal Revenue 
Code of 1986 is amended by striking ‘‘$50.33’’ and 
inserting ‘‘$100.66’’. 
(5) TAX PARITY FOR LARGE CIGARS.— 
(A) IN GENERAL.—Paragraph (2) of sec-
tion 5701(a) of the Internal Revenue Code of 
1986 is amended by striking ‘‘52.75 percent’’ 
and all that follows through the period and in-
serting the following: ‘‘$49.56 per pound and a 
proportionate tax at the like rate on all frac-
tional parts of a pound but not less than 
10.066 cents per cigar.’’. 
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415 
(B) GUIDANCE.—The Secretary of the 
Treasury, or the Secretary’s delegate, may issue 
guidance regarding the appropriate method for 
determining the weight of large cigars for pur-
poses of calculating the applicable tax under 
section 5701(a)(2) of the Internal Revenue 
Code of 1986. 
(6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO 
AND CERTAIN PROCESSED TOBACCO.—Subsection (o) 
of section 5702 of the Internal Revenue Code of 
1986 is amended by inserting ‘‘, and includes proc-
essed tobacco that is removed for delivery or deliv-
ered 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’’. 
(7) CLARIFYING
TAX
RATE
FOR
OTHER
TO-
BACCO PRODUCTS.— 
(A) IN GENERAL.—Section 5701 of the In-
ternal Revenue Code of 1986 is amended by 
adding at the end the following new subsection: 
‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not 
otherwise described under this section that has been deter-
mined to be a tobacco product by the Food and Drug Ad-
ministration through its authorities under the Family 
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416 
Smoking Prevention and Tobacco Control Act shall be 
taxed at a level of tax equivalent to the tax rate for ciga-
rettes on an estimated per use basis as determined by the 
Secretary.’’. 
(B) ESTABLISHING PER USE BASIS.—For 
purposes of section 5701(i) of the Internal Rev-
enue Code of 1986, not later than 12 months 
after the later of the date of the enactment of 
this Act or the date that a product has been de-
termined to be a tobacco product by the Food 
and Drug Administration, the Secretary of the 
Treasury (or the Secretary of the Treasury’s 
delegate) shall issue final regulations estab-
lishing the level of tax for such product that is 
equivalent to the tax rate for cigarettes on an 
estimated per use basis. 
(8) CLARIFYING
DEFINITION
OF
TOBACCO 
PRODUCTS.— 
(A) IN GENERAL.—Subsection (c) of sec-
tion 5702 of the Internal Revenue Code of 1986 
is amended to read as follows: 
‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod-
ucts’ means— 
‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 
tobacco, and roll-your-own tobacco, and 
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417 
‘‘(2) any other product subject to tax pursuant 
to section 5701(i).’’. 
(B) CONFORMING
AMENDMENTS.—Sub-
section (d) of section 5702 of such Code is 
amended by striking ‘‘cigars, cigarettes, smoke-
less tobacco, pipe tobacco, or roll-your-own to-
bacco’’ each place it appears and inserting ‘‘to-
bacco products’’. 
(9) INCREASING TAX ON CIGARETTES.— 
(A) 
SMALL
CIGARETTES.—Section 
5701(b)(1) of such Code is amended by striking 
‘‘$50.33’’ and inserting ‘‘$100.66’’. 
(B) 
LARGE
CIGARETTES.—Section 
5701(b)(2) of such Code is amended by striking 
‘‘$105.69’’ and inserting ‘‘$211.38’’. 
(10) TAX RATES ADJUSTED FOR INFLATION.— 
Section 5701 of such Code, as amended by sub-
section (g), is amended by adding at the end the fol-
lowing new subsection: 
‘‘(j) INFLATION ADJUSTMENT.— 
‘‘(1) IN GENERAL.—In the case of any calendar 
year beginning after 2021, the dollar amounts pro-
vided under this chapter shall each be increased by 
an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
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418 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year, determined by substituting ‘calendar year 
2017’ for ‘calendar year 2016’ in subparagraph 
(A)(ii) thereof. 
‘‘(2) ROUNDING.—If any amount as adjusted 
under paragraph (1) is not a multiple of $0.01, such 
amount shall be rounded to the next highest multiple 
of $0.01.’’. 
(11) FLOOR STOCKS TAXES.— 
(A) IMPOSITION
OF
TAX.—On tobacco 
products manufactured in or imported into the 
United States which are removed before any tax 
increase 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) CREDIT AGAINST TAX.—Each person 
shall be allowed as a credit against the taxes 
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419 
imposed by paragraph (1) an amount equal to 
$500. Such credit shall not exceed the amount 
of taxes imposed by paragraph (1) on such date 
for which such person is liable. 
(C) LIABILITY FOR TAX AND METHOD OF 
PAYMENT.— 
(i) LIABILITY
FOR
TAX.—A person 
holding tobacco products on any tax in-
crease date to which any tax imposed by 
paragraph (1) applies shall be liable for 
such tax. 
(ii) METHOD OF PAYMENT.—The tax 
imposed by paragraph (1) shall be paid in 
such manner as the Secretary shall pre-
scribe by regulations. 
(iii) TIME
FOR
PAYMENT.—The tax 
imposed by paragraph (1) shall be paid on 
or before the date that is 120 days after 
the effective date of the tax rate increase. 
(D) 
ARTICLES
IN
FOREIGN
TRADE 
ZONES.—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 article which 
is located in a foreign trade zone on any tax in-
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420 
crease date shall be subject to the tax imposed 
by paragraph (1) if— 
(i) internal revenue taxes have been 
determined, or customs duties liquidated, 
with respect to such article before such 
date pursuant to a request 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 officer of the 
United States Customs and Border Protec-
tion of the Department of Homeland Secu-
rity pursuant to the 2d proviso of such sec-
tion 3(a). 
(E) DEFINITIONS.—For purposes of this 
subsection— 
(i) IN GENERAL.—Any term used in 
this subsection which is also used in sec-
tion 5702 of such Code shall have the 
same meaning as such term has in such 
section. 
(ii) TAX INCREASE DATE.—The term 
‘‘tax increase date’’ means the effective 
date of any increase in any tobacco prod-
uct excise tax rate pursuant to the amend-
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421 
ments made by this section (other than 
subsection (j) thereof). 
(iii) SECRETARY.—The term ‘‘Sec-
retary’’ means the Secretary of the Treas-
ury or the Secretary’s delegate. 
(F) CONTROLLED GROUPS.—Rules similar 
to the rules of section 5061(e)(3) of such Code 
shall apply for purposes of this subsection. 
(G) OTHER LAWS APPLICABLE.—All provi-
sions of law, including penalties, applicable with 
respect to the taxes imposed by section 5701 of 
such Code shall, insofar as applicable and not 
inconsistent with the provisions of this sub-
section, apply to the floor stocks taxes imposed 
by paragraph (1), to the same extent as if such 
taxes were imposed by such section 5701. The 
Secretary may treat any person who bore the 
ultimate burden of the tax imposed by para-
graph (1) as the person to whom a credit or re-
fund under such provisions may be allowed or 
made. 
(12) EFFECTIVE DATES.— 
(A) IN GENERAL.—Except as provided in 
paragraphs (2) through (4), the amendments 
made by this section shall apply to articles re-
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422 
moved (as defined in section 5702(j) of the In-
ternal Revenue Code of 1986) after the last day 
of the month which includes the date of the en-
actment of this Act. 
(B) DISCRETE
SINGLE-USE
UNITS
AND 
PROCESSED TOBACCO.—The amendments made 
by subsections (c)(1)(C), (c)(2), and (f) shall 
apply to articles removed (as defined in section 
5702(j) of the Internal Revenue Code of 1986) 
after the date that is 6 months after the date 
of the enactment of this Act. 
(C) LARGE
CIGARS.—The amendments 
made by subsection (e) shall apply to articles 
removed after December 31, 2021. 
(D) OTHER
TOBACCO
PRODUCTS.—The 
amendments made by subsection (g)(1) shall 
apply to products removed after the last day of 
the month which includes the date that the Sec-
retary of the Treasury (or the Secretary of the 
Treasury’s delegate) issues final regulations es-
tablishing the level of tax for such product. 
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423 
SEC. 506. RURAL MATERNAL AND OBSTETRIC MODERNIZA-
TION OF SERVICES. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Rural Maternal and Obstetric Modernization of Services 
Act’’ or the ‘‘Rural MOMS Act’’. 
(b) IMPROVING RURAL MATERNAL AND OBSTETRIC 
CARE DATA.— 
(1) MATERNAL MORTALITY AND MORBIDITY AC-
TIVITIES.—Section 301 of the Public Health Service 
Act (42 U.S.C. 241) is amended— 
(A) 
by 
redesignating 
subsections 
(e) 
through (h) as subsections (f) through (i), re-
spectively; and 
(B) by inserting after subsection (d), the 
following: 
‘‘(e) The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall ex-
pand, intensify, and coordinate the activities of the Cen-
ters for Disease Control and Prevention with respect to 
maternal mortality and morbidity.’’. 
(2) OFFICE
OF
WOMEN’S
HEALTH.—Section 
310A(b)(1) of the Public Health Service Act (42 
U.S.C. 
242s(b)(1)) 
is 
amended 
by 
inserting 
‘‘sociocultural (race, ethnicity, language, class, in-
come), including among American Indians and Alas-
ka Natives, as such terms are defined in section 4 
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424 
of the Indian Health Care Improvement Act, and ge-
ographic contexts,’’ after ‘‘biological,’’. 
(3) SAFE MOTHERHOOD.—Section 317K(b)(2) 
of the Public Health Service Act (42 U.S.C. 247b– 
12(b)(2)) is amended— 
(A) in subparagraph (L), by striking 
‘‘and’’ at the end; 
(B) by redesignating subparagraph (M) as 
subparagraph (N); and 
(C) by inserting after subparagraph (L), 
the following: 
‘‘(M) an examination of the relationship 
between maternal health services in rural areas 
and outcomes in delivery and postpartum care; 
and’’. 
(4) OFFICE
OF
RESEARCH
ON
WOMEN’S 
HEALTH.—Section 486 of the Public Health Service 
Act (42 U.S.C. 287d) is amended— 
(A) in subsection (b)— 
(i) by redesignating paragraphs (4) 
through (9) as paragraphs (5) through 
(10), respectively; 
(ii) by inserting after paragraph (3) 
the following: 
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‘‘(4) carry out paragraphs (1) and (2) with re-
spect to pregnancy, with priority given to deaths re-
lated to pregnancy;’’; and 
(iii) in paragraph (5) (as so redesig-
nated), by striking ‘‘through (3)’’ and in-
serting ‘‘through (4)’’; and 
(B) in subsection (d)(4)(A)(iv), by insert-
ing ‘‘, including maternal mortality and other 
maternal morbidity outcomes’’ before the semi-
colon. 
(c) RURAL OBSTETRIC NETWORK GRANTS.—The 
Public Health Service Act is amended by inserting after 
section 317L–1 (42 U.S.C. 247b–13a) the following: 
‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 
‘‘(a) IN GENERAL.—For the purpose of enabling the 
Secretary (through grants, contracts, or otherwise), acting 
through the Administrator of the Health Resources and 
Services Administration, to establish collaborative im-
provement and innovation networks (referred to in this 
section as ‘rural obstetric networks’) to improve outcomes 
in birth and maternal morbidity and mortality, there is 
appropriated to the Secretary, out of any money in the 
Treasury not otherwise appropriated, $3,000,000 for each 
of fiscal years 2020 through 2024. Such amounts shall 
remain available until expended. 
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‘‘(b) USE OF FUNDS.—Amount appropriated under 
subsection (a) shall be used for the establishment of col-
laborative improvement and innovation networks to im-
prove maternal health in rural areas by improving out-
comes in birth and maternal morbidity and mortality. 
