487 
(A)(i) shall at any one time be of the same po-
litical party. Such members shall have recog-
nized expertise in and personal experience with 
racial and ethnic health inequities, health care 
needs of vulnerable and marginalized popu-
lations, and health equity as a vehicle for im-
proving health status and health outcomes. 
Such members shall be appointed to the Com-
mission as follows: 
(i) 4 members of the Commission 
shall be appointed by the President. 
(ii) 2 members of the Commission 
shall be appointed by the President pro 
tempore of the Senate, upon the rec-
ommendations of the majority leader and 
the minority leader of the Senate. Each 
member appointed to the Commission 
under this clause shall be appointed from 
a different political party. 
(iii) 2 members of the Commission 
shall be appointed by the Speaker of the 
House of Representatives upon the rec-
ommendations of the majority leader and 
the minority leader of the House of Rep-
resentatives. Each member appointed to 
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the Commission under this clause shall be 
appointed from a different political party. 
(C) EX OFFICIO MEMBER.—The Commis-
sion shall have the following nonvoting, ex offi-
cio members: 
(i) The Director for Civil Rights and 
Health Equity of the Department of 
Health and Human Services. 
(ii) The Deputy Assistant Secretary 
for Minority Health of the Department of 
Health and Human Services. 
(iii) The Director of the National In-
stitute on Minority Health and Health Dis-
parities. 
(iv) The Chairperson of the Advisory 
Committee on Minority Health established 
under section 1707(c) of the Public Health 
Service Act (42 U.S.C. 300u–6(c)). 
(3) TERMS.—The term of office of each mem-
ber appointed under paragraph (2)(B) of the Com-
mission shall be 6 years. 
(4) CHAIRPERSON; VICE CHAIRPERSON.— 
(A) CHAIRPERSON.—The President shall, 
with the concurrence of a majority of the mem-
bers of the Commission appointed under para-
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graph (2)(B), designate a Chairperson from 
among the members of the Commission ap-
pointed under such paragraph. 
(B) VICE CHAIRPERSON.— 
(i) DESIGNATION.—The Speaker of 
the House of Representatives shall, in con-
sultation with the majority leaders and the 
minority leaders of the Senate and the 
House of Representatives and with the 
concurrence of a majority of the members 
of the Commission appointed under para-
graph (2)(B), designate a Vice Chairperson 
from among the members of the Commis-
sion appointed under such paragraph. The 
Vice Chairperson may not be a member of 
the same political party as the Chair-
person. 
(ii) DUTY.—The Vice Chairperson 
shall act in place of the Chairperson in the 
absence of the Chairperson. 
(5) REMOVAL
OF
MEMBERS.—The President 
may remove a member of the Commission only for 
neglect of duty or malfeasance in office. 
(6) QUORUM.—A majority of members of the 
Commission appointed under paragraph (2)(B) shall 
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constitute a quorum of the Commission, but a lesser 
number of members may hold hearings. 
(b) DUTIES OF THE COMMISSION.— 
(1) IN GENERAL.—The Commission shall— 
(A) monitor and report on the implementa-
tion of this Act; and 
(B) investigate, monitor, and report on 
progress towards health equity and the elimi-
nation of health disparities. 
(2) 
ANNUAL
REPORT.—The 
Commission 
shall— 
(A) submit to the President and Congress 
at least one report annually on health equity 
and health disparities; and 
(B) include in such report— 
(i) a description of actions taken by 
the Department of Health and Human 
Services and any other Federal agency re-
lated to health equity or health disparities; 
and 
(ii) recommendations on ensuring eq-
uitable health care and eliminating health 
disparities. 
(c) POWERS.— 
(1) HEARINGS.— 
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491 
(A) IN GENERAL.—The Commission or, at 
the direction of the Commission, any sub-
committee or member of the Commission, may, 
for the purpose of carrying out this section, as 
the Commission or the subcommittee or mem-
ber considers advisable— 
(i) hold such hearings, meet and act 
at such times and places, take such testi-
mony, receive such evidence, and admin-
ister such oaths; and 
(ii) require, by subpoena or otherwise, 
the attendance and testimony of such wit-
nesses and the production of such books, 
records, correspondence, memoranda, pa-
pers, documents, tapes, and materials. 
(B) 
LIMITATION
ON
HEARINGS.—The 
Commission may hold a hearing under subpara-
graph (A)(i) only if the hearing is approved— 
(i) by a majority of the members of 
the Commission appointed under sub-
section (a)(2)(B); or 
(ii) by a majority of such members 
present at a meeting when a quorum is 
present. 
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(2) ISSUANCE
AND
ENFORCEMENT
OF
SUB-
POENAS.— 
(A) ISSUANCE.—A subpoena issued under 
paragraph (1) shall— 
(i) bear the signature of the Chair-
person of the Commission; and 
(ii) be served by any person or class 
of persons designated by the Chairperson 
for that purpose. 
(B) ENFORCEMENT.—In the case of contu-
macy or failure to obey a subpoena issued 
under paragraph (1), the United States district 
court for the district in which the subpoenaed 
person resides, is served, or may be found may 
issue an order requiring the person to appear at 
any designated place to testify or to produce 
documentary or other evidence. 
(C) NONCOMPLIANCE.—Any failure to 
obey the order of the court may be punished by 
the court as a contempt of court. 
(3) WITNESS ALLOWANCES AND FEES.— 
(A) IN GENERAL.—Section 1821 of title 
28, United States Code, shall apply to a witness 
requested or subpoenaed to appear at a hearing 
of the Commission. 
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493 
(B) EXPENSES.—The per diem and mile-
age allowances for a witness shall be paid from 
funds available to pay the expenses of the Com-
mission. 
(4) POSTAL SERVICES.—The Commission may 
use the United States mails in the same manner and 
under the same conditions as other agencies of the 
Federal Government. 
(5) GIFTS.—The Commission may accept, use, 
and dispose of gifts or donations of services or prop-
erty. 
(d) ADMINISTRATIVE PROVISIONS.— 
(1) STAFF.— 
(A) DIRECTOR.—There shall be a full-time 
staff director for the Commission who shall— 
(i) serve as the administrative head of 
the Commission; and 
(ii) be appointed by the Chairperson 
with the concurrence of the Vice Chair-
person. 
(B) OTHER
PERSONNEL.—The Commis-
sion may— 
(i) appoint such other personnel as it 
considers advisable, subject to the provi-
sions of title 5, United States Code, gov-
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erning appointments in the competitive 
service, and the provisions of chapter 51 
and subchapter III of chapter 53 of that 
title relating to classification and General 
Schedule pay rates; and 
(ii) may procure temporary and inter-
mittent services under section 3109(b) of 
title 5, United States Code, at rates for in-
dividuals not in excess of the daily equiva-
lent paid for positions at the maximum 
rate for GS–15 of the General Schedule 
under section 5332 of title 5, United 
States Code. 
(2) COMPENSATION OF MEMBERS.— 
(A) 
NON-FEDERAL
EMPLOYEES.—Each 
member of the Commission who is not an offi-
cer or employee of the Federal Government 
shall be compensated at a rate equal to the 
daily equivalent of the annual rate of basic pay 
prescribed for level IV of the Executive Sched-
ule under section 5315 of title 5, United States 
Code, for each day (including travel time) dur-
ing which the member is engaged in the per-
formance of the duties of the Commission. 
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495 
(B) FEDERAL EMPLOYEES.—Each member 
of the Commission who is an officer or em-
ployee of the Federal Government shall serve 
without compensation in addition to the com-
pensation received for the services of the mem-
ber as an office or employee of the Federal 
Government. 
(C) TRAVEL EXPENSES.—A member of the 
Commission shall be allowed travel expenses, in-
cluding per diem in lieu of subsistence, at rates 
authorized for an employee of an agency under 
subchapter I of chapter 57 of title 5, United 
States Code, while away from the home or reg-
ular place of business of the member in the per-
formance of the duties of the Commission. 
(3) COOPERATION.—The Commission may se-
cure directly from any Federal department or agency 
such information as the Commission considers nec-
essary to carry out this Act. Upon request of the 
Chairman of the Commission, the head of such de-
partment or agency shall furnish such information to 
the Commission. 
(e) PERMANENT COMMISSION.—Section 1013 of title 
5, United States Code, shall not apply to the Commission. 
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496 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated for fiscal year 2025 and 
each fiscal year thereafter such sums as may be necessary 
to carry out the duties of the Commission. 
SEC. 4507. GRANTS FOR HOSPITALS TO PROMOTE EQUI-
TABLE HEALTH CARE AND OUTCOMES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services (in this section referred to as the 
‘‘Secretary’’) shall award grants to hospitals to promote 
equitable health care treatment and services, and reduce 
disparities in care and outcomes. 
(b) CONSULTATION.—In establishing the criteria for 
grants under this section and evaluating applications for 
such grants, the Secretary shall consult with the Director 
for Civil Rights and Health Equity of the Department of 
Health and Human Services. 
(c) USE OF FUNDS.—A hospital shall use funds re-
ceived from a grant under this section to establish or ex-
pand programs to provide equitable health care to all pa-
tients and to ensure equitable health care outcomes. Such 
uses may include— 
(1) providing explicit and implicit bias training 
to medical providers and staff; 
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(2) providing translation or interpretation serv-
ices for patients; 
(3) recruiting and training a diverse workforce; 
(4) tracking data related to care and outcomes; 
and 
(5) training on cultural sensitivity. 
(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to hospitals that 
have received disproportionate share hospital payments 
under section 1886(r) of the Social Security Act (42 
U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 
1396r–4) with respect to fiscal year 2023. 
(e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 
under this section shall be used to supplement, not sup-
plant, any nongovernment efforts, or other Federal, State, 
or local funds provided to a recipient. 
(f) EQUITABLE HEALTH CARE DEFINED.—The term 
‘‘equitable health care’’ has the meaning given such term 
in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu-
rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 
added by section 4502(a). 
(g) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
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Subtitle G—Investing in Equity 
SEC. 4601. DEFINITIONS. 
In this subtitle: 
(1) ADVISORY COUNCIL.—The term ‘‘Advisory 
Council’’ means the Pay for Equity Council con-
vened under section 4603. 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(3) STRATEGY.—The term ‘‘Strategy’’ means 
the Pay for Equity Strategy set forth under section 
4602. 
SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY. 
(a) IN GENERAL.—The Secretary, in consultation 
with the heads of other appropriate Federal agencies, shall 
develop jointly with the Advisory Council and submit to 
the Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce and the Committee on 
Ways and Means of the House of Representatives, and 
make publicly available on the internet website of the De-
partment of Health and Human Services, a Pay for Eq-
uity Strategy. 
(b) CONTENTS.—The Strategy shall establish goals 
for Federal programs, including those authorized under ti-
tles XVIII and XIX of the Social Security Act, to 
incentivize health equity, which may include at least— 
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(1) incorporating measures of equity into all 
payment models by 2026; 
(2) tying a percentage of reimbursement in 
value-based payment models to equity measure per-
formance by 2029; and 
(3) increasing the number of safety net pro-
viders participating in value-based payment by a set 
percentage by 2031. 
(c) DUTIES OF THE SECRETARY.—The Secretary, in 
carrying out subsection (a), shall oversee the following: 
(1) Collecting and making publicly available in-
formation submitted by the Advisory Council. 
(2) Coordinating and assessing existing Federal 
Government programs and activities to assess capac-
ity to meet equity goals. 
(3) Providing technical assistance, as appro-
priate, such as disseminating identified best prac-
tices and information sharing based on reports de-
veloped as a result of this subtitle. 
(d) INITIAL STRATEGY; UPDATES.—The Secretary 
shall— 
(1) not later than 18 months after the date of 
enactment of this Act, develop, publish, and submit 
to the Committee on Finance of the Senate and the 
Committee on Energy and Commerce and the Com-
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mittee on Ways and Means of the House of Rep-
resentatives the strategy outlined in subsection (a); 
and 
(2) biennially update, publish, and submit to 
Congress an updated strategy to— 
(A) reflect new developments, challenges, 
opportunities, and solutions; and 
(B) review progress and, based on the re-
sults of such review, recommend priority actions 
for improving the implementation of such rec-
ommendations, as appropriate. 
(e) PROCESS FOR PUBLIC INPUT.—The Secretary 
shall establish a process for public input to inform the de-
velopment of, and updates to, the Strategy, including a 
process for the public to submit recommendations to the 
Advisory Council and an opportunity for public comment 
on the proposed Strategy. 
SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL. 
(a) CONVENING.—The Secretary shall convene a Pay 
for Equity Advisory Council to advise and provide rec-
ommendations, including identified best practices, to the 
Secretary on the Pay for Equity Strategy. 
(b) MEMBERSHIP.— 
(1) IN GENERAL.—The members of the Advi-
sory Council shall consist of— 
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(A) the appointed members under para-
graph (2); and 
(B) the Federal members under paragraph 
(3). 
(2) APPOINTED MEMBERS.—In addition to the 
Federal members under paragraph (3), the Sec-
retary shall appoint not more than 15 voting mem-
bers of the Advisory Council who are not representa-
tives of Federal departments or agencies and who 
shall include at least 1 representative of each of the 
following: 
(A) Beneficiaries of Medicare and Med-
icaid. 
(B) Safety net health care providers. 
(C) Value-based payment experts. 
(D) Other members with expertise and 
lived experience the Secretary deems appro-
priate. 
(3) FEDERAL MEMBERS.—The Federal mem-
bers of the Advisory Council, who shall be nonvoting 
members, shall consist of the following: 
(A) The Administrator of the Centers for 
Medicare & Medicaid Services (or the Adminis-
trator’s designee). 
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(B) The Administrator of the Health Re-
sources and Services Administration. 
(4) DIVERSE
REPRESENTATION.—The Sec-
retary shall ensure that the membership of the Advi-
sory Council reflects the diversity of individuals im-
pacted by Federal health payment programs. 
(c) MEETINGS.—The Advisory Council shall meet 
quarterly during the 1-year period beginning on the date 
of enactment of this Act and at least 3 times during each 
year thereafter. Meetings of the Advisory Council shall be 
open to the public. 
TITLE V—IMPROVING HEALTH 
OUTCOMES 
FOR 
WOMEN, 
GENDER-DIVERSE 
PEOPLE, 
CHILDREN, AND FAMILIES 
Subtitle A—Underserved 
Communities 
SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280h et seq.) is amended by adding at the end 
the following: 
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‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER-
SERVED COMMUNITIES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Administrator of the Health Resources 
and Services Administration and other Federal officials 
determined appropriate by the Secretary, may award 
grants to eligible entities— 
‘‘(1) to promote health for medically under-
served communities, such as racial and ethnic minor-
ity women, racial and ethnic minority children, ado-
lescents, and lesbian, gay, bisexual, transgender, 
queer, nonbinary, gender-nonconforming, or ques-
tioning communities; and 
‘‘(2) to strengthen health outreach initiatives in 
medically underserved communities, including lin-
guistically isolated populations. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support the activities of 
community health workers, including such activities— 
‘‘(1) to provide education and outreach regard-
ing enrollment in health insurance including the 
State Children’s Health Insurance Program under 
title XXI of the Social Security Act, Medicare under 
title XVIII of such Act, and Medicaid under title 
XIX of such Act; 
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‘‘(2) to provide education and outreach in a 
community setting regarding health problems preva-
lent among medically underserved communities, and 
especially among racial and ethnic minority women, 
racial and ethnic minority children, adolescents, and 
lesbian, gay, bisexual, transgender, queer, nonbinary, 
gender-nonconforming, or questioning communities; 
‘‘(3) to provide education and experiential 
learning opportunities and target risk factors and 
healthy behaviors that impede or contribute to 
achieving positive health outcomes, including— 
‘‘(A) healthy nutrition; 
‘‘(B) physical activity; 
‘‘(C) overweight or obesity; 
‘‘(D) tobacco use, including the use of e- 
cigarettes and vaping; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) sexual health; 
‘‘(H) mental health; 
‘‘(I) musculoskeletal health and arthritis; 
‘‘(J) prenatal and postnatal care; 
‘‘(K) dental and oral health; 
‘‘(L) understanding informed consent; 
‘‘(M) stigma; and 
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‘‘(N) environmental hazards; 
‘‘(4) to promote community wellness and aware-
ness; and 
‘‘(5) to provide education and refer target popu-
lations to appropriate health care agencies and com-
munity-based programs and organizations in order 
to increase access to quality health care services, in-
cluding preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that, with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides in-language training and 
supervision to community health workers to en-
able such workers to provide authorized pro-
gram activities in (at least) the most commonly 
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used languages within a particular geographic 
region; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide culturally com-
petent services in the linguistic context most 
appropriate for the individuals served by the 
program; 
‘‘(E) contain a plan to document and dis-
seminate project descriptions and results to 
other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
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‘‘(ii) providing other services, as the 
Secretary determines to be appropriate, 
which may include transportation and 
translation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas 
that— 
‘‘(A)(i) have a high percentage of residents 
who are uninsured or underinsured (if the tar-
geted geographic area is located in a State that 
has elected to make medical assistance available 
under section 1902(a)(10)(A)(i)(VIII) of the 
Social Security Act to individuals described in 
such section); 
‘‘(ii) have a high percentage of under-
insured residents in a particular geographic 
area (if the targeted geographic area is located 
in a State that has not so elected); or 
‘‘(iii) have a high number of households ex-
periencing extreme poverty; and 
‘‘(B) have a high percentage of families for 
whom English is not their primary language or 
including smaller limited English-proficient 
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communities within the region that are not oth-
erwise reached by linguistically appropriate 
health services; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
‘‘(f) QUALITY ASSURANCE
AND COST-EFFECTIVE-
NESS.—The Secretary shall establish guidelines for ensur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for ensuring the cost-effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
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‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of these programs on 
the health outcomes of the community resi-
dents. 
