I 
117TH CONGRESS 
1ST SESSION H. R. 3407 
To improve Federal efforts with respect to the prevention of maternal 
mortality, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 20, 2021 
Ms. KELLY of Illinois (for herself, Mrs. BEATTY, Ms. MOORE of Wisconsin, 
Ms. DEGETTE, Mr. BLUMENAUER, Mr. SCHNEIDER, Mrs. LAWRENCE, 
Ms. CASTOR of Florida, Ms. DELBENE, Ms. SEWELL, Mr. DEFAZIO, Ms. 
DEAN, Mr. SWALWELL, Mr. MEEKS, Mr. BUTTERFIELD, Mr. CARSON, 
Mr. PAYNE, Ms. KUSTER, Ms. CLARKE of New York, Mr. GRIJALVA, Ms. 
BARRAGA´N, Ms. MENG, Mr. LOWENTHAL, Ms. LEE of California, Ms. 
WILSON of Florida, and Ms. BLUNT ROCHESTER) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and Edu-
cation and Labor, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To improve Federal efforts with respect to the prevention 
of maternal mortality, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Mothers and Offspring 
Mortality and Morbidity Awareness Act’’ or the ‘‘MOM-
MA’s Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Every year, across the United States, nearly 
4,000,000 women give birth, about 700 women suf-
fer fatal complications during pregnancy, while giv-
ing birth or during the postpartum period, and 
about 70,000 women suffer near-fatal, partum-re-
lated complications. 
(2) The maternal mortality rate is often used as 
a proxy to measure the overall health of a popu-
lation. While the infant mortality rate in the United 
States has reached its lowest point, the risk of death 
for women in the United States during pregnancy, 
childbirth, or the postpartum period is higher than 
such risk in many other high-income countries. The 
estimated maternal mortality rate (deaths per 
100,000 live births) for the 48 contiguous States 
and Washington, DC, increased from 14.5 percent in 
2000 to 17.3 in 2017. The United States is the only 
industrialized nation with a rising maternal mor-
tality rate. 
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(3) The National Vital Statistics System of the 
Centers for Disease Control and Prevention has 
found that in 2018, there were 17.4 maternal deaths 
for every 100,000 live births in the United States. 
This ratio is more than double that of most other 
high-income countries. 
(4) It is estimated that more than 60 percent 
of maternal deaths in the United States are prevent-
able. 
(5) According to the Centers for Disease Con-
trol and Prevention, the maternal mortality rate var-
ies drastically for women by race and ethnicity. 
There are about 13 deaths per 100,000 live births 
for White women, 40.8 deaths per 100,000 live 
births for non-Hispanic Black women, and 29.7 
deaths per 100,000 live births for American Indian/ 
Alaskan Native women. While maternal mortality 
disparately impacts Black women, this urgent public 
health crisis traverses race, ethnicity, socioeconomic 
status, educational background, and geography. 
(6) In the United States, non-Hispanic Black 
women are about 3 times more likely to die from 
causes related to pregnancy and childbirth compared 
to non-Hispanic White women, which is one of the 
most disconcerting racial disparities in public health. 
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This disparity widens in certain cities and States 
across the country. 
(7) According to the National Center for Health 
Statistics of the Centers for Disease Control and 
Prevention, the maternal mortality rate heightens 
with age, as women 40 and older die at a rate of 
81.9 per 100,000 births compared to 10.6 per 
100,000 for women under 25. This translates to 
women over 40 being 7.7 times more likely to die 
compared to their counterparts under 25 years of 
age. 
(8) The COVID–19 pandemic risks exacer-
bating the maternal health crisis. A recent study of 
the Centers for Disease Control and Prevention sug-
gests that pregnant women are at a significantly 
higher risk for severe outcomes, including death, 
from COVID–19 as compared to non-pregnant 
women. The COVID–19 pandemic has also de-
creased access to prenatal and postpartum care. 
(9) The findings described in paragraphs (1) 
through (8) are of major concern to researchers, 
academics, members of the business community, and 
providers across the obstetric continuum represented 
by organizations such as— 
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(P) the Society for Maternal-Fetal Medi-
cine; and 
(Q) the What To Expect Project. 
