824 
(c) CURRICULUM.—The consensus standard physio-
logic maternity care curriculum described in subsection 
(a)(1) shall— 
(1) have a public health focus with a foundation 
in health promotion and disease prevention; 
(2) foster physiologic childbearing and person 
and family centered care; 
(3) reflect the extensive, growing research evi-
dence about— 
(A) the innate abilities and processes of 
the birthing person and the fetus or newborn 
for 
labor, 
birth, 
postpartum 
transition, 
breastfeeding, and attachment, when promoted, 
supported, and protected; and 
(B) the effects of factors that disturb and 
disrupt these processes; 
(4) integrate strategies to reduce maternal and 
infant morbidity and mortality; 
(5) incorporate recommendations to ensure re-
spectful, safe, and seamless consultation, referral, 
transport, and transfer of care when necessary; 
(6) include cultural sensitivity and strategies to 
decrease inequities in maternity outcomes; and 
(7) include implicit bias training. 
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825 
(d) REPORT.—Not later than 6 months after the final 
meeting of the Commission, the Secretary of Health and 
Human Services shall— 
(1) submit to Congress a report containing the 
recommendations made by the Commission under 
this section; and 
(2) make such report publicly available. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$1,000,000 for each of the fiscal years 2023 and 2024, 
and such sums as are necessary for each of the fiscal years 
2025 through 2027. 
SEC. 5219. DISSEMINATION OF THE QUALITY FAMILY PLAN-
NING GUIDELINES. 
(a) IN GENERAL.—Not later than 180 days after the 
date of enactment of this Act, the Secretary of Health and 
Human Services and the Director of the Centers for Dis-
ease Control and Prevention shall— 
(1) develop a plan for outreach to publicly fund-
ed health care providers, including federally qualified 
health centers (as defined in section 1861(aa)(4) of 
the Social Security Act (42 U.S.C. 1395x(aa)(4))) 
and branches of the Indian Health Service, about 
the quality family planning guidelines referred to in 
section 5304; and 
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826 
(2) award grants to eligible entities to imple-
ment such guidelines for all patients seeking family 
planning services. 
(b) DEFINITION.—In this section, the term ‘‘eligible 
entity’’ means a publicly funded health care provider that 
serves persons of reproductive age. 
Subtitle D—Federal Agency 
Coordination on Maternal Health 
SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
(a) IN GENERAL.—Part A of title II of the Public 
Health Service Act (42 U.S.C. 202 et seq.) is amended 
by adding at the end the following: 
‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Deputy Assistant Secretary for Women’s Health under 
section 229 and in collaboration with the Federal officials 
specified in subsection (b), shall establish the Interagency 
Coordinating Committee on the Promotion of Optimal Ma-
ternity Outcomes (referred to in this section as the 
‘ICCPOM’). 
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‘‘(b) OTHER AGENCIES.—The officials specified in 
this subsection are the Secretary of Labor, the Secretary 
of Defense, the Secretary of Veterans Affairs, the Surgeon 
General, the Director of the Centers for Disease Control 
and Prevention, the Administrator of the Health Re-
sources and Services Administration, the Administrator of 
the Centers for Medicare & Medicaid Services, the Direc-
tor of the Indian Health Service, the Administrator of the 
Substance Abuse and Mental Health Services Administra-
tion, the Director of the National Institute of Child Health 
and Human Development, the Director of the Agency for 
Healthcare Research and Quality, the Assistant Secretary 
for Children and Families, the Deputy Assistant Secretary 
for Minority Health, the Director of the Office of Per-
sonnel Management, and such other Federal officials as 
the Secretary of Health and Human Services determines 
to be appropriate. 
‘‘(c) CHAIR.—The Deputy Assistant Secretary for 
Women’s Health shall serve as the chair of the ICCPOM. 
‘‘(d) DUTIES.—The ICCPOM shall guide policy and 
program development across the Federal Government with 
respect to promotion of optimal maternity care, provided, 
however, that nothing in this section shall be construed 
as transferring regulatory or program authority from an 
agency to the ICCPOM. 
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828 
‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 
seek the input of, and shall consult with, all appropriate 
and interested stakeholders, including State health depart-
ments, public health research and interest groups, founda-
tions, childbearing individuals and their advocates, and 
maternity care professional associations and organiza-
tions, reflecting racially, ethnically, demographically, and 
geographically diverse communities. 
‘‘(f) ANNUAL REPORT.— 
‘‘(1) IN GENERAL.—The Secretary, on behalf of 
the ICCPOM, shall annually submit to Congress a 
report that summarizes— 
‘‘(A) all programs and policies of Federal 
agencies (including the Medicare Program 
under title XVIII of the Social Security Act and 
the Medicaid program under title XIX of such 
Act) designed to promote optimal maternity 
care, focusing particularly on programs and 
policies that support the adoption of evidence- 
based maternity care, as defined by timely, sci-
entifically sound systematic reviews; 
‘‘(B) all programs and policies of Federal 
agencies (including the Medicare Program 
under title XVIII of the Social Security Act and 
the Medicaid program under title XIX of such 
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829 
Act) designed to address the problems of mater-
nal mortality and morbidity, infant mortality, 
prematurity, and low birth weight, including 
such programs and policies designed to address 
racial and ethnic inequities with respect to each 
of such problems; 
‘‘(C) the extent of progress in reducing 
maternal mortality and infant mortality, low 
birth weight, and prematurity at State and na-
tional levels; and 
‘‘(D) such other information regarding op-
timal maternity care (such as quality and per-
formance measures) as the Secretary deter-
mines to be appropriate. 
‘‘(2) REDUCING INEQUITIES WITH RESPECT TO 
INDIGENOUS STATUS.—The information specified in 
paragraph (1)(C) shall be included in each such re-
port in a manner that disaggregates such informa-
tion by race, ethnicity, and indigenous status in 
order to determine the extent of progress in reduc-
ing racial and ethnic inequities and inequities related 
to indigenous status. 
‘‘(3) CERTAIN
INFORMATION.—Each report 
under paragraph (1) shall include information 
(disaggregated by race, ethnicity, and indigenous 
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831 
‘‘(J) The rate and trend of pre-term birth. 
‘‘(K) The rate and trend of low birth 
weight. 
‘‘(L) 
The 
cost 
of 
maternity 
care 
disaggregated by place of birth and provider of 
care, including— 
‘‘(i) uncomplicated vaginal birth; 
‘‘(ii) complicated vaginal birth; 
‘‘(iii) uncomplicated cesarean birth; 
and 
‘‘(iv) complicated cesarean birth. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated, in addition to amounts 
authorized to be appropriated under section 229(e), to 
carry out this section $1,000,000 for each of the fiscal 
years 2023 through 2027.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) INCLUSION AS DUTY OF HHS OFFICE ON 
WOMEN’S HEALTH.—Section 229(b) of such Act (42 
U.S.C. 237a(b)), as amended by section 5216, is 
further amended by adding at the end the following 
new paragraph: 
‘‘(9) establish the Interagency Coordinating 
Committee on the Promotion of Optimal Maternity 
Outcomes in accordance with section 229A; and’’. 
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832 
(2) TREATMENT OF BIENNIAL REPORTS.—Sec-
tion 229(d) of such Act (42 U.S.C. 237a(d)) is 
amended by inserting ‘‘(other than under subsection 
(b)(9))’’ after ‘‘under this section’’. 
SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH 
CENTERS PROGRAM TO INCLUDE CENTERS 
ON OPTIMAL MATERNITY OUTCOMES. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall support the establishment of 
additional Prevention Research Centers under the Preven-
tion Research Center Program administered by the Cen-
ters for Disease Control and Prevention. Such additional 
centers shall each be known as a Center for Excellence 
on Optimal Maternity Outcomes. 
(b) RESEARCH.—Each Center for Excellence on Opti-
mal Maternity Outcomes shall— 
(1) conduct at least one focused program of re-
search to improve maternity outcomes, including the 
reduction of cesarean birth rates, early elective in-
ductions, prematurity rates, and low birth weight 
rates within an underserved population that has a 
disproportionately large burden of suboptimal mater-
nity outcomes, including maternal mortality and 
morbidity, infant mortality, prematurity, or low 
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833 
birth weight, which such program shall include de-
veloping performance and quality measures for ac-
countability; 
(2) work with partners on special interest 
projects, as specified by the Centers for Disease 
Control and Prevention and other relevant agencies 
within the Department of Health and Human Serv-
ices, and on projects funded by other sources; and 
(3) involve a minimum of two distinct birth set-
ting models, such as— 
(A) a hospital labor and delivery model 
and freestanding birth center model; or 
(B) a hospital labor and delivery model 
and planned home birth model. 
(c) INTERDISCIPLINARY PROVIDERS.—Each Center 
for Excellence on Optimal Maternity Outcomes shall in-
clude the following interdisciplinary providers of maternity 
care: 
(1) Obstetrician-gynecologists. 
(2) At least two of the following providers: 
(A) Family practice physicians. 
(B) Nurse practitioners. 
(C) Physician assistants. 
(D) Certified professional midwives, cer-
tified nurse-midwives, or certified midwives. 
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834 
(d) SERVICES.—Research conducted by each Center 
for Excellence on Optimal Maternity Outcomes shall in-
clude at least 2 (and preferably more) of the following sup-
portive provider services: 
(1) Mental health. 
(2) Doula labor support. 
(3) Nutrition education. 
(4) Childbirth education. 
(5) Social work. 
(6) Physical therapy or occupation therapy. 
(7) Substance use disorder services. 
(8) Home visiting. 
(e) COORDINATION.—The programs of research at 
each of the Centers of Excellence on Optimal Maternity 
Outcomes shall complement and not replicate the work of 
the other. 
(f) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$2,000,000 for each of the fiscal years 2023 through 
2027. 
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SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER 
FOR MEDICARE AND MEDICAID INNOVATION 
TO EXPLICITLY INCLUDE MATERNITY CARE 
AND CHILDREN’S HEALTH MODELS. 
Section 1115A(b)(2) of the Social Security Act (42 
U.S.C. 1315a(b)(2)) is amended— 
(1) in subparagraph (B), by adding at the end 
the following: 
‘‘(xxviii) 
Promoting 
evidence-based 
models of care that have been associated 
with reductions in pregnancy-related and 
infant health inequities, including incor-
porating the use of and payment for 
doulas, 
particularly 
community-based 
doulas, and promoting support for people 
during pregnancy and for the one-year pe-
riod after the last day of such person’s 
pregnancy, through evidence-based models 
of antepartum, birth, postpartum care, and 
two-generation birthing person and new-
born care models, and supporting the risk- 
appropriate use of out-of-hospital birth 
models, including births at home and in 
freestanding birth centers. Such models 
shall be selected and evaluated based on 
their impact on quality, equity, and devel-
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836 
opmental outcomes, notwithstanding any 
other provision of this section.’’; 
(2) in subparagraph (C), by adding at the end 
the following: 
‘‘(ix) Whether the model includes a 
regular process for ensuring the provision 
of culturally and linguistically appropriate 
services. 
‘‘(x) Whether health care services and 
supportive services included in the model 
are tailored to community health and 
health-related social needs and provided by 
community-based and community-led pro-
viders. 
‘‘(xi) Whether the model is designed 
to mitigate harmful effects of discrimina-
tion on the basis of race, sex, disability, 
ethnicity, language, and age.’’; and 
(3) by adding at the end the following: 
‘‘(D) MANDATORY HEALTH EQUITY MOD-
ELS TO BE TESTED.—The Secretary shall se-
lect— 
‘‘(i) Medicaid global and episode-based 
payment models for culturally and linguis-
tically appropriate antepartum, labor and 
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839 
discrimination, and provided by commu-
nity-based and community-led providers; 
and 
‘‘(v) one or more models exclusively 
focused on early intervention and preven-
tion for children enrolled in a State plan 
(or waiver of such plan) under title XIX or 
a State child health plan under title XXI 
using evidence-based interventions includ-
ing parenting support programs, home-vis-
iting services, and dyadic therapy treat-
ment for children and adolescents at-risk. 
Such models shall be selected and evaluated 
based on their impact on quality, equity, and 
developmental outcomes, notwithstanding any 
other provision of this section.’’. 
SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY 
PLANNING GUIDELINES. 
(a) IN GENERAL.—Not later than six months after 
the date of enactment of this Act, the Director of the Cen-
ters for Disease Control and Prevention and the Office 
of Population Affairs shall review and expand the 2014 
Quality Family Planning Guidelines to address— 
(1) health inequities; and 
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840 
(2) the importance of patient-directed contra-
ceptive decision making. 
(b) CONSULTATION.—In carrying out subsection (a), 
the Director of the Centers for Disease Control and Pre-
vention and the Office of Population Affairs shall convene 
a meeting, and solicit the views of, stakeholders including 
experts on health inequities, experts on reproductive coer-
cion, representatives of provider organizations, patient ad-
vocates, reproductive justice organizations, organizations 
that represent racial and ethnic minority communities, or-
ganizations that represent people with disabilities, organi-
zations that represent LGBTQ persons, and organizations 
that represent people with limited English proficiency. 
Subtitle E—Reproductive and 
Sexual Health 
SEC. 5401. FINDINGS; SENSE OF CONGRESS ON URGENT 
BARRIERS TO ABORTION ACCESS AND VITAL 
SOLUTIONS. 
(a) FINDINGS.—Congress finds the following: 
(1) Affordable, comprehensive health insurance 
that includes coverage for a full range of pregnancy- 
related care, including abortion, is critical to the 
health of every person regardless of actual or per-
ceived race, color, national origin, immigration sta-
tus, sex (including sexual orientation, gender iden-
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841 
tity, pregnancy, childbirth, a medical condition relat-
ing to pregnancy or childbirth, or sex stereotyping), 
age, or disability status. 
(2) Abortion services are essential to health 
care and access to those services is central to peo-
ple’s ability to participate equally in the economic 
and social life of the United States. Abortion access 
allows people who are pregnant to make their own 
decisions about their pregnancies, their families, and 
their lives. 
(3) Reproductive justice seeks to address re-
strictions on reproductive health, including abortion, 
that perpetuate systems of oppression, lack of bodily 
autonomy, White supremacy, and anti-Black racism. 
The violent legacy of these systems of oppression has 
manifested in policies including enslavement, rape, 
and experimentation on Black people, forced steri-
lizations, medical experimentation on low-income 
people’s reproductive systems, and the forcible re-
moval of Indigenous children. Access to equitable re-
productive health care, including abortion services, 
has always been deficient in the United States for 
Black, Indigenous, and other People of Color 
(BIPOC) and their families. Transgender, non-
binary, and gender-expansive individuals, and spe-
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842 
cifically those who are Black, disabled, and at the 
intersections of multiple forms of oppression, also 
experience inequitable access to abortion services due 
to systemic violence. Centering abortion rights and 
access as a ‘‘women’s health’’ issue restricts access 
to those with reproductive needs who do not identify 
as cisgender women. In order to work towards repro-
ductive justice for all communities, transgender, 
nonbinary, and gender expansive must be centered 
in conversations of abortion access. Improving abor-
tion access for this community requires a gender- 
neutral approach to abortion care, rights, and justice 
policy. 