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‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
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‘‘(F) by taking into consideration the 
needs of the communities served, including the 
prevalence rates of risk factors that impede 
achieving positive healthy outcomes among 
pregnant, birthing, and postpartum people and 
children, especially among racial and ethnic mi-
nority pregnant, birthing, and postpartum peo-
ple and children; or 
‘‘(G) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation that serves a population. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
Tribal government (including a federally recog-
nized Tribe or Alaska Native village); or 
‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
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derserved population, as defined by section 
330(b)(3); 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332; and 
‘‘(C) that includes populations that are lin-
guistically isolated, such as geographic areas 
with a shortage of health professionals able to 
provide linguistically appropriate services. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2025 through 2029.’’. 
Subtitle B—Pregnancy Screening 
SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE 
DEMONSTRATION PROGRAM. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
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‘‘SEC. 399V–8. PREGNANCY INTENTION SCREENING INITIA-
TIVE DEMONSTRATION PROGRAM. 
‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 
acting through the Director of the Centers for Disease 
Control and Prevention, shall establish a demonstration 
program to facilitate the clinical adoption of pregnancy in-
tention screening initiatives by health care and social serv-
ices providers. 
‘‘(b) GRANTS.—The Secretary may carry out the 
demonstration program through awarding grants to eligi-
ble entities to implement pregnancy intention screening 
initiatives, collect data, and evaluate such initiatives. 
‘‘(c) ELIGIBLE ENTITIES.—To be eligible for a grant 
under this section, an entity shall— 
‘‘(1) 
provide 
non-directive, 
comprehensive, 
medically accurate information; and 
‘‘(2) be a community-based organization, vol-
untary health organization, public health depart-
ment, community health center, or other interested 
public or private primary, behavioral, or other health 
care or social service provider or organization. 
‘‘(d) PREGNANCY INTENTION SCREENING INITIA-
TIVE.—For purposes of this section, the term ‘pregnancy 
intention screening initiative’ means any initiative by an 
eligible entity to routinely screen people with respect to 
their pregnancy intentions and goals to either prevent un-
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intended pregnancies or improve the likelihood of healthy 
pregnancies, in order to better provide health care that 
meets the contraceptive or pre-pregnancy needs and goals 
of such people. 
‘‘(e) EVALUATION.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall, by grant or contract, 
and after consultation as described in paragraph (2), 
conduct an evaluation of the demonstration pro-
gram, with respect to pregnancy intention screening 
initiatives, conducted under this section. Such eval-
uation shall include: 
‘‘(A) Assessment of the implementation of 
pregnancy intention screening protocols among 
a diverse group of patients and providers, in-
cluding collecting data on the experiences and 
outcomes for diverse patient populations in a 
variety of clinical settings. 
‘‘(B) Analysis of outcome measures that 
will facilitate effective and widespread adoption 
of such protocols by health care providers for 
inquiring about and responding to pregnancy 
goals of people with both contraceptive and pre- 
pregnancy care. 
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‘‘(C) Consideration of health inequities 
among the population served. 
‘‘(D) Assessment of the equitable and vol-
untary application of such initiatives to minor-
ity and medically underserved communities. 
‘‘(E) Assessment of the training, capacity, 
and ongoing technical assistance needed for 
providers to effectively implement such preg-
nancy intention screening protocols. 
‘‘(F) Assessment of whether referral sys-
tems for selected protocols follow evidence-based 
standards that ensure access to comprehensive 
health services and appropriate follow-up care. 
‘‘(G) Measuring through rigorous methods 
the effect of such initiatives on key health out-
comes. 
‘‘(2) CONSULTATION WITH INDEPENDENT, EX-
PERT ADVISORY PANEL.—In conducting the evalua-
tion under paragraph (1), the Director of the Cen-
ters for Disease Control and Prevention shall consult 
with physicians, physician assistants, advanced prac-
tice registered nurses, nurse midwives, and other 
health care providers who specialize in women’s 
health, and other experts in public health, clinical 
practice, program evaluation, and research. 
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‘‘(3) REPORT.—Not later than one year after 
the last day of the demonstration program under 
this section, the Director of the Centers for Disease 
Control and Prevention shall— 
‘‘(A) submit to Congress a report on the 
results of the evaluation conducted under para-
graph (1); and 
‘‘(B) make the report publicly available. 
‘‘(f) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
To carry out this section, there is authorized to be 
appropriated $10,000,000 for each of fiscal years 
2025 through 2029. 
‘‘(2) LIMITATION.—Not more than 20 percent 
of funds appropriated to carry out this section pur-
suant to paragraph (1) for a fiscal year may be used 
for purposes of the evaluation under subsection 
(e).’’. 
SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 
AND AWARENESS. 
(a) IN GENERAL.—The Secretary shall establish and 
implement a birth defects prevention and public awareness 
program, consisting of the activities described in sub-
sections (b) and (c). 
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(b) NATIONWIDE MEDIA CAMPAIGN.—In carrying 
out subsection (a), the Secretary shall conduct or support 
a nationwide media campaign to increase awareness 
among health care providers and at-risk populations about 
pregnancy and breastfeeding information services. 
(c) GRANTS FOR PREGNANCY AND BREASTFEEDING 
INFORMATION SERVICES.— 
(1) IN GENERAL.—In carrying out subsection 
(a), the Secretary shall award grants to State or re-
gional agencies or organizations for any of the fol-
lowing: 
(A) INFORMATION SERVICES.—The provi-
sion of, or campaigns to increase awareness 
about, pregnancy and breastfeeding information 
services. 
(B) SURVEILLANCE AND RESEARCH.—The 
conduct or support of— 
(i) surveillance of or research on— 
(I) maternal exposures and ma-
ternal health conditions that may in-
fluence the risk of birth defects, pre-
maturity, or other adverse pregnancy 
outcomes; and 
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(II) maternal exposures that may 
influence health risks to a breastfed 
infant; or 
(ii) networking to facilitate surveil-
lance or research described in this sub-
paragraph. 
(2) PREFERENCE FOR CERTAIN STATES.—The 
Secretary, in making any grant under this sub-
section, shall give preference to States, otherwise 
equally 
qualified, 
that 
have 
pregnancy 
and 
breastfeeding information services in place. 
(3) MATCHING
FUNDS.—The Secretary may 
only award a grant under this subsection to a State 
or regional agency or organization that agrees, with 
respect to the costs to be incurred in carrying out 
the grant activities, to make available (directly or 
through donations from public or private entities) 
non-Federal funds toward such costs in an amount 
equal to not less than 25 percent of the amount of 
the grant. 
(4) COORDINATION.—The Secretary shall en-
sure that activities funded through a grant under 
this subsection are coordinated, to the maximum ex-
tent practicable, with other birth defects prevention 
and environmental health activities of the Federal 
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Government, including with respect to pediatric envi-
ronmental health specialty units and children’s envi-
ronmental health centers. 
(d) EVALUATION.—The Secretary shall provide for 
an evaluation of pregnancy and breastfeeding information 
services carried out by States to identify efficient and ef-
fective models of— 
(1) providing information; 
(2) raising awareness and increasing knowledge 
about birth defects prevention measures and tar-
geting education to at-risk groups; 
(3) modifying risk behaviors; or 
(4) other outcome measures as determined ap-
propriate by the Secretary. 
(e) DEFINITIONS.—In this section: 
(1) MATERNAL.—The term ‘‘maternal’’ refers 
to people who are pregnant or breastfeeding. 
(2) PREGNANCY AND BREASTFEEDING INFOR-
MATION
SERVICES.—The term ‘‘pregnancy and 
breastfeeding information services’’ includes only— 
(A) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during pregnancy 
or breastfeeding that may be associated with 
birth defects, health risks to a breastfed infant, 
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or other health risks, such as exposures to 
medications, chemicals, infections, foodborne 
pathogens, illnesses, nutrition, lifestyle, or 
climate- and weather-related factors; 
(B) the provision of accurate, evidence- 
based information weighing risks of exposures 
during breastfeeding against the benefits of 
breastfeeding; and 
(C) the provision of information described 
in subparagraph (A) or (B) through counselors, 
websites, fact sheets, telephonic or electronic 
communication, community outreach efforts, or 
other appropriate means. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease 
Control and Prevention. 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated— 
(1) $5,000,000 for fiscal year 2025; 
(2) $6,000,000 for fiscal year 2026; 
(3) $7,000,000 for fiscal year 2027; 
(4) $8,000,000 for fiscal year 2028; and 
(5) $9,000,000 for fiscal year 2029. 
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Subtitle C—Pregnancy-related 
Care 
SEC. 5201. COMMUNITY ACCESS, RESOURCES, AND EM-
POWERMENT FOR MOMS. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Community Access, Resources, and Empowerment for 
Moms Act’’ or the ‘‘CARE for Moms Act’’. 
(b) IMPROVING FEDERAL EFFORTS WITH RESPECT 
TO PREVENTION OF MATERNAL MORTALITY.— 
(1) FUNDING
FOR
STATE-BASED
PERINATAL 
QUALITY COLLABORATIVES DEVELOPMENT AND SUS-
TAINABILITY.— 
(A) IN GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services, acting 
through the Division of Reproductive Health of 
the Centers for Disease Control and Prevention 
(referred to in this paragraph as the ‘‘Sec-
retary’’), shall establish a grant program to be 
known as the ‘‘State-Based Perinatal Quality 
Collaborative Grant Program’’, under which the 
Secretary shall award grants to eligible entities 
for the purpose of development and sustain-
ability 
of 
State-based 
perinatal 
quality 
collaboratives in every State, the District of Co-
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lumbia, and eligible territories, in order to 
measurably 
improve 
perinatal 
care 
and 
perinatal health outcomes for pregnant and 
postpartum women and their infants. 
(B) GRANT
AMOUNTS.—Grants awarded 
under this paragraph shall be in amounts not to 
exceed $250,000 per year, for the duration of 
the grant period. 
(C) STATE-BASED
PERINATAL
QUALITY 
COLLABORATIVE
DEFINED.—For purposes of 
this paragraph, the term ‘‘State-based perinatal 
quality collaborative’’ means a network of teams 
that— 
(i) is multidisciplinary in nature and 
includes the full range of perinatal and 
maternity care providers; 
(ii) works to improve measurable out-
comes for maternal and infant health by 
advancing evidence-informed clinical prac-
tices using quality improvement principles; 
(iii) works with hospital-based or out-
patient facility-based clinical teams, ex-
perts, and stakeholders, including patients 
and families, to spread best practices and 
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optimize resources to improve perinatal 
care and outcomes; 
(iv) employs strategies that include 
the use of the collaborative learning model 
to provide opportunities for hospitals and 
clinical teams to collaborate on improve-
ment strategies, rapid-response data to 
provide timely feedback to hospital and 
other clinical teams to track progress, and 
quality improvement science to provide 
support and coaching to hospital and clin-
ical teams; 
(v) has the goal of improving popu-
lation-level outcomes in maternal and in-
fant health; and 
(vi) has the goal of improving out-
comes of all birthing people, through the 
coordination, integration, and collaboration 
across birth settings. 
(D) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—For purposes of carrying out this 
paragraph, there is authorized to be appro-
priated $35,000,000 for each of fiscal years 
2025 through 2029. 
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(2) EXPANSION OF MEDICAID AND CHIP COV-
ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 
(A) 
REQUIRING
COVERAGE
OF
ORAL 
HEALTH
SERVICES
FOR
PREGNANT
AND 
POSTPARTUM WOMEN.— 
(i) MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d), as 
amended by section 4251(d)(3)(A), is 
amended— 
(I) in subsection (a)(4)— 
(aa) by striking ‘‘; and (D)’’ 
and inserting ‘‘; (D)’’; 
(bb) by striking ‘‘; and (E)’’ 
and inserting ‘‘; (E)’’; 
(cc) by striking ‘‘; and (F)’’ 
and inserting ‘‘; (F)’’; and 
(dd) by striking the semi-
colon at the end and inserting ‘‘; 
and (G) oral health services for 
pregnant and postpartum women 
(as defined in subsection (nn));’’; 
and 
(II) by adding at the end the fol-
lowing new subsection: 
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‘‘(nn) ORAL HEALTH SERVICES FOR PREGNANT AND 
POSTPARTUM WOMEN.— 
‘‘(1) IN GENERAL.—For purposes of this title, 
the term ‘oral health services for pregnant and 
postpartum women’ means dental services necessary 
to prevent disease and promote oral health, restore 
oral structures to health and function, and treat 
emergency conditions that are furnished to a woman 
during pregnancy (or during the 1-year period be-
ginning on the last day of the pregnancy). 
‘‘(2) COVERAGE
REQUIREMENTS.—To satisfy 
the requirement to provide oral health services for 
pregnant and postpartum women, a State shall, at 
a minimum, provide coverage for preventive, diag-
nostic, periodontal, and restorative care consistent 
with recommendations for perinatal oral health care 
and dental care during pregnancy from the Amer-
ican Academy of Pediatric Dentistry and the Amer-
ican College of Obstetricians and Gynecologists.’’. 
(ii) CHIP.—Section 2103(c)(6) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(c)(6)) is amended— 
(I) in subparagraph (A)— 
(aa) by inserting ‘‘or a tar-
geted 
low-income 
pregnant 
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woman’’ after ‘‘targeted low-in-
come child’’; and 
(bb) by inserting ‘‘, and, in 
the case of a targeted low-income 
child who is pregnant or a tar-
geted 
low-income 
pregnant 
woman, satisfy the coverage re-
quirements specified in section 
1905(nn)’’ after ‘‘emergency con-
ditions’’; and 
(II) in subparagraph (B), by in-
serting ‘‘(but only if, in the case of a 
targeted low-income child who is preg-
nant or a targeted low-income preg-
nant woman, the benchmark dental 
benefit package satisfies the coverage 
requirements 
specified 
in 
section 
1905(nn))’’ after ‘‘subparagraph (C)’’. 
(B) REQUIRING
12-MONTH
CONTINUOUS 
COVERAGE OF FULL BENEFITS FOR PREGNANT 
AND POSTPARTUM INDIVIDUALS UNDER MED-
ICAID AND CHIP.— 
(i) MEDICAID.—Section 1902 of the 
Social Security Act (42 U.S.C. 1396a) is 
amended— 
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(I) in subsection (a)— 
(aa) in paragraph (86), by 
striking ‘‘and’’ at the end; 
(bb) in paragraph (87), by 
striking the period at the end 
and inserting ‘‘; and’’; and 
(cc) by inserting after para-
graph (87) the following new 
paragraph: 
‘‘(88) provide that the State plan is in compli-
ance with subsection (e)(16).’’; and 
(II) in subsection (e)(16)— 
(aa) in subparagraph (A), 
by striking ‘‘At the option of the 
State, the State plan (or waiver 
of such State plan) may provide’’ 
and inserting ‘‘A State plan (or 
waiver of such State plan) shall 
provide’’; 
(bb) in subparagraph (B), in 
the matter preceding clause (i), 
by striking ‘‘by a State making 
an election under this para-
graph’’ and inserting ‘‘under a 
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State plan (or a waiver of such 
State plan)’’; and 
(cc) by striking subpara-
graph (C). 
(ii) CHIP.— 
(I) 
IN
GENERAL.—Section 
2107(e)(1)(J) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)(J)), as 
inserted by section 9822 of the Amer-
ican Rescue Plan Act of 2021 (Public 
Law 117–2), is amended to read as 
follows: 
‘‘(J) Paragraphs (5) and (16) of section 
1902(e) (relating to the requirement to provide 
medical assistance under the State plan or 
waiver consisting of full benefits during preg-
nancy 
and 
throughout 
the 
12-month 
postpartum period under title XIX).’’. 
(II) 
CONFORMING.—Section 
2112(d)(2)(A) of the Social Security 
Act (42 U.S.C. 1397ll(d)(2)(A)) is 
amended by striking ‘‘the month in 
which the 60-day period’’ and all that 
follows through ‘‘pursuant to section 
2107(e)(1),’’. 
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(C) MAINTENANCE OF EFFORT.— 
(i) MEDICAID.—Section 1902(l) of the 
Social Security Act (42 U.S.C. 1396a(l)) is 
amended by adding at the end the fol-
lowing new paragraph: 
‘‘(5) During the period that begins on the date of 
enactment of this paragraph and ends on the date that 
is 5 years after such date of enactment, as a condition 
for receiving any Federal payments under section 1903(a) 
for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to women who 
are eligible for medical assistance under the State plan 
or under a waiver of such plan on the basis of being preg-
nant or having been pregnant, eligibility standards, meth-
odologies, or procedures under the State plan or waiver 
that are more restrictive than the eligibility standards, 
methodologies, or procedures, respectively, under such 
plan or waiver that are in effect on the date of enactment 
of this paragraph.’’. 
(ii) CHIP.—Section 2105(d) of the 
Social Security Act (42 U.S.C. 1397ee(d)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(4) IN
ELIGIBILITY
STANDARDS
FOR
TAR-
GETED
LOW-INCOME
PREGNANT
WOMEN.—During 
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the period that begins on the date of enactment of 
this paragraph and ends on the date that is 5 years 
after such date of enactment, as a condition of re-
ceiving payments under subsection (a) and section 
1903(a), a State that elects to provide assistance to 
women on the basis of being pregnant (including 
pregnancy-related assistance provided to targeted 
low-income pregnant women (as defined in section 
2112(d)), pregnancy-related assistance provided to 
women who are eligible for such assistance through 
application of section 1902(v)(4)(A)(i) under section 
2107(e)(1), or any other assistance under the State 
child health plan (or a waiver of such plan) which 
is provided to women on the basis of being preg-
nant) shall not have in effect, with respect to such 
women, eligibility standards, methodologies, or pro-
cedures under such plan (or waiver) that are more 
restrictive than the eligibility standards, methodolo-
gies, or procedures, respectively, under such plan (or 
waiver) that are in effect on the date of enactment 
of this paragraph.’’. 
(D) INFORMATION
ON
BENEFITS.—The 
Secretary of Health and Human Services shall 
make publicly available on the internet website 
of the Department of Health and Human Serv-
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ices, information regarding benefits available to 
pregnant and postpartum women and under the 
Medicaid program and the Children’s Health 
Insurance Program, including information on— 
(i) benefits that States are required to 
provide 
to 
pregnant 
and 
postpartum 
women under such programs; 
(ii) optional benefits that States may 
provide 
to 
pregnant 
and 
postpartum 
women under such programs; and 
(iii) the availability of different kinds 
of benefits for pregnant and postpartum 
women, including oral health and mental 
health benefits and breastfeeding services 
and supplies, under such programs. 