(10) Hemorrhage, cardiovascular and coronary 
conditions, cardiomyopathy, infection or sepsis, em-
bolism, mental health conditions (including sub-
stance use disorder), hypertensive disorders, stroke 
and cerebrovascular accidents, and anesthesia com-
plications are the predominant medical causes of 
maternal-related deaths and complications. Most of 
these conditions are largely preventable or manage-
able. Even when these conditions are not prevent-
able, mortality and morbidity may be prevented 
when conditions are diagnosed and treated in a 
timely manner. 
(11) According to a study published by the 
Journal of Perinatal Education, doula-assisted 
mothers are 4 times less likely to have a low-birth-
weight baby, 2 times less likely to experience a birth 
complication involving themselves or their baby, and 
significantly more likely to initiate breastfeeding. 
Doula care has also been shown to produce cost sav-
ings resulting in part from reduced rates of cesarean 
and pre-term births. 
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(12) Intimate partner violence is one of the 
leading causes of maternal death, and women are 
more likely to experience intimate partner violence 
during pregnancy than at any other time in their 
lives. It is also more dangerous than pregnancy. In-
timate partner violence during pregnancy and 
postpartum crosses every demographic and has been 
exacerbated by the COVID–19 pandemic. 
(13) Oral health is an important part of 
perinatal health. Reducing bacteria in a woman’s 
mouth during pregnancy can significantly reduce her 
risk of developing oral diseases and spreading decay- 
causing bacteria to her baby. Moreover, some evi-
dence suggests that women with periodontal disease 
during pregnancy could be at greater risk for poor 
birth outcomes, such as preeclampsia, pre-term 
birth, and low-birth weight. Furthermore, a woman’s 
oral health during pregnancy is a good predictor of 
her newborn’s oral health, and since mothers can 
unintentionally spread oral bacteria to their babies, 
putting their children at higher risk for tooth decay, 
prevention efforts should happen even before chil-
dren are born, as a matter of pre-pregnancy health 
and prenatal care during pregnancy. 
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(14) In the United States, death reporting and 
analysis is a State function rather than a Federal 
process. States report all deaths—including mater-
nal deaths—on a semi-voluntary basis, without 
standardization across States. While the Centers for 
Disease Control and Prevention has the capacity and 
system for collecting death-related data based on 
death certificates, these data are not sufficiently re-
ported by States in an organized and standard for-
mat across States such that the Centers for Disease 
Control and Prevention is able to identify causes of 
maternal death and best practices for the prevention 
of such death. 
(15) Vital statistics systems often underesti-
mate maternal mortality and are insufficient data 
sources from which to derive a full scope of medical 
and social determinant factors contributing to ma-
ternal deaths, such as intimate partner violence. 
While the addition of pregnancy checkboxes on death 
certificates since 2003 have likely improved States’ 
abilities to identify pregnancy-related deaths, they 
are not generally completed by obstetric providers or 
persons trained to recognize pregnancy-related mor-
tality. Thus, these vital forms may be missing infor-
mation or may capture inconsistent data. Due to 
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varying maternal mortality-related analyses, lack of 
reliability, and granularity in data, current maternal 
mortality informatics do not fully encapsulate the 
myriad medical and socially determinant factors that 
contribute to such high maternal mortality rates 
within the United States compared to other devel-
oped nations. Lack of standardization of data and 
data sharing across States and between Federal en-
tities, health networks, and research institutions 
keep the Nation in the dark about ways to prevent 
maternal deaths. 
(16) Having reliable and valid State data ag-
gregated at the Federal level are critical to the Na-
tion’s ability to quell surges in maternal death and 
imperative for researchers to identify long-lasting 
interventions. 
(17) Leaders in maternal wellness highly rec-
ommend that maternal deaths and cases of maternal 
morbidity, including complications that result in 
chronic illness and future increased risk of death, be 
investigated at the State level first, and that stand-
ardized, streamlined, de-identified data regarding 
maternal deaths be sent annually to the Centers for 
Disease Control and Prevention. Such data stand-
ardization and collection would be similar in oper-
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ation and effect to the National Program of Cancer 
Registries of the Centers for Disease Control and 
Prevention and akin to the Confidential Enquiry in 
Maternal Deaths Programme in the United King-
dom. Such a maternal mortalities and morbidities 
registry and surveillance system would help pro-
viders, academicians, lawmakers, and the public to 
address questions concerning the types of, causes of, 
and best practices to thwart, maternal mortality and 
morbidity. 