(4) The legacy of restrictions on reproductive 
health, rights, and justice is not a dated vestige of 
a dark history. Access to abortion services is ob-
structed across the United States in various ways, 
including blockades of health care facilities and asso-
ciated violence, prohibitions of, and restrictions on, 
insurance coverage, parental involvement laws (noti-
fication and consent), restrictions that shame and 
stigmatize people seeking abortion services, and 
medically unnecessary regulations that neither con-
fer any health benefit nor further the safety of abor-
tion services, but which harm people by delaying, 
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843 
complicating access to, and reducing the availability 
of, abortion services. As of December 2, 2021, 19 
States have enacted 106 restrictions, including 12 
new abortion bans, making 2021 the year with the 
highest number of restrictions passed since Roe v. 
Wade was decided in 1973. Additionally, 21 States 
are poised to immediately ban or significantly re-
strict access to abortion services if the Supreme 
Court chooses to overturn or weaken Roe v. Wade. 
These unprecedented attacks on abortion rights and 
access fall especially heavily on people with low in-
comes, BIPOC, immigrants, young people, people 
with disabilities, those living in rural and other 
medically underserved areas, and transgender, non-
binary, and gender expansive individuals. 
(5) Since 1976, the Federal Government has 
withheld funds for abortion coverage in most cir-
cumstances through the Hyde amendment and simi-
lar coverage restrictions, affecting individuals of re-
productive age in the United States who are insured 
through the Medicaid program, as well as individuals 
who receive insurance or care through other Federal 
health plans and programs. Of women aged 15 to 44 
enrolled in Medicaid in 2017, 55 percent lived in the 
35 States and the District of Columbia that do not 
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844 
cover abortion, except in limited circumstances. This 
amounts to roughly 7,300,000 women of reproduc-
tive age, including 3,100,000 women living below the 
Federal poverty level. Women of color are dispropor-
tionately likely to be insured by the Medicaid pro-
gram, and nationwide, 32 percent of Black women 
and 27 percent of Hispanic women aged 15 to 44 
were enrolled in Medicaid in 2017, compared with 
16 percent of White women. 
(6) Abortion-specific restrictions are even more 
compounded by the ongoing criminalization of people 
who are pregnant, including those who are incarcer-
ated, living with HIV, or with substance-use dis-
orders. These communities already experience health 
inequities due to social, political, and environmental 
inequities, and restrictions on abortion services exac-
erbate these harms. Removing medically unjustified 
restrictions on abortion services would constitute one 
important step on the path toward realizing repro-
ductive justice by ensuring that the full range of re-
productive health care is accessible to all who need 
it. 
(7) Abortion-specific restrictions are a tool of 
gender oppression, as they target health care serv-
ices that are used primarily by individuals with re-
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845 
productive needs. These paternalistic restrictions 
rely on and reinforce harmful stereotypes about gen-
der roles, people’s decision making, and people’s 
need for protection instead of support, undermining 
their ability to control their own lives and well-being. 
These restrictions harm the basic autonomy, dignity, 
and equality of individuals with reproductive health 
needs, and their ability to participate in the social 
and economic life of the Nation. 
(8) Many abortion-specific restrictions do not 
confer any health or safety benefits on the patient. 
Instead, these restrictions have the purpose and ef-
fect of unduly burdening people’s personal and pri-
vate medical decisions to end their pregnancies by 
making access to abortion services more difficult, 
invasive, and costly, often forcing people to travel 
significant distances and make multiple unnecessary 
visits to the provider, and in some cases, foreclosing 
the option altogether. 
(9) Congress has used its authority in the past 
to protect access to abortion services and health care 
providers’ ability to provide abortion services. In the 
early 1990s, protests and blockades at health care 
facilities where abortion services were provided, and 
associated violence, increased dramatically and 
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846 
reached crisis level, requiring congressional action. 
Congress passed the Freedom of Access to Clinic 
Entrances Act (Public Law 103–259; 108 Stat. 694) 
to address that situation and protect physical access 
to abortion services. 
(10) Congressional action is necessary to put an 
end to harmful restrictions, to federally protect ac-
cess to abortion services for everyone regardless of 
where they live, and to protect the ability of health 
care providers to provide these services in a safe and 
accessible manner. 
(11) The Equal Access to Abortion Coverage in 
Health Insurance Act of 2021 or the EACH Act of 
2021 (H.R. 2234, S. 1021) introduced in the 117th 
Congress, would reverse the Hyde amendment and 
related abortion coverage restrictions. It would cre-
ate an enforceable statutory right for people who re-
ceive health coverage or care through enumerated 
Federal programs (including Medicaid, the Chil-
dren’s Health Insurance Program, Medicare, the In-
dian Health Service, among others) and plans (in-
cluding government-sponsored health insurance due 
to a current or former employment relationship) to 
receive abortion coverage. It would require the Fed-
eral government to facilitate abortion access for indi-
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847 
viduals eligible to receive health care in Federal fa-
cilities or in facilitates with which it contracts to 
provide health care, such as immigration detention 
centers. It also prohibits the Federal Government 
from prohibiting, restricting, or otherwise inhibiting 
State or local governments or private health insur-
ance issuers from providing abortion coverage. 
(12) The Women’s Health Protection Act of 
2021 (H.R. 3755, S. 1975) introduced in the 117th 
Congress, would establish an enforceable statutory 
right for health care providers to provide, and abor-
tion patients to receive, abortions free from medi-
cally unnecessary restrictions, limitations, and bans 
that delay, and at times, completely obstruct, access 
to abortion. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that eliminating the Hyde amendment, enacting the 
Equal Access to Abortion Coverage in Health Insurance 
Act of 2021, and enacting the Women’s Health Protection 
Act of 2021, are critical to— 
(1) promoting equitable abortion access, includ-
ing coverage, for all who seek care; 
(2) creating enforceable rights to receive, and 
receive coverage for, such care; 
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848 
(3) advancing equitable access to comprehensive 
health coverage, which cannot be achieved without 
abortion coverage; and 
(4) alleviating urgent racial, gender, and other 
inequities in health and health care and cor-
responding reproductive injustices. 
SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND 
INFORMATION PROGRAMS. 
(a) EMERGENCY
CONTRACEPTION
PUBLIC
EDU-
CATION PROGRAM.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Centers for Disease 
Control and Prevention, shall develop and dissemi-
nate to the public medically accurate and complete 
information on emergency contraceptives. 
(2) DISSEMINATION.—The Secretary may dis-
seminate medically accurate and complete informa-
tion under paragraph (1) directly or through ar-
rangements with nonprofit organizations, community 
health workers, including promotores, consumer 
groups, institutions of higher education, clinics, the 
media, and Federal, State, and local agencies. 
(3) INFORMATION.—The information dissemi-
nated under paragraph (1) shall— 
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(A) include, at a minimum, a description 
of emergency contraceptives and an explanation 
of the use, safety, efficacy, affordability, and 
availability, including over-the-counter access, 
of such contraceptives and options for access to 
such 
contraceptives 
without 
cost-sharing 
through insurance and other programs; and 
(B) be pilot tested for consumer com-
prehension, cultural and linguistic appropriate-
ness, and acceptance of the messages across 
geographically, racially, ethnically, and linguis-
tically diverse populations. 
(b) EMERGENCY
CONTRACEPTION
INFORMATION 
PROGRAM FOR HEALTH CARE PROVIDERS.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Administrator of the Health Resources 
and Services Administration and in consultation 
with major medical and public health organizations, 
shall develop and disseminate to health care pro-
viders, including pharmacists, information on emer-
gency contraceptives. 
(2) INFORMATION.—The information dissemi-
nated under paragraph (1) shall include, at a min-
imum— 
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850 
(A) information describing the use, safety, 
efficacy, and availability of emergency contra-
ceptives, and options for access without cost- 
sharing through insurance and other programs; 
(B) a recommendation regarding the use of 
such contraceptives; and 
(C) information explaining how to obtain 
copies of the information developed under sub-
section (a) for distribution to the patients of 
the providers. 
(c) DEFINITIONS.—In this section: 
(1) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means an individual who is li-
censed or certified under State law to provide health 
care services and who is operating within the scope 
of such license. Such term shall include a phar-
macist. 
(2) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the same 
meaning given such term in section 101(a) of the 
Higher Education Act of 1965 (20 U.S.C. 1001(a)). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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851 
such sums as may be necessary for each of the fiscal years 
2023 through 2027. 
SEC. 5403. ACCESS TO BIRTH CONTROL DUTIES OF PHAR-
MACIES TO ENSURE PROVISION OF FDA-AP-
PROVED CONTRACEPTION. 
Part B of title II of the Public Health Service Act 
(42 U.S.C. 238 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 
OF FDA-APPROVED CONTRACEPTION. 
‘‘(a) IN GENERAL.—Subject to subsection (c), a 
pharmacy that receives Food and Drug Administration- 
approved drugs or devices in interstate commerce shall 
maintain compliance with the following: 
‘‘(1) If a customer requests a contraceptive or 
a medication related to a contraceptive, including 
emergency contraception, that is in stock, the phar-
macy shall ensure that the contraceptive is provided 
to the customer without delay. 
‘‘(2) If a customer requests a contraceptive or 
a medication related to a contraceptive that is not 
in stock and the pharmacy in the normal course of 
business stocks contraception, the pharmacy shall 
immediately inform the customer that the contracep-
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852 
tive is not in stock and without delay offer the cus-
tomer the following options: 
‘‘(A) If the customer prefers to obtain the 
contraceptive or a medication related to a con-
traceptive through a referral or transfer, the 
pharmacy shall— 
‘‘(i) locate a pharmacy of the cus-
tomer’s choice or the closest pharmacy 
confirmed to have the contraceptive or a 
medication related to a contraceptive in 
stock; and 
‘‘(ii) refer the customer or transfer 
the prescription to that pharmacy. 
‘‘(B) If the customer prefers for the phar-
macy to order the contraceptive or a medication 
related to a contraceptive, the pharmacy shall 
obtain the contraceptive or medication under 
the pharmacy’s standard procedure for expe-
dited ordering of medication and notify the cus-
tomer when the contraceptive or medication ar-
rives. 
‘‘(3) The pharmacy shall ensure that— 
‘‘(A) the pharmacy does not operate an en-
vironment in which customers are intimidated, 
threatened, or harassed in the delivery of serv-
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853 
ices relating to a request for contraception or a 
medication related to a contraceptive; 
‘‘(B) the pharmacy’s employees do not 
interfere with or obstruct the delivery of serv-
ices relating to a request for contraception or a 
medication related to a contraceptive; 
‘‘(C) the pharmacy’s employees do not in-
tentionally misrepresent or deceive customers 
about the availability of a contraceptive or a 
medication related to a contraceptive, or the 
mechanism of action of such contraceptive or 
medication; 
‘‘(D) the pharmacy’s employees do not 
breach medical confidentiality with respect to a 
request for a contraceptive or a medication re-
lated to a contraceptive or threaten to breach 
such confidentiality; or 
‘‘(E) the pharmacy’s employees do not 
refuse to return a valid, lawful prescription for 
a contraceptive or a medication related to a 
contraceptive upon customer request. 
‘‘(b) 
CONTRACEPTIVES
NOT
ORDINARILY 
STOCKED.—Nothing in subsection (a)(2) shall be con-
strued to require any pharmacy to comply with such sub-
section if the pharmacy does not ordinarily stock contra-
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854 
ceptives or a medication related to a contraceptive in the 
normal course of business. 
‘‘(c) REFUSALS PURSUANT
TO STANDARD PHAR-
MACY PRACTICE.—This section does not prohibit a phar-
macy from refusing to provide a contraceptive or a medi-
cation related to a contraceptive to a customer in accord-
ance with any of the following: 
‘‘(1) If it is unlawful to dispense the contracep-
tive or a medication related to a contraceptive to the 
customer without a valid, lawful prescription and no 
such prescription is presented. 
‘‘(2) If the customer is unable to pay for the 
contraceptive or the medication related to a contra-
ceptive. 
‘‘(3) If the employee of the pharmacy refuses to 
provide the contraceptive or a medication related to 
a contraceptive on the basis of a professional clinical 
judgment. 
‘‘(d) RELATION TO OTHER LAW.— 
‘‘(1) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to invalidate or limit 
rights, remedies, procedures, or legal standards 
under title VII of the Civil Rights Act of 1964. 
‘‘(2) CERTAIN
CLAIMS.—The Religious Free-
dom Restoration Act of 1993 shall not provide a 
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855 
basis for a claim concerning, or a defense to a claim 
under, this section, or provide a basis for challenging 
the application or enforcement of this section. 
‘‘(e) PREEMPTION.—This section does not preempt 
any provision of State law or any professional obligation 
made applicable by a State board or other entity respon-
sible for licensing or discipline of pharmacies or phar-
macists, to the extent that such State law or professional 
obligation provides protections for customers that are 
greater than the protections provided by this section. 
‘‘(f) ENFORCEMENT.— 
‘‘(1) CIVIL PENALTY.—A pharmacy that vio-
lates a requirement of subsection (a) is liable to the 
United States for a civil penalty in an amount not 
exceeding $1,000 per day of violation, not to exceed 
$100,000 for all violations adjudicated in a single 
proceeding. 
‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 
aggrieved as a result of a violation of a requirement 
of subsection (a) may, in any court of competent ju-
risdiction, commence a civil action against the phar-
macy involved to obtain appropriate relief, including 
actual and punitive damages, injunctive relief, and a 
reasonable attorney’s fee and cost. 
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856 
‘‘(3) LIMITATIONS.—A civil action under para-
graph (1) or (2) may not be commenced against a 
pharmacy after the expiration of the 5-year period 
beginning on the date on which the pharmacy alleg-
edly engaged in the violation involved. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) CONTRACEPTION.—The term ‘contracep-
tion’ or ‘contraceptive’ means any drug or device ap-
proved by the Food and Drug Administration to pre-
vent pregnancy. 
‘‘(2) EMPLOYEE.—The term ‘employee’ means 
a person hired, by contract or any other form of an 
agreement, by a pharmacy. 
‘‘(3) MEDICATION RELATED TO A CONTRACEP-
TIVE.—The term ‘medication related to a contracep-
tive’ means any drug or device approved by the Food 
and Drug Administration that a medical professional 
determines necessary to use before or in conjunction 
with a contraceptive. 
‘‘(4) PHARMACY.—The term ‘pharmacy’ means 
an entity that— 
‘‘(A) is authorized by a State to engage in 
the business of selling prescription drugs at re-
tail; and 
‘‘(B) employs one or more employees. 
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857 
‘‘(5) PRODUCT.—The term ‘product’ means a 
Food and Drug Administration-approved drug or de-
vice. 
‘‘(6) PROFESSIONAL
CLINICAL
JUDGMENT.— 
The term ‘professional clinical judgment’ means the 
use of professional knowledge and skills to form a 
clinical judgment, in accordance with prevailing 
medical standards. 
‘‘(7) WITHOUT
DELAY.—The term ‘without 
delay’, with respect to a pharmacy providing, pro-
viding a referral for, or ordering contraception, or 
transferring the prescription for contraception, 
means within the usual and customary timeframe at 
the pharmacy for providing, providing a referral for, 
or ordering other products, or transferring the pre-
scription for other products, respectively. 