(E) FEDERAL FUNDING FOR COST OF EX-
TENDED MEDICAID AND CHIP COVERAGE FOR 
POSTPARTUM WOMEN.— 
(i) MEDICAID.—Section 1905 of the 
Social Security Act (42 U.S.C. 1396d), as 
amended by title IV and subparagraph 
(A)(i)(II), is further amended— 
(I) in subsection (b), by striking 
‘‘and (mm)’’ and inserting ‘‘(mm), 
and (oo)’’; and 
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(II) by adding at the end the fol-
lowing: 
‘‘(oo) INCREASED FMAP FOR EXTENDED MEDICAL 
ASSISTANCE FOR POSTPARTUM INDIVIDUALS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), the Federal medical assistance percentage for a 
State, with respect to amounts expended by such 
State for medical assistance for an individual who is 
eligible for such assistance on the basis of being 
pregnant or having been pregnant that is provided 
during the 305-day period that begins on the 60th 
day after the last day of the individual’s pregnancy 
(including any such assistance provided during the 
month in which such period ends), shall be equal 
to— 
‘‘(A) during the first 20-quarter period for 
which this subsection is in effect with respect to 
a State, 100 percent; and 
‘‘(B) with respect to a State, during each 
quarter thereafter, 90 percent. 
‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 
Any payment made to a territory for expenditures 
for medical assistance for an individual described in 
paragraph (1) that is subject to the Federal medical 
assistance percentage specified under paragraph (1) 
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shall not be taken into account for purposes of ap-
plying payment limits under subsections (f) and (g) 
of section 1108.’’. 
(ii) CHIP.—Section 2105(c) of the 
Social Security Act (42 U.S.C. 1397ee(c)) 
is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(13) ENHANCED
PAYMENT
FOR
EXTENDED 
ASSISTANCE
PROVIDED
TO
PREGNANT
WOMEN.— 
Notwithstanding 
subsection 
(b), 
the 
enhanced 
FMAP, with respect to payments under subsection 
(a) for expenditures under the State child health 
plan (or a waiver of such plan) for assistance pro-
vided under the plan (or waiver) to a woman who is 
eligible for such assistance on the basis of being 
pregnant (including pregnancy-related assistance 
provided to a targeted low-income pregnant woman 
(as defined in section 2112(d)), pregnancy-related 
assistance provided to a woman who is eligible for 
such assistance through application of section 
1902(v)(4)(A)(i) under section 2107(e)(1), or any 
other assistance under the plan (or waiver) provided 
to a woman who is eligible for such assistance on the 
basis of being pregnant) during the 305-day period 
that begins on the 60th day after the last day of her 
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pregnancy (including any such assistance provided 
during the month in which such period ends), shall 
be equal to— 
‘‘(A) during the first 20-quarter period for 
which this subsection is in effect with respect to 
a State, 100 percent; and 
‘‘(B) with respect to a State, during each 
quarter thereafter, 90 percent.’’. 
(F) GUIDANCE
ON
STATE
OPTIONS
FOR 
MEDICAID
COVERAGE
OF
DOULA
SERVICES.— 
Not later than 1 year after the date of the en-
actment of this section, the Secretary of Health 
and Human Services shall issue guidance for 
the States concerning options for Medicaid cov-
erage and payment for support services pro-
vided by doulas. 
(G) ENHANCED FMAP FOR RURAL OBSTET-
RIC
AND
GYNECOLOGICAL
SERVICES.—Section 
1905 of the Social Security Act (42 U.S.C. 
1396d), as amended by title IV and subpara-
graphs (A) and (E), is further amended— 
(i) in subsection (b), by striking ‘‘and 
(oo)’’ and inserting ‘‘(oo), and (pp)’’; and 
(ii) by adding at the end the following 
new subsection: 
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‘‘(pp) INCREASED FMAP FOR MEDICAL ASSISTANCE 
FOR OBSTETRIC AND GYNECOLOGICAL SERVICES FUR-
NISHED AT RURAL HOSPITALS.— 
‘‘(1) IN GENERAL.—Notwithstanding subsection 
(b), the Federal medical assistance percentage for a 
State, with respect to amounts expended by such 
State for medical assistance for obstetric or gyneco-
logical services that are furnished in a hospital that 
is located in a rural area (as defined for purposes 
of section 1886) shall be equal to 90 percent for 
each calendar quarter beginning with the first cal-
endar quarter during which this subsection is in ef-
fect. 
‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 
Any payment made to a territory for expenditures 
for medical assistance described in paragraph (1) 
that is subject to the Federal medical assistance per-
centage specified under paragraph (1) shall not be 
taken into account for purposes of applying payment 
limits under subsections (f) and (g) of section 
1108.’’. 
(H) EFFECTIVE DATES.— 
(i) IN GENERAL.—Subject to clauses 
(ii) and (iii)— 
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(I) the amendments made by 
subparagraphs (A), (B), and (E) shall 
take effect on the first day of the first 
calendar quarter that begins on or 
after the date that is 1 year after the 
date of enactment of this section; 
(II) the amendments made by 
subparagraph (C) shall take effect on 
the date of enactment of this section; 
and 
(III) the amendments made by 
subparagraph (G) shall take effect on 
the first day of the first calendar 
quarter that begins on or after the 
date of enactment of this section. 
(ii) EXCEPTION FOR STATE LEGISLA-
TION.—In the case of a State plan under 
title XIX of the Social Security Act or a 
State child health plan under title XXI of 
such Act that the Secretary of Health and 
Human Services determines requires State 
legislation in order for the respective plan 
to meet any requirement imposed by 
amendments made by this paragraph, the 
respective plan shall not be regarded as 
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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 section. For purposes of the previous 
sentence, 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. 
(iii) STATE OPTION FOR EARLIER EF-
FECTIVE DATE.—A State may elect to have 
subsection (e)(16) of section 1902 of the 
Social Security Act (42 U.S.C. 1396a) and 
subparagraph (J) of section 2107(e)(1) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397gg(e)(1)), as amended by subpara-
graph (B), and subsection (oo) of section 
1905 of the Social Security Act (42 U.S.C. 
1396d) and paragraph (13) of section 
2105(c) of the Social Security Act (42 
U.S.C. 1397ee(c)), as added by subpara-
graph (E), take effect with respect to the 
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State on the first day of any fiscal quarter 
that begins before the date described in 
clause (i) and apply to amounts payable to 
the State for expenditures for medical as-
sistance, child health assistance, or preg-
nancy-related assistance to pregnant or 
postpartum individuals furnished on or 
after such day. 
(3) REGIONAL
CENTERS
OF
EXCELLENCE.— 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) (as amended by section 
5101) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 399V–9. REGIONAL CENTERS OF EXCELLENCE AD-
DRESSING IMPLICIT BIAS AND CULTURAL 
COMPETENCY IN PATIENT-PROVIDER INTER-
ACTIONS EDUCATION. 
‘‘(a) IN GENERAL.—Not later than one year after the 
date of enactment of this section, the Secretary, in con-
sultation with such other agency heads as the Secretary 
determines appropriate, shall award cooperative agree-
ments for the establishment or support of regional centers 
of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider inter-
actions education for the purpose of enhancing and im-
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proving how health care professionals are educated in im-
plicit bias and delivering culturally competent health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper-
ative agreement under subsection (a), an entity shall— 
‘‘(1) be a public or other nonprofit entity speci-
fied by the Secretary that provides educational and 
training opportunities for students and health care 
professionals, which may be a health system, teach-
ing hospital, community health center, medical 
school, school of public health, school of nursing, 
dental school, social work school, school of profes-
sional psychology, or any other health professional 
school or program at an institution of higher edu-
cation (as defined in section 101 of the Higher Edu-
cation Act of 1965) focused on the prevention, treat-
ment, or recovery of health conditions that con-
tribute to maternal mortality and the prevention of 
maternal mortality and severe maternal morbidity; 
‘‘(2) demonstrate community engagement and 
participation, such as through partnerships with 
home visiting and case management programs and 
community-based organizations serving minority 
populations; 
‘‘(3) demonstrate engagement with groups en-
gaged in the implementation of health care profes-
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sional training in implicit bias and delivering cul-
turally competent care, such as departments of pub-
lic health, perinatal quality collaboratives, hospital 
systems, and health care professional groups, in 
order to obtain input on resources needed for effec-
tive implementation strategies; and 
‘‘(4) provide to the Secretary such information, 
at such time and in such manner, as the Secretary 
may require. 
‘‘(c) DIVERSITY.—In awarding a cooperative agree-
ment under subsection (a), the Secretary shall take into 
account any regional differences among eligible entities 
and make an effort to ensure geographic diversity among 
award recipients. 
‘‘(d) DISSEMINATION OF INFORMATION.— 
‘‘(1) PUBLIC
AVAILABILITY.—The Secretary 
shall make publicly available on the internet website 
of the Department of Health and Human Services 
information submitted to the Secretary under sub-
section (b)(4). 
‘‘(2) EVALUATION.—The Secretary shall evalu-
ate each regional center of excellence established or 
supported pursuant to subsection (a) and dissemi-
nate the findings resulting from each such evalua-
tion to the appropriate public and private entities. 
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‘‘(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 
2025 through 2029.’’. 
(4) 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’’; 
(B) in subclause (I) (as so designated), by 
striking ‘‘1 year’’ and all that follows through 
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‘‘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.’’. 
(c) FULL SPECTRUM DOULA WORKFORCE.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall establish and implement a 
program to award grants or contracts to health pro-
fessions schools, schools of public health, academic 
health centers, State or local governments, terri-
tories, Indian Tribes and Tribal organizations, 
Urban Indian organizations, Native Hawaiian orga-
nizations, or other appropriate public or private non-
profit entities or community-based organizations (or 
consortia of any such entities, including entities pro-
moting multidisciplinary approaches), to establish or 
expand programs to grow and diversify the doula 
workforce, including through improving the capacity 
and supply of health care providers. 
(2) USE OF FUNDS.—Amounts made available 
by paragraph (1) shall be used for the following ac-
tivities: 
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(A) Establishing programs that provide 
education and training to individuals seeking 
appropriate training or certification as full 
spectrum doulas. 
(B) Expanding the capacity of existing 
programs described in subparagraph (A), for 
the purpose of increasing the number of stu-
dents enrolled in such programs, including by 
awarding scholarships for students who agree to 
work in underserved communities after receiv-
ing such education and training. 
(C) Developing and implementing strate-
gies to recruit and retain students from under-
served communities, particularly from demo-
graphic groups experiencing high rates of ma-
ternal mortality and severe maternal morbidity, 
including racial and ethnic minority groups, 
into programs described in subparagraphs (A) 
and (B). 
(3) FUNDING.—In addition to amounts other-
wise available, there is appropriated to the Secretary 
of Health and Human Services for fiscal year 2025, 
out of any money in the Treasury not otherwise ap-
propriated, $50,000,000, to remain available until 
expended, for carrying out this subsection. 
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(d) GRANTS
FOR
RURAL
OBSTETRIC
MOBILE 
HEALTH UNITS.—Part B of title III of the Public Health 
Service Act (42 U.S.C. 243 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 320C. GRANTS FOR RURAL OBSTETRIC MOBILE 
HEALTH UNITS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration (referred to in this section as the ‘Sec-
retary’), shall establish a pilot program under which the 
Secretary shall make grants to States— 
‘‘(1) to purchase and equip rural mobile health 
units for the purpose of providing pre-conception, 
pregnancy, postpartum, and obstetric emergency 
services in rural and underserved communities; 
‘‘(2) to train providers including obstetrician- 
gynecologists, certified nurse-midwives, nurse practi-
tioners, nurses, and midwives to operate and provide 
obstetric services, including training and planning 
for obstetric emergencies, in such mobile health 
units; and 
‘‘(3) to address access issues, including social 
determinants of health and wrap-around clinical and 
community services including nutrition, housing, lac-
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tation services, and transportation support and re-
ferrals. 
‘‘(b) NO SHARING OF DATA WITH LAW ENFORCE-
MENT.—As a condition of receiving a grant under this sec-
tion, a State shall submit to the Secretary an assurance 
that the State will not make available to Federal or State 
law enforcement any personally identifiable information 
regarding any pregnant or postpartum individual collected 
pursuant to such grant. 
‘‘(c) GRANT DURATION.—The period of a grant 
under this section shall not exceed 5 years. 
‘‘(d) IMPLEMENTING AND REPORTING.— 
‘‘(1) IN
GENERAL.—States that receive pilot 
grants under this section shall— 
‘‘(A) implement the program funded by the 
pilot grants; and 
‘‘(B) not later than 3 years after the date 
of enactment of this section, and not later than 
6 years after such date of enactment, submit to 
the Secretary a report that describes the results 
of such program, including— 
‘‘(i) relevant information and relevant 
quantitative indicators of the programs’ 
success in improving the standard of care 
and maternal health outcomes for individ-
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uals in rural and underserved communities 
seen for pre-conception, pregnancy, or 
postpartum visits in the rural mobile 
health units, stratified by the categories of 
data specified in paragraph (2); 
‘‘(ii) relevant qualitative evaluations 
from individuals receiving pre-conception, 
pregnant, or postpartum care from rural 
mobile health units, including measures of 
patient-reported experience of care and 
measures of patient-reported issues with 
access to care without the rural mobile 
health unit pilot; and 
‘‘(iii) strategies to sustain such pro-
grams beyond the duration of the grant 
and expand such programs to other rural 
and underserved communities. 
‘‘(2) CATEGORIES OF DATA.—The categories of 
data specified in this paragraph are the following: 
‘‘(A) Race, ethnicity, sex, gender, gender 
identity, primary language, age, geography, in-
surance status, disability status. 
‘‘(B) Number of visits provided for pre-
conception, prenatal, or postpartum care. 
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‘‘(C) Number of repeat visits provided for 
preconception, prenatal, or postpartum care. 
‘‘(D) Number of screenings or tests pro-
vided for smoking, substance use, hypertension, 
sexually-transmitted diseases, diabetes, HIV, 
depression, intimate partner violence, pap 
smears, and pregnancy. 
‘‘(3) DATA PRIVACY PROTECTION.—The reports 
referred to in paragraph (1)(B) shall not contain 
any personally identifiable information regarding 
any pregnant or postpartum individual. 
‘‘(e) EVALUATION.—The Secretary shall conduct an 
evaluation of the pilot program under this section to deter-
mine the impact of the pilot program with respect to— 
‘‘(1) the effectiveness of the grants awarded 
under this section to improve maternal health out-
comes in rural and underserved communities, with 
data stratified by race, ethnicity, primary language, 
socioeconomic status, geography, insurance type, and 
other factors as the Secretary determines appro-
priate; 
‘‘(2) spending on maternity care by States par-
ticipating in the pilot program; 
‘‘(3) to the extent practicable, qualitative and 
quantitative measures of patient experience; and 
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‘‘(4) any other areas of assessment that the 
Secretary determines relevant. 
‘‘(f) REPORT.—Not later than one year after the 
completion of the pilot program under this section, the 
Secretary shall submit to Congress, and make publicly 
available, a report that describes— 
‘‘(1) the results of the evaluation conducted 
under subsection (e); and 
‘‘(2) a recommendation regarding whether the 
pilot program should be continued after fiscal year 
2029 and expanded on a national basis. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to the Secretary to carry 
out this section $10,000,000 for each of fiscal years 2025 
through 2029.’’. 
(e) REQUIRING NOTIFICATION OF IMPENDING HOS-
PITAL OBSTETRIC UNIT CLOSURE.—Section 1866(a)(1) 
of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is 
amended— 
(1) in subparagraph (X), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (Y)(ii)(V), by striking the 
period and inserting ‘‘, and’’; and 
(3) by inserting after subparagraph (Y) the fol-
lowing new subparagraph: 
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‘‘(Z) beginning 180 days after the date of the 
enactment of this subparagraph, in the case of a 
hospital, not less than 90 days prior to the closure 
of any obstetric unit of the hospital, to submit to the 
Secretary a notification which shall include— 
‘‘(i) a report analyzing the impact the clo-
sure will have on the community; 
‘‘(ii) steps the hospital will take to identify 
other health care providers that can alleviate 
any service gaps as a result of the closure; and 
‘‘(iii) any additional information as may be 
required by the Secretary.’’. 
(f) EVALUATION
AND
REPORT
ON
MATERNAL 
HEALTH NEEDS.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, the Secretary of 
Health and Human Services shall conduct, and sub-
mit to Congress a report that describes the results 
of, an evaluation of— 
(A) where the maternal health needs are 
greatest in the United States; and 
(B) the Federal expenditures made to ad-
dress such needs. 
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(2) PERIOD COVERED.—The evaluation under 
paragraph (1) shall cover the period of calendar 
years 2000 through 2023. 
(3) ANALYSIS.—The evaluation under para-
graph (1) shall include analysis of the following: 
(A) How Federal funds provided to States 
for maternal health were distributed across re-
gions, States, and localities or counties. 
(B) Barriers to applying for and receiving 
Federal funds for maternal health, including, 
with respect to initial applications— 
(i) requirements for submission in 
partnership with other entities; and 
(ii) stringent network requirements. 
(C) Why applicants did not receive fund-
ing, including limited availability of funds, the 
strength of the respective applications, and fail-
ure to adhere to requirements. 
(4) DISAGGREGATION
OF
DATA.—The report 
under paragraph (1) shall disaggregate data on 
mothers served by race, ethnicity, insurance status, 
and language spoken. 
(g) INCREASING EXCISE TAXES ON CIGARETTES AND 
ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO-
BACCO PRODUCT TAX RATES.— 
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(1) TAX
PARITY
FOR
ROLL-YOUR-OWN
TO-
BACCO.—Section 5701(g) of the Internal Revenue 
Code of 1986 is amended by striking ‘‘$24.78’’ and 
inserting ‘‘$49.56’’. 
(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’’; 
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552 
(ii) in paragraphs (2) and (3), by in-
serting ‘‘that is not a discrete single-use 
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, made from, or derived from tobacco or nico-
tine 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-
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553 
tional parts of a pound but not less than 
10.066 cents per cigar.’’. 