(18) The United Nations’ Millennium Develop-
ment Goal 5a aimed to reduce by 75 percent, be-
tween 1990 and 2015, the maternal mortality rate, 
yet this metric has not been achieved. In fact, the 
maternal mortality rate in the United States has 
been estimated to have more than doubled between 
2000 and 2014. 
(19) Many States have struggled to establish or 
maintain Maternal Mortality Review Committees 
(referred to in this section as ‘‘MMRC’’). On the 
State level, MMRCs have lagged because States have 
not had the resources to mount local reviews. State- 
level reviews are necessary as only the State depart-
ments of health have the authority to request med-
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ical records, autopsy reports, and police reports crit-
ical to the function of the MMRC. 
(20) The United States has no comparable, co-
ordinated Federal process by which to review cases 
of maternal mortality, systems failures, or best prac-
tices. Many States have active MMRCs and leverage 
their work to impact maternal wellness. For exam-
ple, the State of California has worked extensively 
with their State health departments, health and hos-
pital systems, and research collaborative organiza-
tions, including the California Maternal Quality Care 
Collaborative and the Alliance for Innovation on Ma-
ternal Health, to establish MMRCs, wherein such 
State has determined the most prevalent causes of 
maternal mortality and recorded and shared data 
with providers and researchers, who have developed 
and implemented safety bundles and care protocols 
related to preeclampsia, maternal hemorrhage, 
peripartum cardiomyopathy, and the like. In this 
way, the State of California has been able to lever-
age its maternal mortality review board system, gen-
erate data, and apply those data to effect changes 
in maternal care-related protocol. To date, the State 
of California has reduced its maternal mortality 
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rate, which is now comparable to the low rates of the 
United Kingdom. 
(21) Hospitals and health systems across the 
United States lack standardization of emergency ob-
stetric protocols before, during, and after delivery. 
Consequently, many providers are delayed in recog-
nizing critical signs indicating maternal distress that 
quickly escalate into fatal or near-fatal incidences. 
Moreover, any attempt to address an obstetric emer-
gency that does not consider both clinical and public 
health approaches falls woefully under the mark of 
excellent care delivery. State-based perinatal quality 
collaboratives, or entities participating in the Alli-
ance for Innovation on Maternal Health (AIM), have 
formed obstetric protocols, tool kits, and other re-
sources to improve system care and response as they 
relate to maternal complications and warning signs 
for such conditions as maternal hemorrhage, hyper-
tension, and preeclampsia. These perinatal quality 
collaboratives serve an important role in providing 
infrastructure that supports quality improvement ef-
forts addressing obstetric care and outcomes. State- 
based perinatal quality collaboratives partner with 
hospitals, physicians, nurses, patients, public health, 
and other stakeholders to provide opportunities for 
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collaborative learning, rapid response data, and qual-
ity improvement science support to achieve systems- 
level change. 
(22) The Centers for Disease Control and Pre-
vention reports that nearly half of all maternal 
deaths occur in the immediate postpartum period— 
the 42 days following a pregnancy—whereas more 
than one-third of maternal deaths occur while a per-
son is still pregnant. Further, 21 percent of mater-
nal deaths occur between 1 and 6 weeks postpartum, 
and 12 percent of maternal deaths occur during the 
remaining portion of the postpartum year. Yet, for 
women eligible for the Medicaid program on the 
basis of pregnancy, such Medicaid coverage lapses at 
the end of the month on which the 60th postpartum 
day lands. 
(23) The experience of serious traumatic 
events, such as being exposed to domestic violence, 
substance use disorder, or pervasive and systematic 
racism, can over-activate the body’s stress-response 
system. Known as toxic stress, the repetition of 
high-doses of cortisol to the brain, can harm healthy 
neurological development and other body systems, 
which can have cascading physical and mental health 
consequences, as documented in the Adverse Child-
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hood Experiences study of the Centers for Disease 
Control and Prevention. 