‘‘(h) EFFECTIVE DATE.—This section shall take ef-
fect on the 31st day after the date of the enactment of 
this section, without regard to whether the Secretary has 
issued any guidance or final rule regarding this section.’’. 
SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY 
YOUTH. 
(a) PURPOSE.—The purpose of this section is to pro-
vide young people with sex education and sexual health 
services that— 
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858 
(1) promote and uphold the rights of young 
people to information and services that empower 
them to make decisions about their bodies, health, 
sexuality, families, and communities in all areas of 
life; 
(2) are evidence-informed, comprehensive in 
scope, confidential, equitable, accessible, medically 
accurate and complete, age and developmentally ap-
propriate, culturally responsive, and trauma-in-
formed and resilience-oriented; 
(3) provide information about the prevention, 
treatment, and care of pregnancy, sexually trans-
mitted infections, and interpersonal violence; 
(4) provide information about the importance of 
consent as a basis for healthy relationships and for 
autonomy in health care; 
(5) provide information on gender roles and 
gender discrimination; 
(6) provide information on the historical and 
current condition in which education and health sys-
tems, policies, programs, services, and practices have 
uniquely and adversely impacted Black, Indigenous, 
Latinx, Asian, Asian American and Pacific Islander, 
and other People of Color; and 
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859 
(7) redress inequities in the delivery of sex edu-
cation and sexual health services to marginalized 
young people. 
(b) DEFINITIONS.—In this section: 
(1) AGE
AND
DEVELOPMENTALLY
APPRO-
PRIATE.—The term ‘‘age and developmentally appro-
priate’’ means topics, messages, and teaching meth-
ods suitable to particular ages, age groups, or devel-
opmental levels, based on cognitive, emotional, so-
cial, and behavioral capacity of most young people at 
that age level. 
(2) CHARACTERISTICS
OF
EFFECTIVE
PRO-
GRAMS.—The term ‘‘characteristics of effective pro-
grams’’ means the aspects of evidence-informed pro-
grams, including development, content, and imple-
mentation of such programs, that— 
(A) have been shown to be effective in 
terms of increasing knowledge, clarifying values 
and attitudes, increasing skills, and impacting 
behavior; and 
(B) are widely recognized by leading med-
ical and public health agencies to be effective in 
changing sexual behaviors that lead to sexually 
transmitted infections, unintended pregnancy, 
and interpersonal violence among young people. 
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860 
(3) CONSENT.—The term ‘‘consent’’ means af-
firmative, conscious, and voluntary agreement to en-
gage in interpersonal, physical, or sexual activity. 
(4) CULTURALLY RESPONSIVE.—The term ‘‘cul-
turally responsive’’ means education and services 
that— 
(A) embrace and actively engage and ad-
just to young people and their various cultural 
identities; 
(B) recognize the ways in which many 
marginalized young people face unique barriers 
in our society that result in increased adverse 
health outcomes and associated stereotypes; and 
(C) may address the ways in which racism 
has shaped national health care policy, the last-
ing historical trauma associated with reproduc-
tive health experiments and forced sterilizations 
of Black, Latinx, and Indigenous communities, 
or sexual stereotypes assigned to young People 
of Color or LGBTQ+ people. 
(5) EVIDENCE-INFORMED.—The term ‘‘evi-
dence-informed’’ means incorporates characteristics, 
content, or skills that have been proven to be effec-
tive through evaluation in changing sexual behavior. 
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861 
(6) GENDER EXPRESSION.—The term ‘‘gender 
expression’’ means the expression of one’s gender, 
such as through behavior, clothing, haircut, or voice, 
and which may or may not conform to socially de-
fined behaviors and characteristics typically associ-
ated with being either masculine or feminine. 
(7) GENDER
IDENTITY.—The term ‘‘gender 
identity’’ means the gender-related identity, appear-
ance, mannerisms, or other gender-related character-
istics of an individual, regardless of the individual’s 
designated sex at birth. 
(8) INCLUSIVE.—The term ‘‘inclusive’’ means 
content and skills that ensure marginalized young 
people are valued, respected, centered, and sup-
ported in sex education instruction and materials. 
(9) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the 
meaning given the term in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001). 
(10) INTERPERSONAL
VIOLENCE.—The term 
‘‘interpersonal violence’’ means abuse, assault, bul-
lying, dating violence, domestic violence, harassment, 
intimate partner violence, or stalking. 
(11) MARGINALIZED
YOUNG
PEOPLE.—The 
term ‘‘marginalized young people’’ means young peo-
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862 
ple who are disadvantaged by underlying structural 
barriers and social inequities, including young people 
who are— 
(A) Black, Indigenous, and other People of 
Color; 
(B) immigrants; 
(C) in contact with the foster care system; 
(D) in contact with the juvenile justice sys-
tem; 
(E) experiencing homelessness; 
(F) pregnant or parenting; 
(G) lesbian, gay, bisexual, transgender, or 
queer; 
(H) living with HIV; 
(I) living with disabilities; 
(J) from families with low-incomes; or 
(K) living in rural areas. 
(12) MEDICALLY ACCURATE AND COMPLETE.— 
The term ‘‘medically accurate and complete’’ means 
that— 
(A) the information provided through the 
education is verified or supported by the weight 
of research conducted in compliance with ac-
cepted scientific methods and is published in 
peer-reviewed journals, where applicable; or 
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863 
(B) the education contains information 
that leading professional organizations and 
agencies with relevant expertise in the field rec-
ognize as accurate, objective, and complete. 
(13) 
RESILIENCE.—The 
term 
‘‘resilience’’ 
means the ability to adapt to trauma and tragedy. 
(14) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services. 
(15) SEX
EDUCATION.—The term ‘‘sex edu-
cation’’ means high quality teaching and learning 
that— 
(A) is delivered, to the maximum extent 
practicable, following the National Sexuality 
Education Standards of the Future of Sex Ed 
Initiative; 
(B) is about a broad variety of topics re-
lated to sex and sexuality, including— 
(i) puberty and adolescent develop-
ment; 
(ii) sexual and reproductive anatomy 
and physiology; 
(iii) sexual orientation, gender iden-
tity, and gender expression; 
(iv) contraception, pregnancy, and re-
production; 
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864 
(v) HIV and other STIs; 
(vi) consent and healthy relationships; 
and 
(vii) interpersonal violence; 
(C) explores values and beliefs about such 
topics; and 
(D) helps young people in gaining the 
skills that are needed to navigate relationships 
and manage one’s own sexual health. 
(16) SEXUAL DEVELOPMENT.—The term ‘‘sex-
ual development’’ means the lifelong process of phys-
ical, behavioral, cognitive, and emotional growth and 
change as it relates to an individual’s sexuality and 
sexual maturation, including puberty, identity devel-
opment, socio-cultural influences, and sexual behav-
iors. 
(17) SEXUAL
HEALTH
SERVICES.—The term 
‘‘sexual health services’’ includes— 
(A) sexual health information, education, 
and counseling; 
(B) all methods of contraception approved 
by the Food and Drug Administration; 
(C) routine gynecological care, including 
human papillomavirus (HPV) vaccines and can-
cer screenings; 
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(D) pre-exposure prophylaxis or post-expo-
sure prophylaxis; 
(E) substance use and mental health serv-
ices; 
(F) interpersonal violence survivor services; 
and 
(G) other prevention, care, or treatment 
services. 
(18) SEXUAL ORIENTATION.—The term ‘‘sexual 
orientation’’ means an individual’s romantic, emo-
tional, or sexual attraction to other people. 
(19) TRAUMA.—The term ‘‘trauma’’ means a 
response to an event, series of events, or set of cir-
cumstances that is experienced or witnessed by an 
individual or group of people as physically or emo-
tionally harmful or life-threatening with lasting ad-
verse effects on their functioning and mental, phys-
ical, social, emotional, or spiritual well-being. 
(20) TRAUMA-INFORMED AND RESILIENCE-ORI-
ENTED.—The term ‘‘trauma-informed and resil-
ience-oriented’’ means an approach that realizes the 
prevalence of trauma, recognizes the various ways 
individuals, organizations, and communities may re-
spond to trauma differently, recognizes that resil-
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866 
ience can be built, and responds by putting this 
knowledge into practice. 
(21) YOUNG PEOPLE.—The term ‘‘young peo-
ple’’ means individuals who are ages 10 through 29 
at the time of commencement of participation in a 
project supported under this section. 
(22) YOUTH-FRIENDLY SEXUAL HEALTH SERV-
ICES.—The term ‘‘youth-friendly sexual health serv-
ices’’ means sexual health services that are provided 
in a confidential, equitable, and accessible manner 
that makes it easy and comfortable for young people 
to seek out and receive services. 
(c) GRANTS FOR SEX EDUCATION AT ELEMENTARY 
AND SECONDARY SCHOOLS AND YOUTH-SERVING ORGA-
NIZATIONS.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Secretary of Education, shall 
award grants, on a competitive basis, to eligible enti-
ties to enable such eligible entities to carry out 
projects that provide young people with sex edu-
cation. 
(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
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867 
(3) ELIGIBLE ENTITY.—In this subsection, the 
term ‘‘eligible entity’’ means a public or private enti-
ty that delivers health education to young people. 
(4) APPLICATIONS.—An eligible entity desiring 
a grant under this subsection shall submit an appli-
cation to the Secretary at such time, in such man-
ner, and containing such information as the Sec-
retary may require. 
(5) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to eligi-
ble entities that are— 
(A) State educational agencies or local 
educational agencies; or 
(B) Indian Tribes or Tribal organizations, 
as defined in section 4 of the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 5304). 
(6) USE OF FUNDS.—Each eligible entity that 
receives a grant under this subsection shall use the 
grant funds to carry out a project that provides 
young people with sex education. 
(d) GRANTS FOR SEX EDUCATION AT INSTITUTIONS 
OF HIGHER EDUCATION.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Secretary of Education, shall 
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868 
award grants, on a competitive basis, to institutions 
of higher education or consortia of such institutions 
to enable such institutions to provide students with 
age and developmentally appropriate sex education. 
(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) APPLICATIONS.—An institution of higher 
education or consortium of such institutions desiring 
a grant under this subsection shall submit an appli-
cation to the Secretary at such time, in such man-
ner, and containing such information as the Sec-
retary may require. 
(4) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to an in-
stitution of higher education that— 
(A) has an enrollment of needy students, 
as defined in section 318(b) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1059e(b)); 
(B) is a Hispanic-serving institution, as 
defined in section 502(a) of such Act (20 
U.S.C. 1101a(a)); 
(C) is a Tribal College or University, as 
defined in section 316(b) of such Act (20 
U.S.C. 1059c(b)); 
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869 
(D) is an Alaska Native-serving institution, 
as defined in section 317(b) of such Act (20 
U.S.C. 1059d(b)); 
(E) is a Native Hawaiian-serving institu-
tion, as defined in section 317(b) of such Act 
(20 U.S.C. 1059d(b)); 
(F) is a Predominantly Black Institution, 
as defined in section 318(b) of such Act (20 
U.S.C. 1059e(b)); 
(G) is a Native American-serving, non-
tribal institution, as defined in section 319(b) 
of such Act (20 U.S.C. 1059f(b)); 
(H) is an Asian American and Native 
American Pacific Islander-serving institution, as 
defined in section 320(b) of such Act (20 
U.S.C. 1059g(b)); or 
(I) is a minority institution, as defined in 
section 365 of such Act (20 U.S.C. 1067k), 
with an enrollment of needy students, as de-
fined in section 312 of such Act (20 U.S.C. 
1058). 
(5) USES OF FUNDS.—An institution of higher 
education or consortium of such institutions receiv-
ing a grant under this subsection shall use grant 
funds to develop and implement a project to inte-
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870 
grate sex education into the institution of higher 
education in order to reach a large number of stu-
dents, by carrying out 1 or more of the following ac-
tivities: 
(A) Adopting and incorporating age and 
developmentally appropriate sex education into 
student orientation, general education, or 
courses. 
(B) Developing or adopting and imple-
menting educational programming outside of 
class that delivers age and developmentally ap-
propriate sex education to students. 
(C) Developing or adopting and imple-
menting innovative technology-based approaches 
to deliver age and developmentally appropriate 
sex education to students. 
(D) Developing or adopting and imple-
menting peer-led activities to generate discus-
sion, educate, and raise awareness among stu-
dents about age and developmentally appro-
priate sex education. 
(E) Developing or adopting and imple-
menting policies and practices to link students 
to sexual health services. 
(e) GRANTS FOR EDUCATOR TRAINING.— 
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871 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Secretary of Education, shall 
award grants, on a competitive basis, to eligible enti-
ties to enable such eligible entities to carry out the 
activities described in paragraph (5). 
(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) ELIGIBLE ENTITY.—In this subsection, the 
term ‘‘eligible entity’’ means— 
(A) a State educational agency or local 
educational agency; 
(B) an Indian Tribe or Tribal organiza-
tion, as defined in section 4 of the Indian Self- 
Determination and Education Assistance Act 
(25 U.S.C. 5304); 
(C) a State or local department of health; 
(D) an educational service agency; 
(E) a nonprofit institution of higher edu-
cation or a consortium of such institutions; or 
(F) a national or statewide nonprofit orga-
nization or consortium of nonprofit organiza-
tions that has as its primary purpose the im-
provement of provision of sex education through 
training and effective teaching of sex education. 
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873 
(iii) support the dissemination of in-
formation on effective practices and re-
search findings concerning the teaching of 
sex education; 
(iv) support research on— 
(I) effective sex education teach-
ing practices; and 
(II) the development of assess-
ment instruments and strategies to 
document— 
(aa) young people’s under-
standing of sex education; and 
(bb) the effects of sex edu-
cation; 
(v) convene conferences on sex edu-
cation, in order to effectively train edu-
cators in the provision of sex education; 
and 
(vi) develop and disseminate appro-
priate research-based materials to foster 
sex education. 
(C) SUBGRANTS.—Each eligible entity re-
ceiving a grant under this subsection may 
award subgrants to nonprofit organizations that 
possess a demonstrated record of providing 
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874 
training to teachers, health educators, faculty, 
administrators, and staff on sex education to— 
(i) train educators in sex education; 
(ii) support internet or distance learn-
ing related to sex education; 
(iii) promote rigorous academic stand-
ards and assessment techniques to guide 
and measure student performance in sex 
education; 
(iv) encourage replication of best 
practices and model programs to promote 
sex education; 
(v) develop and disseminate effective, 
research-based sex education learning ma-
terials; or 
(vi) develop academic courses on the 
pedagogy of sex education at institutions 
of higher education. 
(f) AUTHORIZATION OF GRANTS TO SUPPORT THE 
DELIVERY
OF
SEXUAL
HEALTH
SERVICES
TO 
MARGINALIZED YOUNG PEOPLE.— 
(1) PROGRAM
AUTHORIZED.—The Secretary 
shall award grants, on a competitive basis, to eligible 
entities to enable such entities to provide youth- 
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875 
friendly sexual health services to marginalized young 
people. 
