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.’’. 
(6) 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 
shall issue guidance for the States concerning op-
tions for Medicaid coverage and payment for support 
services provided by doulas. 
(7) ENHANCED FMAP FOR RURAL OBSTETRIC 
AND GYNECOLOGICAL SERVICES.—Section 1905 of 
the Social Security Act (42 U.S.C. 1396d), as 
amended by paragraphs (1) and (5), is further 
amended— 
(A) in subsection (b), by striking ‘‘and 
(ii)’’ and inserting ‘‘(ii), (jj), (kk), and (ll)’’; 
and 
(B) by adding at the end the following new 
subsection: 
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‘‘(ll) 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.’’. 
(8) EFFECTIVE DATES.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C)— 
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(i) the amendments made by para-
graphs (1), (2), and (5) shall take effect 
on the first day of the first calendar quar-
ter that begins on or after the date that is 
1 year after the date of enactment of this 
Act; 
(ii) the amendments made by para-
graph (3) shall take effect on the date of 
enactment of this Act; and 
(iii) the amendments made by para-
graph (7) shall take effect on the first day 
of the first calendar quarter that begins on 
or after the date of enactment 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 
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-
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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. 
(C) STATE OPTION FOR EARLIER EFFEC-
TIVE DATE.—A State may elect to have sub-
section (e)(16) of section 1902 of the Social Se-
curity 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 
paragraph (2), and subsection (kk) 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 paragraph (5), take ef-
fect with respect to the State on the first day 
of any fiscal quarter that begins before the date 
described in subparagraph (A) and apply to 
amounts payable to the State for expenditures 
for medical assistance, child health assistance, 
or pregnancy-related assistance to pregnant or 
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postpartum individuals furnished on or after 
such day. 
(c) 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: 
‘‘SEC. 399V–8. 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 
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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 or 
community-based organizations serving minority 
populations; 
‘‘(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 
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‘‘(4) provide to the Secretary such information, 
at such time and in such manner, as the Secretary 
may require. 
‘‘(c) DIVERSITY.—In awarding a cooperative agree-
ment under subsection (a), the Secretary shall take into 
account any regional differences among eligible entities 
and make an effort to ensure geographic diversity among 
award recipients. 
‘‘(d) DISSEMINATION OF INFORMATION.— 
‘‘(1) PUBLIC
AVAILABILITY.—The Secretary 
shall make publicly available on the internet website 
of the Department of Health and Human Services 
information submitted to the Secretary under sub-
section (b)(3). 
‘‘(2) EVALUATION.—The Secretary shall evalu-
ate each regional center of excellence established or 
supported pursuant to subsection (a) and dissemi-
nate the findings resulting from each such evalua-
tion to the appropriate public and private entities. 
‘‘(3) DISTRIBUTION.—The Secretary shall share 
evaluations and overall findings with State depart-
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 
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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 
2024 through 2028.’’. 
(d) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM 
FOR
WOMEN, 
INFANTS, 
AND
CHILDREN.—Section 
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 
postpartum woman for a period of 2 
years.’’. 
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(e) DEFINITION OF MATERNAL MORTALITY.—In this 
section, 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. 
SEC. 4. FULL SPECTRUM DOULA WORKFORCE. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish and implement a program 
to award grants or contracts to health professions schools, 
schools of public health, academic health centers, State or 
local governments, territories, Indian Tribes and Tribal 
organizations, Urban Indian organizations, Native Hawai-
ian organizations, community-based organizations, or 
other appropriate public or private nonprofit entities (or 
consortia of any such entities, including entities promoting 
multidisciplinary approaches), to establish or expand pro-
grams to grow and diversify the doula workforce, including 
through improving the capacity and supply of health care 
providers. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Establishing programs that provide edu-
cation and training to individuals seeking appro-
priate training or certification as full spectrum 
doulas. 
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(2) Expanding the capacity of existing pro-
grams described in paragraph (1), for the purpose of 
increasing the number of students enrolled in such 
programs, including by awarding scholarships for 
students who agree to work in underserved commu-
nities after receiving such education and training. 
(3) Developing and implementing strategies to 
recruit and retain students from underserved com-
munities, particularly from demographic groups ex-
periencing high rates of maternal mortality and se-
vere maternal morbidity, including racial and ethnic 
minority groups, into programs described in para-
graphs (1) and (2). 
(c) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Secretary for fiscal 
year 2024, out of any money in the Treasury not otherwise 
appropriated, $50,000,000, to remain available until ex-
pended, for carrying out this section. 
SEC. 5. 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: 
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‘‘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-
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 
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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 be responsible for— 
‘‘(A) implementing the program funded by 
the pilot grants; and 
‘‘(B) not later than 3 years after the date 
of enactment of this Act, and 6 years after the 
date of enactment of this Act, submitting a re-
port containing the results of such program to 
the Secretary, including— 
‘‘(i) relevant information and relevant 
quantitative indicators of the programs’ 
success in improving the standard of care 
and maternal health outcomes for individ-
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); 
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‘‘(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, dis-
ability status, and insurance status. 
‘‘(B) Number of visits provided for pre-
conception, prenatal, or postpartum care. 
‘‘(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, 
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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 
‘‘(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 
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Secretary shall submit to the Congress, and make publicly 
available, a report containing— 
‘‘(1) the results of any evaluation conducted 
under subsection (e); and 
‘‘(2) a recommendation regarding whether the 
pilot program should be continued after fiscal year 
2028 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 2024 
through 2028.’’. 
SEC. 6. 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: 
‘‘(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 
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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.’’. 
SEC. 7. REPORT ON MATERNAL HEALTH NEEDS. 
(a) IN GENERAL.—Not later than 24 months after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall prepare, and submit to the Con-
gress, a report on— 
(1) where the maternal health needs are great-
est in the United States; and 
(2) the Federal expenditures made to address 
such needs. 
(b) PERIOD COVERED.—The report under subsection 
(a) shall cover the period of 2000 through 2022. 
(c) CONTENTS.—The report under subsection (a) 
shall include analysis of the following: 
(1) How Federal funds provided to States for 
maternal health were distributed across regions, 
States, and localities or counties. 
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