(24) A growing body of evidence-based research 
has shown the correlation between the stress associ-
ated with systematic racism and one’s birthing out-
comes. The undue stress of sex and race discrimina-
tion paired with institutional racism has been dem-
onstrated to contribute to a higher risk of maternal 
mortality, irrespective of one’s gestational age, ma-
ternal age, socioeconomic status, educational level, 
or individual-level health risk factors, including pov-
erty, limited access to prenatal care, and poor phys-
ical and mental health (although these are not nomi-
nal factors). Black women remain the most at risk 
for pregnancy-associated or pregnancy-related causes 
of death. When it comes to preeclampsia, for exam-
ple, for which obesity is a risk factor, Black women 
of normal weight remain at a higher at risk of dying 
during the perinatal period compared to non-Black 
obese women. 
(25) The rising maternal mortality rate in the 
United States is driven predominantly by the dis-
proportionately high rates of Black maternal mor-
tality. 
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(26) Compared to women from other racial and 
ethnic demographics, Black women across the socio-
economic spectrum experience prolonged, unrelenting 
stress related to systematic racial and gender dis-
crimination, contributing to higher rates of maternal 
mortality, giving birth to low-weight babies, and ex-
periencing pre-term birth. Racism is a risk-factor for 
these aforementioned experiences. This cumulative 
stress, called weathering, often extends across the 
life course and is situated in everyday spaces where 
Black women establish livelihood. Systematic racism, 
structural barriers, lack of access to care, lack of ac-
cess to nutritious food, and social determinants of 
health exacerbate Black women’s likelihood to expe-
rience poor or fatal birthing outcomes, but do not 
fully account for the great disparity. 
(27) Black women are twice as likely to experi-
ence postpartum depression, and disproportionately 
higher rates of preeclampsia compared to White 
women. 
(28) Racism is deeply ingrained in United 
States systems, including in health care delivery sys-
tems between patients and providers, often resulting 
in disparate treatment for pain, irreverence for cul-
tural norms with respect to health, and dismissive-
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ness. However, the provider pool is not primed with 
many people of color, nor are providers (whether 
maternity care clinicians or maternity care support 
personnel) consistently required to undergo implicit 
bias, cultural competency, respectful care practices, 
or empathy training on a consistent, on-going basis. 
(29) Not all people who have been pregnant or 
given birth identify as being a ‘‘woman’’. The terms 
‘‘birthing people’’ or ‘‘birthing persons’’ are also 
used to describe pregnant and postpartum people. 
SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO 
PREVENTION OF MATERNAL MORTALITY. 
(a) TECHNICAL ASSISTANCE FOR STATES WITH RE-
SPECT
TO REPORTING MATERNAL MORTALITY.—Not 
later than one year after the date of enactment of this 
Act, the Director of the Centers for Disease Control and 
Prevention (referred to in this section as the ‘‘Director’’), 
in consultation with the Administrator of the Health Re-
sources and Services Administration, shall provide tech-
nical assistance to States that elect to report comprehen-
sive data on maternal mortality and factors relating to 
such mortality (including oral and mental health), inti-
mate partner violence, and breastfeeding health informa-
tion, for the purpose of encouraging uniformity in the re-
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porting of such data and to encourage the sharing of such 
data among the respective States. 
(b) BEST PRACTICES RELATING TO PREVENTION OF 
MATERNAL MORTALITY.— 
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act— 
(A) the Director, in consultation with rel-
evant patient and provider groups, shall issue 
best practices to State maternal mortality re-
view committees on how best to identify and re-
view maternal mortality cases, taking into ac-
count any data made available by States relat-
ing to maternal mortality, including data on 
oral, mental, and breastfeeding health, and uti-
lization of any emergency services; and 
(B) the Director, working in collaboration 
with the Health Resources and Services Admin-
istration, shall issue best practices to hospitals, 
State professional society groups, and perinatal 
quality collaboratives on how best to prevent 
maternal mortality. 
(2) AUTHORIZATION OF APPROPRIATIONS.—For 
purposes of carrying out this subsection, there is au-
thorized to be appropriated $5,000,000 for each of 
fiscal years 2021 through 2025. 