(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) ELIGIBLE ENTITY.—In this subsection, the 
term ‘‘eligible entity’’ means— 
(A) a public or private youth-serving orga-
nization; or 
(B) a covered entity, as defined in section 
340B of the Public Health Service Act (42 
U.S.C. 256b). 
(4) APPLICATIONS.—An eligible entity desiring 
a grant under this subsection shall submit an appli-
cation to the Secretary at such time, in such man-
ner, and containing such information as the Sec-
retary may require. 
(5) USES OF FUNDS.—Each eligible entity that 
receives a grant under this subsection may use the 
grant funds to— 
(A) develop and implement an evidence-in-
formed project to deliver sexual health services 
to marginalized young people; 
(B) establish, alter, or modify staff posi-
tions, service delivery policies and practices, 
service delivery locations, service delivery envi-
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876 
ronments, service delivery schedules, or other 
services components in order to increase youth- 
friendly sexual health services to marginalized 
young people; 
(C) conduct outreach to marginalized 
young people to invite them to participate in 
the eligible entity’s sexual health services and to 
provide feedback to inform improvements in the 
delivery of such services; 
(D) establish and refine systems of referral 
to connect marginalized young people to other 
sexual health services and supportive services; 
(E) establish partnerships and collabora-
tions 
with 
entities 
providing 
services 
to 
marginalized young people to link such young 
people to sexual health services, such as by de-
livering health services at locations where they 
congregate, providing transportation to loca-
tions where sexual health services are provided, 
or other linkages to services approaches; 
(F) provide evidence-informed, comprehen-
sive in scope, confidential, equitable, accessible, 
medically accurate and complete, age and devel-
opmentally appropriate, culturally responsive, 
and trauma-informed and resilience-oriented 
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877 
sexual health information to marginalized 
young people in the languages and cultural con-
texts that are most appropriate for the 
marginalized young people to be served by the 
eligible entity; 
(G) promote effective communication re-
garding sexual health among marginalized 
young people; and 
(H) provide training and support for eligi-
ble entity personnel and community members 
who work with marginalized young people about 
the content, skills, and professional disposition 
needed to provide youth-friendly sex education 
and youth-friendly sexual health services. 
(g) REPORTING AND IMPACT EVALUATION.— 
(1) GRANTEE
REPORT
TO
SECRETARY.—For 
each year an eligible entity receives grant funds 
under subsection (d), (e), (f), or (g), the eligible en-
tity shall submit to the Secretary a report that in-
cludes— 
(A) the use of grant funds by the eligible 
entity; 
(B) how the use of grant funds has in-
creased the access of young people to sex edu-
cation or sexual health services; and 
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878 
(C) such other information as the Sec-
retary may require. 
(2) SECRETARY’S REPORT TO CONGRESS.—Not 
later than 1 year after the date of the enactment of 
this Act, and annually thereafter for a period of 5 
years, the Secretary shall prepare and submit to 
Congress a report on the activities funded under this 
section. The Secretary’s report to Congress shall in-
clude— 
(A) a statement of how grants awarded by 
the Secretary meet the purposes described in 
subsection (b)(1); and 
(B) information about— 
(i) the number of eligible entities that 
are receiving grant funds under sub-
sections (d), (e), (f), and (g); 
(ii) the specific activities supported by 
grant funds awarded under subsections 
(d), (e), (f), and (g); 
(iii) the number of young people 
served by projects funded under sub-
sections (d), (e), (f), and (g), in the aggre-
gate and disaggregated and cross-tabulated 
by grant program, race and ethnicity, sex, 
sexual orientation, gender identity, and 
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879 
other characteristics determined by the 
Secretary (except that such disaggregation 
or cross-tabulation shall not be required in 
a case in which the results would reveal 
personally identifiable information about 
an individual young person); 
(iv) the number of teachers, health 
educators, faculty, school administrators, 
and staff trained under subsection (f); and 
(v) the status of the evaluation re-
quired under paragraph (3). 
(3) MULTI-YEAR EVALUATION.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary shall enter into a contract 
with a nonprofit organization with experience in 
conducting impact evaluations to conduct a 
multi-year evaluation on the impact of the 
projects funded under subsections (d), (e), (f), 
and (g) and to report to Congress and the Sec-
retary on the findings of such evaluation. 
(B) EVALUATION.—The evaluation con-
ducted under this paragraph shall— 
(i) be conducted in a manner con-
sistent with relevant, nationally recognized 
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880 
professional 
and 
technical 
evaluation 
standards; 
(ii) use sound statistical methods and 
techniques 
relating 
to 
the 
behavioral 
sciences, including quasi-experimental de-
signs, inferential statistics, and other 
methodologies and techniques that allow 
for conclusions to be reached; 
(iii) be carried out by an independent 
organization that has not received a grant 
under subsection (d), (e), (f), or (g); and 
(iv) be designed to provide informa-
tion on output measures and outcome 
measures to be determined by the Sec-
retary. 
(C) REPORT.—Not later than 6 years after 
the date of enactment of this Act, the organiza-
tion conducting the evaluation under this para-
graph shall prepare and submit to the appro-
priate committees of Congress and the Sec-
retary a report on such evaluation. Such report 
shall be made publicly available, including on 
the website of the Department of Health and 
Human Services. 
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881 
(h) NONDISCRIMINATION.—Activities funded under 
this section shall not discriminate on the basis of actual 
or perceived sex (including sexual orientation and gender 
identity), age, parental status, race, color, ethnicity, na-
tional origin, disability, or religion. Nothing in this section 
shall be construed to invalidate or limit rights, remedies, 
procedures, or legal standards available under any other 
Federal law or any law of a State or a political subdivision 
of a State, including the Civil Rights Act of 1964 (42 
U.S.C. 2000a et seq.), title IX of the Education Amend-
ments of 1972 (20 U.S.C. 1681 et seq.), section 504 of 
the Rehabilitation Act of 1973 (29 U.S.C. 794), the Amer-
icans with Disabilities Act of 1990 (42 U.S.C. 12101 et 
seq.), and section 1557 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18116). 
(i) LIMITATION.—No Federal funds provided under 
this section may be used for sex education or sexual health 
services that— 
(1) withhold health-promoting or life-saving in-
formation about sexuality-related topics, including 
HIV; 
(2) are medically inaccurate or incomplete; 
(3) promote gender or racial stereotypes or are 
unresponsive to gender or racial inequities; 
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882 
(4) fail to address the needs of sexually active 
young people; 
(5) fail to address the needs of pregnant or par-
enting young people; 
(6) fail to address the needs of survivors of 
interpersonal violence; 
(7) fail to address the needs of young people of 
all physical, developmental, or mental abilities; 
(8) fail to be inclusive of individuals with vary-
ing gender identities, gender expressions, and sexual 
orientations; or 
(9) are inconsistent with the ethical imperatives 
of medicine and public health. 
(j) AMENDMENTS TO OTHER LAWS.— 
(1) AMENDMENT
TO
THE
PUBLIC
HEALTH 
SERVICE ACT.—Section 2500 of the Public Health 
Service Act (42 U.S.C. 300ee) is amended by strik-
ing subsections (b) through (d) and inserting the fol-
lowing: 
‘‘(b) CONTENTS
OF PROGRAMS.—All programs of 
education and information receiving funds under this sub-
chapter shall include information about the potential ef-
fects of intravenous substance use.’’. 
(2) AMENDMENTS TO THE ELEMENTARY AND 
SECONDARY EDUCATION ACT OF 1965.—Section 8526 
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883 
of the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7906) is amended— 
(A) by striking paragraphs (3), (5), and 
(6); 
(B) in paragraph (2), by inserting ‘‘or’’ 
after the semicolon; 
(C) by redesignating paragraph (4) as 
paragraph (3); and 
(D) in paragraph (3), as redesignated by 
subparagraph (C), by striking the semicolon 
and inserting a period. 
(k) FUNDING.— 
(1) AUTHORIZATION.—For the purpose of car-
rying out this section, there is authorized to be ap-
propriated $100,000,000 for each of fiscal years 
2022 through 2027. Amounts appropriated under 
this paragraph shall remain available until expended. 
(2) RESERVATIONS OF FUNDS.— 
(A) IN GENERAL.—Of the amount author-
ized under paragraph (1), the Secretary shall 
reserve— 
(i) not more than 30 percent for the 
purposes of awarding grants for sex edu-
cation at elementary and secondary schools 
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884 
and youth-serving organizations under sub-
section (d); 
(ii) not more than 10 percent for the 
purpose of awarding grants for sex edu-
cation at institutions of higher education 
under subsection (e); 
(iii) not more than 15 percent for the 
purpose of awarding grants for educator 
training under subsection (f); 
(iv) not more than 30 percent for the 
purpose of awarding grants for sexual 
health services for marginalized youth 
under subsection (g); and 
(v) not less than 5 percent for the 
purpose of carrying out the reporting and 
impact evaluation required under sub-
section (h). 
(B) RESEARCH, TRAINING AND TECHNICAL 
ASSISTANCE.—The Secretary shall reserve not 
less than 10 percent of the amount authorized 
under paragraph (1) for expenditures by the 
Secretary to provide, directly or through a com-
petitive grant process, research, training, and 
technical assistance, including dissemination of 
research and information regarding effective 
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885 
and promising practices, providing consultation 
and resources, and developing resources and 
materials to support the activities of recipients 
of grants. In carrying out such functions, the 
Secretary shall collaborate with a variety of en-
tities that have expertise in sex education and 
sexual health services standards setting, design, 
development, delivery, research, monitoring, and 
evaluation. 
(3) REPROGRAMMING
OF
ABSTINENCE
ONLY 
UNTIL MARRIAGE PROGRAM FUNDING.—The unobli-
gated balance of funds made available to carry out 
section 510 of the Social Security Act (42 U.S.C. 
710) (as in effect on the day before the date of en-
actment of this Act) are hereby transferred and shall 
be used by the Secretary to carry out this section. 
The amounts transferred and made available to 
carry out this section shall remain available until ex-
pended. 
(4) REPEAL OF ABSTINENCE ONLY UNTIL MAR-
RIAGE PROGRAM.—Section 510 of the Social Secu-
rity Act (42 U.S.C. 710 et seq.) is repealed. 
SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMER-
GENCIES. 
(a) MEDICARE.— 
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886 
(1) 
LIMITATION
ON
PAYMENT.—Section 
1866(a)(1) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended— 
(A) by moving the indentation of subpara-
graph (W) 2 ems to the left; 
(B) in subparagraph (X)— 
(i) by moving the indentation 2 ems 
to the left; and 
(ii) by striking ‘‘and’’ at the end; 
(C) in subparagraph (Y)— 
(i) by striking ‘‘and’’ at the end of 
item (bb); and 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(D) by inserting after subparagraph (Y) 
the following new subparagraph: 
‘‘(Z) in the case of a hospital or critical access 
hospital, to adopt and enforce a policy to ensure 
compliance with the requirements of subsection (l) 
and to meet the requirements of such subsection.’’. 
(2) ASSISTANCE TO VICTIMS.—Section 1866 of 
the Social Security Act (42 U.S.C. 1395cc) is 
amended by adding at the end the following new 
subsection: 
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887 
‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER-
GENCIES.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(1)(Z), a hospital meets the requirements of this 
subsection if the hospital provides each of the serv-
ices described in paragraph (2) to each individual, 
whether or not eligible for benefits under this title 
or under any other form of health insurance, who 
comes to the hospital on or after January 1, 2021, 
and— 
‘‘(A) who states to hospital personnel that 
they are victims of sexual assault; 
‘‘(B) who is accompanied by an individual 
who states to hospital personnel that the indi-
vidual is a victim of sexual assault; or 
‘‘(C) whom hospital personnel, during the 
course of treatment and care for the individual, 
have reason to believe is a victim of sexual as-
sault. 
‘‘(2) REQUIRED
SERVICES
DESCRIBED.—For 
purposes of paragraph (1), the services described in 
this subparagraph are the following: 
‘‘(A) Provision of medically and factually 
accurate and unbiased written and oral infor-
mation about emergency contraception that— 
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888 
‘‘(i) is written in clear and concise 
language; 
‘‘(ii) is readily comprehensible; 
‘‘(iii) includes an explanation that 
emergency contraceptives— 
‘‘(I) have been approved by the 
Food and Drug Administration for in-
dividuals and are a safe and effective 
way to prevent pregnancy after unpro-
tected intercourse or contraceptive 
failure if taken in a timely manner; 
‘‘(II) are more effective the soon-
er it is taken; and 
‘‘(III) do not cause an abortion 
and cannot interrupt an established 
pregnancy; 
‘‘(iv) meet such conditions regarding 
the provision of such information in lan-
guages other than English as the Secretary 
may establish; and 
‘‘(v) are provided without regard to 
the ability of the individual or their family 
to pay costs associated with the provision 
of such information to the individual. 
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889 
‘‘(B) Immediate offer to provide emergency 
contraception to the individual at the hospital 
and, in the case that such individual accepts 
such offer, immediate provision to such indi-
vidual of such contraception on the same day it 
is requested without regard to the inability of 
the individual or their family to pay costs asso-
ciated with the offer and provision of such con-
traception. 
‘‘(C) Development and implementation of a 
written policy to ensure that an individual is 
present at the hospital, or on-call, who— 
‘‘(i) has authority to dispense or pre-
scribe emergency contraception, independ-
ently, or under a protocol prepared by a 
physician for the administration of emer-
gency contraception at the hospital to a 
victim of sexual assault; and 
‘‘(ii) is trained to comply with the re-
quirements of this section. 
‘‘(D) Provision of medically and factually 
accurate and unbiased written and oral infor-
mation and counseling about post-exposure pro-
phylaxis (PEP) protocol for the prevention of 
HIV. 
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890 
‘‘(E) Immediate offer to begin PEP to the 
individual at the hospital except in cases where 
the medical professional’s best judgement is 
that further evaluation is required or that such 
a regimen will be substantially detrimental to 
the health of such individual. Such provision 
shall be offered regardless of the individual’s 
ability to pay. Hospitals shall be responsible for 
ensuring adequate supply of PEP medications 
to provide to patients. 
‘‘(3) HOSPITAL
DEFINED.—For purposes of 
this paragraph, the term ‘hospital’ includes a critical 
access 
hospital, 
as 
defined 
in 
section 
1861(mm)(1).’’. 
(b) LIMITATION ON PAYMENT UNDER MEDICAID.— 
Section 1903(i) of the Social Security Act (42 U.S.C. 
1396b(i)) is amended by inserting after paragraph (8) the 
following new paragraph: 
‘‘(9) with respect to any amount expended for 
care or services furnished under the plan by a hos-
pital on or after January 1, 2021, unless such hos-
pital meets the requirements specified in section 
1866(l) for purposes of title XVIII;’’. 
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891 
SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2021. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Menstrual Equity For All Act of 2021’’. 
(b) MENSTRUAL PRODUCTS FOR STUDENTS AT ELE-
MENTARY AND SECONDARY SCHOOLS.— 
(1) IN GENERAL.—Section 4108(5)(C) of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7118(5)(C)) is amended— 
(A) in clause (vi), by striking ‘‘or’’ after 
the semicolon; 
(B) in clause (vii), by inserting ‘‘or’’ after 
the semicolon; and 
(C) by adding at the end the following: 
‘‘(viii) provide free menstrual products 
to students who use menstrual products;’’. 