Rural obstetric networks established in accordance with 
this section shall— 
‘‘(1) assist pregnant women and individuals in 
rural areas connect with prenatal, labor and birth, 
and postpartum care to improve outcomes in birth 
and maternal mortality and morbidity; 
‘‘(2) identify successful prenatal, labor and 
birth, and postpartum health delivery models for in-
dividuals in rural areas, including evidence-based 
home visiting programs and successful, culturally 
competent models with positive maternal health out-
comes that advance health equity; 
‘‘(3) develop a model for collaboration between 
health facilities that have an obstetric health unit 
and health facilities that do not have an obstetric 
health unit; 
‘‘(4) provide training and guidance for health 
facilities that do not have obstetric health units; 
‘‘(5) collaborate with academic institutions that 
can provide regional expertise and research on ac-
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cess, outcomes, needs assessments, and other identi-
fied data; and 
‘‘(6) measure and address inequities in birth 
outcomes among rural residents, with an emphasis 
on Black and American Indians and Alaska Native 
residents, as such terms are defined in section 4 of 
the Indian Health Care Improvement Act. 
‘‘(c) REQUIREMENTS.— 
‘‘(1) ESTABLISHMENT.—Not later than October 
1, 2020, the Secretary shall establish rural obstetric 
health networks in at least 5 regions. 
‘‘(2) DEFINITIONS.—In this section: 
‘‘(A) FRONTIER AREA.—The term ‘frontier 
area’ means a frontier county, as defined in sec-
tion 1886(d)(3)(E)(iii)(III) of the Social Secu-
rity Act. 
‘‘(B) INDIAN
TRIBE.—The term ‘Indian 
tribe’ has the meaning given such term in sec-
tion 4 of the Indian Health Care Improvement 
Act. 
‘‘(C) NATIVE
HAWAIIAN
HEALTH
CARE 
SYSTEM.—The term ‘Native Hawaiian Health 
Care System’ has the meaning given such term 
in section 12 of the Native Hawaiian Health 
Care Improvement Act. 
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‘‘(D) REGION.—The term ‘region’ means a 
State, Indian tribe, rural area, or frontier area. 
‘‘(E) RURAL AREA.—The term ‘rural area’ 
has the meaning given that term in section 
1886(d)(2)(D) of the Social Security Act. 
‘‘(F) TRIBAL
ORGANIZATION.—The term 
‘tribal organization’ has the meaning given such 
term in the Indian Self-Determination Act. 
‘‘(G) STATE.—The term ‘State’ has the 
meaning given that term for purposes of title V 
of the Social Security Act.’’. 
(d) TELEHEALTH NETWORK AND TELEHEALTH RE-
SOURCE CENTERS GRANT PROGRAMS.—Section 330I of 
the Public Health Service Act (42 U.S.C. 254c–14) is 
amended— 
(1) in subsection (f)(1)(B)(iii), by adding at the 
end the following: 
‘‘(XIII) Providers of maternal, 
including prenatal, labor and birth, 
and postpartum care services and en-
tities operation obstetric care units.’’; 
(2) in subsection (i)(1)(B), by inserting ‘‘labor 
and birth, postpartum,’’ before ‘‘or prenatal’’; and 
(3) in subsection (k)(1)(B), by inserting ‘‘equip-
ment useful for caring for pregnant women and indi-
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viduals, including ultrasound machines and fetal 
monitoring equipment,’’ before ‘‘and other equip-
ment’’. 
(e) RURAL MATERNAL AND OBSTETRIC CARE TRAIN-
ING DEMONSTRATION.—Part D of title VII of the Public 
Health Service Act is amended by inserting after section 
760 (42 U.S.C. 294k) the following: 
‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 
TRAINING DEMONSTRATION. 
‘‘(a) IN GENERAL.—The Secretary shall establish a 
training demonstration program to award grants to eligi-
ble entities to support— 
‘‘(1) training for physicians, medical residents, 
including family medicine and obstetrics and gyne-
cology residents, and fellows to practice maternal 
and obstetric medicine in rural community-based 
settings; 
‘‘(2) training for licensed and accredited nurse 
practitioners, physician assistants, certified nurse 
midwives, certified midwives, certified professional 
midwives, home visiting nurses, or non-clinical pro-
fessionals such as doulas and community health 
workers, to provide maternal care services in rural 
community-based settings; and 
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‘‘(3) establishing, maintaining, or improving 
academic units or programs that— 
‘‘(A) provide training for students or fac-
ulty, including through clinical experiences and 
research, to improve maternal care in rural 
areas; or 
‘‘(B) develop evidence-based practices or 
recommendations for the design of the units or 
programs described in subparagraph (A), in-
cluding curriculum content standards. 
‘‘(b) ACTIVITIES.— 
‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 
FELLOWS.—A recipient of a grant under subsection 
(a)(1)— 
‘‘(A) shall use the grant funds— 
‘‘(i) to plan, develop, and operate a 
training program to provide obstetric care 
in rural areas for family practice or obstet-
rics and gynecology residents and fellows; 
or 
‘‘(ii) to train new family practice or 
obstetrics and gynecology residents and fel-
lows in maternal and obstetric health care 
to provide and expand access to maternal 
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and obstetric health care in rural areas; 
and 
‘‘(B) may use the grant funds to provide 
additional support for the administration of the 
program or to meet the costs of projects to es-
tablish, maintain, or improve faculty develop-
ment, or departments, divisions, or other units 
necessary to implement such training. 
‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re-
cipient of a grant under subsection (a)(2)— 
‘‘(A) shall use the grant funds to plan, de-
velop, or operate a training program to provide 
maternal health care services in rural, commu-
nity-based settings; and 
‘‘(B) may use the grant funds to provide 
additional support for the administration of the 
program or to meet the costs of projects to es-
tablish, maintain, or improve faculty develop-
ment, or departments, divisions, or other units 
necessary to implement such program. 
‘‘(3) ACADEMIC UNITS OR PROGRAMS.—A re-
cipient of a grant under subsection (a)(3) shall enter 
into a partnership with organizations such as an 
education accrediting organization (such as the Liai-
son Committee on Medical Education, the Accredita-
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tion Council for Graduate Medical Education, the 
Commission on Osteopathic College Accreditation, 
the Accreditation Commission for Education in 
Nursing, the Commission on Collegiate Nursing 
Education, the Accreditation Commission for Mid-
wifery Education, or the Accreditation Review Com-
mission on Education for the Physician Assistant) to 
carry out activities under subsection (a)(3). 
‘‘(4) TRAINING
PROGRAM
REQUIREMENTS.— 
The recipient of a grant under subsection (a)(1) or 
(a)(2) shall ensure that training programs carried 
out under the grant include instruction on— 
‘‘(A) maternal mental health, including 
perinatal 
depression 
and 
anxiety 
and 
postpartum depression; 
‘‘(B) maternal substance use disorder; 
‘‘(C) social determinants of health that im-
pact individuals living in rural communities, in-
cluding poverty, social isolation, access to nutri-
tion, education, transportation, and housing; 
and 
‘‘(D) implicit bias. 
‘‘(c) ELIGIBLE ENTITIES.— 
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‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 
FELLOWS.—To be eligible to receive a grant under 
subsection (a)(1), an entity shall— 
‘‘(A) be a consortium consisting of— 
‘‘(i) at least one teaching health cen-
ter; or 
‘‘(ii) the sponsoring institution (or 
parent institution of the sponsoring insti-
tution) of— 
‘‘(I) an obstetrics and gynecology 
or family medicine residency program 
that is accredited by the Accreditation 
Council of Graduate Medical Edu-
cation (or the parent institution of 
such a program); or 
‘‘(II) a fellowship in maternal or 
obstetric medicine, as determined ap-
propriate by the Secretary; or 
‘‘(B) be an entity described in subpara-
graph (A)(ii) that provides opportunities for 
medical residents or fellows to train in rural 
community-based settings. 
‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 
eligible to receive a grant under subsection (a)(2), 
an entity shall be— 
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‘‘(A) a teaching health center (as defined 
in section 749A(f)); 
‘‘(B) a federally qualified health center (as 
defined in section 1905(l)(2)(B) of the Social 
Security Act); 
‘‘(C) a community mental health center (as 
defined in section 1861(ff)(3)(B) of the Social 
Security Act); 
‘‘(D) a rural health clinic (as defined in 
section 1861(aa) of the Social Security Act); 
‘‘(E) a freestanding birth center (as de-
fined in section 1905(l)(3) of the Social Secu-
rity Act); 
‘‘(F) a health center operated by the In-
dian Health Service, an Indian tribe, a tribal 
organization, or a Native Hawaiian Health Care 
System (as such terms are defined in section 4 
of the Indian Health Care Improvement Act 
and section 12 of the Native Hawaiian Health 
Care Improvement Act); or 
‘‘(G) an entity with a demonstrated record 
of success in providing academic training for 
nurse practitioners, physician assistants, cer-
tified nurse-midwives, certified midwives, cer-
tified professional midwives, home visiting 
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435 
nurses, or non-clinical professionals, such as 
doulas and community health workers. 
‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 
eligible to receive a grant under subsection (a)(3), 
an entity shall be a school of medicine or osteopathic 
medicine, a nursing school, a physician assistant 
training program, an accredited public or nonprofit 
private hospital, an accredited medical residency pro-
gram, a school accredited by the Midwifery Edu-
cation and Accreditation Council, or a public or pri-
vate nonprofit entity which the Secretary has deter-
mined is capable of carrying out such grant. 
‘‘(4) APPLICATION.—To be eligible to receive a 
grant under subsection (a), an entity shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require, including an estimate of the 
amount to be expended to conduct training activities 
under the grant (including ancillary and administra-
tive costs). 
‘‘(d) DURATION.—Grants awarded under this section 
shall be for a minimum of 5 years. 
‘‘(e) STUDY AND REPORT.— 
‘‘(1) STUDY.— 
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‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator of the Health Re-
sources and Services Administration, shall con-
duct a study on the results of the demonstra-
tion program under this section. 
‘‘(B) DATA SUBMISSION.—Not later than 
90 days after the completion of the first year 
of the training program, and each subsequent 
year for the duration of the grant, that the pro-
gram is in effect, each recipient of a grant 
under subsection (a) shall submit to the Sec-
retary such data as the Secretary may require 
for analysis for the report described in para-
graph (2). 
‘‘(2) REPORT TO CONGRESS.—Not later than 1 
year after receipt of the data described in paragraph 
(1)(B), the Secretary shall submit to Congress a re-
port that includes— 
‘‘(A) an analysis of the effect of the dem-
onstration program under this section on the 
quality, quantity, and distribution of maternal, 
including prenatal, labor and birth, and 
postpartum care services and the demographics 
of the recipients of those services; 
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‘‘(B) an analysis of maternal and infant 
health outcomes (including quality of care, mor-
bidity, and mortality) before and after imple-
mentation of the program in the communities 
served by entities participating in the dem-
onstration; and 
‘‘(C) recommendations on whether the 
demonstration program should be expanded. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2020 through 2024.’’. 
(f) GAO REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Comptroller General 
of the United States shall submit to the appropriate com-
mittees of Congress a report on the maternal, including 
prenatal, labor and birth, and postpartum care in rural 
areas. Such report shall include the following: 
(1) The location of gaps in maternal and ob-
stetric clinicians and health professionals, including 
non-clinical professionals such as doulas and com-
munity health workers. 
(2) The location of gaps in facilities able to pro-
vide maternal, including prenatal, labor and birth, 
and postpartum care in rural areas, including care 
for high-risk pregnancies. 
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(3) The gaps in data on maternal mortality and 
recommendations to standardize the format on col-
lecting data related to maternal mortality and mor-
bidity. 
(4) The gaps in maternal health by race and 
ethnicity in rural communities, with a focus on ra-
cial inequities for Black residents and among Indian 
Tribes and American Indian/Alaska Native rural 
residents (as such terms are defined in section 4 of 
the Indian Health Care Improvement Act). 