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(c) ALLIANCE
FOR
INNOVATION
ON
MATERNAL 
HEALTH GRANT PROGRAM.— 
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (referred to in 
this subsection as the ‘‘Secretary’’), acting through 
the Associate Administrator of the Maternal and 
Child Health Bureau of the Health Resources and 
Services Administration, shall establish a grant pro-
gram to be known as the Alliance for Innovation on 
Maternal Health Grant Program (referred to in this 
subsection as ‘‘AIM’’) under which the Secretary 
shall award grants to eligible entities for the purpose 
of— 
(A) directing widespread adoption and im-
plementation 
of 
maternal 
safety 
bundles 
through collaborative State-based teams; and 
(B) collecting and analyzing process, struc-
ture, and outcome data to drive continuous im-
provement in the implementation of such safety 
bundles by such State-based teams with the ul-
timate goal of eliminating preventable maternal 
mortality and severe maternal morbidity in the 
United States. 
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(2) ELIGIBLE ENTITIES.—In order to be eligi-
ble for a grant under paragraph (1), an entity 
shall— 
(A) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require; 
and 
(B) demonstrate in such application that 
the entity is an interdisciplinary, multi-stake-
holder, national organization with a national 
data-driven maternal safety and quality im-
provement initiative based on implementation 
approaches that have been proven to improve 
maternal safety and outcomes in the United 
States. 
(3) USE OF FUNDS.—An eligible entity that re-
ceives a grant under paragraph (1) shall use such 
grant funds— 
(A) to develop and implement, through a 
robust, multi-stakeholder process, maternal 
safety bundles to assist States, perinatal quality 
collaboratives, and health care systems in align-
ing national, State, and hospital-level quality 
improvement efforts to improve maternal health 
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outcomes, specifically the reduction of maternal 
mortality and severe maternal morbidity; 
(B) to ensure, in developing and imple-
menting maternal safety bundles under sub-
paragraph (A), that such maternal safety bun-
dles— 
(i) satisfy the quality improvement 
needs of a State, perinatal quality collabo-
rative, or health care system by factoring 
in the results and findings of relevant data 
reviews, such as reviews conducted by a 
State maternal mortality review committee; 
and 
(ii) address topics which may in-
clude— 
(I) information on evidence-based 
practices to improve the quality and 
safety of maternal health care in hos-
pitals and other health care settings 
of a State or health care system, in-
cluding by addressing topics com-
monly associated with health com-
plications or risks related to prenatal 
care, labor care, birthing, and post-
partum care; 
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(II) best practices for improving 
maternal health care based on data 
findings and reviews conducted by a 
State maternal mortality review com-
mittee that address topics of relevance 
to common complications or health 
risks related to prenatal care, labor 
care, birthing, and postpartum care; 
(III) information on addressing 
determinants of health that impact 
maternal health outcomes for women 
before, during, and after pregnancy; 
(IV) obstetric hemorrhage; 
(V) obstetric and postpartum 
care for women with substance use 
disorders, including opioid use dis-
order; 
(VI) maternal cardiovascular sys-
tem; 
(VII) maternal mental health; 
(VIII) postpartum care basics for 
maternal safety; 
(IX) reduction of peripartum ra-
cial and ethnic disparities; 
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thorized to be appropriated $10,000,000 for each of 
fiscal years 2021 through 2025. 
(d) FUNDING FOR STATE-BASED PERINATAL QUAL-
ITY
COLLABORATIVES
DEVELOPMENT
AND
SUSTAIN-
ABILITY.— 
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (referred to in 
this subsection as the ‘‘Secretary’’), acting through 
the Division of Reproductive Health of the Centers 
for Disease Control and Prevention, shall establish a 
grant program to be known as the State-Based 
Perinatal Quality Collaborative grant program under 
which the Secretary awards grants to eligible entities 
for the purpose of development and sustainability of 
perinatal quality collaboratives in every State, the 
District of Columbia, and eligible territories, in 
order to measurably improve perinatal care and 
perinatal 
health 
outcomes 
for 
pregnant 
and 
postpartum women and their infants. 
(2) GRANT AMOUNTS.—Grants awarded under 
this subsection shall be in amounts not to exceed 
$250,000 per year, for the duration of the grant pe-
riod. 