(2) DEFINITIONS.—Section 4102 of the Ele-
mentary and Secondary Education Act of 1965 (20 
U.S.C. 7112) is amended— 
(A) 
by 
redesignating 
paragraphs 
(6) 
through (8) as paragraphs (7) through (9), re-
spectively; and 
(B) by inserting after paragraph (5) the 
following: 
‘‘(6) MENSTRUAL PRODUCTS.—The term ‘men-
strual products’ means sanitary napkins and tam-
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892 
pons that conform to applicable industry stand-
ards.’’. 
(3) RULEMAKING.—Not later than 1 year after 
the date of enactment of this section, the Secretary 
of Education, in consultation with the Secretary of 
Health and Human Services, shall promulgate rules 
with respect to the definition of ‘‘menstrual prod-
ucts’’ in paragraph (6) of section 4102 of the Ele-
mentary and Secondary Education Act of 1965 (20 
U.S.C. 7112), as amended by section 3(b). 
(c) MENSTRUAL PRODUCTS FOR STUDENTS AT IN-
STITUTIONS OF HIGHER EDUCATION.— 
(1) PURPOSE.—The purpose of this section is 
to alleviate— 
(A) the barriers to academic success faced 
by many college and graduate students due to 
the inability of such students to afford to pur-
chase menstrual products; and 
(B) the unique set of burdens that college 
and graduate students experiencing period pov-
erty face that can be compounded by lack of ac-
cess to basic needs such as housing, food, trans-
portation, and access to physical and mental 
health services. 
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893 
(2) IN GENERAL.—The Secretary of Education 
shall establish a program to award grants, on a com-
petitive basis, to at least 4 institutions of higher 
education, to— 
(A) support programs that provide free 
menstrual products to students; and 
(B) report on best practices of such pro-
grams. 
(3) APPLICATION.—To apply for a grant under 
this subsection, an institution of higher education 
shall submit to the Secretary an application in such 
form, at such time, and containing such information 
as the Secretary determines appropriate, including 
an assurance that such grant will be used to carry 
out the activities described in paragraph (5). 
(4) COMMUNITY COLLEGES.—At least 50 per-
cent of the grants awarded under this subsection 
shall be awarded to community colleges. 
(5) GRANT USES.—A grant awarded under this 
subsection may only be used to— 
(A) carry out or expand activities that 
fund programs that support direct provision of 
free menstrual products to students in appro-
priate campus locations, including— 
(i) campus restroom facilities; 
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894 
(ii) wellness centers; and 
(iii) on-campus residential buildings; 
(B) report on best practices of such pro-
grams; 
(C) conduct outreach to students to en-
courage participation in menstrual equity pro-
grams and services; 
(D) help eligible students apply for and en-
roll in local, State, and Federal public assist-
ance programs; and 
(E) coordinate and collaborate with gov-
ernment or community-based organizations to 
carry out the activities described in subpara-
graphs (A) through (D). 
(6) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall prioritize— 
(A) institutions with Federal Pell Grant 
enrollment that is at least 25 percent of the 
total enrollment of such institution; and 
(B) historically Black colleges and univer-
sities, 
Hispanic-serving 
institutions, 
Asian 
American and Native American Pacific Is-
lander-serving institutions, and other minority 
serving institutions. 
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895 
(7) MENSTRUAL PRODUCT DEFINED.—In this 
subsection, the term ‘‘menstrual product’’ means a 
sanitary napkin or tampon that conforms to industry 
standards. 
(8) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated, out of 
funds appropriated for a fiscal year to the Fund for 
the Improvement of Postsecondary Education under 
section 741 of the Higher Education Act of 1965 
(20 U.S.C. 1138), $5,000,000 to carry out the grant 
program under this subsection. 
(d) MENSTRUAL PRODUCTS FOR INCARCERATED IN-
DIVIDUALS AND DETAINEES.— 
(1) REQUIREMENT FOR STATES.—Beginning on 
the date that is 180 days after the date of the enact-
ment of this section, and annually thereafter, the 
chief executive officer of each State that receives a 
grant under subpart 1 of part E of title I of the 
Omnibus Crime Control and Safe Streets Act of 
1968 (42 U.S.C. 3750 et seq.) (commonly referred 
to as the ‘‘Edward Byrne Memorial Justice Assist-
ance Grant Program’’) shall submit to the Attorney 
General a certification, in such form and containing 
such information as the Attorney General may re-
quire, that— 
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896 
(A) all incarcerated individuals and detain-
ees in that State have access to menstrual prod-
ucts— 
(i) on demand; and 
(ii) at no cost to such individuals and 
detainees; and 
(B) no visitor is prohibited from visiting an 
incarcerated individual due to the visitor’s use 
of menstrual products. 
(2) REDUCTION IN GRANT FUNDING.—In the 
case of a State whose chief executive officer fails to 
submit a certification required under paragraph (1) 
in a fiscal year, the Attorney General shall reduce 
the amount that the State would have otherwise re-
ceived under section 505 of title I of the Omnibus 
Crime Control and Safe Streets Act of 1968 (42 
U.S.C. 3755) by 20 percent for the following fiscal 
year. 
(3) REALLOCATION.—Amounts not allocated to 
a State under section 505 of title I of the Omnibus 
Crime Control and Safe Streets Act of 1968 (42 
U.S.C. 3755) for a fiscal year pursuant to para-
graph (2) shall be reallocated under such section to 
States that submit such certifications. 
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897 
(4) MENSTRUAL PRODUCTS.—For the purposes 
of paragraph (1), the term ‘‘menstrual products’’ 
means sanitary napkins and tampons that conform 
to applicable industry standards. 
(5) AVAILABILITY FOR FEDERAL PRISONERS.— 
The Attorney General shall make rules requiring, 
and the Director of the Bureau of Prisons shall take 
such actions as may be necessary to ensure, the dis-
tribution and accessibility (without charge) of men-
strual products to prisoners in the custody of the 
Bureau of Prisons, including any prisoner in a Fed-
eral penal or correctional institution, any Federal 
prisoner in a State penal or correctional institution, 
and any Federal prisoner in a facility administered 
by a private detention entity, and that each prisoner 
who requires these products may receive them in 
sufficient quantity. 
(6) AVAILABILITY FOR DETAINEES.—The Sec-
retary of Homeland Security shall take such actions 
as may be necessary to ensure that menstrual prod-
ucts are distributed and made accessible to each 
alien detained by the Secretary of Homeland Secu-
rity, including any alien in a facility administered by 
a private detention entity, at no expense to the alien. 
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898 
(e) MENSTRUAL
PRODUCTS
AVAILABILITY
FOR 
HOMELESS INDIVIDUALS UNDER EMERGENCY FOOD AND 
SHELTER GRANT PROGRAM.—Subsection (a) of section 
316 of the McKinney-Vento Homeless Assistance Act (42 
U.S.C. 11346(a)) is amended— 
(1) in paragraph (5), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (6), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(7) guidelines that ensure that amounts pro-
vided under the program to private nonprofit organi-
zations and local governments may be used to pro-
vide sanitary napkins and tampons that conform to 
applicable industry standards.’’. 
(f) MENSTRUAL PRODUCTS COVERED
BY MED-
ICAID.— 
(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a)— 
(i) by redesignating paragraphs (30) 
and (31) as paragraphs (31) and (32), re-
spectively; and 
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899 
(ii) by inserting after paragraph (29) 
the following new paragraph: 
‘‘(30) menstrual products (as defined in sub-
section (hh));’’; and 
(B) by adding at the end the following: 
‘‘(jj) MENSTRUAL PRODUCTS.—For purposes of sub-
section (a)(30), the term ‘menstrual products’ means sani-
tary napkins, tampons, liners, cups, and similar items 
used by individuals with respect to menstruation and that 
conform to industry standards.’’. 
(2) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall apply with respect to medical as-
sistance furnished during or after the first cal-
endar quarter beginning on or after the date 
that is 1 year after the date of the enactment 
of this section. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) that the Secretary of Health and 
Human Services determines requires State leg-
islation in order for the respective plan to meet 
any requirement imposed by amendments made 
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900 
by this section, the respective plan shall not be 
regarded 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 the 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 legis-
lature. 
(g) MENSTRUAL PRODUCTS FOR EMPLOYEES.—Sec-
tion 6 of the Occupational Safety and Health Act of 1970 
(29 U.S.C. 655) is amended by adding at the end the fol-
lowing: 
‘‘(h) The Secretary shall by rule promulgate a re-
quirement that each employer with not less than 100 em-
ployees provide menstrual products free of charge for em-
ployees of the employer. For purposes of the preceding 
sentence, ‘menstrual products’ means sanitary napkins 
and tampons that conform to applicable industry stand-
ards.’’. 
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901 
(h) MENSTRUAL PRODUCTS
IN FEDERAL BUILD-
INGS.— 
(1) REQUIREMENT.—Each appropriate author-
ity shall ensure that menstrual products are stocked 
in, and available free of charge in, each covered rest-
room in each covered public building under the juris-
diction of such authority. 
(2) DEFINITIONS.—In this section: 
(A) APPROPRIATE AUTHORITY.—The term 
‘‘appropriate authority’’ means the head of a 
Federal agency, the Architect of the Capitol, or 
other official authority responsible for the oper-
ation of a covered public building. 
(B) COVERED
PUBLIC
BUILDING.—The 
term ‘‘covered public building’’ means a public 
building, as defined in section 3301 of title 40, 
United States Code, that is open to the public 
and contains a public restroom, and includes a 
building listed in section 6301 or 5101 of such 
title. 
(C) COVERED RESTROOM.—The term ‘‘cov-
ered restroom’’ means a restroom in a covered 
public building. 
(D) MENSTRUAL
PRODUCTS.—The term 
‘‘menstrual products’’ means sanitary napkins 
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902 
and tampons that conform to applicable indus-
try standards. 
SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 
WOMEN’S HEALTH. 
Section 229(b) of the Public Health Service Act (42 
U.S.C. 237a(b)), as amended by sections 5217 and 5301, 
is further amended by adding at the end the following: 
‘‘(10) facilitate policymakers, health system 
leaders and providers, consumers, and other stake-
holders in understanding optimal maternity care and 
support for the provision of such care, including the 
priorities of— 
‘‘(A) protecting, promoting, and supporting 
the innate capacities of childbearing individuals 
and 
their 
newborns 
for 
childbirth, 
breastfeeding, and attachment; 
‘‘(B) using obstetric interventions only 
when such interventions are supported by 
strong, high-quality evidence, and minimizing 
overuse of maternity practices that have been 
shown to have benefit in limited situations and 
that can expose people, infants, or both to risk 
of harm if used routinely and indiscriminately, 
including continuous electronic fetal monitoring, 
labor induction, epidural analgesia, primary ce-
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903 
sarean section, and routine repeat cesarean 
birth; 
‘‘(C) reliably incorporating noninvasive, 
evidence-based practices that have a docu-
mented correlation with considerable improve-
ment in outcomes with no detrimental side ef-
fects, such as smoking cessation programs in 
pregnancy, maternal immunizations, and proven 
models (including group prenatal care, mid-
wifery care, and doula support) that integrate 
health assessment, education, and support into 
a unified program and supporting evidence- 
based breastfeeding promotion efforts with re-
spect for a breastfeeding individual’s personal 
decision making; 
‘‘(D) a shared understanding of the quali-
fications of licensed providers of maternity care 
and the best evidence about the safety, satisfac-
tion, outcomes, and costs of maternity care, and 
appropriate deployment of such caregivers with-
in the maternity care workforce to address the 
needs of childbearing individuals and newborns 
and the growing shortage of maternity care-
givers; 
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904 
‘‘(E) a shared understanding of the results 
of the best available research comparing hos-
pital, birth center, and planned home births, in-
cluding information about each setting’s safety, 
satisfaction, outcomes, and costs; 
‘‘(F) a shared understanding of the impor-
tance for the safety and choices of birthing 
families of an integrated maternity care system 
with seamless processes for consultation, shared 
care, transfer and transport across maternity 
care settings, and providers when birthing peo-
ple and their newborns require a higher level of 
care; 
‘‘(G) high-quality, evidence-based child-
birth education that— 
‘‘(i) promotes a healthy and safe ap-
proach to pregnancy, childbirth, and early 
parenting; 
‘‘(ii) is taught by certified educators, 
peer counselors, and health professionals; 
and 
‘‘(iii) 
promotes 
informed 
decision 
making by childbearing individuals; and 
‘‘(H) developing measures that enable a 
more robust, balanced set of standardized ma-
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905 
ternity care measures, including performance 
and quality measures.’’. 
SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN 
STUDENTS, INTERNS, AND RESIDENTS SU-
PERVISED BY CERTIFIED NURSE MIDWIVES 
OR CERTIFIED MIDWIVES WITHIN INPATIENT 
HOSPITAL SERVICES UNDER MEDICARE. 
(a) IN GENERAL.—Section 1861(b) of the Social Se-
curity Act (42 U.S.C. 1395x(b)) is amended— 
(1) in paragraph (6), by striking ‘‘; or’’ at the 
end and inserting ‘‘, or in the case of services in a 
hospital or osteopathic hospital by a student midwife 
or an intern or resident-in-training under a teaching 
program previously described in this paragraph who 
is in the field of obstetrics and gynecology, if such 
student midwife, intern, or resident-in-training is su-
pervised by a certified nurse-midwife or certified 
midwife to the extent permitted under applicable 
State law and as may be authorized by the hos-
pital;’’; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new 
paragraph: 
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906 
‘‘(8) a certified nurse-midwife or certified mid-
wife where the hospital has a teaching program ap-
proved as specified in paragraph (6), if— 
‘‘(A) the hospital elects to receive any pay-
ment due under this title for reasonable costs of 
such services; and 
‘‘(B) all certified nurse-midwives or cer-
tified midwives in such hospital agree not to bill 
charges for professional services rendered in 
such hospital to individuals covered under the 
insurance program established by this title.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to services furnished on or after 
the date of the enactment of this Act. 
SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS 
AND MINORITY-SERVING INSTITUTIONS TO 
INCREASE DIVERSITY IN MATERNAL, REPRO-
DUCTIVE, AND SEXUAL HEALTH PROFES-
SIONALS. 
(a) GRANTS TO HEALTH PROFESSIONAL ORGANIZA-
TIONS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Administrator 
of the Health Resources and Services Administra-
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907 
tion, shall carry out a grant program under which 
the Secretary may make to eligible organizations— 
(A) for fiscal year 2023, planning grants 
described in paragraph (2); and 
(B) for the subsequent 4-year period, im-
plementation grants described in paragraph (3). 
(2) PLANNING GRANTS.— 
(A) IN
GENERAL.—Planning grants de-
scribed in this paragraph are grants for the fol-
lowing purposes: 
(i) To collect data and identify any 
workforce inequalities, with respect to a 
health profession, at each of the following 
areas along the health professional con-
tinuum: 
(I) Pipeline availability, with re-
spect to students at the high school 
and college or university levels consid-
ering, and working toward, entrance 
in the profession, including barriers 
triggered by criminal records. 
(II) Entrance into the training 
program for the profession. 