(5) A list of specific activities that the Sec-
retary of Health and Human Services plans to con-
duct on maternal, including prenatal, labor and 
birth, and postpartum care. 
(6) A plan for completing such activities. 
(7) An explanation of Federal agency involve-
ment and coordination needed to conduct such ac-
tivities. 
(8) A budget for conducting such activities. 
(9) Other information that the Comptroller 
General determines appropriate. 
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SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 
UNEXPECTED INFANT DEATH AND SUDDEN 
UNEXPLAINED DEATH IN CHILDHOOD. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration and in con-
sultation with the Director of the Centers for Disease Con-
trol and Prevention and the Director of the National Insti-
tutes of Health (in this section referred to as the ‘‘Sec-
retary’’), shall establish and implement a culturally and 
linguistically competent public health awareness and edu-
cation campaign to provide information that is focused on 
decreasing the risk factors for sudden unexpected infant 
death and sudden unexplained death in childhood, includ-
ing educating individuals about safe sleep environments, 
sleep positions, and reducing exposure to smoking during 
pregnancy and after birth. 
(b) TARGETED POPULATIONS.—The campaign under 
subsection (a) shall be designed to reduce health dispari-
ties through the targeting of populations with high rates 
of sudden unexpected infant death and sudden unex-
plained death in childhood. 
(c) CONSULTATION.—In establishing and imple-
menting the campaign under subsection (a), the Secretary 
shall consult with national organizations representing 
health care providers, including nurses and physicians, 
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parents, child care providers, children’s advocacy and safe-
ty organizations, maternal and child health programs, nu-
trition professionals focusing on women, infants, and chil-
dren, and other individuals and groups determined nec-
essary by the Secretary for such establishment and imple-
mentation. 
(d) GRANTS.— 
(1) IN
GENERAL.—In carrying out the cam-
paign under subsection (a), the Secretary shall 
award grants to national organizations, State and 
local health departments, and community-based or-
ganizations for the conduct of education and out-
reach programs for nurses, parents, child care pro-
viders, public health agencies, and community orga-
nizations. 
(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), an entity shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2021 through 2025. 
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441 
SEC. 
508. 
REDUCING 
UNINTENDED 
TEENAGE 
PREG-
NANCIES. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART W—YOUTH ACCESS TO SEXUAL HEALTH 
SERVICES 
‘‘SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT 
THE ACCESS OF MARGINALIZED YOUTH TO 
SEXUAL HEALTH SERVICES. 
‘‘(a) GRANTS.—The Secretary may award grants on 
a competitive basis to eligible entities to support the access 
of marginalized youth to sexual health services. 
‘‘(b) USE
OF FUNDS.—An eligible entity that is 
awarded a grant under subsection (a) may use the funds 
to— 
‘‘(1) provide medically accurate and complete 
and age-, developmentally, and culturally appro-
priate sexual health information to marginalized 
youth, including information on how to access sexual 
health services; 
‘‘(2) promote effective communication regarding 
sexual health among marginalized youth; 
‘‘(3) promote and support better health, edu-
cation, and economic opportunities for school-age 
parents; and 
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‘‘(4) 
train 
individuals 
who 
work 
with 
marginalized youth to promote— 
‘‘(A) the prevention of unintended preg-
nancy; 
‘‘(B) the prevention of sexually transmitted 
infections, 
including 
the 
human 
immuno-
deficiency virus (HIV); 
‘‘(C) healthy relationships; and 
‘‘(D) the development of safe and sup-
portive environments. 
‘‘(c) APPLICATION.—To be awarded a grant under 
subsection (a), an eligible entity shall submit an applica-
tion to the Secretary at such time, in such manner, and 
containing such information as the Secretary may require. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to eligible enti-
ties— 
‘‘(1) with a history of supporting the access of 
marginalized youth to sexuality education or sexual 
health services; and 
‘‘(2) that plan to serve marginalized youth that 
are not served by Federal adolescent programs for 
the prevention of pregnancy, HIV, and other sexu-
ally transmitted infections. 
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‘‘(e) REQUIREMENTS.—The Secretary may not award 
a grant under subsection (a) to an eligible entity unless— 
‘‘(1) such eligible entity has formed a partner-
ship with a community organization; and 
‘‘(2) such eligible entity agrees— 
‘‘(A) to employ a scientifically effective 
strategy; 
‘‘(B) that all information provided to 
marginalized youth will be— 
‘‘(i) age- and developmentally appro-
priate; 
‘‘(ii) medically accurate and complete; 
‘‘(iii) scientifically based; and 
‘‘(iv) provided in the language and 
cultural context that is most appropriate 
for the individuals served by the eligible 
entity; and 
‘‘(C) that for each year the eligible entity 
receives grant funds under subsection (a), the 
eligible entity will submit to the Secretary an 
annual report that includes— 
‘‘(i) the use of grant funds by the eli-
gible entity; 
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‘‘(ii) how the use of grant funds has 
increased the access of marginalized youth 
to sexual health services; and 
‘‘(iii) such other information as the 
Secretary may require. 
‘‘(f) PUBLICATION AND EVALUATIONS.— 
‘‘(1) EVALUATIONS.—Not less than once every 
two years after the date of the enactment of this 
part, the Secretary shall evaluate the effectiveness of 
whichever of the following is greater: 
‘‘(A) Eight grants awarded under sub-
section (a). 
‘‘(B) Ten percent of the grants awarded 
under subsection (a). 
‘‘(2) PUBLICATION.—The Secretary shall make 
available to the public— 
‘‘(A) the evaluations required under para-
graph (1); and 
‘‘(B) the reports required under subsection 
(e)(2)(C). 
‘‘(g) LIMITATIONS.—No funds made available to an 
eligible entity under this section may be used by such enti-
ty to provide access to sexual health services that— 
‘‘(1) withhold sexual health-promoting or life- 
saving information; 
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‘‘(2) are medically inaccurate or have been sci-
entifically shown to be ineffective; 
‘‘(3) promote gender stereotypes; 
‘‘(4) are insensitive or unresponsive to the 
needs of young people, including— 
‘‘(A) youth with varying gender identities, 
gender expressions, and sexual orientations; 
‘‘(B) sexually active youth; 
‘‘(C) pregnant or parenting youth; 
‘‘(D) survivors of sexual abuse or assault; 
and 
‘‘(E) youth of all physical, developmental, 
and mental abilities; or 
‘‘(5) are inconsistent with the ethical impera-
tives of medicine and public health. 
‘‘(h) TRANSFER OF FUNDS.—Any unobligated bal-
ance of funds made available under section 510(d) of the 
Social Security Act (42 U.S.C. 710(d)) (as in effect on 
the day before the date of the enactment of this part) are 
hereby transferred and made available to the Secretary to 
carry out this section. The amounts transferred and made 
available to carry out this section shall remain available 
until expended. 
‘‘(i) DEFINITIONS.—In this section: 
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‘‘(1) COMMUNITY
ORGANIZATION.—The term 
‘community organization’ includes a State or local 
health or education agency, public school, youth-fo-
cused organization that is faith-based and commu-
nity-based, juvenile justice entity, or other organiza-
tion that provides confidential and appropriate sexu-
ality 
education 
or 
sexual 
health 
services 
to 
marginalized youth. 
‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ includes a State or local health or education 
agency, public school, nonprofit organization, hos-
pital, or an Indian Tribe or Tribal organization (as 
such terms are defined in section 4 of the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 5304)). 
‘‘(3) 
MARGINALIZED
YOUTH.—The 
term 
‘marginalized youth’ means a person under the age 
of 26 that is disadvantaged by underlying structural 
barriers and social inequity. 
‘‘(4) MEDICALLY ACCURATE AND COMPLETE.— 
The term ‘medically accurate and complete’, when 
used with respect to information, means information 
that— 
‘‘(A) is supported by research and recog-
nized as accurate, objective, and complete by 
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leading medical, psychological, psychiatric, or 
public health organizations and agencies; and 
‘‘(B) does not withhold any information re-
lating to the effectiveness and benefits of cor-
rect and consistent use of condoms or other 
contraceptives and pregnancy prevention meth-
ods. 
‘‘(5) SCIENTIFICALLY EFFECTIVE STRATEGY.— 
The term ‘scientifically effective strategy’ means a 
strategy that— 
‘‘(A) is widely recognized by leading med-
ical and public health agencies as effective in 
promoting sexual health awareness and healthy 
behavior; and 
‘‘(B) either— 
‘‘(i) has been demonstrated to be ef-
fective on the basis of rigorous scientific 
research; or 
‘‘(ii) incorporates characteristics of ef-
fective programs. 
‘‘(6) SEXUAL
HEALTH
SERVICES.—The term 
‘sexual health services’ includes— 
‘‘(A) sexual health information, education, 
and counseling; 
‘‘(B) contraception; 
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‘‘(C) emergency contraception; 
‘‘(D) condoms and other barrier methods 
to prevent pregnancy or sexually transmitted in-
fections; 
‘‘(E) routine gynecological care, including 
human papillomavirus (HPV) vaccines and can-
cer screenings; 
‘‘(F) pre-exposure prophylaxis or post-ex-
posure prophylaxis; 
‘‘(G) mental health services; 
‘‘(H) sexual assault survivor services; and 
‘‘(I) other prevention, care, or treatment.’’. 
SEC. 509. GESTATIONAL DIABETES. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by adding after section 
317H the following: 
‘‘SEC. 317H–1. GESTATIONAL DIABETES. 
‘‘(a) UNDERSTANDING
AND MONITORING GESTA-
TIONAL DIABETES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, in consultation with the Di-
abetes Mellitus Interagency Coordinating Committee 
established under section 429 and representatives of 
appropriate national health organizations, shall de-
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velop a multisite gestational diabetes research 
project within the diabetes program of the Centers 
for Disease Control and Prevention to expand and 
enhance surveillance data and public health research 
on gestational diabetes. 
‘‘(2) AREAS TO BE ADDRESSED.—The research 
project developed under paragraph (1) shall ad-
dress— 
‘‘(A) procedures to establish accurate and 
efficient systems for the collection of gestational 
diabetes data within each State and common-
wealth, territory, or possession of the United 
States; 
‘‘(B) the progress of collaborative activities 
with the National Vital Statistics System, the 
National Center for Health Statistics, and 
State health departments with respect to the 
standard birth certificate, in order to improve 
surveillance of gestational diabetes; 
‘‘(C) postpartum methods of tracking indi-
viduals with gestational diabetes after delivery 
as well as targeted interventions proven to 
lower the incidence of type 2 diabetes in that 
population; 
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‘‘(D) variations in the distribution of diag-
nosed and undiagnosed gestational diabetes, 
and of impaired fasting glucose tolerance and 
impaired fasting glucose, within and among 
groups of pregnant individuals; and 
‘‘(E) factors and culturally sensitive inter-
ventions that influence risks and reduce the in-
cidence of gestational diabetes and related com-
plications during childbirth, including cultural, 
behavioral, racial, ethnic, geographic, demo-
graphic, socioeconomic, and genetic factors. 
‘‘(3) REPORT.—Not later than 2 years after the 
date of the enactment of this section, and annually 
thereafter, the Secretary shall generate a report on 
the findings and recommendations of the research 
project including prevalence of gestational diabetes 
in the multisite area and disseminate the report to 
the appropriate Federal and non-Federal agencies. 
‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE-
SEARCH.— 
‘‘(1) IN GENERAL.—The Secretary shall expand 
and intensify public health research regarding gesta-
tional diabetes. Such research may include— 
‘‘(A) developing and testing novel ap-
proaches for improving postpartum diabetes 
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testing or screening and for preventing type 2 
diabetes in individuals who can become preg-
nant with a history of gestational diabetes; and 
‘‘(B) conducting public health research to 
further understanding of the epidemiologic, 
socioenvironmental, behavioral, translation, and 
biomedical factors and health systems that in-
fluence the risk of gestational diabetes and the 
development of type 2 diabetes in individuals 
who can become pregnant with a history of ges-
tational diabetes. 