(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. 
(C) CONFORMING
AMENDMENT.—Section 
5702 of such Code is amended by striking sub-
section (l). 
(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.— 
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554 
(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 
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.— 
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555 
(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 
‘‘(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 para-
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graph (7), 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 2024, the dollar amounts pro-
vided under this chapter shall each be increased by 
an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year, determined by substituting ‘calendar year 
2023’ 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— 
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(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 
imposed by subparagraph (A) an amount equal 
to the lesser of $1,000 or the amount of such 
taxes. For purposes of the preceding sentence, 
all persons treated as a single employer under 
subsection (b), (c), (m), or (o) of section 414 of 
the Internal Revenue Code of 1986 shall be 
treated as 1 person for purposes of this sub-
paragraph. 
(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 
subparagraph (A) applies shall be liable for 
such tax. 
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558 
(ii) METHOD OF PAYMENT.—The tax 
imposed by subparagraph (A) shall be paid 
in such manner as the Secretary shall pre-
scribe by regulations. 
(iii) TIME
FOR
PAYMENT.—The tax 
imposed by subparagraph (A) shall be paid 
on or before the date that is 120 days 
after the effective date of the tax rate in-
crease. 
(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-
crease date shall be subject to the tax imposed 
by subparagraph (A) if— 
(i) internal revenue taxes have been 
determined, or customs duties liquidated, 
with respect to such article before such 
date pursuant to a request made under the 
first 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-
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559 
tion of the Department of Homeland Secu-
rity pursuant to the second proviso of such 
section 3(a). 
(E) DEFINITIONS.—For purposes of this 
paragraph— 
(i) IN GENERAL.—Any term used in 
this paragraph 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-
ments made by this subsection (other than 
paragraph (10) 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 paragraph. 
(G) OTHER LAWS APPLICABLE.—All provi-
sions of law, including penalties, applicable with 
respect to the taxes imposed by section 5701 of 
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560 
such Code shall, insofar as applicable and not 
inconsistent with the provisions of this para-
graph, apply to the floor stocks taxes imposed 
by subparagraph (A), 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 sub-
paragraph (A) as the person to whom a credit 
or refund under such provisions may be allowed 
or made. 
(12) EFFECTIVE DATES.— 
(A) IN GENERAL.—Except as provided in 
subparagraphs (B) and (C), the amendments 
made by this subsection shall apply to articles 
removed (as defined in section 5702(j) of the 
Internal Revenue Code of 1986) after the last 
day of the month which includes the date of the 
enactment of this Act. 
(B) DISCRETE SINGLE-USE UNITS, LARGE 
CIGARS, 
AND
PROCESSED
TOBACCO.—The 
amendments made by paragraphs (3)(A)(iii), 
(3)(B), (5), and (6) shall apply to articles re-
moved (as defined in section 5702(j) of the In-
ternal Revenue Code of 1986) after the date 
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561 
that is 6 months after the date of the enact-
ment of this Act. 
(C) OTHER
TOBACCO
PRODUCTS.—The 
amendments made by paragraph (7)(A) 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. 
SEC. 5202. MOMMIES. 
(a) GAO STUDY AND REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Comp-
troller General of the United States shall submit to 
Congress a report on the gaps in coverage with re-
spect to— 
(A) pregnant individuals enrolled under a 
State plan (or waiver of such plan) under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) and the Children’s Health Insurance 
Program under title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.); and 
(B) postpartum individuals enrolled under 
a State plan (or waiver of such plan) under title 
XIX of the Social Security Act (42 U.S.C. 1396 
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562 
et seq.) and the Children’s Health Insurance 
Program under title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) who received as-
sistance under either such program during their 
pregnancy. 
(2) CONTENT
OF
REPORT.—The report re-
quired under this paragraph shall include the fol-
lowing: 
(A) Information about the abilities and 
successes of State Medicaid agencies in deter-
mining whether pregnant and postpartum indi-
viduals are eligible under another insurance af-
fordability program, and in transitioning any 
such individuals who are so eligible to coverage 
under such a program at the end of their period 
of eligibility for medical assistance, pursuant to 
section 435.1200 of the title 42, Code of Fed-
eral Regulations (as in effect on September 1, 
2018). 
(B) Information on factors contributing to 
gaps in coverage that disproportionately impact 
underserved populations, including low-income 
individuals, Black, Indigenous, and other indi-
viduals of color, individuals who reside in a 
health professional shortage area (as defined in 
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563 
section 332(a)(1)(A) of the Public Health Serv-
ice Act (42 U.S.C. 254e(a)(1)(A))) or individ-
uals who are members of a medically under-
served population (as defined by section 
330(b)(3) 
of 
such 
Act 
(42 
U.S.C. 
254b(b)(3)(A))). 
(C) Recommendations for addressing and 
reducing such gaps in coverage. 
(D) Such other information as the Comp-
troller General deems necessary. 
(3) DATA DISAGGREGATION.—To the greatest 
extent possible, the Comptroller General shall 
disaggregate data presented in the report, including 
by age, gender identity, race, ethnicity, income level, 
and other demographic factors. 
(b) MATERNITY
CARE
HOME
DEMONSTRATION 
PROJECT.—Title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) is amended by inserting the following 
new section after section 1947: 
‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 
PROJECT. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of the enactment of this section, the Secretary shall 
establish a demonstration project (in this section referred 
to as the ‘demonstration project’) under which the Sec-
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retary shall provide grants to States to enter into arrange-
ments with eligible entities to implement or expand a ma-
ternity care home model for eligible individuals. 
‘‘(b) GOALS
OF DEMONSTRATION PROJECT.—The 
goals of the demonstration project are the following: 
‘‘(1) To improve— 
‘‘(A) maternity and infant care outcomes; 
‘‘(B) birth equity; 
‘‘(C) health equity for— 
‘‘(i) Black, Indigenous, and other peo-
ple of color; 
‘‘(ii) 
lesbian, 
gay, 
bisexual, 
transgender, queer, non-binary, and gender 
nonconfirming individuals; 
‘‘(iii) people with disabilities; and 
‘‘(iv) other underserved populations; 
‘‘(D) communication by maternity, infant 
care, and social services providers; 
‘‘(E) integration of perinatal support serv-
ices, including community health workers, 
doulas, social workers, public health nurses, 
peer lactation counselors, lactation consultants, 
childbirth educators, peer mental health work-
ers, and others, into health care entities and or-
ganizations; 
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‘‘(F) care coordination between maternity, 
infant care, oral health services, and social serv-
ices providers within the community; 
‘‘(G) the quality and safety of maternity 
and infant care; 
‘‘(H) the experience of individuals receiv-
ing maternity care, including by increasing the 
ability of an individual to develop and follow 
their own birthing plans; and 
‘‘(I) access to adequate prenatal and 
postpartum care, including— 
‘‘(i) prenatal care that is initiated in 
a timely manner; 
‘‘(ii) not fewer than 5 post-pregnancy 
visits to a maternity care provider; and 
‘‘(iii) interpregnancy care. 
‘‘(2) To provide coordinated, evidence-based, re-
spectful, culturally and linguistically appropriate, 
and person-centered maternity care management. 
‘‘(3) To decrease— 
‘‘(A) severe and preventable maternal mor-
bidity and maternal mortality; 
‘‘(B) overall health care spending; 
‘‘(C) unnecessary emergency department 
visits; 
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‘‘(D) inequities in maternal and infant care 
outcomes, including racial, economic, disability, 
gender-based, and geographical inequities; 
‘‘(E) racial, gender, economic, and other 
discrimination among health care professionals; 
‘‘(F) racism, discrimination, disrespect, 
and abuse in maternity care settings; 
‘‘(G) the rate of cesarean deliveries for 
low-risk pregnancies; 
‘‘(H) the rate of pre-term births and in-
fants born with low birth weight; and 
‘‘(I) the rate of avoidable maternal and 
newborn hospitalizations and admissions to in-
tensive care units. 
‘‘(c) CONSULTATION.—In designing and imple-
menting the demonstration project the Secretary shall 
consult with stakeholders, including— 
‘‘(1) States; 
‘‘(2) organizations representing relevant health 
care professionals, including oral health services pro-
fessionals; 
‘‘(3) organizations, particularly reproductive 
justice and birth justice organizations led by people 
of color, that represent consumers of maternal 
health care, including consumers of maternal health 
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567 
care who are disproportionately impacted by poor 
maternal health outcomes; 
‘‘(4) representatives with experience imple-
menting other maternity care home models, includ-
ing representatives from the Center for Medicare 
and Medicaid Innovation; 
‘‘(5) community-based health care professionals, 
including doulas, lactation consultants, and other 
stakeholders; 
‘‘(6) experts in promoting health equity and 
combating racial bias in health care settings; and 
‘‘(7) Black, Indigenous, and other maternal 
health care consumers of color who have experienced 
severe maternal morbidity. 
‘‘(d) APPLICATION AND SELECTION OF STATES.— 
‘‘(1) IN GENERAL.—A State seeking to partici-
pate in the demonstration project shall submit an 
application to the Secretary at such time and in 
such manner as the Secretary shall require. 
‘‘(2) SELECTION OF STATES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
select at least 10 States to participate in the 
demonstration project. 
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‘‘(B) SELECTION REQUIREMENTS.—In se-
lecting States to participate in the demonstra-
tion project, the Secretary shall— 
‘‘(i) ensure that there is geographic 
and regional diversity in the areas in which 
activities will be carried out under the 
project; 
‘‘(ii) ensure that States with signifi-
cant inequities in maternal and infant 
health outcomes, including severe maternal 
morbidity, and other inequities based on 
race, income, or access to maternity care, 
are included; and 
‘‘(iii) ensure that at least 1 territory 
is included. 
‘‘(e) GRANTS.— 
‘‘(1) IN
GENERAL.—From amounts appro-
priated under subsection (l), the Secretary shall 
award 1 grant for each year of the demonstration 
project to each State that is selected to participate 
in the demonstration project. 
‘‘(2) USE OF GRANT FUNDS.—A State may use 
funds received under this section to— 
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569 
‘‘(A) award grants or make payments to 
eligible entities as part of an arrangement de-
scribed in subsection (f)(2); 
‘‘(B) provide financial incentives to health 
care professionals, including community-based 
health care workers and community-based 
doulas, who participate in the State’s maternity 
care home model; 
‘‘(C) provide adequate training for health 
care professionals, including community-based 
health care workers, doulas, and care coordina-
tors, who participate in the State’s maternity 
care home model, which may include training 
for cultural humility and antiracism, racial bias, 
health equity, reproductive and birth justice, 
trauma-informed care, home visiting skills, and 
respectful communication and listening skills, 
particularly in regards to maternal health; 
‘‘(D) pay for personnel and administrative 
expenses associated with designing, imple-
menting, and operating the State’s maternity 
care home model; 
‘‘(E) pay for items and services that are 
furnished under the State’s maternity care 
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570 
home model and for which payment is otherwise 
unavailable under this title; 
‘‘(F) pay for services and materials to en-
sure culturally and linguistically appropriate 
communication, including— 
‘‘(i) language services such as inter-
preters and translation of written mate-
rials; and 
‘‘(ii) development of culturally and lin-
guistically appropriate materials; and aux-
iliary aids and services; and 
‘‘(G) pay for other costs related to the 
State’s maternity care home model, as deter-
mined by the Secretary. 
‘‘(3) GRANT
FOR
NATIONAL
INDEPENDENT 
EVALUATOR.— 
‘‘(A) IN
GENERAL.—From the amounts 
appropriated under subsection (l), prior to 
awarding any grants under paragraph (1), the 
Secretary shall enter into a contract with a na-
tional external entity to create a single, uniform 
process to— 
‘‘(i) ensure that States that receive 
grants under paragraph (1) comply with 
the requirements of this section; and 
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571 
‘‘(ii) evaluate the outcomes of the 
demonstration project in each participating 
State. 
‘‘(B) ANNUAL REPORT.—The contract de-
scribed in subparagraph (A) shall require the 
national external entity to submit to the Sec-
retary— 
‘‘(i) a yearly evaluation report for 
each year of the demonstration project; 
and 
‘‘(ii) a final impact report after the 
demonstration project has concluded. 
‘‘(C) SECRETARY’S AUTHORITY.—Nothing 
in this paragraph shall prevent the Secretary 
from making a determination that a State is 
not in compliance with the requirements of this 
section without the national external entity 
making such a determination. 
‘‘(f) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—As a condition of receiving 
a grant under this section, a State shall enter into 
an arrangement with one or more eligible entities 
that meets the requirements of paragraph (2). 
‘‘(2) ARRANGEMENTS
WITH
ELIGIBLE
ENTI-
TIES.—Under an arrangement between a State and 
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572 
an eligible entity under this subsection, the eligible 
entity shall perform the following functions, with re-
spect to eligible individuals enrolled with the entity 
under the State’s maternity care home model— 
‘‘(A) provide culturally and linguistically 
appropriate congruent care, which may include 
prenatal care, family planning services, medical 
care, mental and behavioral care, postpartum 
care, and oral health services to such eligible in-
dividuals through a team of health care profes-
sionals, which may include obstetrician-gyne-
cologists, maternal-fetal medicine specialists, 
family physicians, primary care providers, oral 
health providers, physician assistants, advanced 
practice registered nurses such as nurse practi-
tioners and certified nurse midwives, certified 
midwives, certified professional midwives, phys-
ical therapists, social workers, traditional and 
community-based doulas, lactation consultants, 
childbirth educators, community health workers, 
peer mental health supporters, and other health 
care professionals; 
‘‘(B) conduct a risk assessment of each 
such eligible individual to determine if their 
pregnancy is high or low risk, and establish a 
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tailored pregnancy care plan, which takes into 
consideration the individual’s own preferences 
and pregnancy care and birthing plans and de-
termines the appropriate support services to re-
duce the individual’s medical, social, and envi-
ronmental risk factors, for each such eligible in-
dividual based on the results of such risk as-
sessment; 
‘‘(C) assign each such eligible individual to 
a culturally and linguistically appropriate care 
coordinator, which may be a nurse, social work-
er, traditional or community-based doula, com-
munity health worker, midwife, or other health 
care provider, who is responsible for ensuring 
that such eligible individual receives the nec-
essary medical care and connections to essential 
support services; 
‘‘(D) provide, or arrange for the provision 
of, essential support services, such as services 
that address— 
‘‘(i) food access, nutrition, and exer-
cise; 
‘‘(ii) smoking cessation; 
‘‘(iii) substance use disorder and ad-
diction treatment; 
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‘‘(iv) anxiety, depression, trauma, and 
other mental and behavioral health issues; 
‘‘(v) breastfeeding, chestfeeding, or 
other infant feeding options supports, initi-
ation, continuation, and duration; 
‘‘(vi) stable, affordable, safe, and 
healthy housing; 
‘‘(vii) transportation; 
‘‘(viii) intimate partner violence; 
‘‘(ix) community and police violence; 
‘‘(x) home visiting services; 
‘‘(xi) childbirth and newborn care edu-
cation; 
‘‘(xii) oral health education; 
‘‘(xiii) continuous labor support; 
‘‘(xiv) group prenatal care; 
‘‘(xv) family planning and contracep-
tive care and supplies; and 
‘‘(xvi) affordable child care; 
‘‘(E) as appropriate, facilitate connections 
to a usual primary care provider, which may be 
a reproductive health care provider; 
‘‘(F) refer to guidelines and opinions of 
medical associations when determining whether 
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an elective delivery should be performed on an 
eligible individual before 39 weeks of gestation; 
‘‘(G) provide such eligible individual with 
evidence-based and culturally and linguistically 
appropriate education and resources to identify 
potential warning signs of pregnancy and 
postpartum complications and when and how to 
obtain medical attention; 
‘‘(H) provide, or arrange for the provision 
of, culturally and linguistically appropriate 
pregnancy and postpartum health services, in-
cluding family planning counseling and services, 
to eligible individuals; 
‘‘(I) track and report postpartum health 
and birth outcomes of such eligible individuals 
and their children; 
‘‘(J) ensure that care is person-centered, 
culturally and linguistically appropriate, and 
patient-led, including by engaging eligible indi-
viduals in their own care, including through 
communication and education; and 
‘‘(K) ensure adequate training for appro-
priately serving the population of individuals el-
igible for medical assistance under the State 
plan (or waiver of such plan), including through 
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reproductive justice, birth justice, birth equity, 
and anti-racist frameworks, home visiting skills, 
and knowledge of social services. 
‘‘(g) TERM
OF DEMONSTRATION PROJECT.—The 
Secretary shall conduct the demonstration project for a 
period of 5 years. 
‘‘(h) REPORT.—Not later than 18 months after the 
date of the enactment of this section and annually there-
after for each year of the demonstration project term, the 
Secretary shall submit a report to Congress on the results 
of the demonstration project, including— 
‘‘(1) the results of the final report of the na-
tional external entity required under subsection 
(e)(3)(B)(ii); and 
‘‘(2) recommendations on whether the model 
studied in the demonstration project should be con-
tinued or more widely adopted, including by private 
health plans. 
‘‘(i) WAIVER AUTHORITY.—To the extent that the 
Secretary determines necessary in order to carry out the 
demonstration project, the Secretary may waive section 
1902(a)(1) (relating to statewideness) and section 
1902(a)(10)(B) (relating to comparability). 
‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 
establish a process to provide technical assistance to 
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577 
States that are awarded grants under this section and to 
eligible entities and other providers participating in a 
State maternity care home model funded by such a grant. 
‘‘(k) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means an entity or organization that provides 
medically accurate, comprehensive maternity services 
to individuals who are eligible for medical assistance 
under a State plan under this title or a waiver of 
such a plan, and may include: 
‘‘(A) A freestanding birth center. 
‘‘(B) An entity or organization receiving 
assistance under section 330 of the Public 
Health Service Act. 
‘‘(C) A federally qualified health center. 
‘‘(D) A rural health clinic. 