(III) Graduation from such train-
ing program. 
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908 
(IV) Entrance into practice, in-
cluding barriers triggered by criminal 
records. 
(V) Retention in practice for 
more than a 5-year period. 
(ii) To develop one or more strategies 
to address the workforce inequalities with-
in the health profession, as identified 
under (and in response to the findings pur-
suant to) clause (i). 
(B) APPLICATION.—To be eligible to re-
ceive a grant under this paragraph, an eligible 
health professional organization shall submit to 
the Secretary an application in such form and 
manner and containing such information as 
specified by the Secretary. 
(C) AMOUNT.—Each grant awarded under 
this paragraph shall be for an amount not to 
exceed $300,000. 
(D) REPORT.—Each recipient of a grant 
under this paragraph shall submit to the Sec-
retary a report containing— 
(i) information on the extent and dis-
tribution of workforce inequities identified 
through the grant; and 
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909 
(ii) reasonable objectives and strate-
gies developed to address such inequalities 
within a 5-, 10-, and 25-year period. 
(3) IMPLEMENTATION GRANTS.— 
(A) IN GENERAL.—Implementation grants 
described in this paragraph are grants to imple-
ment one or more of the strategies developed 
pursuant to a planning grant awarded under 
paragraph (2). 
(B) APPLICATION.—To be eligible to re-
ceive a grant under this paragraph, an eligible 
health professional organization shall submit to 
the Secretary an application in such form and 
manner as specified by the Secretary. Each 
such application shall contain information on— 
(i) the capability of the organization 
to carry out a strategy described in sub-
paragraph (A); 
(ii) the involvement of partners or 
coalitions; 
(iii) the organization’s plans for devel-
oping sustainability of the efforts after the 
culmination of the grant cycle, and any 
other information specified by the Sec-
retary. 
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910 
(C) AMOUNT; 
DURATION.—Each grant 
awarded under this paragraph shall be for an 
amount not to exceed $500,000 each year of 
the grant. The term of a grant under this sub-
section shall not exceed 4 years. 
(D) REPORTS.—For each of the first 3 
years for which an eligible health professional 
organization is awarded a grant under this 
paragraph, the organization shall submit to the 
Secretary of Health and Human Services a re-
port on the activities carried out by such orga-
nization through the grant during such year 
and objectives for the subsequent year. For the 
fourth year for which an eligible health profes-
sional organization is awarded a grant under 
this paragraph, the organization shall submit to 
the Secretary a report that includes an analysis 
of all the activities carried out by the organiza-
tion through the grant and a detailed plan for 
the continuation of the organization’s outreach 
efforts. 
(4) ELIGIBLE HEALTH PROFESSIONAL ORGANI-
ZATION DEFINED.—For purposes of this subsection, 
the term ‘‘eligible health professional organization’’ 
means a professional organization representing ob-
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911 
stetrician-gynecologists, certified nurse midwives, 
certified midwives, family practice physicians, nurse 
practitioners whose scope of practice includes mater-
nity or sexual and reproductive health care, physi-
cian assistants whose scope of practice includes ob-
stetrical or sexual and reproductive health care, or 
certified professional midwives, adolescent medicine 
specialists, and pediatricians who provide sexual and 
reproductive health care. 
(b) 
GRANTS
TO
MINORITY-SERVING
INSTITU-
TIONS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Administrator 
of the Health Resources and Services Administration 
(referred to in this section as the ‘‘Secretary’’), shall 
carry out a grant program under which the Sec-
retary may make to eligible organizations— 
(A) for fiscal years 2023 and 2024, plan-
ning grants described in paragraph (2); and 
(B) for the subsequent ten-year period, im-
plementation grants described in paragraph (3). 
(2) PLANNING GRANTS.— 
(A) IN
GENERAL.—Planning grants de-
scribed in this paragraph are grants for plans 
the following purposes: 
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912 
(i) To develop or expand academic 
programs to educate maternity care clini-
cians and maternity care support per-
sonnel, including— 
(I) nurses with the intention of 
providing maternity, newborn, or sex-
ual and reproductive health care; 
(II) 
nurse-practitioners 
whose 
scope of practice includes maternity, 
newborn, or sexual and reproductive 
health care; and 
(III) maternity care support per-
sonnel, such as doulas and lactation 
counselors. 
(ii) To develop or expand academic 
programs to educate obstetrician-gyne-
cologists. 
(B) APPLICATION.—To be eligible to re-
ceive a grant under this paragraph, an eligible 
minority serving institution shall submit to the 
Secretary an application in such form and man-
ner and containing such information as speci-
fied by the Secretary. 
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913 
(C) AMOUNT.—Each grant awarded under 
this paragraph shall be for an amount not to 
exceed $400,000 for each of two years. 
(D) REPORT.—Each recipient of a grant 
under this paragraph shall submit to the Sec-
retary an annual report describing the planned 
development or expansion of educational pro-
grams, including— 
(i) the types of clinical or support per-
sonnel and the degrees or certificates to be 
conferred; 
(ii) the associated curricula; 
(iii) the faculty and their capabilities 
and commitments, including any plans for 
recruitment; 
(iv) the anticipated number of stu-
dents to be enrolled and plans for their re-
cruitment and social, emotional, and finan-
cial support; and 
(v) the objectives and strategies for 
addressing inequities and preparing stu-
dents to provide high-quality culturally 
congruent care. 
(3) IMPLEMENTATION GRANTS.— 
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914 
(A) IN GENERAL.—Implementation grants 
described in this paragraph are grants to imple-
ment the strategies developed under paragraph 
(2). 
(B) APPLICATION.—To be eligible to re-
ceive a grant under this paragraph, an eligible 
minority serving institution shall submit to the 
Secretary of Health and Human Services an 
application in such form and manner as speci-
fied by the Secretary. Each such application 
shall contain information on the capability of 
the institution to carry out a strategy described 
in paragraph (2), plans for sustainability of the 
program after the culmination of the grant 
cycle, and any other information specified by 
the Secretary. 
(C) AMOUNT.—Each grant under this 
paragraph shall be for an amount not to exceed 
$1,000,000 each year during the 10-year period 
of the grant. 
(D) REPORTS.— 
(i) INITIAL PERIOD.—For each of the 
first 9 years for which an eligible minority- 
serving institution is awarded a grant 
under this paragraph, the institution shall 
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915 
submit a report to the Secretary on the ac-
tivities carried out by such institution 
through the grant during such year and 
objectives for the subsequent year. 
(ii) FINAL YEAR.—For the tenth year 
for which an eligible minority-serving insti-
tution is awarded a grant under this para-
graph, the organization shall submit to the 
Secretary a report that includes an anal-
ysis of all the activities carried out by the 
institution through the grant and a de-
tailed plan for continuation of the edu-
cational program. 
(4) ELIGIBLE MINORITY-SERVING INSTITUTIONS 
DEFINED.—For the purposes of this subsection, the 
term ‘‘minority-serving institution’’ means a histori-
cally Black college or university, Tribal college or 
university, Latino-serving institution, Asian Amer-
ican and Pacific Islander serving institution, or 
other minority serving institution of higher edu-
cation. 
(c) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out— 
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(1) subsection (a), $2,000,000 for fiscal year 
2023 and $3,000,000 for each of the fiscal years 
2024 through 2027; and 
(2) subsection (b), $4,000,000 for each of fiscal 
years 2023 and 2024 and $10,000,000 for each of 
fiscal years 2025 through 2034. 
Subtitle F—Children’s Health 
SEC. 5501. CARING FOR KIDS ACT. 
(a) 
PERMANENT
EXTENSION
OF
CHILDREN’S 
HEALTH INSURANCE PROGRAM.— 
(1) IN GENERAL.—Section 2104(a)(28) of the 
Social Security Act (42 U.S.C. 1397dd(a)(28)) is 
amended to read as follows: 
‘‘(28) for fiscal year 2027 and each subsequent 
year, such sums as are necessary to fund allotments 
to States under subsections (c) and (m).’’. 
(2) ALLOTMENTS.— 
(A) IN GENERAL.—Section 2104(m) of the 
Social Security Act (42 U.S.C. 1397dd(m)) is 
amended— 
(i) in paragraph (2)(B)(i), by striking 
‘‘,, 2023, and 2027’’ and inserting ‘‘and 
2023’’; 
(ii) in paragraph (7)— 
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917 
(I) in subparagraph (A), by strik-
ing ‘‘and ending with fiscal year 
2027,’’; and 
(II) in the flush left matter at 
the end, by striking ‘‘or fiscal year 
2026’’ and inserting ‘‘fiscal year 
2026, or a subsequent even-numbered 
fiscal year’’; 
(iii) in paragraph (9)— 
(I) by striking ‘‘(10), or (11)’’ 
and inserting ‘‘or (10)’’; and 
(II) by striking ‘‘2023, or 2027,’’ 
and inserting ‘‘or 2023’’; and 
(iv) by striking paragraph (11). 
(B) CONFORMING
AMENDMENT.—Section 
50101(b)(2) of the Bipartisan Budget Act of 
2018 (Public Law 115–123) is repealed. 
(b) PERMANENT EXTENSIONS OF OTHER PROGRAMS 
AND DEMONSTRATION PROJECTS.— 
(1) 
PEDIATRIC
QUALITY
MEASURES
PRO-
GRAM.—Section 1139A(i)(1) of the Social Security 
Act (42 U.S.C. 1320b–9a(i)(1)) is amended— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
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918 
(B) in subparagraph (D), by striking the 
period at the end and insert a semicolon; and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(E) for fiscal year 2028, $15,000,000 for 
the purpose of carrying out this section (other 
than subsections (e), (f), and (g)); and 
‘‘(F) for a subsequent fiscal year, the 
amount appropriated under this paragraph for 
the previous fiscal year, increased by the per-
centage increase in the consumer price index for 
all urban consumers (all items; United States 
city average) over such previous fiscal year, for 
the purpose of carrying out this section (other 
than subsections (e), (f), and (g)).’’. 
(2) EXPRESS LANE ELIGIBILITY OPTION.—Sec-
tion 1902(e)(13) of the Social Security Act (42 
U.S.C. 1396a(e)(13)) is amended by striking sub-
paragraph (I). 
(3) ASSURANCE OF AFFORDABILITY STANDARD 
FOR CHILDREN AND FAMILIES.— 
(A) IN GENERAL.—Section 2105(d)(3) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397ee(d)(3)) is amended— 
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919 
(i) in the paragraph heading, by strik-
ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(ii) in subparagraph (A), in the mat-
ter preceding clause (i)— 
(I) by striking ‘‘During the pe-
riod that begins on the date of enact-
ment of the Patient Protection and 
Affordable Care Act and ends on Sep-
tember 30, 2027’’ and inserting ‘‘Be-
ginning on the date of the enactment 
of the Patient Protection and Afford-
able Care Act’’; 
(II) by striking ‘‘During the pe-
riod that begins on October 1, 2019, 
and ends on September 30, 2027’’ 
and inserting ‘‘Beginning on October 
1, 2019’’; and 
(III) by striking ‘‘The preceding 
sentences shall not be construed as 
preventing a State during any such 
periods from’’ and inserting ‘‘The pre-
ceding sentences shall not be con-
strued as preventing a State from’’. 
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920 
(B) CONFORMING AMENDMENTS.—Section 
1902(gg)(2) of the Social Security Act (42 
U.S.C. 1396a(gg)(2)) is amended— 
(i) in the paragraph heading, by strik-
ing ‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(ii) by striking ‘‘through September 
30’’ and all that follows through ‘‘ends on 
September 30, 2027’’ and inserting ‘‘(but 
beginning on October 1, 2019,’’. 
(4) 
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(A) in the paragraph heading, by striking 
‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and 
inserting ‘‘AFTER FISCAL YEAR 2008’’; and 
(B) in subparagraph (A), by striking ‘‘for 
any of fiscal years 2009 through 2027’’ and in-
serting ‘‘for any fiscal year after fiscal year 
2008’’. 
(5) OUTREACH AND ENROLLMENT PROGRAM.— 
Section 2113 of the Social Security Act (42 U.S.C. 
1397mm) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking ‘‘dur-
ing the period of fiscal years 2009 through 
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921 
2027’’ and inserting ‘‘, beginning with fis-
cal year 2009,’’; 
(ii) in paragraph (2)— 
(I) by striking ‘‘10 percent of 
such amounts’’ and inserting ‘‘10 per-
cent of such amounts for the period or 
the fiscal year for which such amounts 
are appropriated’’; and 
(II) by striking ‘‘during such pe-
riod’’ and inserting ‘‘, during such pe-
riod or such fiscal year,’’; and 
(iii) in paragraph (3), by striking 
‘‘For the period of fiscal years 2024 
through 2027, an amount equal to 10 per-
cent of such amounts’’ and inserting ‘‘Be-
ginning with fiscal year 2024, an amount 
equal to 10 percent of such amounts for 
the period or the fiscal year for which such 
amounts are appropriated’’; and 
(B) in subsection (g)— 
(i) by striking ‘‘2017,,’’ and inserting 
‘‘2017,’’; 
(ii) by striking ‘‘and $48,000,000’’ 
and inserting ‘‘$48,000,000’’; and 
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922 
(iii) by inserting after ‘‘through 
2027’’ the following: ‘‘, $12,000,000 for 
fiscal year 2028, and, for each fiscal year 
after fiscal year 2028, the amount appro-
priated under this subsection for the pre-
vious fiscal year, increased by the percent-
age increase in the consumer price index 
for all urban consumers (all items; United 
States city average) over such previous fis-
cal year’’. 
(6) 
CHILD
ENROLLMENT
CONTINGENCY 
FUND.—Section 2104(n) of the Social Security Act 
(42 U.S.C. 1397dd(n)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A)(ii)— 
(I) 
by 
striking 
‘‘and 
2024 
through 2026’’ and inserting ‘‘begin-
ning with fiscal year 2024’’; and 
(II) by striking ‘‘2023, and 
2027’’ and inserting ‘‘, and 2023’’; 
and 
(ii) in subparagraph (B)— 
(I) by striking ‘‘2024 through 
2026’’ and inserting ‘‘beginning with 
fiscal year 2024’’; and 
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923 
(II) by striking ‘‘2023, and 
2027’’ and inserting ‘‘, and 2023’’; 
and 
(B) in paragraph (3)(A)— 
(i) by striking ‘‘fiscal years 2024 
through 2026’’ and inserting ‘‘beginning 
with fiscal year 2024’’; and 
(ii) by striking ‘‘2023, or 2027’’ and 
inserting ‘‘, or 2023’’. 
SEC. 5502. END DIAPER NEED ACT OF 2021. 
(a) TARGETED FUNDING FOR DIAPER ASSISTANCE 
(INCLUDING DIAPERING SUPPLIES AND ADULT INCONTI-
NENCE MATERIALS AND SUPPLIES) THROUGH THE SO-
CIAL SERVICES BLOCK GRANT PROGRAM.— 
(1) INCREASE IN FUNDING FOR SOCIAL SERV-
ICES BLOCK GRANT PROGRAM.— 
(A) IN GENERAL.—The amount specified 
in subsection (c) of section 2003 of the Social 
Security Act (42 U.S.C. 1397b) for purposes of 
subsections (a) and (b) of such section is 
deemed to be $1,900,000,000 for each of fiscal 
years 2023 through 2026, of which, the amount 
equal to $200,000,000, reduced by the amounts 
reserved under subparagraph (B)(ii) for each 
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924 
such fiscal year, shall be obligated by States in 
accordance with paragraph (2). 