‘‘(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection $5,000,000 for each of fiscal years 
2021 through 2025. 
‘‘(c) DEMONSTRATION GRANTS TO LOWER
THE 
RATE OF GESTATIONAL DIABETES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall award grants, on a 
competitive basis, to eligible entities for demonstra-
tion projects that implement evidence-based inter-
ventions to reduce the incidence of gestational diabe-
tes, the recurrence of gestational diabetes in subse-
quent pregnancies, and the development of type 2 di-
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abetes in individuals who can become pregnant with 
a history of gestational diabetes. 
‘‘(2) PRIORITY.—In making grants under this 
subsection, the Secretary shall give priority to 
projects focusing on— 
‘‘(A) helping individuals who can become 
pregnant who have 1 or more risk factors for 
developing gestational diabetes; 
‘‘(B) working with individuals who can be-
come pregnant with a history of gestational dia-
betes during a previous pregnancy; 
‘‘(C) providing postpartum care for indi-
viduals who can become pregnant with gesta-
tional diabetes; 
‘‘(D) tracking cases where individuals who 
can become pregnant with a history of gesta-
tional diabetes developed type 2 diabetes; 
‘‘(E) educating mothers with a history of 
gestational diabetes about the increased risk of 
their child developing diabetes; 
‘‘(F) working to prevent gestational diabe-
tes and prevent or delay the development of 
type 2 diabetes in individuals who can become 
pregnant with a history of gestational diabetes; 
and 
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‘‘(G) achieving outcomes designed to assess 
the efficacy and cost-effectiveness of interven-
tions that can inform decisions on long-term 
sustainability, including third-party reimburse-
ment. 
‘‘(3) APPLICATION.—An eligible entity desiring 
to receive a grant under this subsection shall submit 
to the Secretary— 
‘‘(A) an application at such time, in such 
manner, and containing such information as the 
Secretary may require; and 
‘‘(B) a plan to— 
‘‘(i) lower the rate of gestational dia-
betes during pregnancy; or 
‘‘(ii) develop methods of tracking indi-
viduals who can become pregnant with a 
history of gestational diabetes and develop 
effective interventions to lower the inci-
dence of the recurrence of gestational dia-
betes in subsequent pregnancies and the 
development of type 2 diabetes. 
‘‘(4) USES OF FUNDS.—An eligible entity re-
ceiving a grant under this subsection shall use the 
grant funds to carry out demonstration projects de-
scribed in paragraph (1), including— 
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‘‘(A) expanding community-based health 
promotion education, activities, and incentives 
focused on the prevention of gestational diabe-
tes and development of type 2 diabetes in indi-
viduals who can become pregnant with a history 
of gestational diabetes; 
‘‘(B) aiding State- and Tribal-based diabe-
tes prevention and control programs to collect, 
analyze, disseminate, and report surveillance 
data on individuals who can become pregnant 
with, and at risk for, gestational diabetes, the 
recurrence of gestational diabetes in subsequent 
pregnancies, and, for individuals who can be-
come pregnant with a history of gestational dia-
betes, the development of type 2 diabetes; and 
‘‘(C) training and encouraging health care 
providers— 
‘‘(i) to promote risk assessment, high- 
quality care, and self-management for ges-
tational diabetes and the recurrence of ges-
tational diabetes in subsequent preg-
nancies; and 
‘‘(ii) to prevent the development of 
type 2 diabetes in individuals who can be-
come pregnant with a history of gesta-
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tional diabetes, and its complications in the 
practice settings of the health care pro-
viders. 
‘‘(5) REPORT.—Not later than 4 years after the 
date of the enactment of this section, the Secretary 
shall prepare and submit to the Congress a report 
concerning the results of the demonstration projects 
conducted through the grants awarded under this 
subsection. 
‘‘(6) DEFINITION
OF
ELIGIBLE
ENTITY.—In 
this subsection, the term ‘eligible entity’ means a 
nonprofit organization (such as a nonprofit academic 
center or community health center) or a State, Trib-
al, or local health agency. 
‘‘(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection $5,000,000 for each of fiscal years 
2021 through 2025. 
‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA-
TIONAL DIABETES.—The Secretary, acting through the 
Director of the Centers for Disease Control and Preven-
tion, shall work with the State- and Tribal-based diabetes 
prevention and control programs assisted by the Centers 
to encourage postpartum followup after gestational diabe-
tes, as medically appropriate, for the purpose of reducing 
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the incidence of gestational diabetes, the recurrence of 
gestational diabetes in subsequent pregnancies, the devel-
opment of type 2 diabetes in individuals with a history 
of gestational diabetes, and related complications.’’. 
SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 
INFORMATION PROGRAMS. 
(a) EMERGENCY
CONTRACEPTION
PUBLIC
EDU-
CATION PROGRAM.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Centers for Disease 
Control and Prevention, shall develop and dissemi-
nate to the public medically accurate and complete 
information on emergency contraceptives. 
(2) DISSEMINATION.—The Secretary may dis-
seminate medically accurate and complete informa-
tion under paragraph (1) directly or through ar-
rangements with nonprofit organizations, community 
health workers including promotores, consumer 
groups, institutions of higher education, clinics, the 
media, and Federal, State, and local agencies. 
(3) INFORMATION.—The information dissemi-
nated under paragraph (1) shall— 
(A) include, at a minimum, a description 
of emergency contraceptives and an explanation 
of the use, safety, efficacy, affordability, and 
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availability, including over-the-counter access, 
of such contraceptives and options for access 
without cost-sharing through insurance and 
other programs; 
(B) include emergency contraception to 
health care providers, including pharmacists; 
and 
(C) be pilot tested for consumer com-
prehension, cultural and linguistic appropriate-
ness, and acceptance of the messages across 
geographically, racially, ethnically, and linguis-
tically diverse populations. 
(b) EMERGENCY
CONTRACEPTION
INFORMATION 
PROGRAM FOR HEALTH CARE PROVIDERS.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Administrator of the Health Resources 
and Services Administration and in consultation 
with major medical and public health organizations, 
shall develop and disseminate to health care pro-
viders, including pharmacists, information on emer-
gency contraceptives. 
(2) INFORMATION.—The information dissemi-
nated under paragraph (1) shall include, at a min-
imum— 
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(A) information describing the use, safety, 
efficacy, and availability of emergency contra-
ceptives, and options for access without cost- 
sharing through insurance and other programs; 
(B) a recommendation regarding the use of 
such contraceptives; and 
(C) information explaining how to obtain 
copies of the information developed under sub-
section (a) for distribution to the patients of 
the providers. 
(c) DEFINITIONS.—In this section: 
(1) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means an individual who is li-
censed or certified under State law to provide health 
care services and who is operating within the scope 
of such license. Such term shall include a phar-
macist. 
(2) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the same 
meaning given such term in section 101(a) of the 
Higher Education Act of 1965 (20 U.S.C. 1001(a)). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of the fiscal years 
2021 through 2025. 
SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS. 
(a) PURPOSES; FINDING; SENSE OF CONGRESS.— 
(1) PURPOSES.—The purposes of this section 
are to provide young people with comprehensive sex 
education programs that— 
(A) promote and uphold the rights of 
young people to information in order to make 
healthy decisions about their sexual health; 
(B) provide the information and skills all 
young people need to make informed, respon-
sible, and healthy decisions in order to become 
sexually healthy adults and have healthy rela-
tionships; 
(C) provide information about the preven-
tion of unintended pregnancy, sexually trans-
mitted infections, including HIV, dating vio-
lence, sexual assault, bullying, and harassment; 
and 
(D) provide resources and information on 
topics ranging from gender stereotyping and 
gender roles and stigma and socio-cultural in-
fluences surrounding sex and sexuality. 
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(2) FINDING
ON
REQUIRED
RESOURCES.—In 
order to provide the comprehensive sex education de-
scribed in paragraph (1), Congress finds that in-
creased resources are required for sex education pro-
grams that— 
(A) substantially incorporate elements of 
evidence-based programs or characteristics of 
effective programs; 
(B) cover a broad range of topics, includ-
ing medically accurate and complete informa-
tion that is age and developmentally appro-
priate about all the aspects of sex, sexual 
health, and sexuality; 
(C) are gender and gender identity-sen-
sitive, emphasizing the importance of equality 
and the social environment for achieving sexual 
and reproductive health and overall well-being; 
(D) promote educational achievement, crit-
ical thinking, decisionmaking, self-esteem, and 
self-efficacy; 
(E) help develop healthy attitudes and in-
sights necessary for understanding relationships 
between oneself and others and society; 
(F) foster leadership skills and community 
engagement by— 
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(i) promoting principles of fairness, 
human dignity, and respect; and 
(ii) engaging young people as partners 
in their communities; and 
(G) are culturally and linguistically appro-
priate, reflecting the diverse circumstances and 
realities of young people. 
(3) SENSE OF CONGRESS.—It is the sense of 
Congress that— 
(A) federally funded sex education pro-
grams should aim to— 
(i) provide information about a range 
of human sexuality topics, including— 
(I) human development, healthy 
relationships, personal skills; 
(II) sexual behavior including ab-
stinence; 
(III) sexual health including pre-
venting unintended pregnancy; 
(IV) sexually transmitted infec-
tions including HIV; and 
(V) society and culture; 
(ii) promote safe and healthy relation-
ships; 
(iii) promote gender equity; 
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(iv) use, and be informed by, the best 
scientific information available; 
(v) be culturally appropriate and in-
clusive of youth with varying gender identi-
ties, gender expressions, and sexual ori-
entations; 
(vi) be built on characteristics of ef-
fective programs; 
(vii) expand the existing body of re-
search on comprehensive sex education 
programs through program evaluation; 
(viii) expand training programs for 
teachers of comprehensive sex education; 
(ix) build on programs funded under 
section 513 of the Social Security Act (42 
U.S.C. 713) and the Office of Adolescent 
Health’s Teen Pregnancy Prevention Pro-
gram, funded under title II of the Consoli-
dated Appropriations Act, 2010 (Public 
Law 111–117; 123 Stat. 3253), and on 
programs supported through the Centers 
for Disease Control and Prevention (CDC); 
and 
(x) promote and uphold the rights of 
young people to information in order to 
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make healthy and autonomous decisions 
about their sexual health; and 
(B) no Federal funds should be used for 
health education programs that— 
(i) withhold health-promoting or life- 
saving information about sexuality-related 
topics, including HIV; 
(ii) are medically inaccurate or have 
been scientifically shown to be ineffective; 
(iii) promote gender or racial stereo-
types; 
(iv) are insensitive and unresponsive 
to the needs of sexually active young peo-
ple; 
(v) are insensitive and unresponsive to 
the needs of survivors of sexual violence; 
(vi) are insensitive and unresponsive 
to the needs of youth of all physical, devel-
opmental, and mental abilities; 
(vii) are insensitive and unresponsive 
to the needs of youth with varying gender 
identities, gender expressions, and sexual 
orientations; or 
(viii) are inconsistent with the ethical 
imperatives of medicine and public health. 
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(b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 
FOR ADOLESCENTS.— 
(1) PROGRAM AUTHORIZED.—The Secretary of 
Health and Human Services, in coordination with 
the Associate Commissioner of the Family and 
Youth Services Bureau of the Administration on 
Children, Youth, and Families of the Department of 
Health and Human Services, the Director of the Of-
fice of Adolescent Health, the Director of the Divi-
sion of Adolescent and School Health within the 
Centers for Disease Control and Prevention and the 
Secretary of Education, shall award grants, on a 
competitive basis, to eligible entities to enable such 
eligible entities to carry out programs that provide 
adolescents with comprehensive sex education, as de-
scribed in paragraph (6). 