‘‘(E) A health facility operated by an In-
dian tribe or tribal organization (as those terms 
are defined in section 4 of the Indian Health 
Care Improvement Act). 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means a pregnant individual or a for-
merly pregnant individual during the 1-year period 
beginning on the last day of the pregnancy, or such 
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578 
longer period beginning on such day as a State may 
elect, who is— 
‘‘(A) enrolled in a State plan under this 
title, a waiver of such a plan, or a State child 
health plan under title XXI; and 
‘‘(B) a patient of an eligible entity which 
has entered into an arrangement with a State 
under subsection (g). 
‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary, for 
each of fiscal years 2025 through 2032, such sums as may 
be necessary to carry out this section.’’. 
(c) REAPPLICATION OF MEDICARE PAYMENT RATE 
FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER 
MEDICAID
AND
INCLUSION
OF
ADDITIONAL
PRO-
VIDERS.— 
(1) REAPPLICATION OF PAYMENT FLOOR; ADDI-
TIONAL PROVIDERS.— 
(A) IN GENERAL.—Section 1902(a)(13) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(13)) is amended— 
(i) in subparagraph (B), by striking ‘‘; 
and’’ and inserting a semicolon; 
(ii) in subparagraph (C), by striking 
the semicolon and inserting ‘‘; and’’; and 
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579 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) payment for primary care services (as 
defined in subsection (jj)(1)) furnished in the 
period that begins on the first day of the first 
month that begins after the date of enactment 
of this subparagraph by a provider described in 
subsection (jj)(2)— 
‘‘(i) at a rate that is not less than 100 
percent of the payment rate that applies to 
such services and the provider of such 
services under part B of title XVIII (or, if 
greater, the payment rate that would be 
applicable under such part if the conver-
sion factor under section 1848(d) for the 
year were the conversion factor under such 
section for 2009); 
‘‘(ii) in the case of items and services 
that are not items and services provided 
under such part, at a rate to be established 
by the Secretary; and 
‘‘(iii) in the case of items and services 
that are furnished in rural areas (as de-
fined in section 1886(d)(2)(D)), health 
professional shortage areas (as defined in 
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580 
section 332(a)(1)(A) of the Public Health 
Service Act (42 U.S.C. 254e(a)(1)(A))), or 
medically underserved areas (according to 
a designation under section 330(b)(3)(A) 
of the Public Health Service Act (42 
U.S.C. 254b(b)(3)(A))), at the rate other-
wise applicable to such items or services 
under clause (i) or (ii) increased, at the 
Secretary’s discretion, by not more than 25 
percent;’’. 
(B) CONFORMING AMENDMENTS.— 
(i) Section 1902(a)(13)(C) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396a(a)(13)(C)) is amended by striking 
‘‘subsection (jj)’’ and inserting ‘‘subsection 
(jj)(1)’’. 
(ii) Section 1905(dd) of the Social Se-
curity Act (42 U.S.C. 1396d(dd)) is 
amended— 
(I) 
by 
striking 
‘‘Notwith-
standing’’ and inserting the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
(II) 
by 
striking 
‘‘section 
1902(a)(13)(C)’’ and inserting ‘‘sub-
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581 
paragraph 
(C) 
of 
section 
1902(a)(13)’’; 
(III) by inserting ‘‘or for services 
described in subparagraph (D) of sec-
tion 1902(a)(13) furnished during an 
additional period specified in para-
graph (2),’’ after ‘‘2015,’’; 
(IV) by striking ‘‘under such sec-
tion’’ and inserting ‘‘under subpara-
graph 
(C) 
or 
(D) 
of 
section 
1902(a)(13), as applicable’’; and 
(V) by adding at the end the fol-
lowing: 
‘‘(2) ADDITIONAL PERIODS.—For purposes of 
paragraph (1), the following are additional periods: 
‘‘(A) The period that begins on the first 
day of the first month that begins after the 
date of enactment of this paragraph.’’. 
(2) 
IMPROVED
TARGETING
OF
PRIMARY 
CARE.—Section 1902(jj) of the Social Security Act 
(42 U.S.C. 1396a(jj)) is amended— 
(A) by redesignating paragraphs (1) and 
(2) as clauses (i) and (ii), respectively, and re-
aligning the left margins accordingly; 
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582 
(B) by striking ‘‘For purposes of sub-
section (a)(13)(C)’’ and inserting the following: 
‘‘(1) IN GENERAL.— 
‘‘(A) DEFINITION.—For purposes of sub-
paragraphs (C) and (D) of subsection (a)(13)’’; 
and 
(C) by inserting after clause (ii) (as so re-
designated) the following: 
‘‘(B) EXCLUSIONS.—Such term does not 
include any services described in subparagraph 
(A) or (B) of paragraph (1) if such services are 
provided in an emergency department of a hos-
pital. 
‘‘(2) ADDITIONAL
PROVIDERS.—For purposes 
of subparagraph (D) of subsection (a)(13), a pro-
vider described in this paragraph is any of the fol-
lowing: 
‘‘(A) A physician with a primary specialty 
designation of family medicine, general internal 
medicine, or pediatric medicine, or obstetrics 
and gynecology. 
‘‘(B) An advanced practice clinician, as de-
fined by the Secretary, that works under the 
supervision of— 
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583 
‘‘(i) a physician that satisfies the cri-
teria specified in subparagraph (A); 
‘‘(ii) a nurse practitioner or a physi-
cian assistant (as such terms are defined 
in section 1861(aa)(5)(A)) who is working 
in accordance with State law; or 
‘‘(iii) or a certified nurse-midwife (as 
defined in section 1861(gg)) or a certified 
professional midwife who is working in ac-
cordance with State law. 
‘‘(C) A rural health clinic, federally quali-
fied health center, health center that receives 
funding under title X of the Public Health 
Service Act, or other health clinic that receives 
reimbursement on a fee schedule applicable to 
a physician. 
‘‘(D) An advanced practice clinician super-
vised by a physician described in subparagraph 
(A), another advanced practice clinician, or a 
certified nurse-midwife. 
‘‘(E) A midwife who is working in accord-
ance with State law.’’. 
(3) ENSURING
PAYMENT
BY
MANAGED
CARE 
ENTITIES.— 
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584 
(A) IN GENERAL.—Section 1903(m)(2)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(m)(2)(A)) is amended— 
(i) in clause (xii), by striking ‘‘and’’ 
after the semicolon; 
(ii) by realigning the left margin of 
clause (xiii) so as to align with the left 
margin of clause (xii) and by striking the 
period at the end of clause (xiii) and in-
serting ‘‘; and’’; and 
(iii) by inserting after clause (xiii) the 
following: 
‘‘(xiv) such contract provides that (I) payments 
to providers specified in section 1902(a)(13)(D) for 
primary care services (as defined in section 1902(jj)) 
that are furnished during a year or period (as speci-
fied 
in 
section 
1902(a)(13)(D) 
and 
section 
1905(dd)) are at least equal to the amounts set 
forth and required by the Secretary by regulation; 
(II) the entity shall, upon request, provide docu-
mentation to the State, sufficient to enable the State 
and the Secretary to ensure compliance with sub-
clause (I); and (III) the Secretary shall approve pay-
ments described in subclause (I) that are furnished 
through an agreed upon capitation, partial capita-
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585 
tion, or other value-based payment arrangement if 
the capitation, partial capitation, or other value- 
based payment arrangement is based on a reason-
able methodology and the entity provides docu-
mentation to the State sufficient to enable the State 
and the Secretary to ensure compliance with sub-
clause (I).’’. 
(B) CONFORMING
AMENDMENT.—Section 
1932(f) of the Social Security Act (42 U.S.C. 
1396u–2(f)) is amended— 
(i) 
by 
striking 
‘‘section 
1902(a)(13)(C)’’ 
and 
inserting 
‘‘sub-
sections 
(C) 
and 
(D) 
of 
section 
1902(a)(13)’’; and 
(ii) by inserting ‘‘, and clause (xiv) of 
section 1903(m)(2)(A)’’ before the period. 
(d) MACPAC REPORT AND CMS GUIDANCE ON IN-
CREASING ACCESS TO DOULA SERVICES FOR MEDICAID 
BENEFICIARIES.— 
(1) MACPAC REPORT.— 
(A) IN GENERAL.—Not later than 1 year 
after the date of the enactment of this Act, the 
Medicaid and CHIP Payment and Access Com-
mission (referred to in this subsection as 
‘‘MACPAC’’) shall publish a report on the cov-
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586 
erage of doula services under State Medicaid 
programs, which shall at a minimum include 
the following: 
(i) Information about coverage for 
doula services under State Medicaid pro-
grams that currently provide coverage for 
such care, including the type of doula serv-
ices offered (such as prenatal, labor and 
delivery, postpartum support, and also 
community-based and traditional doula 
services). 
(ii) An analysis of barriers to covering 
doula services under State Medicaid pro-
grams. 
(iii) An identification of effective 
strategies to increase the use of doula serv-
ices in order to provide better care and 
achieve better maternal and infant health 
outcomes, including strategies that States 
may use to recruit, train, and certify a di-
verse doula workforce, particularly from 
underserved communities, communities of 
color, and communities facing linguistic or 
cultural barriers. 
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(iv) Recommendations for legislative 
and administrative actions to increase ac-
cess to doula services in State Medicaid 
programs, including actions that ensure 
doulas may earn a living wage that ac-
counts for their time and costs associated 
with providing care and community-based 
doula program administration and oper-
ation. 
(B) STAKEHOLDER
CONSULTATION.—In 
developing the report required under subpara-
graph (A), MACPAC shall consult with relevant 
stakeholders, including— 
(i) States; 
(ii) organizations, especially reproduc-
tive justice and birth justice organizations 
led by people of color, representing con-
sumers of maternal health care, including 
those that are disproportionately impacted 
by poor maternal health outcomes; 
(iii) organizations and individuals rep-
resenting doulas, including community- 
based doula programs and those who serve 
underserved communities, including com-
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588 
munities of color, and communities facing 
linguistic or cultural barriers; 
(iv) organizations representing health 
care providers; and 
(v) Black, Indigenous, and other ma-
ternal health care consumers of color who 
have experienced severe maternal mor-
bidity. 
(2) CMS GUIDANCE.— 
(A) IN GENERAL.—Not later than 1 year 
after the date that MACPAC publishes the re-
port required under paragraph (1)(A), the Ad-
ministrator of the Centers for Medicare & Med-
icaid Services shall issue guidance to States on 
increasing access to doula services under Med-
icaid. Such guidance shall at a minimum in-
clude— 
(i) options for States to provide med-
ical assistance for doula services under 
State Medicaid programs; 
(ii) best practices for ensuring that 
doulas, including community-based doulas, 
receive reimbursement for doula services 
provided under a State Medicaid program, 
at a level that allows doulas to earn a liv-
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589 
ing wage that accounts for their time and 
costs associated with providing care and 
community-based doula program adminis-
tration; and 
(iii) best practices for increasing ac-
cess to doula services, including services 
provided 
by 
community-based 
doulas, 
under State Medicaid programs. 
(B) STAKEHOLDER
CONSULTATION.—In 
developing the guidance required under sub-
paragraph (A), the Administrator of the Cen-
ters for Medicare & Medicaid Services shall con-
sult with MACPAC and other relevant stake-
holders, including— 
(i) State Medicaid officials; 
(ii) organizations representing con-
sumers of maternal health care, including 
those that are disproportionately impacted 
by poor maternal health outcomes; 
(iii) organizations representing doulas, 
including community-based doulas and 
those who serve underserved communities, 
such as communities of color and commu-
nities facing linguistic or cultural barriers; 
and 
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(iv) organizations representing med-
ical professionals. 
(e) GAO REPORT ON STATE MEDICAID PROGRAMS’ 
USE OF TELEHEALTH TO INCREASE ACCESS TO MATER-
NITY CARE.—Not later than 1 year after the date of the 
enactment of this Act, the Comptroller General of the 
United States shall submit a report to Congress on State 
Medicaid programs’ use of telehealth to increase access to 
maternity care. Such report shall include the following: 
(1) The number of State Medicaid programs 
that utilize telehealth that increases access to mater-
nity care. 
(2) With respect to State Medicaid programs 
that utilize telehealth that increases access to mater-
nity care, information about— 
(A) common characteristics of such pro-
grams’ approaches to utilizing telehealth that 
increases access to maternity care; 
(B) differences in States’ approaches to 
utilizing telehealth to improve access to mater-
nity care, and the resulting differences in State 
maternal health outcomes, as determined by 
factors described in subsection (C); and 
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591 
(C) when compared to patients who receive 
maternity care in person, what is known 
about— 
(i) the demographic characteristics, 
such as race, ethnicity, sex, sexual orienta-
tion, gender identity, disability status, age, 
and preferred language of the individuals 
enrolled in such programs who use tele-
health to access maternity care; 
(ii) health outcomes for such individ-
uals, including frequency of mortality and 
severe morbidity, as compared to individ-
uals with similar characteristics who did 
not use telehealth to access maternity care; 
(iii) the services provided to individ-
uals through telehealth, including family 
planning services, mental health care serv-
ices, and oral health services; 
(iv) the devices and equipment pro-
vided to individuals for remote patient 
monitoring and telehealth, including blood 
pressure monitors and blood glucose mon-
itors; 
(v) the quality of maternity care pro-
vided through telehealth, including whether 
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592 
maternity care provided through telehealth 
is culturally and linguistically appropriate; 
(vi) the level of patient satisfaction 
with maternity care provided through tele-
health to individuals enrolled in State Med-
icaid programs; 
(vii) the impact of utilizing telehealth 
to increase access to maternity care on 
spending, cost savings, access to care, and 
utilization of care under State Medicaid 
programs; and 
(viii) the accessibility and effectiveness 
of telehealth for maternity care during the 
COVID–19 pandemic. 
(3) An identification and analysis of the bar-
riers to using telehealth to increase access to mater-
nity care under State Medicaid programs. 
(4) Recommendations for such legislative and 
administrative actions related to increasing access to 
telehealth maternity services under Medicaid as the 
Comptroller General deems appropriate. 
SEC. 5203. SOCIAL DETERMINANTS FOR MOMS. 
(a) TASK FORCE TO DEVELOP A STRATEGY TO AD-
DRESS
SOCIAL
DETERMINANTS
OF
MATERNAL 
HEALTH.— 
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593 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall convene a task force (in this 
subsection referred to as the ‘‘Task Force’’) to de-
velop a strategy to coordinate efforts between Fed-
eral agencies to address social determinants of ma-
ternal 
health 
with 
respect 
to 
pregnant 
and 
postpartum individuals. 
(2) EX
OFFICIO
MEMBERS.—The ex officio 
members of the Task Force shall consist of the fol-
lowing: 
(A) The Secretary of Health and Human 
Services (or a designee thereof). 
(B) The Secretary of Housing and Urban 
Development (or a designee thereof). 
(C) The Secretary of Transportation (or a 
designee thereof). 
(D) The Secretary of Agriculture (or a 
designee thereof). 
(E) The Secretary of Labor (or a designee 
thereof). 
(F) The Administrator of the Environ-
mental Protection Agency (or a designee there-
of). 
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(G) The Assistant Secretary for the Ad-
ministration for Children and Families (or a 
designee thereof). 
(H) The Administrator of the Centers for 
Medicare & Medicaid Services (or a designee 
thereof). 
(I) The Director of the Indian Health 
Service (or a designee thereof). 
(J) The Director of the National Institutes 
of Health (or a designee thereof). 
(K) The Administrator of the Health Re-
sources and Services Administration (or a des-
ignee thereof). 
(L) The Deputy Assistant Secretary for 
Minority Health of the Department of Health 
and Human Services (or a designee thereof). 
(M) The Deputy Assistant Secretary for 
Women’s Health of the Department of Health 
and Human Services (or a designee thereof). 
(N) The Director of the Centers for Dis-
ease Control and Prevention (or a designee 
thereof). 
(O) The Director of the Office on Violence 
Against Women of the Department of Justice 
(or a designee thereof). 
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(3) APPOINTED MEMBERS.—In addition to the 
ex officio members of the Task Force, the Secretary 
of Health and Human Services shall appoint the fol-
lowing members of the Task Force: 
(A) At least two representatives of pa-
tients, to include— 
(i) a representative of patients who 
have suffered from severe maternal mor-
bidity; or 
(ii) a representative of patients who is 
a family member of an individual who suf-
fered a pregnancy-related death. 
(B) At least two leaders of community- 
based organizations that address maternal mor-
tality and severe maternal morbidity with a spe-
cific focus on racial and ethnic inequities. In 
appointing such leaders under this subpara-
graph, the Secretary of Health and Human 
Services shall give priority to individuals who 
are leaders of organizations led by individuals 
from racial and ethnic minority groups. 
(C) At least two perinatal health workers. 
(D) A professionally diverse panel of ma-
ternity care providers. 
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(4) CHAIR.—The Secretary of Health and 
Human Services shall select the chair of the Task 
Force from among the members of the Task Force. 
(5) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Task Force shall 
submit to Congress a report on— 
(A) the strategy developed under para-
graph (1); 
(B) recommendations on funding amounts 
with respect to implementing such strategy; and 
(C) recommendations for how to expand 
coverage of social services to address social de-
terminants of maternal health under Medicaid 
managed care organizations and State Medicaid 
programs. 
(6) TERMINATION.—Section 1013 of title 5, 
United States Code, shall not apply to the Task 
Force with respect to termination. 
(b) HOUSING FOR MOMS GRANT PROGRAM.— 
(1) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means— 
(i) a community-based organization; 
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(ii) a State or local governmental enti-
ty, including a State or local public health 
department; 
(iii) an Indian tribe or Tribal organi-
zation (as such terms are defined in sec-
tion 4 of the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 
5304)); or 
(iv) an Urban Indian organization (as 
such term is defined in section 4 of the In-
dian Health Care Improvement Act (25 
U.S.C. 1603)). 
(B) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Housing and Urban De-
velopment. 
(2) ESTABLISHMENT.—The Secretary shall es-
tablish a Housing for Moms grant program to make 
grants to eligible entities to increase access to safe, 
stable, affordable, and adequate housing for preg-
nant and postpartum individuals and their families. 
(3) APPLICATION.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
submit to the Secretary an application at such time, 
in such manner, and containing such information as 
the Secretary may provide. 