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(3) STATE-BASED
PERINATAL
QUALITY
COL-
LABORATIVE DEFINED.—For purposes of this sub-
section, the term ‘‘State-based perinatal quality col-
laborative’’ means a network of teams that— 
(A) is multidisciplinary in nature and in-
cludes the full range of perinatal and maternity 
care providers; 
(B) works to improve measurable outcomes 
for maternal and infant health by advancing 
evidence-informed clinical practices using qual-
ity improvement principles; 
(C) works with hospital-based or out-
patient facility-based clinical teams, experts, 
and stakeholders, including patients and fami-
lies, to spread best practices and optimize re-
sources to improve perinatal care and outcomes; 
(D) employs strategies that include the use 
of the collaborative learning model to provide 
opportunities for hospitals and clinical teams to 
collaborate on improvement strategies, rapid-re-
sponse data to provide timely feedback to hos-
pital and other clinical teams to track progress, 
and quality improvement science to provide sup-
port and coaching to hospital and clinical 
teams; 
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(E) has the goal of improving population- 
level outcomes in maternal and infant health; 
and 
(F) has the goal of improving outcomes of 
all birthing people, through the coordination, 
integration, and collaboration across birth set-
tings. 
(4) AUTHORIZATION OF APPROPRIATIONS.—For 
purposes of carrying out this subsection, there is au-
thorized to be appropriated $14,000,000 per year 
for each of fiscal years 2021 through 2025. 
(e) EXPANSION OF MEDICAID AND CHIP COVERAGE 
FOR PREGNANT AND POSTPARTUM WOMEN.— 
(1) REQUIRING COVERAGE OF ORAL HEALTH 
SERVICES
FOR
PREGNANT
AND
POSTPARTUM 
WOMEN.— 
(A) MEDICAID.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d) is amend-
ed— 
(i) in subsection (a)(4)— 
(I) by striking ‘‘; and (D)’’ and 
inserting ‘‘; (D)’’; and 
(II) by inserting ‘‘; and (E) oral 
health services for pregnant and 
postpartum women (as defined in sub-
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section 
(hh))’’ 
after 
‘‘subsection 
(bb))’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(hh) 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.’’. 
(B) CHIP.—Section 2103(c)(5)(A) of the 
Social 
Security 
Act 
(42 
U.S.C. 
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1397cc(c)(5)(A)) is amended by inserting ‘‘or a 
targeted low-income pregnant woman’’ after 
‘‘targeted low-income child’’. 
(2) EXTENDING
MEDICAID
COVERAGE
FOR 
PREGNANT
AND
POSTPARTUM
WOMEN.—Section 
1902 of the Social Security Act (42 U.S.C. 1396a) 
is amended— 
(A) in subsection (e)— 
(i) in paragraph (5)— 
(I) by inserting ‘‘(including oral 
health services for pregnant and 
postpartum women (as defined in sec-
tion 1905(hh)))’’ after ‘‘postpartum 
medical assistance under the plan’’; 
and 
(II) by striking ‘‘60-day’’ and in-
serting ‘‘1-year’’; and 
(ii) in paragraph (6), by striking ‘‘60- 
day’’ and inserting ‘‘1-year’’; and 
(B) in subsection (l)(1)(A), by striking 
‘‘60-day’’ and inserting ‘‘1-year’’. 
(3) EXTENDING
MEDICAID
COVERAGE
FOR 
LAWFUL
RESIDENTS.—Section 1903(v)(4)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
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1396b(v)(4)(A)(i)) is amended by striking ‘‘60-day’’ 
and inserting ‘‘1-year’’. 
(4) EXTENDING
CHIP
COVERAGE
FOR
PREG-
NANT
AND
POSTPARTUM
WOMEN.—Section 
2112(d)(2)(A) of the Social Security Act (42 U.S.C. 
1397ll(d)(2)(A)) is amended by striking ‘‘60-day’’ 
and inserting ‘‘1-year’’. 
(5) MAINTENANCE OF EFFORT.— 
(A) MEDICAID.—Section 1902(l) of the So-
cial Security Act (42 U.S.C. 1396a(l)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(5) During the period that begins on the date of 
enactment of this paragraph and ends on the date that 
is five years after such date of enactment, as a condition 
for receiving any Federal payments under section 1903(a) 
for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to 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 
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plan or waiver that are in effect on the date of enactment 
of this paragraph.’’. 