(2) DURATION.—Grants awarded under this 
section shall be for a period of 5 years. 
(3) ELIGIBLE
ENTITY.—In this section, the 
term ‘‘eligible entity’’ means a public or private enti-
ty that focuses on adolescent health and education 
or has experience working with adolescents. 
(4) APPLICATIONS.—An eligible entity desiring 
a grant under this subsection shall submit an appli-
cation to the Secretary at such time, in such man-
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465 
ner, and containing such information as the Sec-
retary may require, including an assurance to par-
ticipate in the evaluation described in subsection (e). 
(5) PRIORITY.—In awarding grants under this 
section, the Secretary shall give priority to eligible 
entities that— 
(A) are State or local public entities; 
(B) are entities not currently receiving 
funds under— 
(i) section 513 of the Social Security 
Act (42 U.S.C. 713); 
(ii) the Office of Adolescent Health’s 
Teen 
Pregnancy 
Prevention 
Program, 
funded under title II of the Consolidated 
Appropriations Act, 2010 (Public Law 
111–117; 123 Stat. 3253), or any substan-
tially similar successive program; or 
(iii) the Centers for Disease Control 
and Prevention’s Division of Adolescent 
and School Health; and 
(C) address health inequities among young 
people that face systemic barriers resulting in 
disproportionate rates of not less than one of 
the following: 
(i) Unintended pregnancies. 
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(ii) Sexually transmitted infections, 
including HIV. 
(iii) Dating violence and sexual vio-
lence. 
(6) USE OF FUNDS.— 
(A) IN
GENERAL.—Each eligible entity 
that receives a grant under this section shall 
use the grant funds to carry out an education 
program that provides adolescents with com-
prehensive sex education that— 
(i) is age and developmentally appro-
priate; 
(ii) is medically accurate and com-
plete; 
(iii) substantially incorporates ele-
ments of evidence-based sex education in-
struction; or 
(iv) creates a demonstration project 
based on characteristics of effective pro-
grams. 
(B) CONTENTS OF COMPREHENSIVE SEX 
EDUCATION
PROGRAMS.—The comprehensive 
sex education programs funded under this sec-
tion shall include instruction and materials that 
address— 
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(i) the physical, social, and emotional 
changes of human development including, 
human anatomy, reproduction, and sexual 
development; 
(ii) healthy relationships, including 
friendships, within families, and society, 
that are based on mutual respect, and the 
ability to distinguish between healthy and 
unhealthy relationships, including— 
(I) effective communication, ne-
gotiation and refusal skills, including 
the skills to recognize and report in-
appropriate or abusive sexual ad-
vances; 
(II) bodily autonomy, setting and 
respecting personal boundaries, prac-
ticing personal safety, and consent; 
and 
(III) the limitations and harm of 
gender-role stereotypes, violence, coer-
cion, bullying, harassment, and intimi-
dation in relationships; 
(iii) healthy decision-making skills 
about sexuality and relationships that in-
clude— 
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(I) critical thinking, problem 
solving, self-efficacy, stress-manage-
ment, self-care, and decisionmaking; 
(II) individual values and atti-
tudes; 
(III) the promotion of positive 
body images; 
(IV) developing an understanding 
that there are a range of body types 
and encouraging positive feeling about 
students’ own body types; 
(V) information on how to re-
spect others and ensure safety on the 
internet and when using other forms 
of digital communication; 
(VI) information on local services 
and resources where students can ob-
tain additional information related to 
bullying, harassment, dating violence 
and sexual assault, suicide prevention, 
and other related care; 
(VII) encouragement for youth to 
communicate with their parents or 
guardians, health and social service 
professionals, and other trusted adults 
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about sexuality and intimate relation-
ships; 
(VIII) information on how to cre-
ate a safe environment for all stu-
dents and others in society; 
(IX) examples of varying types of 
relationships, 
couples, 
and 
family 
structures; and 
(X) affirmative representation of 
varying gender identities, gender ex-
pressions, and sexual orientations, in-
cluding individuals and relationships 
between same sex couples and their 
families; 
(iv) abstinence, delaying age of first 
sexual activity, the use of condoms, preven-
tive medication, vaccination, birth control, 
and other sexually transmitted infection 
prevention measures, and the options for 
pregnancy, including parenting, adoption, 
and abortion, including— 
(I) the importance of effectively 
using condoms, preventive medication, 
and applicable vaccinations to protect 
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470 
against sexually transmitted infec-
tions, including HIV; 
(II) the benefits of effective con-
traceptive and condom use in avoiding 
unintended pregnancy; 
(III) the relationship between 
substance use and sexual health and 
behaviors; and 
(IV) 
information 
about 
local 
health services where students can ob-
tain additional information and serv-
ices related to sexual and reproductive 
health and other related care; 
(v) through affirmative recognition, 
the roles that traditions, values, religion, 
norms, gender roles, acculturation, family 
structure, health beliefs, and political 
power play in how students make decisions 
that affect their sexual health, using exam-
ples of various types of races, ethnicities, 
cultures, and families, including single-par-
ent households and young families; 
(vi) information about gender identity, 
gender expression, and sexual orientation 
for all students, including— 
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(I) affirmative recognition that 
people have different gender identi-
ties, gender expressions, and sexual 
orientations; and 
(II) community resources that 
can provide additional support for in-
dividuals with varying gender identi-
ties, gender expressions, and sexual 
orientations; and 
(vii) opportunities to explore the roles 
that race, ethnicity, immigration status, 
disability status, economic status, home-
lessness, foster care status, and language 
within different communities affect sexual 
attitudes in society and culture and how 
this may impact student sexual health. 
(c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 
AT INSTITUTIONS OF HIGHER EDUCATION.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Secretary of Education, shall 
award grants, on a competitive basis, to institutions 
of higher education or consortia of such institutions 
to enable such institutions to provide young people 
with comprehensive sex education, as described in 
paragraph (5)(B). 
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(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) APPLICATIONS.—An institution of higher 
education or consortium of such institutions desiring 
a grant under this subsection shall submit an appli-
cation to the Secretary at such time, in such man-
ner, and containing such information as the Sec-
retary may require, including an assurance to par-
ticipate in the evaluation described in subsection (e). 
(4) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to an in-
stitution of higher education that— 
(A) has an enrollment of needy students, 
as defined in section 318(b) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1059e(b)); 
(B) is a Hispanic-serving institution, as 
defined in section 502(a) of such Act (20 
U.S.C. 1101a(a)); 
(C) is a Tribal College or University, as 
defined in section 316(b) of such Act (20 
U.S.C. 1059c(b)); 
(D) is an Alaska Native-serving institution, 
as defined in section 317(b) of such Act (20 
U.S.C. 1059d(b)); 
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(E) is a Native Hawaiian-serving institu-
tion, as defined in section 317(b) of such Act 
(20 U.S.C. 1059d(b)); 
(F) is a Predominately Black Institution, 
as defined in section 318(b) of such Act (20 
U.S.C. 1059e(b)); 
(G) is a Native American-serving, non-
tribal institution, as defined in section 319(b) 
of such Act (20 U.S.C. 1059f(b)); 
(H) is an Asian American and Native 
American Pacific Islander-serving institution, as 
defined in section 320(b) of such Act (20 
U.S.C. 1059g(b)); or 
(I) is a minority institution, as defined in 
section 365 of such Act (20 U.S.C. 1067k), 
with an enrollment of needy students, as de-
fined in section 312 of such Act (20 U.S.C. 
1058). 
(5) USES OF FUNDS.— 
(A) IN GENERAL.—An institution of higher 
education, or a consortium, receiving a grant 
under this subsection shall use grant funds to 
integrate issues relating to comprehensive sex 
education into the institution of higher edu-
cation, or consortium, in order to reach a large 
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number of students, by carrying out 1 or more 
of the following activities: 
(i) Developing or adopting educational 
content for issues relating to comprehen-
sive sex education that will be incorporated 
into student orientation, general education, 
or core courses. 
(ii) Developing or adopting, and im-
plementing schoolwide educational pro-
gramming outside of class that delivers ele-
ments of comprehensive sex education pro-
grams to students, faculty, and staff. 
(iii) Developing or adopting innovative 
technology-based approaches to deliver sex 
education to students, faculty, and staff. 
(iv) Developing or adopting, and im-
plementing peer-outreach and education 
programs to generate discussion, educate, 
and raise awareness among students about 
issues relating to comprehensive sex edu-
cation. 
(B) CONTENTS OF SEX EDUCATION PRO-
GRAMS.—Each institution of higher education’s 
program of comprehensive sex education funded 
under this section shall include instruction and 
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materials that address the contents required 
under subsection (b)(6). 
(d) GRANTS
FOR PRE-SERVICE
AND IN-SERVICE 
TEACHER TRAINING.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Director of the Centers for 
Disease Control and Prevention and the Secretary of 
Education, shall award grants, on a competitive 
basis, to eligible entities to enable such eligible enti-
ties to carry out the activities described in para-
graph (5). 
(2) DURATION.—Grants awarded under this 
section shall be for a period of 5 years. 
(3) ELIGIBLE
ENTITY.—In this section, the 
term ‘‘eligible entity’’ means— 
(A) a State educational agency, as defined 
in section 8101 of the Elementary and Sec-
ondary Education of 1965 (20 U.S.C. 7801); 
(B) a local educational agency, as defined 
in section 8101 of the Elementary and Sec-
ondary Education of 1965 (20 U.S.C. 7801); 
(C) a Tribe or Tribal organization, as de-
fined in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 
5304); 
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(D) a State or local department of health; 
(E) a State or local department of edu-
cation; 
(F) an educational service agency, as de-
fined in section 8101 of the Elementary and 
Secondary Education of 1965 (20 U.S.C. 
7801); 
(G) a nonprofit institution of higher edu-
cation, as defined in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001); 
(H) a national or statewide nonprofit orga-
nization that has as its primary purpose the im-
provement of provision of comprehensive sex 
education through training and effective teach-
ing of comprehensive sex education; or 
(I) a consortium of nonprofit organizations 
that has as its primary purpose the improve-
ment of provision of comprehensive sex edu-
cation through training and effective teaching 
of comprehensive sex education. 
(4) APPLICATION.—An eligible entity desiring a 
grant under this subsection shall submit an applica-
tion to the Secretary at such time, in such manner, 
and containing such information as the Secretary 
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477 
may require, including an assurance to participate in 
the evaluation described in subsection (e). 
(5) AUTHORIZED ACTIVITIES.— 
(A) REQUIRED
ACTIVITY.—Each eligible 
entity receiving a grant under this section shall 
use grant funds for professional development 
and training of relevant faculty, school adminis-
trators, teachers, and staff, in order to increase 
effective teaching of comprehensive sex edu-
cation students. 
(B) PERMISSIBLE ACTIVITIES.—Each eligi-
ble entity receiving a grant under this section 
may use grant funds to— 
(i) provide research-based training of 
teachers for comprehensive sex education 
for adolescents as a means of broadening 
student knowledge about issues related to 
human development, healthy relationships, 
personal skills, and sexual behavior, includ-
ing abstinence, sexual health, and society 
and culture; 
(ii) support the dissemination of infor-
mation on effective practices and research 
findings concerning the teaching of com-
prehensive sex education; 
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(iii) support research on— 
(I) effective comprehensive sex 
education teaching practices; and 
(II) the development of assess-
ment instruments and strategies to 
document— 
(aa) student understanding 
of comprehensive sex education; 
and 
(bb) the effects of com-
prehensive sex education; 
(iv) convene national conferences on 
comprehensive sex education, in order to 
effectively train teachers in the provision of 
comprehensive sex education; and 
(v) develop and disseminate appro-
priate research-based materials to foster 
comprehensive sex education. 