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598 
(4) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to an eli-
gible entity that— 
(A) is a community-based organization or 
will partner with a community-based organiza-
tion to implement initiatives to increase access 
to safe, stable, affordable, and adequate hous-
ing for pregnant and postpartum individuals 
and their families; 
(B) is operating in an area with high rates 
of adverse maternal health outcomes or signifi-
cant racial or ethnic inequities in maternal 
health outcomes, to the extent such data are 
available; and 
(C) is operating in an area with a high 
poverty rate or a significant number of individ-
uals who lack consistent access to safe, stable, 
affordable, and adequate housing. 
(5) USE OF FUNDS.—An eligible entity that re-
ceives a grant under this subsection shall use funds 
from the grant for the purposes of— 
(A) identifying and conducting outreach to 
pregnant and postpartum individuals who are 
low-income and lack consistent access to safe, 
stable, affordable, and adequate housing; 
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(B) providing safe, stable, affordable, and 
adequate housing options to such individuals; 
(C) connecting such individuals with local 
organizations offering safe, stable, affordable, 
and adequate housing options; 
(D) providing application assistance to 
such individuals seeking to enroll in programs 
offering safe, stable, affordable, and adequate 
housing options; 
(E) providing direct financial assistance to 
such individuals for the purposes of maintaining 
safe, stable, and adequate housing for the dura-
tion 
of 
the 
individual’s 
pregnancy 
and 
postpartum periods; and 
(F) working with relevant stakeholders to 
ensure that local housing and homeless shelter 
infrastructure is supportive to pregnant and 
postpartum individuals, including through— 
(i) health-promoting housing codes; 
(ii) enforcement of housing codes; 
(iii) proactive rental inspection pro-
grams; 
(iv) code enforcement officer training; 
and 
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(v) partnerships between regional of-
fices of the Department of Housing and 
Urban Development and community-based 
organizations to ensure housing laws are 
understood and violations are discovered. 
(6) REPORTING.— 
(A) ELIGIBLE
ENTITIES.—The Secretary 
shall require each eligible entity receiving a 
grant under this subsection to annually submit 
to the Secretary and make publicly available a 
report on the status of activities conducted 
using the grant. 
(B) SECRETARY.—Not later than the end 
of each fiscal year in which grants are made 
under this subsection, the Secretary shall sub-
mit to Congress and make publicly available a 
report that— 
(i) summarizes the reports received 
under subparagraph (A); 
(ii) evaluates the effectiveness of 
grants awarded under this subsection in 
increasing access to safe, stable, afford-
able, and adequate housing for pregnant 
and postpartum individuals and their fami-
lies; and 
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(iii) makes recommendations with re-
spect to ensuring activities described in 
paragraph 
(5) 
continue 
after 
grant 
amounts made available under this sub-
section are expended. 
(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection $10,000,000 for fiscal year 2025, 
which shall remain available until expended. 
(c) DEPARTMENT OF TRANSPORTATION.— 
(1) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of 
Transportation shall submit to Congress and make 
publicly available a report containing— 
(A) an assessment of transportation bar-
riers preventing individuals from attending pre-
natal and postpartum appointments, accessing 
maternal health care services, or accessing serv-
ices and resources related to social deter-
minants of maternal health; 
(B) recommendations on how to overcome 
the barriers assessed under subparagraph (A); 
and 
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(C) an assessment of transportation safety 
risks for pregnant individuals and recommenda-
tions on how to mitigate those risks. 
(2) CONSIDERATIONS.—In carrying out para-
graph (1), the Secretary of Transportation shall give 
special consideration to solutions for— 
(A) pregnant and postpartum individuals 
living in a health professional shortage area 
designated under section 332 of the Public 
Health Service Act (42 U.S.C. 254e); 
(B) pregnant and postpartum individuals 
living in areas with high maternal mortality or 
severe morbidity rates or significant racial or 
ethnic inequities in maternal health outcomes; 
and 
(C) pregnant and postpartum individuals 
with a disability that impacts mobility. 
(d) DEPARTMENT OF AGRICULTURE.— 
(1) SPECIAL SUPPLEMENTAL NUTRITION PRO-
GRAM FOR WOMEN, INFANTS, AND CHILDREN.— 
(A) EXTENSION
OF
POSTPARTUM
PE-
RIOD.—Section 17(b)(10) of the Child Nutri-
tion Act of 1966 (42 U.S.C. 1786(b)(10)) is 
amended by striking ‘‘six’’ and inserting ‘‘24’’. 
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603 
(B) REPORT.—Not later than 2 years after 
the date of enactment of this Act, the Secretary 
shall submit to Congress a report that evaluates 
the effect of the amendment made by subpara-
graph (A) on— 
(i) maternal and infant health out-
comes, including racial and ethnic inequi-
ties with respect to those outcomes; 
(ii) 
breastfeeding 
rates 
among 
postpartum individuals; 
(iii) qualitative evaluations of family 
experiences under the special supplemental 
nutrition program for women, infants, and 
children established under section 17 of 
the Child Nutrition Act of 1966 (42 
U.S.C. 1786); and 
(iv) other relevant information as de-
termined by the Secretary. 
(2) GRANT PROGRAM FOR HEALTHY FOOD AND 
CLEAN
WATER
FOR
PREGNANT
AND
POSTPARTUM 
INDIVIDUALS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a program (referred to in this paragraph 
as the ‘‘program’’) to award grants, on a com-
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petitive basis, to eligible entities to carry out 
the activities described in subparagraph (D). 
(B) APPLICATION.—To be eligible for a 
grant under the program, an eligible entity 
shall submit to the Secretary an application at 
such time, in such manner, and containing such 
information as the Secretary determines appro-
priate. 
(C) PRIORITY.—In awarding grants under 
the program, the Secretary shall give priority to 
an eligible entity that— 
(i) is, or will partner with, an eligible 
entity described in paragraph (3)(A)(i); 
and 
(ii) is operating in an area with a high 
rate of— 
(I) adverse maternal health out-
comes; or 
(II) significant racial or ethnic 
inequities in maternal health out-
comes. 
(D) USE
OF
FUNDS.—An eligible entity 
shall use a grant awarded under the program to 
deliver healthy food, infant formula, clean 
water, or diapers to pregnant and postpartum 
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individuals located in areas that are food 
deserts, as determined by the Secretary using 
data from the Food Access Research Atlas of 
the Department of Agriculture. 
(E) REPORTS.— 
(i) ELIGIBLE
ENTITIES.—Not later 
than 1 year after the date on which an eli-
gible entity receives a grant under the pro-
gram, and annually thereafter, the eligible 
entity shall submit to the Secretary a re-
port on the status of activities conducted 
using the grant, which shall contain such 
information as the Secretary may require. 
(ii) SECRETARY.— 
(I) IN GENERAL.—Not later than 
2 years after the date on which the 
first grant is awarded under the pro-
gram, the Secretary shall submit to 
Congress a report that includes— 
(aa) a summary of the re-
ports submitted by eligible enti-
ties under clause (i); 
(bb) an assessment of the 
extent to which food distributed 
using grants awarded under the 
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program was purchased from 
local and regional food systems; 
(cc) an evaluation of the ef-
fect of the program on maternal 
and infant health outcomes, in-
cluding racial and ethnic inequi-
ties with respect to those out-
comes; and 
(dd) recommendations with 
respect to ensuring the activities 
described in subparagraph (D) 
continue after the grant period 
funding those activities expires. 
(II) 
PUBLICATION.—The 
Sec-
retary shall make the report sub-
mitted under subclause (I) publicly 
available on the website of the De-
partment of Agriculture. 
(F) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There is authorized to be appropriated 
to carry out the program $5,000,000 for the 
period of fiscal years 2025 through 2027. 
(3) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means— 
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(i) a community-based organization; 
(ii) a State or local governmental enti-
ty, including a State or local public health 
department; 
(iii) an Indian Tribe or Tribal organi-
zation (as those terms are defined in sec-
tion 4 of the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 
5304)); and 
(iv) an Urban Indian organization (as 
defined in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603)). 
(B) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Agriculture. 
(e) ENVIRONMENTAL STUDY THROUGH NATIONAL 
ACADEMIES.— 
(1) IN GENERAL.—Not later than 60 days after 
the date of enactment of this Act, the Administrator 
of the Environmental Protection Agency shall seek 
to enter into an agreement with the National Acad-
emies of Sciences, Engineering, and Medicine (re-
ferred to in this subsection as the ‘‘National Acad-
emies’’) under which the National Academies agree 
to conduct a study on the impacts of, with respect 
to maternal and infant health incomes, water and 
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air quality, exposure to extreme temperatures, envi-
ronmental chemicals, environmental risks in the 
workplace and the home, and pollution levels. 
(2) STUDY
REQUIREMENTS.—The agreement 
under paragraph (1) shall direct the National Acad-
emies to make recommendations for— 
(A) improving environmental conditions to 
improve maternal and infant health outcomes; 
and 
(B) reducing or eliminating racial and eth-
nic inequities in those outcomes. 
(3) REPORT.—The agreement under paragraph 
(1) shall direct the National Academies to complete 
the study under this subsection, and submit to Con-
gress and make publicly available a report on the re-
sults of the study, not later than 1 year after the 
date of enactment of this Act. 
(f) CHILD CARE ACCESS.— 
(1) 
GRANT
PROGRAM.—The 
Secretary 
of 
Health and Human Services (in this subsection re-
ferred to as the ‘‘Secretary’’) shall award grants to 
eligible organizations to carry out programs to pro-
vide pregnant and postpartum individuals with free 
and accessible drop-in child care services during pre-
natal and postpartum appointments. 
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(2) APPLICATION.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
submit to the Secretary an application at such time, 
in such manner, and containing such information as 
the Secretary may require. 
(3) ELIGIBLE ORGANIZATIONS.— 
(A) ELIGIBILITY.—To be eligible to receive 
a grant under this subsection, an organization 
shall be an organization that— 
(i) provides child care services; and 
(ii) can carry out a program providing 
pregnant and postpartum individuals with 
free and accessible drop-in child care serv-
ices during prenatal and postpartum ap-
pointments. 
(B) PRIORITIZATION.—In selecting grant 
recipients under this subsection, the Secretary 
shall give priority to eligible organizations that 
operate in an area that has, to the extent data 
with respect to such an area are available— 
(i) high rates of adverse maternal 
health outcomes; or 
(ii) significant racial or ethnic inequi-
ties in maternal health outcomes. 
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(4) TIMING.—The Secretary shall commence 
the grant program under paragraph (1) not later 
than 1 year after the date of enactment of this Act. 
(5) REPORTING.— 
(A) GRANTEES.—Each recipient of a grant 
under this subsection shall annually submit to 
the Secretary and make publicly available a re-
port on the status of activities conducted using 
the grant. Each such report shall include— 
(i) an analysis of the effect of the 
funded 
program 
on 
prenatal 
and 
postpartum appointment attendance rates; 
(ii) summaries of qualitative assess-
ments of the funded program from— 
(I) pregnant and postpartum in-
dividuals participating in the pro-
gram; and 
(II) the families of such individ-
uals; and 
(iii) such additional information as 
the Secretary may require. 
(B) SECRETARY.—Not later than the end 
of fiscal year 2027, the Secretary shall submit 
to the Congress, and make publicly available, a 
report containing each of the following: 
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(i) A summary of the reports received 
under subparagraph (A). 
(ii) An assessment of the effects, if 
any, of the funded programs on maternal 
health outcomes, with a specific focus on 
racial and ethnic inequities in such out-
comes. 
(iii) A description of actions the Sec-
retary can take to ensure that pregnant 
and postpartum individuals eligible for 
medical assistance under a State plan 
under title XIX of the Social Security Act 
(42 U.S.C. 1936 et seq.) have access to 
free and accessible drop-in child care serv-
ices during prenatal and postpartum ap-
pointments, including identification of the 
funding necessary to carry out such ac-
tions. 
(6) DROP-IN
CHILD
CARE
SERVICES
DE-
FINED.—In this subsection, the term ‘‘drop-in child 
care services’’ means child care (including early 
childhood education) services that are— 
(A) delivered at a facility that meets the 
requirements of all applicable laws and regula-
tions of the State or local government in which 
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it is located, including the requirements for li-
censing of the facility as a child care facility; 
and 
(B) provided in single encounters without 
requiring full-time enrollment of a person in a 
child care program. 
(7) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this subsection, there is authorized to be 
appropriated $5,000,000 for the period of fiscal 
years 2025 through 2027. 
(g) GRANTS TO LOCAL ENTITIES ADDRESSING SO-
CIAL DETERMINANTS OF MATERNAL HEALTH.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this subsection referred to as 
the ‘‘Secretary’’) shall award grants to eligible enti-
ties to— 
(A) address social determinants of mater-
nal health for pregnant and postpartum individ-
uals; and 
(B) eliminate racial and ethnic inequities 
in maternal health outcomes. 
(2) APPLICATION.—To be eligible to receive a 
grant under this subsection an eligible entity shall 
submit to the Secretary an application at such time, 
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in such manner, and containing such information as 
the Secretary may provide. 
(3) 
PRIORITIZATION.—In 
awarding 
grants 
under paragraph (1), the Secretary shall give pri-
ority to an eligible entity that— 
(A) is a community-based organization, or 
will partner with a community-based organiza-
tion to carry out the activities under paragraph 
(4); 
(B) is operating in an area with high rates 
of adverse maternal health outcomes or signifi-
cant racial or ethnic inequities in maternal 
health outcomes; and 
(C) is operating in an area with a high 
poverty rate. 
(4) ACTIVITIES.—An eligible entity that re-
ceives a grant under this subsection may use funds 
received through the grant to— 
(A) hire and retain staff; 
(B) develop and distribute a list of avail-
able resources with respect to social service pro-
grams in a community; 
(C) establish a resource center that pro-
vides multiple social service programs in a sin-
gle location; 
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(D) offer programs and resources in the 
communities in which the respective eligible en-
tities are located to address social determinants 
of health for pregnant and postpartum individ-
uals; and 
(E) consult with such pregnant and 
postpartum individuals to conduct an assess-
ment of the activities under this paragraph. 
(5) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide to grant recipients under this sub-
section technical assistance to plan for sustaining 
programs to address social determinants of maternal 
health among pregnant and postpartum individuals 
after the period of the grant. 
(6) REPORTING.— 
(A) GRANTEES.—Not later than 1 year 
after the date on which an eligible entity first 
receives a grant under this subsection, and an-
nually thereafter, an eligible entity shall submit 
to the Secretary, and make publicly available, a 
report on the status of activities conducted 
using the grant. Each such report shall include 
data 
on 
the 
effects 
of 
such 
activities, 
disaggregated by race, ethnicity, gender, and 
other relevant factors. 
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615 
(B) SECRETARY.—Not later than the end 
of fiscal year 2029, the Secretary shall submit 
to Congress a report that includes— 
(i) a summary of the reports received 
under subparagraph (A); and 
(ii) recommendations for— 
(I) improving maternal health 
outcomes; and 
(II) reducing or eliminating ra-
cial and ethnic inequities in maternal 
health outcomes. 
(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection $15,000,000 for each of fiscal years 
2025 through 2029. 
(h) DEFINITIONS.—In this section: 
(1) CULTURALLY CONGRUENT.—The term ‘‘cul-
turally congruent’’, with respect to care or maternity 
care provided to a health care consumer, means care 
that is in agreement with the preferred cultural val-
ues, beliefs, worldview, language, and practices of 
the health care consumer and other relevant stake-
holders. 
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(2) MATERNITY
CARE
PROVIDER.—The term 
‘‘maternity care provider’’ means a health care pro-
vider who— 
(A) is a physician, physician assistant, 
midwife who meets at a minimum the inter-
national definition of the midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
Midwives, nurse practitioner, or clinical nurse 
specialist; and 
(B) has a focus on maternal or perinatal 
health. 
(3) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means a death occurring during or 
within a one-year period after pregnancy, caused by 
pregnancy-related or childbirth complications, in-
cluding a suicide, overdose, or other death resulting 
from a mental health or substance use disorder at-
tributed to or aggravated by pregnancy-related or 
childbirth complications. 
(4) PERINATAL HEALTH WORKER.—The term 
‘‘perinatal health worker’’ means a doula, commu-
nity health worker, peer supporter, breastfeeding 
and lactation educator or counselor, nutritionist or 
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dietitian, childbirth educator, social worker, home 
visitor, language interpreter, or navigator. 
(5) POSTPARTUM AND POSTPARTUM PERIOD.— 
The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 
refer to the 1-year period beginning on the last day 
of the pregnancy of an individual. 
(6) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘‘racial and ethnic minority group’’ has the 
meaning given such term in section 1707(g)(1) of 
the Public Health Service Act (42 U.S.C. 300u– 
6(g)(1)). 
(7) SEVERE MATERNAL MORBIDITY.—The term 
‘‘severe maternal morbidity’’ means a health condi-
tion, including mental health conditions and sub-
stance use disorders, attributed to or aggravated by 
pregnancy or childbirth that results in significant 
short-term or long-term consequences to the health 
of the individual who was pregnant. 
(8) SOCIAL
DETERMINANTS
OF
MATERNAL 
HEALTH DEFINED.—The term ‘‘social determinants 
of maternal health’’ means non-clinical factors that 
impact maternal health outcomes, including— 
(A) economic factors, which may include 
poverty, employment, food security, support for 
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and access to lactation and other infant feeding 
options, housing stability, and related factors; 
(B) neighborhood factors, which may in-
clude quality of housing, access to transpor-
tation, access to child care, availability of 
healthy foods and nutrition counseling, avail-
ability of clean water, air and water quality, 
ambient temperatures, neighborhood crime and 
violence, access to broadband, and related fac-
tors; 
(C) social and community factors, which 
may include systemic racism, gender discrimi-
nation or discrimination based on other pro-
tected classes, workplace conditions, incarcer-
ation, and related factors; 
(D) household factors, which may include 
ability to conduct lead testing and abatement, 
car seat installation, indoor air temperatures, 
and related factors; 
(E) education access and quality factors, 
which may include educational attainment, lan-
guage and literacy, and related factors; and 
(F) health care access factors, including 
health insurance coverage, access to culturally 
congruent health care services, providers, and 
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non-clinical support, access to home visiting 
services, access to wellness and stress manage-
ment programs, health literacy, access to tele-
health and items required to receive telehealth 
services, and related factors. 