(B) CHIP.—Section 2105(d) of the Social 
Security Act (42 U.S.C. 1397ee(d)) is amended 
by adding at the end the following new para-
graph: 
‘‘(4) IN
ELIGIBILITY
STANDARDS
FOR
TAR-
GETED
LOW-INCOME
PREGNANT
WOMEN.—During 
the period that begins on the date of enactment of 
this paragraph and ends on the date that is five 
years after such date of enactment, as a condition 
of receiving payments under subsection (a) and sec-
tion 1903(a), a State that elects to provide assist-
ance to women on the basis of being pregnant (in-
cluding pregnancy-related assistance provided to tar-
geted low-income pregnant women (as defined in 
section 2112(d)), pregnancy-related assistance pro-
vided 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 pregnant) shall not have in effect, with re-
spect to such women, eligibility standards, meth-
odologies, or procedures under such plan (or waiver) 
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that are more restrictive than the eligibility stand-
ards, methodologies, or procedures, respectively, 
under such plan (or waiver) that are in effect on the 
date of enactment of this paragraph.’’. 
(6) INFORMATION
ON
BENEFITS.—The Sec-
retary of Health and Human Services shall make 
publicly available on the internet website of the De-
partment of Health and Human Services, informa-
tion regarding benefits available to pregnant and 
postpartum women and under the Medicaid program 
and the Children’s Health Insurance Program, in-
cluding information on— 
(A) benefits that States are required to 
provide to pregnant and postpartum women 
under such programs; 
(B) optional benefits that States may pro-
vide to pregnant and postpartum women under 
such programs; and 
(C) the availability of different kinds of 
benefits for pregnant and postpartum women, 
including oral health and mental health bene-
fits, under such programs. 
(7) FEDERAL
FUNDING
FOR
COST
OF
EX-
TENDED
MEDICAID
AND
CHIP
COVERAGE
FOR 
POSTPARTUM WOMEN.— 
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(A) MEDICAID.—Section 1905 of the So-
cial Security Act (42 U.S.C. 1396d), as amend-
ed by paragraph (1), is further amended— 
(i) in subsection (b), by striking ‘‘and 
(ff)’’ and inserting ‘‘(aa), and (ii)’’; and 
(ii) by adding at the end the fol-
lowing: 
‘‘(b) INCREASED FMAP FOR EXTENDED MEDICAL 
ASSISTANCE
FOR
POSTPARTUM
WOMEN.—Notwith-
standing subsection (b), the Federal medical assistance 
percentage for a State, with respect to amounts expended 
by such State for medical assistance for a woman 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 her pregnancy (including any such assistance provided 
during the month in which such period ends), shall be 
equal to— 
‘‘(1) 100 percent for the first 20 calendar quar-
ters during which this subsection is in effect; and 
‘‘(2) 90 percent for calendar quarters there-
after.’’. 
(B) CHIP.—Section 2105(c) of the Social 
Security Act (42 U.S.C. 1397ee(c)) is amended 
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by adding at the end the following new para-
graph: 
‘‘(12) 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 
pregnancy (including any such assistance provided 
during the month in which such period ends), shall 
be equal to— 
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‘‘(A) 100 percent for the first 20 calendar 
quarters during which this paragraph is in ef-
fect; and 
‘‘(B) 90 percent for calendar quarters 
thereafter.’’. 
(8) GUIDANCE ON STATE OPTIONS FOR MED-
ICAID COVERAGE OF DOULA SERVICES.—Not later 
than 1 year after the date of the enactment of this 
Act, the Secretary of Health and Human Services, 
acting through the Administrator of the Centers for 
Medicare & Medicaid Services, shall issue guidance 
for the States concerning options for Medicaid cov-
erage and payment for support services provided by 
doulas. 
(9) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall take effect on the first day of the 
first calendar quarter that begins on or after 
the date that is one year after the date of en-
actment of this Act. 
(B) 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 
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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 sub-
section, the respective plan shall not be re-
garded as failing to comply with the require-
ments of such title solely on the basis of its fail-
ure to meet such an additional requirement be-
fore the first day of the first calendar quarter 
beginning after the close of the first regular 
session of the State legislature that begins after 
the date of enactment of this Act. For purposes 
of the previous 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 sepa-
rate regular session of the State legislature. 