(B) APPROPRIATION.— 
(i) IN GENERAL.—Out of any money 
in the Treasury of the United States not 
otherwise appropriated, there is appro-
priated $200,000,000 for each of fiscal 
years 2023 through 2026, to carry out this 
subsection. 
(ii) RESERVATIONS.— 
(I) PURPOSES.—The Secretary 
shall reserve, from the amount appro-
priated under clause (i) to carry out 
this subsection— 
(aa) for each of fiscal years 
2023 through 2026, not more 
than 2 percent of the amount ap-
propriated for the fiscal year for 
purposes of entering into an 
agreement with a national entity 
described in clause (iii) to assist 
in providing technical assistance 
and training, to support effective 
policy, practice, research, and 
cross-system collaboration among 
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925 
grantees and subgrantees, and to 
assist in the administration of 
the program described in this 
subsection; and 
(bb) for fiscal year 2023, an 
amount, 
not 
to 
exceed 
$2,000,000, for purposes of con-
ducting 
an 
evaluation 
under 
paragraph (4). 
(II) NO STATE ENTITLEMENT TO 
RESERVED
FUNDS.—The State enti-
tlement under section 2002(a) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1397a(a)) shall not apply to the 
amounts reserved under subclause (I). 
(iii) NATIONAL ENTITY DESCRIBED.— 
A national entity described in this clause is 
a nonprofit organization described in sec-
tion 501(c)(3) of the Internal Revenue 
Code of 1986 and exempt from taxation 
under section 501(a) of such Code, that— 
(I) has experience in more than 1 
State in the area of— 
(aa) 
community 
distribu-
tions of basic need services, in-
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926 
cluding 
experience 
collecting, 
warehousing, 
and 
distributing 
basic necessities such as diapers, 
food, or menstrual products; 
(bb) child care; 
(cc) child development ac-
tivities in low-income commu-
nities; or 
(dd) 
motherhood, 
father-
hood, or parent education efforts 
serving low-income parents of 
young children; 
(II) demonstrates competency to 
implement a project, provide fiscal ac-
countability, collect data, and prepare 
reports and other necessary docu-
mentation; and 
(III) demonstrates a willingness 
to share information with researchers, 
practitioners, and other interested 
parties. 
(2) RULES
GOVERNING
USE
OF
ADDITIONAL 
FUNDS.— 
(A) IN GENERAL.—Funds are used in ac-
cordance with this paragraph if— 
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927 
(i) the State, in consultation with rel-
evant stakeholders, including agencies, pro-
fessional associations, and nonprofit orga-
nizations, distributes the funds to eligible 
entities to— 
(I) decrease the need for diapers 
and diapering supplies and adult in-
continence materials and supplies in 
low-income families and meet such 
unmet needs of infants and toddlers, 
medically complex children, and low- 
income adults and adults with disabil-
ities in such families through— 
(aa) the distribution of free 
diapers and diapering supplies, 
medically necessary diapers, and 
adult incontinence materials and 
supplies; 
(bb) community outreach to 
assist in participation in existing 
diaper distribution programs or 
programs that distribute medi-
cally necessary diapers or adult 
incontinence materials and sup-
plies; or 
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928 
(cc) improving access to dia-
pers 
and 
diapering 
supplies, 
medically necessary diapers, and 
adult incontinence materials and 
supplies; and 
(II) increase the ability of com-
munities and low-income families in 
such communities to provide for the 
need for diapers and diapering sup-
plies, medically necessary diapers, and 
adult continence materials and sup-
plies, of infants and toddlers, medi-
cally complex children, and low-income 
adults and adults with disabilities; 
(ii) the funds are used subject to the 
limitations in section 2005 of the Social 
Security Act (42 U.S.C. 1397d); 
(iii) the funds are used to supplement, 
not supplant, State general revenue funds 
provided for the purposes described in 
clause (i); and 
(iv) the funds are not used for costs 
that are reimbursable by the Federal 
Emergency Management Agency, under a 
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929 
contract for insurance, or by self-insur-
ance. 
(B) ALLOWABLE USES BY ELIGIBLE ENTI-
TIES.—An eligible entity receiving funds made 
available under paragraph (1) shall use the 
funds for any of the following: 
(i) To pay for the purchase and dis-
tribution of diapers and diapering supplies, 
medically necessary diapers, and funding 
diaper (including medically necessary dia-
pers) distribution that serves low-income 
families with— 
(I) 1 or more children 3 years of 
age or younger; or 
(II) 1 or more medically complex 
children. 
(ii) To pay for the purchase and dis-
tribution of adult incontinence materials 
and supplies and funding distribution of 
such materials and supplies that serves 
low-income families with 1 or more low-in-
come adults or adults with disabilities who 
rely on adult incontinence materials and 
supplies. 
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930 
(iii) To integrate activities carried out 
under clause (i) with other basic needs as-
sistance programs serving eligible children 
and their families, including the following: 
(I) Programs funded by the tem-
porary assistance for needy families 
program under part A of title IV of 
the Social Security Act (42 U.S.C. 
601 et seq.), including the State 
maintenance of effort provisions of 
such program. 
(II) Programs designed to sup-
port the health of eligible children, 
such as the Children’s Health Insur-
ance Program under title XXI of the 
Social Security Act, the Medicaid pro-
gram under title XIX of such Act, or 
State funded health care programs. 
(III) Programs funded through 
the special supplemental nutrition 
program for women, infants, and chil-
dren under section 17 of the Child 
Nutrition Act of 1966. 
(IV) Programs that offer early 
home visiting services, including the 
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931 
maternal, infant, and early childhood 
home visiting program (including the 
Tribal home visiting program) under 
section 511 of the Social Security Act 
(42 U.S.C. 711). 
(V) Programs to provide im-
proved and affordable access to child 
care, 
including 
programs 
funded 
through the Child Care and Develop-
ment Fund, the temporary assistance 
for needy families program under part 
A of title IV of the Social Security 
Act (42 U.S.C. 601 et seq.), or a 
State-funded program. 
(C) AVAILABILITY OF FUNDS.— 
(i) FUNDS DISTRIBUTED TO ELIGIBLE 
ENTITIES.—Funds made available under 
paragraph (1) that are distributed to an el-
igible entity by a State for a fiscal year 
may be expended by the eligible entity only 
in such fiscal year or the succeeding fiscal 
year. 
(ii) EVALUATION.—Funds reserved 
under paragraph (1)(B)(ii)(I)(aa) to carry 
out the evaluation under paragraph (4) 
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932 
shall be available for expenditure during 
the 3-year period that begins on the date 
of enactment of this Act. 
(D) NO EFFECT ON OTHER PROGRAMS.— 
Any assistance or benefits received by a family 
through funds made available under paragraph 
(1) shall be disregarded for purposes of deter-
mining the family’s eligibility for, or amount of, 
benefits under any other Federal needs-based 
programs. 
(3) ANNUAL REPORTS.—A State shall include 
in the annual report required under section 2006 of 
the Social Security Act (42 U.S.C. 1397e) covering 
each of fiscal years 2022 through 2025, information 
detailing how eligible entities, including subgrantees, 
used funds made available under paragraph (1) to 
distribute diapers and diapering supplies and adult 
incontinence materials and supplies to families in 
need. Each such report shall include the following: 
(A) The number and age of infants, tod-
dlers, medically complex children, and low-in-
come adults and adults with disabilities who re-
ceived assistance or benefits through such 
funds. 
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933 
(B) The number of families that have re-
ceived assistance or benefits through such 
funds. 
(C) The number of diapers, medically nec-
essary diapers, or adult incontinence materials 
and supplies (such as adult diapers, briefs, pro-
tective underwear, pull-ons, pull-ups, liners, 
shields, guards, pads, undergarments), and the 
number of each type of diapering or adult in-
continence supply, distributed through the use 
of such funds. 
(D) The ZIP Code or ZIP Codes where the 
eligible entity (or subgrantee) distributed dia-
pers and diapering supplies and adult inconti-
nence materials and supplies. 
(E) The method or methods the eligible en-
tity (or subgrantee) uses to distribute diapers 
and diapering supplies and, adult incontinence 
materials and supplies. 
(F) Such other information as the Sec-
retary may specify. 
(4) EVALUATION.—The Secretary, in consulta-
tion with States, the national entity described in 
paragraph (1)(B)(iii), and eligible entities receiving 
funds made available under this subsection, shall— 
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934 
(A) not later than 2 years after the date 
of enactment of this Act— 
(i) complete an evaluation of the effec-
tiveness of the assistance program carried 
out pursuant to this subsection, such as 
the effect of activities carried out under 
this section on mitigating the health and 
developmental risks of unmet diaper need 
among infants, toddlers, medically complex 
children, and other family members in low- 
income families, including the risks of dia-
per dermatitis, urinary tract infections, 
and parental and child depression and anx-
iety; 
(ii) submit to the relevant congres-
sional committees a report on the results 
of such evaluation; and 
(iii) publish the results of the evalua-
tion on the internet website of the Depart-
ment of Health and Human Services; 
(B) not later than 3 years after the date 
of enactment of this Act, update the evaluation 
required by subparagraph (A)(i); and 
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935 
(C) not later than 90 days after completion 
of the updated evaluation under subparagraph 
(B)— 
(i) submit to the relevant congres-
sional committees a report describing the 
results of such updated evaluation; and 
(ii) publish the results of such evalua-
tion on the internet website of the Depart-
ment of Health and Human Services. 
(5) GUIDANCE.—Not later than 180 days after 
enactment of this Act, the Secretary shall issue 
guidance regarding how the provisions of this sub-
section should be carried out, including information 
regarding eligible entities, allowable use of funds, 
and reporting requirements. 
(6) DEFINITIONS.—In this subsection: 
(A) ADULT
INCONTINENCE
MATERIALS 
AND SUPPLIES.—The term ‘‘adult incontinence 
materials and supplies’’ means those supplies 
that are used to assist low-income adults or 
adults with disabilities and includes adult dia-
pers, briefs, protective underwear, pull-ons, 
pull-ups, liners, shields, guards, pads, undergar-
ments, disposable wipes, over-the-counter adult 
diaper rash cream products, intermittent cath-
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eterization, indwelling catheters, condom cath-
eters, urinary drainage bags, external collection 
devices, wearable urinals, and penile clamps. 
(B) ADULTS
WITH
DISABILITIES.—The 
term ‘‘adults with disabilities’’ means individ-
uals who— 
(i) have attained age 18; and 
(ii) have a disability (as such term is 
defined, with respect to an individual, in 
section 3 of the Americans with Disabil-
ities Act of 1990 (42 U.S.C. 12102)). 
(C) DIAPER.—The term ‘‘diaper’’ means 
an absorbent garment that— 
(i) is washable or disposable that may 
be worn by an infant or toddler who is not 
toilet-trained; and 
(ii) if disposable— 
(I) does not use any latex or 
common allergens; and 
(II) meets or exceeds the quality 
standards for diapers commercially 
available through retail sale in the fol-
lowing categories: 
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937 
(aa) Absorbency (with ac-
ceptable rates for first and sec-
ond wetting). 
(bb) Waterproof outer cover. 
(cc) Flexible leg openings. 
(dd) Refastening closures. 
(D) DIAPERING
SUPPLIES.—The term 
‘‘diapering supplies’’ means items, including di-
aper wipes and diaper cream, necessary to en-
sure that— 
(i) an eligible child using a diaper is 
properly cleaned and protected from diaper 
rash; or 
(ii) a medically complex child who 
uses a medically necessary diaper is prop-
erly cleaned and protected from diaper 
rash. 
(E) ELIGIBLE CHILD.—The term ‘‘eligible 
child’’ means a child who— 
(i) has not attained 4 years of age; 
and 
(ii) is a member of a low-income fam-
ily. 
(F) ELIGIBLE ENTITIES.—The term ‘‘eligi-
ble entity’’ means a State or local governmental 
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938 
entity, an Indian tribe or tribal organization (as 
defined in section 4 of the Indian Self-Deter-
mination and Education Assistance Act), or a 
nonprofit organization described in section 
501(c)(3) of the Internal Revenue Code of 1986 
and exempt from taxation under section 501(a) 
of such Code that— 
(i) has experience in the area of— 
(I) community distributions of 
basic need services, including experi-
ence collecting, warehousing, and dis-
tributing basic necessities such as dia-
pers, food, or menstrual products; 
(II) child care; 
(III) child development activities 
in low-income communities; or 
(IV) motherhood, fatherhood, or 
parent education efforts serving low- 
income parents of young children; 
(ii) demonstrates competency to im-
plement a project, provide fiscal account-
ability, collect data, and prepare reports 
and other necessary documentation; and 
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939 
(iii) demonstrates a willingness to 
share information with researchers, practi-
tioners, and other interested parties. 
(G) FEDERAL POVERTY LINE.—The term 
‘‘Federal poverty line’’ means the Federal pov-
erty line as defined by the Office of Manage-
ment and Budget and revised annually in ac-
cordance with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981 applicable to 
a family of the size involved. 
(H) LOW-INCOME.—The term ‘‘low-in-
come’’, with respect to a family, means a family 
whose self-certified income is not more than 
200 percent of the Federal poverty line. 
(I) MEDICALLY
COMPLEX
CHILD.—The 
term ‘‘medically complex child’’ means an indi-
vidual who has attained age 3 and for whom a 
licensed health care provider has provided a di-
agnosis of bowel or bladder incontinence, a 
bowel or bladder condition that causes excess 
urine or stool (such as short gut syndrome or 
diabetes insipidus), or a severe skin condition 
that causes skin erosions (such as epidermolysis 
bullosa). 
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940 
(J) MEDICALLY NECESSARY DIAPER.—The 
term ‘‘medically necessary diaper’’ means an 
absorbent garment that is— 
(i) washable or disposable; 
(ii) worn by a medically complex child 
who has been diagnosed with bowel or 
bladder incontinence, a bowel or bladder 
condition that causes excess urine or stool 
(such as short gut syndrome or diabetes 
insipidus), or a severe skin condition that 
causes skin erosions (such as epidermolysis 
bullosa) and needs such garment to correct 
or ameliorate such condition; and 
(iii) if disposable— 
(I) does not use any latex or 
common allergens; and 
(II) meets or exceeds the quality 
standards for diapers commercially 
available through retail sale in the fol-
lowing categories: 
(aa) Absorbency (with ac-
ceptable rates for first and sec-
ond wetting). 
(bb) Waterproof outer cover. 
(cc) Flexible leg openings. 
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941 
(dd) Refastening closures. 
(7) EXEMPTION OF PROGRAM FROM SEQUES-
TRATION.— 
(A) IN GENERAL.—Section 255(h) of the 
Balanced Budget and Emergency Deficit Con-
trol Act of 1985 (2 U.S.C. 905(h)) is amended 
by inserting after ‘‘Supplemental Security In-
come Program (28–0406–0–1–609).’’ the fol-
lowing: 
‘‘Targeted funding for States for diaper assist-
ance (including diapering supplies and adult inconti-
nence materials and supplies) through the Social 
Services Block Grant Program.’’. 