SEC. 5204. KIRA JOHNSON ACT. 
(a) INVESTMENTS IN COMMUNITY-BASED ORGANIZA-
TIONS TO IMPROVE BLACK MATERNAL HEALTH OUT-
COMES.— 
(1) AWARDS.—Following the 1-year period de-
scribed in paragraph (3), the Secretary of Health 
and Human Services (in this subsection referred to 
as the ‘‘Secretary’’) shall award grants to eligible 
entities to establish or expand programs to prevent 
maternal mortality and severe maternal morbidity 
among Black pregnant and postpartum individuals. 
(2) ELIGIBILITY.—To be eligible to seek a 
grant under this subsection, an entity shall be a 
community-based organization offering programs 
and resources aligned with evidence-based practices 
for improving maternal health outcomes for Black 
pregnant and postpartum individuals. 
(3) OUTREACH
AND
TECHNICAL
ASSISTANCE 
PERIOD.—During the 1-year period beginning on the 
date of enactment of this Act, the Secretary shall— 
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(A) conduct outreach to encourage eligible 
entities to apply for grants under this sub-
section; and 
(B) provide technical assistance to eligible 
entities on best practices for applying for grants 
under this subsection. 
(4) SPECIAL CONSIDERATION.— 
(A) OUTREACH.—In conducting outreach 
under paragraph (3), the Secretary shall give 
special consideration to eligible entities that— 
(i) are based in, and provide support 
for, communities with high rates of adverse 
maternal health outcomes or significant ra-
cial and ethnic inequities in maternal 
health outcomes, to the extent such data 
are available; 
(ii) are led by Black people; and 
(iii) offer programs and resources that 
are aligned with evidence-based practices 
for improving maternal health outcomes 
for Black pregnant and postpartum indi-
viduals. 
(B) AWARDS.—In awarding grants under 
this subsection, the Secretary shall give special 
consideration to eligible entities that— 
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(i) are described in clauses (i), (ii), 
and (iii) of subparagraph (A); 
(ii) offer programs and resources de-
signed in consultation with and intended 
for Black pregnant and postpartum indi-
viduals; and 
(iii) offer programs and resources in 
the communities in which the respective el-
igible entities are located that— 
(I) promote maternal mental 
health and maternal substance use 
disorder treatments and supports that 
are aligned with evidence-based prac-
tices for improving maternal mental 
and behavioral health outcomes for 
Black pregnant and postpartum indi-
viduals; 
(II) address social determinants 
of maternal health for pregnant and 
postpartum individuals; 
(III) 
promote 
evidence-based 
health literacy and pregnancy, child-
birth, and parenting education for 
pregnant and postpartum individuals; 
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(IV) 
provide 
support 
from 
perinatal health workers to pregnant 
and postpartum individuals; 
(V) provide culturally congruent 
training to perinatal health workers; 
(VI) conduct or support research 
on maternal health issues dispropor-
tionately impacting Black pregnant 
and postpartum individuals; 
(VII) provide support to family 
members of individuals who suffered a 
pregnancy-associated death or preg-
nancy-related death; 
(VIII) operate midwifery prac-
tices that provide culturally congruent 
maternal health care and support, in-
cluding for the purposes of— 
(aa) supporting additional 
education, training, and certifi-
cation programs, including sup-
port for distance learning; 
(bb) providing financial sup-
port to current and future mid-
wives to address education costs, 
debts, and other needs; 
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(cc) clinical site investments; 
(dd) supporting preceptor 
development trainings; 
(ee) expanding the mid-
wifery practice; or 
(ff) related needs identified 
by the midwifery practice and de-
scribed in the practice’s applica-
tion; or 
(IX) have developed other pro-
grams and resources that address 
community-specific needs for pregnant 
and postpartum individuals and are 
aligned with evidence-based practices 
for improving maternal health out-
comes 
for 
Black 
pregnant 
and 
postpartum individuals. 
(5) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide to grant recipients under this sub-
section technical assistance on— 
(A) capacity building to establish or ex-
pand programs to prevent adverse maternal 
health outcomes among Black pregnant and 
postpartum individuals; 
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(B) best practices in data collection, meas-
urement, evaluation, and reporting; and 
(C) planning for sustaining programs to 
prevent maternal mortality and severe maternal 
morbidity 
among 
Black 
pregnant 
and 
postpartum individuals after the period of the 
grant. 
(6) EVALUATION.—Not later than the end of 
fiscal year 2029, the Secretary shall submit to the 
Congress an evaluation of the grant program under 
this subsection that— 
(A) assesses the effectiveness of outreach 
efforts during the application process in diversi-
fying the pool of grant recipients; 
(B) makes recommendations for future 
outreach efforts to diversify the pool of grant 
recipients for Department of Health and 
Human Services grant programs and funding 
opportunities related to maternal health; 
(C) assesses the effectiveness of programs 
funded by grants under this subsection in im-
proving maternal health outcomes for Black 
pregnant and postpartum individuals, to the ex-
tent practicable; and 
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(D) makes recommendations for future 
Department of Health and Human Services 
grant programs and funding opportunities that 
deliver funding to community-based organiza-
tions that provide programs and resources that 
are aligned with evidence-based practices for 
improving maternal health outcomes for Black 
pregnant and postpartum individuals. 
(7) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this subsection, there is authorized to be 
appropriated $10,000,000 for each of fiscal years 
2025 through 2029. 
(b) INVESTMENTS IN COMMUNITY-BASED ORGANIZA-
TIONS TO IMPROVE MATERNAL HEALTH OUTCOMES IN 
UNDERSERVED COMMUNITIES.— 
(1) AWARDS.—Following the 1-year period de-
scribed in paragraph (3), the Secretary of Health 
and Human Services (in this subsection referred to 
as the ‘‘Secretary’’) shall award grants to eligible 
entities to establish or expand programs to prevent 
maternal mortality and severe maternal morbidity 
among underserved groups. 
(2) ELIGIBILITY.—To be eligible to seek a 
grant under this subsection, an entity shall be a 
community-based organization offering programs 
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626 
and resources aligned with evidence-based practices 
for improving maternal health outcomes for preg-
nant and postpartum individuals. 
(3) OUTREACH
AND
TECHNICAL
ASSISTANCE 
PERIOD.—During the 1-year period beginning on the 
date of enactment of this Act, the Secretary shall— 
(A) conduct outreach to encourage eligible 
entities to apply for grants under this sub-
section; and 
(B) provide technical assistance to eligible 
entities on best practices for applying for grants 
under this subsection. 
(4) SPECIAL CONSIDERATION.— 
(A) OUTREACH.—In conducting outreach 
under paragraph (3), the Secretary shall give 
special consideration to eligible entities that— 
(i) are based in, and provide support 
for, communities with high rates of adverse 
maternal health outcomes or significant ra-
cial and ethnic inequities in maternal 
health outcomes, to the extent such data 
are available; 
(ii) are led by individuals from ra-
cially, ethnically, and geographically di-
verse backgrounds; and 
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(iii) offer programs and resources that 
are aligned with evidence-based practices 
for improving maternal health outcomes 
for pregnant and postpartum individuals. 
(B) AWARDS.—In awarding grants under 
this subsection, the Secretary shall give special 
consideration to eligible entities that— 
(i) are described in clauses (i), (ii), 
and (iii) of subparagraph (A); 
(ii) offer programs and resources de-
signed in consultation with and intended 
for pregnant and postpartum individuals 
from underserved groups; 
(iii) offer programs and resources in 
the communities in which the respective el-
igible entities are located that— 
(I) promote maternal mental 
health and maternal substance use 
disorder treatments and support that 
are aligned with evidence-based prac-
tices for improving maternal mental 
and behavioral health outcomes for 
pregnant and postpartum individuals; 
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(II) address social determinants 
of maternal health for pregnant and 
postpartum individuals; 
(III) 
promote 
evidence-based 
health literacy and pregnancy, child-
birth, and parenting education for 
pregnant and postpartum individuals; 
(IV) 
provide 
support 
from 
perinatal health workers to pregnant 
and postpartum individuals; 
(V) provide culturally congruent 
training to perinatal health workers; 
(VI) conduct or support research 
on maternal health outcomes and in-
equities; 
(VII) provide support to family 
members of individuals who suffered a 
pregnancy-associated death or preg-
nancy-related death; or 
(VIII) operate midwifery prac-
tices that provide culturally congruent 
maternal health care and support, in-
cluding for the purposes of— 
(aa) supporting additional 
education, training, and certifi-
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629 
cation programs, including sup-
port for distance learning; 
(bb) providing financial sup-
port to current and future mid-
wives to address education costs, 
debts, and other needs; 
(cc) clinical site investments; 
(dd) supporting preceptor 
development trainings; 
(ee) expanding the mid-
wifery practice; or 
(ff) related needs identified 
by the midwifery practice and de-
scribed in the practice’s applica-
tion; or 
(iv) have developed other programs 
and resources that address community-spe-
cific needs for pregnant and postpartum 
individuals and are aligned with evidence- 
based practices for improving maternal 
health 
outcomes 
for 
pregnant 
and 
postpartum individuals. 
(5) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide to grant recipients under this sub-
section technical assistance on— 
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630 
(A) capacity building to establish or ex-
pand programs to prevent adverse maternal 
health 
outcomes 
among 
pregnant 
and 
postpartum 
individuals 
from 
underserved 
groups; 
(B) best practices in data collection, meas-
urement, evaluation, and reporting; and 
(C) planning for sustaining programs to 
prevent maternal mortality and severe maternal 
morbidity among pregnant and postpartum in-
dividuals from underserved groups after the pe-
riod of the grant. 
(6) EVALUATION.—Not later than the end of 
fiscal year 2029, the Secretary shall submit to the 
Congress an evaluation of the grant program under 
this subsection that— 
(A) assesses the effectiveness of outreach 
efforts during the application process in diversi-
fying the pool of grant recipients; 
(B) makes recommendations for future 
outreach efforts to diversify the pool of grant 
recipients for Department of Health and 
Human Services grant programs and funding 
opportunities related to maternal health; 
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631 
(C) assesses the effectiveness of programs 
funded by grants under this subsection in im-
proving maternal health outcomes for pregnant 
and postpartum individuals from underserved 
groups, to the extent practicable; and 
(D) makes recommendations for future 
Department of Health and Human Services 
grant programs and funding opportunities that 
deliver funding to community-based organiza-
tions that provide programs and resources that 
are aligned with evidence-based practices for 
improving maternal health outcomes for preg-
nant and postpartum individuals. 
(7) DEFINITION.—In this subsection, the term 
‘‘underserved groups’’ refers to pregnant and 
postpartum individuals— 
(A) from racial and ethnic minority 
groups; 
(B) whose household income is equal to or 
less than 150 percent of the Federal poverty 
line; 
(C) who live in health professional shortage 
areas (as such term is defined in section 332 of 
the Public Health Service Act (42 U.S.C. 
254e)); 
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(D) who live in counties with no hospital 
offering obstetric care, no birth center, and no 
obstetric provider; or 
(E) who live in counties with a level of vul-
nerability of moderate-to-high or higher, accord-
ing to the Social Vulnerability Index of the Cen-
ters for Disease Control and Prevention. 
(8) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this subsection, there is authorized to be 
appropriated $10,000,000 for each of fiscal years 
2025 through 2029. 
(c) RESPECTFUL MATERNITY CARE TRAINING FOR 
ALL EMPLOYEES IN MATERNITY CARE SETTINGS.—Part 
B of title VII of the Public Health Service Act (42 U.S.C. 
293 et seq.) (as amended by section 3002), is amended 
by adding at the end the following: 
‘‘SEC. 743. RESPECTFUL MATERNITY CARE TRAINING FOR 
ALL EMPLOYEES IN MATERNITY CARE SET-
TINGS. 
‘‘(a) GRANTS.—The Secretary shall award grants for 
programs to reduce and prevent bias, racism, and dis-
crimination in maternity care settings and to advance re-
spectful, culturally congruent, trauma-informed care. 
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‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 
under subsection (a), the Secretary shall give special con-
sideration to applications for programs that would— 
‘‘(1) apply to all maternity care providers and 
any employees who interact with pregnant and 
postpartum individuals in the provider setting, in-
cluding front desk employees, sonographers, sched-
ulers, health care professionals, hospital or health 
system administrators, security staff, and other em-
ployees; 
‘‘(2) emphasize periodic, as opposed to one- 
time, trainings for all birthing professionals and em-
ployees described in paragraph (1); 
‘‘(3) address implicit bias, racism, and cultural 
humility; 
‘‘(4) be delivered in ongoing education settings 
for providers maintaining their licenses, with a pref-
erence for trainings that provide continuing edu-
cation units; 
‘‘(5) include trauma-informed care best prac-
tices and an emphasis on shared decision making be-
tween providers and patients; 
‘‘(6) include antiracism training and programs; 
‘‘(7) be delivered in undergraduate programs 
that funnel into health professions schools; 
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‘‘(8) be delivered in settings that apply to pro-
viders of the special supplemental nutrition program 
for women, infants, and children under section 17 of 
the Child Nutrition Act of 1966; 
‘‘(9) integrate bias training in obstetric emer-
gency simulation trainings or related trainings; 
‘‘(10) include training for emergency depart-
ment employees and emergency medical technicians 
on recognizing warning signs for severe pregnancy- 
related complications; 
‘‘(11) offer training to all maternity care pro-
viders on the value of racially, ethnically, and profes-
sionally diverse maternity care teams to provide cul-
turally congruent care; or 
‘‘(12) be based on one or more programs de-
signed by a historically Black college or university or 
other minority-serving institution. 
‘‘(c) APPLICATION.—To seek a grant under sub-
section (a), an entity shall submit an application at such 
time, in such manner, and containing such information as 
the Secretary may require. 
‘‘(d) REPORTING TO SECRETARY.—Each recipient of 
a grant under this section shall annually submit to the 
Secretary a report on the status of activities conducted 
using the grant, including, as applicable, a description of 
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the impact of training provided through the grant on pa-
tient outcomes and patient experience for pregnant and 
postpartum individuals from racial and ethnic minority 
groups and their families. 
‘‘(e) DISSEMINATION OF FINDINGS.—Based on the 
annual reports submitted pursuant to subsection (d), the 
Secretary— 
‘‘(1) shall produce an annual report on the find-
ings resulting from programs funded through this 
section; 
‘‘(2) shall disseminate such report to all recipi-
ents of grants under this section and to the public; 
and 
‘‘(3) may include in such report findings on 
best practices for improving patient outcomes and 
patient experience for pregnant and postpartum in-
dividuals from racial and ethnic minority groups and 
their families in maternity care settings. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) The term ‘postpartum’ means the one-year 
period beginning on the last day of an individual’s 
pregnancy. 
‘‘(2) The term ‘culturally congruent’ means in 
agreement with the preferred cultural values, beliefs, 
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world view, language, and practices of the health 
care consumer and other stakeholders. 
‘‘(3) The term ‘maternity care provider’ means 
a health care provider who— 
‘‘(A) is a physician, physician assistant, 
midwife who meets at a minimum the inter-
national definition of the midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
Midwives, nurse practitioner, or clinical nurse 
specialist; and 
‘‘(B) has a focus on maternal or perinatal 
health. 
‘‘(4) The term ‘racial and ethnic minority 
group’ has the meaning given such term in section 
1707(g)(1). 
‘‘(g) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $5,000,000 for each of fiscal years 2025 through 
2029.’’. 
(d) STUDY ON REDUCING AND PREVENTING BIAS, 
RACISM, AND DISCRIMINATION IN MATERNITY CARE SET-
TINGS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall seek to enter into an agree-
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ment, not later than 90 days after the date of enact-
ment of this Act, with the National Academies of 
Sciences, Engineering, and Medicine (referred to in 
this subsection as the ‘‘National Academies’’) under 
which the National Academies agree to— 
(A) conduct a study on the design and im-
plementation of programs to reduce and prevent 
bias, racism, and discrimination in maternity 
care settings and to advance respectful, cul-
turally congruent, trauma-informed care; and 
(B) not later than 2 years after the date 
of enactment of this Act— 
(i) complete the study; and 
(ii) transmit a report on the results of 
the study to the Congress. 
(2) POSSIBLE TOPICS.—The agreement entered 
into pursuant to paragraph (1) may provide for the 
study of any of the following: 
(A) The development of a scorecard or 
other evaluation standards for programs de-
signed to reduce and prevent bias, racism, and 
discrimination in maternity care settings to as-
sess the effectiveness of such programs in im-
proving patient outcomes and patient experi-
ence for pregnant and postpartum individuals 
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from racial and ethnic minority groups and 
their families. 
(B) Determination of the types and fre-
quency of training to reduce and prevent bias, 
racism, and discrimination in maternity care 
settings that are demonstrated to improve pa-
tient outcomes or patient experience for preg-
nant and postpartum individuals from racial 
and ethnic minority groups and their families. 
(e) RESPECTFUL MATERNITY CARE COMPLIANCE 
PROGRAM.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this subsection as 
the ‘‘Secretary’’) shall award grants to accredited 
hospitals, health systems, and other maternity care 
settings to establish as an integral part of quality 
implementation initiatives within one or more hos-
pitals or other birth settings a respectful maternity 
care compliance program. 