(C) SUBGRANTS.—Each eligible entity re-
ceiving a grant under this subsection may 
award subgrants to nonprofit organizations that 
possess a demonstrated record of providing 
training to faculty, school administrators, 
teachers, and staff on comprehensive sex edu-
cation to— 
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(i) train teachers in comprehensive 
sex education; 
(ii) support internet or distance learn-
ing related to comprehensive sex education; 
(iii) promote rigorous academic stand-
ards and assessment techniques to guide 
and measure student performance in com-
prehensive sex education; 
(iv) encourage replication of best 
practices and model programs to promote 
comprehensive sex education; 
(v) develop and disseminate effective, 
research-based comprehensive sex edu-
cation learning materials; 
(vi) develop academic courses on the 
pedagogy of sex education at institutions 
of higher education; or 
(vii) convene State-based conferences 
to train teachers in comprehensive sex edu-
cation and to identify strategies for im-
provement. 
(e) IMPACT EVALUATION AND REPORTING.— 
(1) MULTI-YEAR EVALUATION.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
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Act, the Secretary shall enter into a contract 
with a nonprofit organization with experience in 
conducting impact evaluations, to conduct a 
multi-year evaluation on the impact of the 
grants under subsections (b), (c), and (d), and 
to report to Congress and the Secretary on the 
findings of such evaluation. 
(B) EVALUATION.—The evaluation con-
ducted under this subsection shall— 
(i) be conducted in a manner con-
sistent with relevant, nationally recognized 
professional 
and 
technical 
evaluation 
standards; 
(ii) use sound statistical methods and 
techniques 
relating 
to 
the 
behavioral 
sciences, including quasi-experimental de-
signs, inferential statistics, and other 
methodologies and techniques that allow 
for conclusions to be reached; 
(iii) be carried out by an independent 
organization that has not received a grant 
under subsection (b), (c), or (d); and 
(iv) be designed to provide informa-
tion on— 
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483 
lying, harassment, stalking; 
and 
(FF) 
academic 
per-
formance; and 
(III) other measures necessary to 
evaluate the impact of the grant pro-
gram. 
(C) REPORT.—Not later than 6 years after 
the date of enactment of this Act, the organiza-
tion conducting the evaluation under this sub-
section shall prepare and submit to the appro-
priate committees of Congress and the Sec-
retary an evaluation report. Such report shall 
be made publicly available, including on the 
website of the Department of Health and 
Human Services. 
(2) SECRETARY’S REPORT TO CONGRESS.—Not 
later than 1 year after the date of the enactment of 
this Act, and annually thereafter for a period of 5 
years, the Secretary shall prepare and submit to the 
appropriate committees of Congress a report on the 
activities to provide adolescents and young people 
with comprehensive sex education and pre-service 
and in-service teacher training funded under this 
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484 
section. The Secretary’s report to Congress shall in-
clude— 
(A) a statement of how grants awarded by 
the Secretary meet the purposes described in 
subsection (a)(1); and 
(B) information about— 
(i) the number of eligible entities and 
institutions of higher education that are 
receiving grant funds under subsections 
(b), (c), and (d); 
(ii) the specific activities supported by 
grant funds awarded under subsections 
(b), (c), and (d); 
(iii) the number of adolescents served 
by grant programs funded under sub-
section (b); 
(iv) the number of young people 
served by grant programs funded under 
subsection (c); 
(v) the number of faculty, school ad-
ministrators, teachers, and staff trained 
under subsection (d); and 
(vi) the status of the evaluation re-
quired under paragraph (1). 
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(f) NONDISCRIMINATION.—Programs funded under 
this section shall not discriminate on the basis of actual 
or perceived sex, race, color, ethnicity, national origin, dis-
ability, sexual orientation, gender identity, or religion. 
Nothing in this section shall be construed to invalidate or 
limit rights, remedies, procedures, or legal standards avail-
able under any other Federal law or any law of a State 
or a political subdivision of a State, including the Civil 
Rights Act of 1964 (42 U.S.C. 2000a et seq.), title IX 
of the Education Amendments of 1972 (20 U.S.C. 1681 
et seq.), section 504 of the Rehabilitation Act of 1973 (29 
U.S.C. 794), the Americans with Disabilities Act of 1990 
(42 U.S.C. 12101 et seq.), and section 1557 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18116). 
(g) LIMITATION.—No Federal funds provided under 
this section may be used for health education programs 
that— 
(1) withhold health-promoting or life-saving in-
formation about sexuality-related topics, including 
HIV; 
(2) are medically inaccurate or have been sci-
entifically shown to be ineffective; 
(3) promote gender or racial stereotypes; 
(4) are insensitive and unresponsive to the 
needs of sexually active young people; 
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(5) are insensitive and unresponsive to the 
needs of pregnant or parenting young people; 
(6) are insensitive and unresponsive to the 
needs of survivors of sexual abuse or assault; 
(7) are insensitive and unresponsive to the 
needs of youth of all physical, developmental, or 
mental abilities; 
(8) are insensitive and unresponsive to individ-
uals with varying gender identities, gender expres-
sions, and sexual orientations; or 
(9) are inconsistent with the ethical imperatives 
of medicine and public health. 
(h) AMENDMENTS TO OTHER LAWS.— 
(1) AMENDMENT
TO
THE
PUBLIC
HEALTH 
SERVICE ACT.—Section 2500 of the Public Health 
Service Act (42 U.S.C. 300ee) is amended by strik-
ing subsections (b) through (d) and inserting the fol-
lowing: 
‘‘(b) CONTENTS
OF PROGRAMS.—All programs of 
education and information receiving funds under this sub-
chapter shall include information about the potential ef-
fects of intravenous substance abuse.’’. 
(2) AMENDMENTS TO THE ELEMENTARY AND 
SECONDARY EDUCATION ACT OF 1965.—Section 8526 
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487 
of the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7906) is amended— 
(A) by striking paragraph (3); 
(B) by redesignating paragraphs (4) and 
(5) as paragraphs (3) and (4), respectively; 
(C) in paragraph (4), by inserting ‘‘or’’ 
after the semicolon; 
(D) in paragraph (5), by striking ‘‘; or’’ 
and inserting a period; and 
(E) by striking paragraph (6). 
(i) DEFINITIONS.—In this section: 
(1) ADOLESCENTS.—The term ‘‘adolescents’’ 
means individuals who are ages 10 through 19 at 
the time of commencement of participation in a pro-
gram supported under this section. 
(2) AGE
AND
DEVELOPMENTALLY
APPRO-
PRIATE.—The term ‘‘age and developmentally appro-
priate’’ means topics, messages, and teaching meth-
ods suitable to particular age, age group of children 
and adolescents, or developmental levels, based on 
cognitive, emotional, social, and behavioral capacity 
of most students at that age level. 
(3) 
APPROPRIATE
COMMITTEES
OF
CON-
GRESS.—The term ‘‘appropriate committees of Con-
gress’’ means the Committee on Health, Education, 
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488 
Labor, and Pensions of the Senate, the Committee 
on Appropriations of the Senate, the Committee on 
Energy and Commerce of the House of Representa-
tives, the Committee on Education and the Work-
force of the House of Representatives, and the Com-
mittee on Appropriations of the House of Represent-
atives. 
(4) CHARACTERISTICS
OF
EFFECTIVE
PRO-
GRAMS.—The term ‘‘characteristics of effective pro-
grams’’ means the aspects of evidence-based pro-
grams, including development, content, and imple-
mentation of such programs, that— 
(A) have been shown to be effective in 
terms of increasing knowledge, clarifying values 
and attitudes, increasing skills, and impacting 
upon behavior; and 
(B) are widely recognized by leading med-
ical and public health agencies to be effective in 
changing sexual behaviors that lead to sexually 
transmitted infections, including HIV, unin-
tended pregnancy, and dating violence and sex-
ual assault among young people. 
(5) COMPREHENSIVE
SEX
EDUCATION.—The 
term ‘‘comprehensive sex education’’ means instruc-
tional part of a comprehensive school health edu-
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489 
cation approach which addresses the physical, men-
tal, emotional, and social dimensions of human sexu-
ality; designed to motivate and assist students to 
maintain and improve their sexual health, prevent 
disease and reduce sexual health-related risk behav-
iors; and enable and empower students to develop 
and demonstrate age and developmentally appro-
priate sexuality and sexual health-related knowledge, 
attitudes, skills, and practices. 
(6) CONSENT.—The term ‘‘consent’’ means af-
firmative, conscious, and voluntary agreement to en-
gage in interpersonal, physical, or sexual activity. 
(7) CULTURALLY
APPROPRIATE.—The term 
‘‘culturally appropriate’’ means materials and in-
struction that respond to culturally diverse individ-
uals, families and communities in an inclusive, re-
spectful and effective manner; including materials 
and instruction that are inclusive of race, ethnicity, 
languages, cultural background, religion, sex, gender 
identity, sexual orientation, and different abilities. 
(8) EVIDENCE-BASED.—The term ‘‘evidence- 
based’’, when used with respect to sex education in-
struction, means a sex education program that has 
been proven through rigorous evaluation to be effec-
tive in changing sexual behavior or incorporates ele-
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490 
ments of other programs that have been proven to 
be effective in changing sexual behavior. 
(9) GENDER EXPRESSION.—The term ‘‘gender 
expression’’, when used with respect to a sex edu-
cation program, means the expression of one’s gen-
der, such as through behavior, clothing, haircut, or 
voice, and which may or may not conform to socially 
defined behaviors and characteristics typically asso-
ciated with being either masculine or feminine. 
(10) GENDER IDENTITY.—Except with respect 
to subsection (f), the term ‘‘gender identity’’, when 
used with respect to a sex education program, means 
the gender-related identity, appearance, mannerisms, 
or other gender-related characteristics of an indi-
vidual, regardless of the individual’s designated sex 
at birth including a person’s deeply held sense or 
knowledge of their own gender; such as male, fe-
male, both or neither. 
(11) INCLUSIVE.—The term ‘‘inclusive’’, when 
used with respect to a sex education program, means 
curriculum that ensures that students from histori-
cally marginalized communities are reflected in 
classroom materials and lessons. 
(12) INSTITUTION OF HIGHER EDUCATION.— 
The term ‘‘institution of higher education’’ has the 
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491 
meaning given the term in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001). 
(13) MEDICALLY ACCURATE AND COMPLETE.— 
The term ‘‘medically accurate and complete’’, when 
used with respect to a sex education program, means 
that— 
(A) the information provided through the 
program is verified or supported by the weight 
of research conducted in compliance with ac-
cepted scientific methods and is published in 
peer-reviewed journals, where applicable; or 
(B)(i) the program contains information 
that leading professional organizations and 
agencies with relevant expertise in the field rec-
ognize as accurate, objective, and complete; and 
(ii) the program does not withhold infor-
mation about the effectiveness and benefits of 
correct and consistent use of condoms and 
other contraceptives. 
(14) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services. 
(15) SEXUAL DEVELOPMENT.—The term ‘‘sex-
ual development’’ means the lifelong process of phys-
ical, behavioral, cognitive, and emotional growth and 
change as it relates to an individual’s sexuality and 
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492 
sexual maturation, including puberty, identity devel-
opment, socio-cultural influences, and sexual behav-
iors. 
(16) SEXUAL ORIENTATION.—Except with re-
spect to subsection (f), the term ‘‘sexual orienta-
tion’’, when used with respect to a sex education 
program, means an individual’s attraction, including 
physical or emotional, to the same or different gen-
der. 
(17) YOUNG PEOPLE.—The term ‘‘young peo-
ple’’ means individuals who are ages 10 through 24 
at the time of commencement of participation in a 
program supported under this section. 
(j) FUNDING.— 
(1) APPROPRIATION.—For the purpose of car-
rying out this section, there is appropriated 
$75,000,000 for each of fiscal years 2021 through 
2026. Amounts appropriated under this subsection 
shall remain available until expended. 