(f) REGIONAL CENTERS OF EXCELLENCE.—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 fol-
lowing new section: 
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‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD-
DRESSING IMPLICIT BIAS AND CULTURAL 
COMPETENCY IN PATIENT-PROVIDER INTER-
ACTIONS EDUCATION. 
‘‘(a) IN GENERAL.—Not later than one year after the 
date of enactment of this section, the Secretary, in con-
sultation with such other agency heads as the Secretary 
determines appropriate, shall award cooperative agree-
ments for the establishment or support of regional centers 
of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider inter-
actions education for the purpose of enhancing and im-
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-
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cation Act of 1965) focused on the prevention, treat-
ment, or recovery of health conditions that con-
tribute to maternal mortality and the prevention of 
maternal mortality and severe maternal morbidity; 
‘‘(2) demonstrate community engagement and 
participation, such as through partnerships with 
home visiting and case management programs; 
‘‘(3) demonstrate engagement with groups en-
gaged in the implementation of health care profes-
sional training in implicit bias and delivering cul-
turally competent care, such as departments of pub-
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.— 
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‘‘(1) PUBLIC
AVAILABILITY.—The Secretary 
shall make publicly available on the internet website 
of the Department of Health and Human Services 
information submitted to the Secretary under sub-
section (b)(3). 
‘‘(2) EVALUATION.—The Secretary shall evalu-
ate each regional center of excellence established or 
supported pursuant to subsection (a) and dissemi-
nate the findings resulting from each such evalua-
tion to the appropriate public and private entities. 
‘‘(3) DISTRIBUTION.—The Secretary shall share 
evaluations and overall findings with State depart-
ments of health and other relevant State level offices 
to inform State and local best practices. 
‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec-
tion, the term ‘maternal mortality’ means death of a 
woman that occurs during pregnancy or within the one- 
year period following the end of such pregnancy. 
‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—For 
purposes of carrying out this section, there is authorized 
to be appropriated $5,000,000 for each of fiscal years 
2021 through 2025.’’. 
(g) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM 
FOR
WOMEN, 
INFANTS, 
AND
CHILDREN.—Section 
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17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42 
U.S.C. 1786(d)(3)(A)(ii)) is amended— 
(1) by striking the clause designation and head-
ing and all that follows through ‘‘A State’’ and in-
serting the following: 
‘‘(ii) WOMEN.— 
‘‘(I) BREASTFEEDING WOMEN.— 
A State’’; 
(2) in subclause (I) (as so designated), by strik-
ing ‘‘1 year’’ and all that follows through ‘‘earlier’’ 
and inserting ‘‘2 years postpartum’’; and 
(3) by adding at the end the following: 
‘‘(II) POSTPARTUM
WOMEN.—A 
State may elect to certify a postpar-
tum woman for a period of 2 years.’’. 
(h) DEFINITIONS.—In this section: 
(1) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means death of a woman that occurs 
during pregnancy or within the one-year period fol-
lowing the end of such pregnancy. 
(2) PREGNANCY RELATED DEATH.—The term 
‘‘pregnancy related death’’ includes the death of a 
woman during pregnancy or within one year of the 
end of pregnancy from a pregnancy complication, a 
chain of events initiated by pregnancy, or the aggra-
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vation of an unrelated condition by the physiologic 
effects of pregnancy. 
(3) SEVERE MATERNAL MORBIDITY.—The term 
‘‘severe maternal morbidity’’ includes unexpected 
outcomes of labor and delivery that result in signifi-
cant short-term or long-term consequences to a 
woman’s health. 
SEC. 4. INCREASING EXCISE TAXES ON CIGARETTES AND 
ESTABLISHING EXCISE TAX EQUITY AMONG 
ALL TOBACCO PRODUCT TAX RATES. 
(a) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO.— 
Section 5701(g) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘$24.78’’ and inserting ‘‘$49.56’’. 
(b) 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’’. 
(c) TAX PARITY FOR SMOKELESS TOBACCO.— 
(1) Section 5701(e) of the Internal Revenue 
Code of 1986 is amended— 
(A) in paragraph (1), by striking ‘‘$1.51’’ 
and inserting ‘‘$26.84’’; 
(B) in paragraph (2), by striking ‘‘50.33 
cents’’ and inserting ‘‘$10.74’’; and 
(C) by adding at the end the following: 
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