(2) PROGRAM
REQUIREMENTS.—A respectful 
maternity care compliance program funded through 
a grant under this subsection shall— 
(A) institutionalize mechanisms to allow 
patients receiving maternity care services, the 
families of such patients, or perinatal health 
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workers supporting such patients to report in-
stances of racism or evidence of bias on the 
basis of race, ethnicity, or another protected 
class; 
(B) institutionalize response mechanisms 
through which representatives of the program 
can directly follow up with the patient, if pos-
sible, and the patient’s family in a timely man-
ner; 
(C) prepare, and make publicly available, a 
hospital- or health system-wide strategy to re-
duce bias on the basis of race, ethnicity, or an-
other protected class in the delivery of mater-
nity care that includes— 
(i) information on the training pro-
grams to reduce and prevent bias, racism, 
and discrimination on the basis of race, 
ethnicity, or another protected class for all 
employees in maternity care settings; 
(ii) information on the number of 
cases reported to the compliance program; 
and 
(iii) the development of methods to 
routinely assess the extent to which bias, 
racism, or discrimination on the basis of 
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race, ethnicity, or another protected class 
are present in the delivery of maternity 
care to patients from racial and ethnic mi-
nority groups; 
(D) develop mechanisms to routinely col-
lect and publicly report hospital-level data re-
lated to patient-reported experience of care; and 
(E) provide annual reports to the Sec-
retary with information about each case re-
ported to the compliance program over the 
course of the year containing such information 
as the Secretary may require, such as— 
(i) de-identified demographic informa-
tion on the patient in the case, such as 
race, ethnicity, gender identity, and pri-
mary language; 
(ii) the content of the report from the 
patient or the family of the patient to the 
compliance program; 
(iii) the response from the compliance 
program; and 
(iv) to the extent applicable, institu-
tional changes made as a result of the 
case. 
(3) SECRETARY REQUIREMENTS.— 
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(A) PROCESSES.—Not later than 180 days 
after the date of enactment of this Act, the Sec-
retary shall establish processes for— 
(i) disseminating best practices for es-
tablishing and implementing a respectful 
maternity care compliance program within 
a hospital or other birth setting; 
(ii) promoting coordination and col-
laboration between hospitals, health sys-
tems, and other maternity care delivery 
settings on the establishment and imple-
mentation of respectful maternity care 
compliance programs; and 
(iii) evaluating the effectiveness of re-
spectful maternity care compliance pro-
grams on maternal health outcomes and 
patient and family experiences, especially 
for patients from racial and ethnic minor-
ity groups and their families. 
(B) STUDY.— 
(i) IN GENERAL.—Not later than 2 
years after the date of enactment of this 
Act, the Secretary shall, through a con-
tract with an independent research organi-
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zation, conduct a study on strategies to ad-
dress— 
(I) racism or bias on the basis of 
race, ethnicity, or another protected 
class in the delivery of maternity care 
services; and 
(II) successful implementation of 
respectful care initiatives. 
(ii) COMPONENTS
OF
STUDY.—The 
study shall include the following: 
(I) An assessment of the reports 
submitted to the Secretary from the 
respectful maternity care compliance 
programs 
pursuant 
to 
paragraph 
(2)(E). 
(II) Based on such assessment, 
recommendations for potential ac-
countability mechanisms related to 
cases of racism or bias on the basis of 
race, ethnicity, or another protected 
class in the delivery of maternity care 
services at hospitals and other birth 
settings. Such recommendations shall 
take into consideration medical and 
non-medical factors that contribute to 
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adverse patient experiences and ma-
ternal health outcomes. 
(iii) REPORT.—The Secretary shall 
submit to the Congress, and make publicly 
available, a report on the results of the 
study under this subparagraph. 
(4) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this subsection, there is authorized to be 
appropriated such sums as may be necessary for fis-
cal years 2025 through 2030. 
(f) GAO REPORT.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act and annually 
thereafter, the Comptroller General of the United 
States shall submit to the Congress, and make pub-
licly available, a report on the establishment of re-
spectful maternity care compliance programs within 
hospitals, health systems, and other maternity care 
settings. 
(2) MATTERS
INCLUDED.—The report under 
paragraph (1) shall include the following: 
(A) Information regarding the extent to 
which hospitals, health systems, and other ma-
ternity care settings have elected to establish 
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respectful maternity care compliance programs, 
including— 
(i) which hospitals and other birth 
settings elect to establish compliance pro-
grams and when such programs are estab-
lished; 
(ii) to the extent practicable, impacts 
of the establishment of such programs on 
maternal health outcomes and patient and 
family experiences in the hospitals and 
other birth settings that have established 
such programs, especially for patients from 
racial and ethnic minority groups and their 
families; 
(iii) information on geographic areas, 
and types of hospitals or other birth set-
tings, where respectful maternity care com-
pliance programs are not being established 
and information on factors contributing to 
decisions to not establish such programs; 
and 
(iv) recommendations for establishing 
respectful maternity care compliance pro-
grams in geographic areas, and types of 
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hospitals or other birth settings, where 
such programs are not being established. 
(B) Whether the funding made available to 
carry out this subsection has been sufficient 
and, if applicable, recommendations for addi-
tional appropriations to carry out this sub-
section. 
(C) Such other information as the Comp-
troller General determines appropriate. 
(g) DEFINITIONS.—In this section: 
(1) CULTURALLY CONGRUENT.—The term ‘‘cul-
turally congruent’’, with respect to care or maternity 
care, means care that is in agreement with the pre-
ferred cultural values, beliefs, worldview, language, 
and practices of the health care consumer and other 
stakeholders. 
(2) MATERNITY
CARE
PROVIDER.—The term 
‘‘maternity care provider’’ means a health care pro-
vider who— 
(A) is a physician, physician assistant, 
midwife who meets at a minimum the inter-
national definition of the midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
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Midwives, nurse practitioner, or clinical nurse 
specialist; and 
(B) has a focus on maternal or perinatal 
health. 
(3) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means a death occurring during or 
within a one-year period after pregnancy, caused by 
pregnancy-related or childbirth complications, in-
cluding a suicide, overdose, or other death resulting 
from a mental health or substance use disorder at-
tributed to or aggravated by pregnancy-related or 
childbirth complications. 
(4) PERINATAL HEALTH WORKER.—The term 
‘‘perinatal health worker’’ means a doula, commu-
nity health worker, peer supporter, breastfeeding 
and lactation educator or counselor, nutritionist or 
dietitian, childbirth educator, social worker, home 
visitor, language interpreter, or navigator. 
(5) POSTPARTUM AND POSTPARTUM PERIOD.— 
The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 
refer to the 1-year period beginning on the last day 
of the pregnancy of an individual. 
(6) 
PREGNANCY-ASSOCIATED
DEATH.—The 
term ‘‘pregnancy-associated death’’ means a death of 
a pregnant or postpartum individual, by any cause, 
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that occurs during, or within 1 year following, the 
individual’s pregnancy, regardless of the outcome, 
duration, or site of the pregnancy. 
(7) PREGNANCY-RELATED
DEATH.—The term 
‘‘pregnancy-related death’’ means a death of a preg-
nant or postpartum individual that occurs during, or 
within 1 year following, the individual’s pregnancy, 
from a pregnancy complication, a chain of events 
initiated by pregnancy, or the aggravation of an un-
related condition by the physiologic effects of preg-
nancy. 
(8) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘‘racial and ethnic minority group’’ has the 
meaning given such term in section 1707(g)(1) of 
the Public Health Service Act (42 U.S.C. 300u– 
6(g)(1)). 
(9) SEVERE MATERNAL MORBIDITY.—The term 
‘‘severe maternal morbidity’’ means a health condi-
tion, including mental health conditions and sub-
stance use disorders, attributed to or aggravated by 
pregnancy or childbirth that results in significant 
short-term or long-term consequences to the health 
of the individual who was pregnant. 
(10) SOCIAL
DETERMINANTS
OF
MATERNAL 
HEALTH DEFINED.—The term ‘‘social determinants 
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of maternal health’’ means non-clinical factors that 
impact maternal health outcomes, including— 
(A) economic factors, which may include 
poverty, employment, food security, support for 
and access to lactation and other infant feeding 
options, housing stability, and related factors; 
(B) neighborhood factors, which may in-
clude quality of housing, access to transpor-
tation, access to child care, availability of 
healthy foods and nutrition counseling, avail-
ability of clean water, air and water quality, 
ambient temperatures, neighborhood crime and 
violence, access to broadband, and related fac-
tors; 
(C) social and community factors, which 
may include systemic racism, gender discrimi-
nation or discrimination based on other pro-
tected classes, workplace conditions, incarcer-
ation, and related factors; 
(D) household factors, which may include 
ability to conduct lead testing and abatement, 
car seat installation, indoor air temperatures, 
and related factors; 
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(E) education access and quality factors, 
which may include educational attainment, lan-
guage and literacy, and related factors; and 
(F) health care access factors, including 
health insurance coverage, access to culturally 
congruent health care services, providers, and 
non-clinical support, access to home visiting 
services, access to wellness and stress manage-
ment programs, health literacy, access to tele-
health and items required to receive telehealth 
services, and related factors. 
SEC. 5205. PERINATAL WORKFORCE. 
(a) HHS AGENCY DIRECTIVES.— 
(1) GUIDANCE TO STATES.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services shall 
issue and disseminate guidance to States to 
educate providers, managed care entities, and 
other insurers about the value and process of 
delivering respectful maternal health care 
through diverse and multidisciplinary care pro-
vider models. 
(B) CONTENTS.—The guidance required 
by subparagraph (A) shall address how States 
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can encourage and incentivize hospitals, health 
systems, midwifery practices, freestanding birth 
centers, other maternity care provider groups, 
managed care entities, and other insurers— 
(i) to recruit and retain maternity 
care providers, mental and behavioral 
health care providers acting in accordance 
with State law, registered dietitians or nu-
trition professionals (as such term is de-
fined in section 1861(vv)(2) of the Social 
Security Act (42 U.S.C. 1395x(vv)(2))), 
and lactation consultants certified by the 
International Board of Lactation Consult-
ants Examiners— 
(I) from racially, ethnically, and 
linguistically diverse backgrounds; 
(II) with experience practicing in 
racially and ethnically diverse commu-
nities; and 
(III) who have undergone train-
ing on implicit bias and racism; 
(ii) to incorporate into maternity care 
teams— 
(I) midwives who meet, at a min-
imum, the international definition of 
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the midwife and global standards for 
midwifery education, as established by 
the International Confederation of 
Midwives; and 
(II) perinatal health workers; 
(iii) to provide collaborative, culturally 
congruent care; and 
(iv) to provide opportunities for indi-
viduals enrolled in accredited midwifery 
education programs to participate in job 
shadowing with maternity care teams in 
hospitals, health systems, midwifery prac-
tices, and freestanding birth centers. 
(2) STUDY ON RESPECTFUL AND CULTURALLY 
CONGRUENT MATERNITY CARE.— 
(A) STUDY.—The Secretary of Health and 
Human Services, acting through the Director of 
the National Institutes of Health (in this para-
graph referred to as the ‘‘Secretary’’), shall 
conduct a study on best practices in respectful 
and culturally congruent maternity care. 
(B) REPORT.—Not later than 2 years after 
the date of enactment of this Act, the Secretary 
shall— 
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(i) complete the study required by 
subparagraph (A); 
(ii) submit to the Congress, and make 
publicly available, a report on the results 
of such study; and 
(iii) include in such report— 
(I) a compendium of examples of 
hospitals, health systems, midwifery 
practices, freestanding birth centers, 
other maternity care provider groups, 
managed care entities, and other in-
surers that are delivering respectful 
and culturally congruent maternal 
health care; 
(II) a compendium of examples 
of hospitals, health systems, midwifery 
practices, freestanding birth centers, 
other maternity care provider groups, 
managed care entities, and other in-
surers that have made progress in re-
ducing inequities in maternal health 
outcomes and improving birthing ex-
periences 
for 
pregnant 
and 
postpartum individuals from racial 
and ethnic minority groups; and 
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(III) recommendations to hos-
pitals, health systems, midwifery prac-
tices, freestanding birth centers, other 
maternity care provider groups, man-
aged care entities, and other insurers, 
for best practices in respectful and 
culturally congruent maternity care. 
(b) GRANTS
TO
GROW
AND
DIVERSIFY
THE 
PERINATAL WORKFORCE.—Title VII of the Public Health 
Service Act is amended by inserting after section 757 (42 
U.S.C. 294f) the following: 
‘‘SEC. 758. PERINATAL WORKFORCE GRANTS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to entities to establish or expand programs de-
scribed in subsection (b) to grow and diversify the 
perinatal workforce. 
‘‘(b) USE OF FUNDS.—Recipients of grants under 
this section shall use the grants to grow and diversify the 
perinatal workforce by— 
‘‘(1) establishing schools or programs that pro-
vide education and training to individuals seeking 
appropriate licensing or certification as— 
‘‘(A) physician assistants who will complete 
clinical training in the field of maternal and 
perinatal health; or 
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‘‘(B) perinatal health workers; and 
‘‘(2) expanding the capacity of existing schools 
or programs described in paragraph (1), for the pur-
poses of increasing the number of students enrolled 
in such schools or programs, including by awarding 
scholarships for students. 
‘‘(c) PRIORITIZATION.—In awarding grants under 
this section, the Secretary shall give priority to any entity 
that— 
‘‘(1) has demonstrated a commitment to re-
cruiting and retaining students and faculty from ra-
cial and ethnic minority groups; 
‘‘(2) has developed a strategy to recruit and re-
tain a diverse pool of students into the perinatal 
workforce program or school supported by funds re-
ceived through the grant, particularly from racial 
and ethnic minority groups and other underserved 
populations; 
‘‘(3) has developed a strategy to recruit and re-
tain students who plan to practice in a health pro-
fessional shortage area designated under section 
332; 
‘‘(4) has developed a strategy to recruit and re-
tain students who plan to practice in an area with 
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significant racial and ethnic inequities in maternal 
health outcomes, to the extent practicable; and 
‘‘(5) includes in the standard curriculum for all 
students within the perinatal workforce program or 
school a bias, racism, or discrimination training pro-
gram that includes training on implicit bias and rac-
ism. 
‘‘(d) REPORTING.—As a condition on receipt of a 
grant under this section for a perinatal workforce program 
or school, an entity shall agree to submit to the Secretary 
an annual report on the activities conducted through the 
grant, including— 
‘‘(1) the number and demographics of students 
participating in the program or school; 
‘‘(2) the extent to which students in the pro-
gram or school are entering careers in— 
‘‘(A) health professional shortage areas 
designated under section 332; and 
‘‘(B) areas with significant racial and eth-
nic inequities in maternal health outcomes, to 
the extent such data are available; and 
‘‘(3) whether the program or school has in-
cluded in the standard curriculum for all students a 
bias, racism, or discrimination training program that 
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includes explicit and implicit bias, and if so the ef-
fectiveness of such training program. 
‘‘(e) PERIOD OF GRANTS.—The period of a grant 
under this section shall not exceed 5 years. 
‘‘(f) APPLICATION.—To seek a grant under this sec-
tion, an entity shall submit to the Secretary an application 
at such time, in such manner, and containing such infor-
mation as the Secretary may require, including any infor-
mation necessary for prioritization under subsection (c). 
‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 
provide, directly or by contract, technical assistance to en-
tities seeking or receiving a grant under this section on 
the development, use, evaluation, and post-grant period 
sustainability of the perinatal workforce programs or 
schools proposed to be, or being, established or expanded 
through the grant. 
‘‘(h) REPORT BY THE SECRETARY.—Not later than 
4 years after the date of enactment of this section, the 
Secretary shall prepare and submit to the Congress, and 
post on the internet website of the Department of Health 
and Human Services, a report on the effectiveness of the 
grant program under this section at— 
‘‘(1) recruiting students from racial and ethnic 
minority groups; 
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‘‘(2) increasing the number of physician assist-
ants who will complete clinical training in the field 
of maternal and perinatal health, and perinatal 
health workers, from racial and ethnic minority 
groups and other underserved populations; 
‘‘(3) increasing the number of physician assist-
ants who will complete clinical training in the field 
of maternal and perinatal health, and perinatal 
health workers, working in health professional short-
age areas designated under section 332; and 
‘‘(4) increasing the number of physician assist-
ants who will complete clinical training in the field 
of maternal and perinatal health, and perinatal 
health workers, working in areas with significant ra-
cial and ethnic inequities in maternal health out-
comes, to the extent such data are available. 
‘‘(i) DEFINITION.—In this section, the term ‘racial 
and ethnic minority group’ has the meaning given such 
term in section 1707(g). 
‘‘(j) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $15,000,000 for each of fiscal years 2025 through 
2029.’’. 
(c) GRANTS TO GROW AND DIVERSIFY THE NURSING 
WORKFORCE IN MATERNAL AND PERINATAL HEALTH.— 
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Title VIII of the Public Health Service Act is amended 
by inserting after section 811 (42 U.S.C. 296j) the fol-
lowing: 
‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to schools of nursing to grow and diversify the 
perinatal nursing workforce. 
‘‘(b) USE OF FUNDS.—Recipients of grants under 
this section shall use the grants to grow and diversify the 
perinatal nursing workforce by providing scholarships to 
students seeking to become— 
‘‘(1) nurse practitioners whose education in-
cludes a focus on maternal and perinatal health; or 
‘‘(2) clinical nurse specialists whose education 
includes a focus on maternal and perinatal health. 
‘‘(c) PRIORITIZATION.—In awarding grants under 
this section, the Secretary shall give priority to any school 
of nursing that— 
‘‘(1) has developed a strategy to recruit and re-
tain a diverse pool of students seeking to enter ca-
reers focused on maternal and perinatal health, par-
ticularly students from racial and ethnic minority 
groups and other underserved populations; 
‘‘(2) has developed a partnership with a prac-
tice setting in a health professional shortage area 
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designated under section 332 for the clinical place-
ments of the school’s students; 
‘‘(3) has developed a strategy to recruit and re-
tain students who plan to practice in an area with 
significant racial and ethnic inequities in maternal 
health outcomes, to the extent practicable; and 
‘‘(4) includes in the standard curriculum for all 
students seeking to enter careers focused on mater-
nal and perinatal health a bias, racism, or discrimi-
nation training program that includes education on 
implicit bias and racism. 
‘‘(d) REPORTING.—As a condition on receipt of a 
grant under this section, a school of nursing shall agree 
to submit to the Secretary an annual report on the activi-
ties conducted through the grant, including, to the extent 
practicable— 
‘‘(1) the number and demographics of students 
in the school of nursing seeking to enter careers fo-
cused on maternal and perinatal health; 
‘‘(2) the extent to which such students are pre-
paring to enter careers in— 
‘‘(A) health professional shortage areas 
designated under section 332; and 
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