(2) RESERVATIONS OF FUNDS.— 
(A) The Secretary shall reserve 50 percent 
of the amount appropriated under paragraph 
(1) for the purposes of awarding grants for 
comprehensive sex education for adolescents 
under subsection (c). 
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494 
In carrying out such functions, the Secretary shall 
collaborate with a variety of entities that have exper-
tise in adolescent sexual health development, edu-
cation, and promotion. 
(4) REPROGRAMMING
OF
ABSTINENCE
ONLY 
UNTIL MARRIAGE PROGRAM FUNDING.—The unobli-
gated balance of funds made available to carry out 
section 510 of the Social Security Act (42 U.S.C. 
710) (as in effect on the day before the date of en-
actment of this Act) are hereby transferred and shall 
be used by the Secretary to carry out this section. 
The amounts transferred and made available to 
carry out this section shall remain available until ex-
pended. 
(5) REPEAL OF ABSTINENCE ONLY UNTIL MAR-
RIAGE PROGRAM.—Section 510 of the Social Secu-
rity Act (42 U.S.C. 710) is repealed. 
SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER-
GENCIES. 
(a) MEDICARE.— 
(1) 
LIMITATION
ON
PAYMENT.—Section 
1866(a)(1) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended— 
(A) by moving the indentation of subpara-
graph (W) 2 ems to the left; 
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495 
(B) in subparagraph (X)— 
(i) by moving the indentation 2 ems 
to the left; and 
(ii) by striking ‘‘and’’ at the end; 
(C) in subparagraph (Y), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by inserting after subparagraph (Y) 
the following new subparagraph: 
‘‘(Z) in the case of a hospital or critical access 
hospital, to adopt and enforce a policy to ensure 
compliance with the requirements of subsection (l) 
and to meet the requirements of such subsection.’’. 
(2) ASSISTANCE TO VICTIMS.—Section 1866 of 
the Social Security Act (42 U.S.C. 1395cc) is 
amended by adding at the end the following new 
subsection: 
‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER-
GENCIES.— 
‘‘(1) IN
GENERAL.—For purposes of section 
1866(a)(1)(Z), a hospital meets the requirements of 
this subsection if the hospital provides each of the 
services described in paragraph (2) to each indi-
vidual, whether or not eligible for benefits under this 
title or under any other form of health insurance, 
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496 
who comes to the hospital on or after January 1, 
2021, and— 
‘‘(A) who states to hospital personnel that 
they are victims of sexual assault; 
‘‘(B) who is accompanied by an individual 
who states to hospital personnel that the indi-
vidual is a victim of sexual assault; or 
‘‘(C) whom hospital personnel, during the 
course of treatment and care for the individual, 
have reason to believe is a victim of sexual as-
sault. 
‘‘(2) REQUIRED
SERVICES
DESCRIBED.—For 
purposes of paragraph (1), the services described in 
this subparagraph are the following: 
‘‘(A) Provision of medically and factually 
accurate and unbiased written and oral infor-
mation about emergency contraception that— 
‘‘(i) is written in clear and concise 
language; 
‘‘(ii) is readily comprehensible; 
‘‘(iii) includes an explanation that 
emergency contraceptives— 
‘‘(I) has been approved by the 
Food and Drug Administration for in-
dividuals and is a safe and effective 
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way to prevent pregnancy after unpro-
tected intercourse or contraceptive 
failure if taken in a timely manner; 
‘‘(II) is more effective the sooner 
it is taken; and 
‘‘(III) does not cause an abortion 
and cannot interrupt an established 
pregnancy; 
‘‘(iv) meets such conditions regarding 
the provision of such information in lan-
guages other than English as the Secretary 
may establish; and 
‘‘(v) is provided without regard to the 
ability of the individual or their family to 
pay costs associated with the provision of 
such information to the individual. 
‘‘(B) Immediate offer to provide emergency 
contraception to the individual at the hospital 
and, in the case that the individual accepts such 
offer, immediate provision to the individual of 
such contraception on the same day it is re-
quested without regard to the inability of the 
individual or their family to pay costs associ-
ated with the offer and provision of such con-
traception. 
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‘‘(C) Development and implementation of a 
written policy to ensure that an individual is 
present at the hospital, or on-call, who— 
‘‘(i) has authority to dispense or pre-
scribe emergency contraception, independ-
ently, or under a protocol prepared by a 
physician for the administration of emer-
gency contraception at the hospital to a 
victim of sexual assault; and 
‘‘(ii) is trained to comply with the re-
quirements of this section. 
‘‘(D) Provision of medically and factually 
accurate and unbiased written and oral infor-
mation and counseling about post-exposure pro-
phylaxis (PEP) protocol for the prevention of 
HIV. 
‘‘(E) Immediately offer to begin PEP to 
the individual at the hospital except in cases 
where the medical professional’s best judgement 
is that further evaluation is required or that 
such a regimen will be substantially detrimental 
to the individual’s health. Such provision shall 
be offered regardless of the individual’s ability 
to pay. Hospitals shall be responsible for ensur-
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ing adequate supply of PEP medications to pro-
vide to patients. 
‘‘(3) HOSPITAL
DEFINED.—For purposes of 
this paragraph, the term ‘hospital’ includes a critical 
access 
hospital, 
as 
defined 
in 
section 
1861(mm)(1).’’. 
(b) LIMITATION ON PAYMENT UNDER MEDICAID.— 
Section 1903(i) of the Social Security Act (42 U.S.C. 
1396b(i)) is amended by inserting after paragraph (8) the 
following new paragraph: 
‘‘(9) with respect to any amount expended for 
care or services furnished under the plan by a hos-
pital on or after January 1, 2021, unless such hos-
pital meets the requirements specified in section 
1866(l) for purposes of title XVIII.’’. 
SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR-
MACIES TO ENSURE PROVISION OF FDA-AP-
PROVED CONTRACEPTION. 
Part B of title II of the Public Health Service Act 
(42 U.S.C. 238 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 
OF FDA-APPROVED CONTRACEPTION. 
‘‘(a) IN GENERAL.—Subject to subsection (c), a 
pharmacy that receives Food and Drug Administration- 
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approved drugs or devices in interstate commerce shall 
maintain compliance with the following: 
‘‘(1) If a customer requests a contraceptive or 
a medication related to a contraceptive, including 
emergency contraception, that is in stock, the phar-
macy shall ensure that the contraceptive is provided 
to the customer without delay. 
‘‘(2) If a customer requests a contraceptive or 
a medication related to a contraceptive that is not 
in stock and the pharmacy in the normal course of 
business stocks contraception, the pharmacy shall 
immediately inform the customer that the contracep-
tive is not in stock and without delay offer the cus-
tomer the following options: 
‘‘(A) If the customer prefers to obtain the 
contraceptive or a medication related to a con-
traceptive through a referral or transfer, the 
pharmacy shall— 
‘‘(i) locate a pharmacy of the cus-
tomer’s choice or the closest pharmacy 
confirmed to have the contraceptive or a 
medication related to a contraceptive in 
stock; and 
‘‘(ii) refer the customer or transfer 
the prescription to that pharmacy. 
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‘‘(2) If the customer is unable to pay for the 
contraceptive or the medication related to a contra-
ceptive. 
‘‘(3) If the employee of the pharmacy refuses to 
provide the contraceptive or a medication related to 
a contraceptive on the basis of a professional clinical 
judgment. 
‘‘(d) RELATION TO OTHER LAW.— 
‘‘(1) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to invalidate or limit 
rights, remedies, procedures, or legal standards 
under title VII of the Civil Rights Act of 1964. 
‘‘(2) CERTAIN
CLAIMS.—The Religious Free-
dom Restoration Act of 1993 shall not provide a 
claim concerning, or a defense to a claim under this 
section, or provide a basis for challenging the appli-
cation or enforcement of this section. 
‘‘(e) PREEMPTION.—This section does not preempt 
any provision of State law or any professional obligation 
made applicable by a State board or other entity respon-
sible for licensing or discipline of pharmacies or phar-
macists, to the extent that such State law or professional 
obligation provides protections for customers that are 
greater than the protections provided by this section. 
‘‘(f) ENFORCEMENT.— 
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‘‘(1) CIVIL PENALTY.—A pharmacy that vio-
lates a requirement of subsection (a) is liable to the 
United States for a civil penalty in an amount not 
exceeding $1,000 per day of violation, not to exceed 
$100,000 for all violations adjudicated in a single 
proceeding. 
‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 
aggrieved as a result of a violation of a requirement 
of subsection (a) may, in any court of competent ju-
risdiction, commence a civil action against the phar-
macy involved to obtain appropriate relief, including 
actual and punitive damages, injunctive relief, and a 
reasonable attorney’s fee and cost. 
‘‘(3) LIMITATIONS.—A civil action under para-
graph (1) or (2) may not be commenced against a 
pharmacy after the expiration of the 5-year period 
beginning on the date on which the pharmacy alleg-
edly engaged in the violation involved. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) CONTRACEPTION.—The term ‘contracep-
tion’ or ‘contraceptive’ means any drug or device ap-
proved by the Food and Drug Administration to pre-
vent pregnancy. 
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‘‘(2) EMPLOYEE.—The term ‘employee’ means 
a person hired, by contract or any other form of an 
agreement, by a pharmacy. 
‘‘(3) MEDICATION RELATED TO A CONTRACEP-
TIVE.—The term ‘medication related to a contracep-
tive’ means any drug or device approved by the Food 
and Drug Administration that a medical professional 
determines necessary to use before or in conjunction 
with a contraceptive. 
‘‘(4) PHARMACY.—The term ‘pharmacy’ means 
an entity that— 
‘‘(A) is authorized by a State to engage in 
the business of selling prescription drugs at re-
tail; and 
‘‘(B) employs one or more employees. 
‘‘(5) PRODUCT.—The term ‘product’ means a 
Food and Drug Administration-approved drug or de-
vice. 
‘‘(6) PROFESSIONAL
CLINICAL
JUDGMENT.— 
The term ‘professional clinical judgment’ means the 
use of professional knowledge and skills to form a 
clinical judgment, in accordance with prevailing 
medical standards. 
‘‘(7) WITHOUT
DELAY.—The term ‘without 
delay’, with respect to a pharmacy providing, pro-
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viding a referral for, or ordering contraception, or 
transferring the prescription for contraception, 
means within the usual and customary timeframe at 
the pharmacy for providing, providing a referral for, 
or ordering other products, or transferring the pre-
scription for other products, respectively. 
‘‘(h) EFFECTIVE DATE.—This section shall take ef-
fect on the 31st day after the date of the enactment of 
this section, without regard to whether the Secretary has 
issued any guidance or final rule regarding this section.’’. 
SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 
WOMEN’S HEALTH. 
Section 229(b) of the Public Health Service Act (42 
U.S.C. 237a(b)) is amended— 
(1) in paragraph (6), at the end, by striking 
‘‘and’’; 
(2) in paragraph (7), at the end, by striking the 
period and inserting a semicolon; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(8) facilitate policymakers, health system lead-
ers and providers, consumers, and other stake-
holders in understanding optimal maternity care and 
support for the provision of such care, including the 
priorities of— 
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‘‘(A) protecting, promoting, and supporting 
the innate capacities of childbearing individuals 
and their newborns for childbirth, breastfeed-
ing, and attachment; 
‘‘(B) using obstetric interventions only 
when such interventions are supported by 
strong, high-quality evidence, and minimizing 
overuse of maternity practices that have been 
shown to have benefit in limited situations and 
that can expose women, infants, or both to risk 
of harm if used routinely and indiscriminately, 
including continuous electronic fetal monitoring, 
labor induction, epidural analgesia, primary ce-
sarean section, and routine repeat cesarean 
birth; 
‘‘(C) reliably incorporating noninvasive, 
evidence-based practices that have documented 
correlation with considerable improvement in 
outcomes with no detrimental side effects, such 
as smoking cessation programs in pregnancy 
and proven models of group prenatal care that 
integrate health assessment, education, and 
support into a unified program and supporting 
evidence-based breastfeeding promotion efforts 
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with respect for a breastfeeding individual’s 
personal decisionmaking; 
‘‘(D) a shared understanding of the quali-
fications of licensed providers of maternity care 
and the best evidence about the safety, satisfac-
tion, outcomes, and costs of their care, and ap-
propriate deployment of such caregivers within 
the maternity care workforce to address the 
needs of childbearing individuals and newborns 
and the growing shortage of maternity care-
givers; 
‘‘(E) a shared understanding of the results 
of the best available research comparing hos-
pital, birth center, and planned home births, in-
cluding information about each setting’s safety, 
satisfaction, outcomes, and costs; 
‘‘(F) high-quality, evidence-based child-
birth education that promotes a natural, 
healthy, and safe approach to pregnancy, child-
birth, and early parenting; is taught by certified 
educators, peer counselors, and health profes-
sionals; and promotes informed decisionmaking 
by childbearing individuals; and 
‘‘(G) developing measures that enable a 
more robust, balanced set of standardized ma-
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509 
ternity care measures, including performance 
and quality measures;’’. 
SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
(a) IN GENERAL.—Part A of title II of the Public 
Health Service Act (42 U.S.C. 202 et seq.) is amended 
by adding at the end the following: 
‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Deputy Assistant Secretary for Women’s Health under 
section 229 and in collaboration with the Federal officials 
specified in subsection (b), shall establish the Interagency 
Coordinating Committee on the Promotion of Optimal Ma-
ternity Outcomes (referred to in this section as the 
‘ICCPOM’). 
‘‘(b) OTHER AGENCIES.—The officials specified in 
this subsection are the Secretary of Labor, the Secretary 
of Defense, the Secretary of Veterans Affairs, the Surgeon 
General, the Director of the Centers for Disease Control 
and Prevention, the Administrator of the Health Re-
sources and Services Administration, the Administrator of 
the Centers for Medicare & Medicaid Services, the Direc-
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tor of the Indian Health Service, the Administrator of the 
Substance Abuse and Mental Health Services Administra-
tion, the Director of the National Institute on Child 
Health and Development, the Director of the Agency for 
Healthcare Research and Quality, the Assistant Secretary 
for Children and Families, the Deputy Assistant Secretary 
for Minority Health, the Director of the Office of Per-
sonnel Management, and such other Federal officials as 
the Secretary of Health and Human Services determines 
to be appropriate. 
‘‘(c) CHAIR.—The Deputy Assistant Secretary for 
Women’s Health shall serve as the chair of the ICCPOM. 
‘‘(d) DUTIES.—The ICCPOM shall guide policy and 
program development across the Federal Government with 
respect to promotion of optimal maternity care, provided, 
however, that nothing in this section shall be construed 
as transferring regulatory or program authority from an 
agency to the ICCPOM. 
‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 
seek the input of, and shall consult with, all appropriate 
and interested stakeholders, including State health depart-
ments, public health research and interest groups, founda-
tions, childbearing individuals and their advocates, and 
maternity care professional associations and organiza-
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tions, reflecting racially, ethnically, demographically, and 
geographically diverse communities. 
‘‘(f) ANNUAL REPORT.— 
‘‘(1) IN GENERAL.—The Secretary, on behalf of 
the ICCPOM, shall annually submit to Congress a 
report that summarizes— 
‘‘(A) all programs and policies of Federal 
agencies (including the Medicare Program 
under title XVIII of the Social Security Act and 
the Medicaid program under title XIX of such 
Act) designed to promote optimal maternity 
care, focusing particularly on programs and 
policies that support the adoption of evidence 
based maternity care, as defined by timely, sci-
entifically sound systematic reviews; 
‘‘(B) all programs and policies of Federal 
agencies (including the Medicare Program 
under title XVIII of the Social Security Act and 
the Medicaid program under title XIX of such 
Act) designed to address the problems of mater-
nal mortality and morbidity, infant mortality, 
prematurity, and low birth weight, including 
such programs and policies designed to address 
racial and ethnic disparities with respect to 
each of such problems; 
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‘‘(C) the extent of progress in reducing 
maternal mortality and infant mortality, low 
birth weight, and prematurity at State and na-
tional levels; and 
‘‘(D) such other information regarding op-
timal maternity care (such as quality and per-
formance measures) as the Secretary deter-
mines to be appropriate. 
The information specified in subparagraph (C) shall 
be included in each such report in a manner that 
disaggregates such information by race, ethnicity, 
and indigenous status in order to determine the ex-
tent of progress in reducing racial and ethnic dis-
parities and disparities related to indigenous status. 
‘‘(2) CERTAIN
INFORMATION.—Each report 
under paragraph (1) shall include information 
(disaggregated by race, ethnicity, and indigenous 
status, as applicable) on the following rates and 
costs by State: 
‘‘(A) The rate of primary cesarean deliv-
eries and repeat cesarean deliveries. 
‘‘(B) The rate of vaginal births after cesar-
ean. 
‘‘(C) The rate of vaginal breech births. 
‘‘(D) The rate of induction of labor. 
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‘‘(E) The rate of freestanding birth center 
births. 
‘‘(F) The rate of planned and unplanned 
home birth. 
‘‘(G) The rate of attended births by pro-
vider, including by an obstetrician-gynecologist, 
family practice physician, obstetrician-gyne-
cologist physician assistant, certified nurse-mid-
wife, certified midwife, and certified profes-
sional midwife. 
‘‘(H) 
The 
cost 
of 
maternity 
care 
disaggregated by place of birth and provider of 
care, including— 
‘‘(i) uncomplicated vaginal birth; 
‘‘(ii) complicated vaginal birth; 
‘‘(iii) uncomplicated cesarean birth; 
and 
‘‘(iv) complicated cesarean birth. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated, in addition to amounts 
authorized to be appropriated under section 229(e), to 
carry out this section $1,000,000 for each of the fiscal 
years 2021 through 2025.’’. 
(b) CONFORMING AMENDMENTS.— 
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(1) INCLUSION AS DUTY OF HHS OFFICE ON 
WOMEN’S HEALTH.—Section 229(b) of such Act (42 
U.S.C. 237a(b)), as amended by section 514, is fur-
ther amended by adding at the end the following 
new paragraph: 
‘‘(9) establish the Interagency Coordinating 
Committee on the Promotion of Optimal Maternity 
Outcomes in accordance with section 229A; and’’. 
(2) TREATMENT OF BIENNIAL REPORTS.—Sec-
tion 229(d) of such Act (42 U.S.C. 237a(d)) is 
amended by inserting ‘‘(other than under subsection 
(b)(9))’’ after ‘‘under this section’’. 
SEC. 516. CONSUMER EDUCATION CAMPAIGN. 
Section 229(b) of the Public Health Service Act (42 
U.S.C. 237a(b)), as amended by sections 514 and 515, 
is further amended by adding at the end the following: 
‘‘(10) not later than one year after the date of 
the enactment of the Health Equity and Account-
ability Act of 2020, develop and implement a 4-year 
culturally and linguistically appropriate multimedia 
consumer education campaign that is designed to 
promote understanding and acceptance of evidence- 
based maternity practices and models of care for op-
timal maternity outcomes among individuals of 
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childbearing ages and families of such individuals 
and that— 
‘‘(A) highlights the importance of pro-
tecting, promoting, and supporting the innate 
capacities of childbearing individuals and their 
newborns for childbirth, breastfeeding, and at-
tachment; 
‘‘(B) promotes understanding of the impor-
tance of using obstetric interventions when 
medically necessary and when supported by 
strong, high-quality evidence; 
‘‘(C) highlights the widespread overuse of 
maternity practices that have been shown to 
have benefit when used appropriately in situa-
tions of medical necessity, but which can expose 
pregnant individuals, infants, or both to risk of 
harm if used routinely and indiscriminately, in-
cluding continuous fetal monitoring, labor in-
duction, epidural anesthesia, elective primary 
cesarean section, and repeat cesarean delivery; 
‘‘(D) emphasizes the noninvasive maternity 
practices that have strong proven correlation or 
may be associated with considerable improve-
ment in outcomes with no detrimental side ef-
fects, and are significantly underused in the 
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United States, including smoking cessation pro-
grams in pregnancy, group model prenatal care, 
continuous labor support, nonsupine positions 
for birth, and external version to turn breech 
babies at term; 
‘‘(E) educates consumers about the quali-
fications of licensed providers of maternity care 
and the best evidence about their safety, satis-
faction, outcomes, and costs; 
‘‘(F) informs consumers about the best 
available research comparing birth center 
births, planned home births, and hospital 
births, including information about each set-
ting’s safety, satisfaction, outcomes, and costs; 
‘‘(G) fosters participation in high-quality, 
evidence-based childbirth education that pro-
motes a natural, healthy, and safe approach to 
pregnancy, childbirth, and early parenting; is 
taught by certified educators, peer counselors, 
and health professionals; and promotes in-
formed decisionmaking by childbearing individ-
uals; and 
‘‘(H) is pilot tested for consumer com-
prehension, cultural sensitivity, and acceptance 
of the messages across geographically, racially, 
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ethnically, and linguistically diverse popu-
lations.’’. 
SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE-
VIEWS FOR CARE OF CHILDBEARING INDI-
VIDUALS AND NEWBORNS. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services, through the Agency for Healthcare 
Research and Quality, shall— 
(1) make publicly available an online biblio-
graphic database identifying systematic reviews, in-
cluding an explanation of the level and quality of 
evidence, for care of childbearing individuals and 
newborns; and 
(2) initiate regular updates that incorporate 
newly issued and updated systematic reviews. 
(b) SOURCES.—To aim for a comprehensive inventory 
of systematic reviews relevant to maternal and newborn 
care, the database shall identify reviews from diverse 
sources, including— 
(1) scientific peer-reviewed journals; 
(2) databases, including Cochrane Database of 
Systematic Reviews, Clinical Evidence, and Data-
base of Abstracts of Reviews of Effects; and 
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(3) Internet websites of agencies and organiza-
tions throughout the world that produce such sys-
tematic reviews. 
(c) FEATURES.—The database shall— 
(1) provide bibliographic citations for each 
record within the database, and for each such cita-
tion include an explanation of the level and quality 
of evidence; 
(2) include abstracts, as available; 
(3) provide reference to companion documents 
as may exist for each review, such as evidence tables 
and guidelines or consumer educational materials de-
veloped from the review; 
(4) provide links to the source of the full review 
and to any companion documents; 
(5) provide links to the source of a previous 
version or update of the review; 
(6) be searchable by intervention or other topic 
of the review, reported outcomes, author, title, and 
source; and 
(7) offer to users periodic electronic notification 
of database updates relating to users’ topics of inter-
est. 
(d) OUTREACH.—Not later than the first date the 
database is made publicly available and periodically there-
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(ii) Entrance into the training pro-
gram for the profession. 
(iii) Graduation from such training 
program. 
(iv) Entrance into practice, including 
barriers triggered by criminal records. 
(v) Retention in practice for more 
than a 5-year period. 
(B) To develop one or more strategies to 
address the workforce disparities within the 
health profession, as identified under (and in 
response to the findings pursuant to) subpara-
graph (A). 
(2) APPLICATION.—To be eligible to receive a 
grant under this subsection, an eligible health pro-
fessional organization shall submit to the Secretary 
of Health and Human Services an application in 
such form and manner and containing such informa-
tion as specified by the Secretary. 
(3) AMOUNT.—Each grant awarded under this 
subsection shall be for an amount not to exceed 
$300,000. 
(4) REPORT.—Each recipient of a grant under 
this subsection shall submit to the Secretary of 
Health and Human Services a report containing— 
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