(B) 
APPLICABILITY.—The 
amendment 
made by this paragraph shall apply to any se-
questration order issued under the Balanced 
Budget and Emergency Deficit Control Act of 
1985 (2 U.S.C. 900 et seq.) on or after the 
date of enactment of this Act. 
(b) IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 
COMPLEX CHILDREN.—Section 1915(c) of the Social Se-
curity Act (42 U.S.C. 1396n(c)) is amended by adding at 
the end the following new paragraph: 
‘‘(11)(A) In the case of any waiver under this sub-
section that provides medical assistance to a medically 
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942 
complex child who has been diagnosed with bowel or blad-
der incontinence, a bowel or bladder condition that causes 
excess urine or stool (such as short gut syndrome or diabe-
tes insipidus), or a severe skin condition that causes skin 
erosions (such as epidermolysis bullosa), such medical as-
sistance shall include, for the duration of the waiver, the 
provision of 200 medically necessary diapers per month 
and diapering supplies. Such medical assistance may in-
clude the provision of medically necessary diapers in 
amounts greater than 200 if a licensed health care pro-
vider (such as a physician, nurse practitioner, or physician 
assistant) specifies that such greater amounts are nec-
essary for such medically complex child. 
‘‘(B) For purposes of this paragraph: 
‘‘(i) The term ‘medically complex child’ means 
an individual who has attained age 3 and for whom 
a licensed health care provider has provided a diag-
nosis of 1 or more significant chronic conditions. 
‘‘(ii) The term ‘medically necessary diaper’ 
means an absorbent garment that is— 
‘‘(I) washable or disposable; 
‘‘(II) worn by a medically complex child 
who has been diagnosed with a condition de-
scribed in subparagraph (A) and needs such 
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943 
garment to correct or ameliorate such condition; 
and 
‘‘(III) if disposable— 
‘‘(aa) does not use any latex or com-
mon allergens; and 
‘‘(bb) meets or exceeds the quality 
standards for diapers commercially avail-
able through retail sale in the following 
categories: 
‘‘(AA) Absorbency (with accept-
able rates for first and second wet-
ting). 
‘‘(BB) Waterproof outer cover. 
‘‘(CC) Flexible leg openings. 
‘‘(DD) Refastening closures. 
‘‘(iii) The term ‘diapering supplies’ means 
items, including diaper wipes and diaper creams, 
necessary to ensure that a medically complex child 
who has been diagnosed with a condition described 
in subparagraph (A) and uses a medically necessary 
diaper is properly cleaned and protected from diaper 
rash.’’. 
(c) INCLUSION OF DIAPERS AND DIAPERING SUP-
PLIES AS QUALIFIED MEDICAL EXPENSES.— 
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944 
(1) 
HEALTH
SAVINGS
ACCOUNTS.—Section 
223(d)(2) of the Internal Revenue Code of 1986 is 
amended— 
(A) by inserting ‘‘, medically necessary dia-
pers, and diapering supplies’’ after ‘‘menstrual 
care products’’ in the last sentence of subpara-
graph (A); and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(E) MEDICALLY
NECESSARY
DIAPERS 
AND
DIAPERING
SUPPLIES.—For purposes of 
this paragraph— 
‘‘(i) MEDICALLY
NECESSARY
DIA-
PERS.—The term ‘medically necessary dia-
per’ means an absorbent garment which is 
washable or disposable and which is worn 
by an individual who has attained 3 years 
of age because of medical necessity, such 
as someone who has been diagnosed with 
bowel or bladder incontinence, a bowel or 
bladder condition that causes excess urine 
or stool (such as short gut syndrome or di-
abetes insipidus), or a severe skin condi-
tion that causes skin erosions (such as 
epidermolysis bullosa) and needs such gar-
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945 
ment to correct or ameliorate such condi-
tion, to serve a preventative medical pur-
pose, or to correct or ameliorate defects or 
physical or mental illnesses or conditions 
diagnosed by a licensed health care pro-
vider, and, if disposable— 
‘‘(I) does not use any latex or 
common allergens; and 
‘‘(II) meets or exceeds the quality 
standards for diapers commercially 
available through retail sale in the fol-
lowing categories: 
‘‘(aa) Absorbency (with ac-
ceptable rates for first and sec-
ond wetting). 
‘‘(bb) 
Waterproof 
outer 
cover. 
‘‘(cc) Flexible leg openings. 
‘‘(dd) Refastening closures. 
‘‘(ii) 
DIAPERING
SUPPLIES.—The 
term ‘diapering supplies’ means items, in-
cluding diaper wipes and diaper creams, 
necessary to ensure that an individual 
wearing medically necessary diapers is 
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946 
properly cleaned and protected from diaper 
rash.’’. 
(2) ARCHER MSAS.—The last sentence of sec-
tion 220(d)(2)(A) of such Code is amended by in-
serting ‘‘, medically necessary diapers (as defined in 
section 223(d)(2)(E)), and diapering supplies (as de-
fined in section 223(d)(2)(E))’’ after ‘‘menstrual 
care products (as defined in section 223(d)(2)(D))’’. 
(3) HEALTH
FLEXIBLE
SPENDING
ARRANGE-
MENTS
AND
HEALTH
REIMBURSEMENT
ARRANGE-
MENTS.—Section 106(f) of such Code is amended— 
(A) by inserting ‘‘, medically necessary dia-
pers (as defined in section 223(d)(2)(E)), and 
diapering supplies (as defined in section 
223(d)(2)(E))’’ after ‘‘menstrual care products 
(as defined in section 223(d)(2)(D))’’; and 
(B) in the heading, by inserting ‘‘, MEDI-
CALLY NECESSARY DIAPERS, AND DIAPERING 
SUPPLIES’’ after ‘‘MENSTRUAL CARE PROD-
UCTS’’. 
(4) EFFECTIVE DATES.— 
(A) DISTRIBUTIONS
FROM
CERTAIN
AC-
COUNTS.—The amendments made by para-
graphs (1) and (2) shall apply to amounts paid 
after December 31, 2023. 
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947 
(B) REIMBURSEMENTS.—The amendment 
made by paragraph (3) shall apply to expenses 
incurred after December 31, 2023. 
SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN 
UNEXPECTED INFANT DEATH AND SUDDEN 
UNEXPLAINED DEATH IN CHILDHOOD. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration and in con-
sultation with the Director of the Centers for Disease Con-
trol and Prevention and the Director of the National Insti-
tutes of Health (in this section referred to as the ‘‘Sec-
retary’’), shall establish and implement a culturally and 
linguistically competent public health awareness and edu-
cation campaign to provide information that is focused on 
decreasing the risk factors for sudden unexpected infant 
death and sudden unexplained death in childhood, includ-
ing educating individuals about safe sleep environments, 
sleep positions, and reducing exposure to smoking during 
pregnancy and after birth. 
(b) TARGETED POPULATIONS.—The campaign under 
subsection (a) shall be designed to reduce health inequities 
through the targeting of populations with high rates of 
sudden unexpected infant death and sudden unexplained 
death in childhood. 
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948 
(c) CONSULTATION.—In establishing and imple-
menting the campaign under subsection (a), the Secretary 
shall consult with national organizations representing 
health care providers, including nurses and physicians, 
parents, child care providers, children’s advocacy and safe-
ty organizations, maternal and child health programs, nu-
trition professionals focusing on people, infants, and chil-
dren, and other individuals and groups determined nec-
essary by the Secretary for such establishment and imple-
mentation. 
(d) GRANTS.— 
(1) IN
GENERAL.—In carrying out the cam-
paign under subsection (a), the Secretary shall 
award grants to national organizations, State and 
local health departments, and community-based or-
ganizations for the conduct of education and out-
reach programs for nurses, parents, child care pro-
viders, public health agencies, and community orga-
nizations. 
(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), an entity shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
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949 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2023 through 2027. 
Subtitle G—Nutrition for Women, 
Children, Families 
SEC. 5601. REMOVING BARRIERS TO HEALTH CARE AND NU-
TRITION ASSISTANCE FOR CHILDREN, PREG-
NANT PERSONS, AND LAWFULLY PRESENT IN-
DIVIDUALS. 
(a) MEDICAID.—Paragraph (4) of section 1903(v) of 
the Social Security Act (42 U.S.C. 1396b(v)) is amended 
to read as follows: 
‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 
403, and 421 of the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996 and paragraph (1), 
payment shall be made to a State under this section for 
medical assistance furnished to an alien under this title 
(including an alien described in such paragraph) who 
meets any of the following conditions: 
‘‘(i) The alien is otherwise eligible for such as-
sistance under the State plan approved under this 
title (other than the requirement of the receipt of 
aid or assistance under title IV, supplemental secu-
rity income benefits under title XVI, or a State sup-
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950 
plementary payment) within either or both of the 
following eligibility categories: 
‘‘(I) Children under 21 years of age, in-
cluding any optional targeted low-income child 
(as 
such 
term 
is 
defined 
in 
section 
1905(u)(2)(B)). 
‘‘(II) Pregnant persons during pregnancy 
and during the 12-month period beginning on 
the last day of the pregnancy. 
‘‘(ii) The alien is lawfully present in the United 
States. 
‘‘(B) No debt shall accrue under an affidavit of sup-
port against any sponsor of an alien who meets the condi-
tions specified in subparagraph (A) on the basis of the 
provision of medical assistance to such alien under this 
paragraph and the cost of such assistance shall not be con-
sidered as an unreimbursed cost.’’. 
(b) CHIP.—Subparagraph (N) of section 2107(e)(1) 
of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended to read as follows: 
‘‘(N) Paragraph (4) of section 1903(v) (re-
lating to coverage of categories of children, 
pregnant persons, and other lawfully present in-
dividuals).’’. 
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951 
(c) SUPPLEMENTAL NUTRITION ASSISTANCE
FOR 
LAWFULLY PRESENT INDIVIDUALS.— 
(1) IN GENERAL.—Section 402(a)(2)(J) of the 
Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1612(a)(2)(J)) is 
amended— 
(A) in the subparagraph heading, by strik-
ing ‘‘CERTAIN CHILDREN’’ inserting ‘‘CHILDREN 
AND LAWFULLY PRESENT INDIVIDUALS’’; and 
(B) by striking ‘‘who is under 18 years of 
age.’’ and inserting ‘‘who is— 
‘‘(i) under 21 years of age; or 
‘‘(ii) lawfully present in the United 
States.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 402(a)(3) of such Act (8 
U.S.C. 1612(a)(3)) is amended by striking sub-
paragraph (B) and inserting the following: 
‘‘(B) SNAP (FOOD
STAMP
PROGRAM).— 
The supplemental nutrition assistance program 
established under the Food and Nutrition Act 
of 2008 (7 U.S.C. 2011 et seq.) (referred to in 
this title as ‘SNAP’ or the ‘food stamp pro-
gram’).’’. 
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952 
(B) Section 403(c)(2)(L) of such Act (42 
U.S.C. 1613(c)(2)(L)) is amended by striking 
‘‘18’’ and all that follows through the period 
and inserting ‘‘21, or to individuals who are 
lawfully present in the United States, under the 
supplemental nutrition assistance program es-
tablished under the Food and Nutrition Act of 
2008 (7 U.S.C. 2011 et seq.).’’. 
(C) Section 5(i)(2)(E) of the Food and 
Nutrition Act of 2008 (7 U.S.C. 2014(i)(2)(E)) 
is amended by striking ‘‘18 years of age.’’ and 
inserting ‘‘21 years of age, or who is lawfully 
present in the United States.’’. 
(d) NONAPPLICATION OF SPONSOR DEEMING; AS-
SURING ELIGIBILITY FOR FAMILIES.—Section 421(d) of 
the Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631(d)) is amended 
by striking paragraph (3) and inserting the following: 
‘‘(3) This section shall not apply to assistance 
or benefits under the supplemental nutrition assist-
ance program established under the Food and Nutri-
tion Act of 2008 (7 U.S.C. 2011 et seq.) for a quali-
fied alien who is eligible under section 402(a)(2)(J) 
and for any member of the household of such quali-
fied alien.’’. 
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953 
(e) 
ENSURING
PROPER
SCREENING.—Section 
11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 
U.S.C. 2020(e)(2)(B)) is amended— 
(1) by redesignating clauses (vi) and (vii) as 
clauses (vii) and (viii), respectively; and 
(2) by inserting after clause (v) the following: 
‘‘(vi) shall provide a method for imple-
menting section 421 of the Personal Re-
sponsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631) 
that does not require any unnecessary in-
formation from applicants who may be ex-
empt from that provision;’’. 
SEC. 5602. CLOSING THE MEAL GAP. 
(a) ELIMINATION OF TIME LIMIT.— 
(1) IN GENERAL.—Section 6 of the Food and 
Nutrition Act of 2008 (7 U.S.C. 2015) is amend-
ed— 
(A) by striking subsection (o); and 
(B) 
by 
redesignating 
subsections 
(p) 
through (s) as subsections (o) through (r), re-
spectively. 
(2) ADDITIONAL
ALLOCATIONS
FOR
STATES 
THAT ENSURE AVAILABILITY OF WORK OPPORTUNI-
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954 
TIES.—Section 16(h) of the Food and Nutrition Act 
of 2008 (7 U.S.C. 2025(h)) is amended— 
(A) in paragraph (1)— 
(i) in subparagraph (C)(iv)(I)— 
(I) by striking ‘‘(F)(viii)’’ each 
place 
it 
appears 
and 
inserting 
‘‘(E)(viii)’’; 
(II) by striking ‘‘(F)(vii)(I)’’ each 
place 
it 
appears 
and 
inserting 
‘‘(E)(vii)(I)’’; 
(III) in item (bb)(BB), by strik-
ing 
‘‘(F)(vii)(II)’’ 
and 
inserting 
‘‘(E)(vii)(II)’’; and 
(IV) in item (cc), by striking 
‘‘(F)(vii)’’ and inserting ‘‘(E)(vii)’’; 
(ii) by striking subparagraph (E); and 
(iii) by redesignating subparagraph 
(F) as subparagraph (E); 
(B) in paragraphs (3) and (4), by striking 
‘‘(1)(F)’’ each place it appears and inserting 
‘‘(1)(E)’’; and 
(C) in paragraph (5)(C)— 
(i) in clause (ii), by adding ‘‘and’’ at 
the end; 
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955 
(ii) in clause (iii), by striking ‘‘; and’’ 
and inserting a period; and 
(iii) by striking clause (iv). 
(3) CONFORMING AMENDMENTS.— 
(A) Section 5(a) of the Food and Nutrition 
Act of 2008 (7 U.S.C. 2014(a)) is amended in 
the second sentence, by striking ‘‘(r)’’ and in-
serting ‘‘(q)’’. 
(B) Section 6(d)(4) of the Food and Nutri-
tion Act of 2008 (7 U.S.C. 2015(d)(4)) is 
amended— 
(i) 
in 
subparagraph 
(B)(ii)(I)(bb)(DD), by striking ‘‘or sub-
section (o)’’; and 
(ii) in subparagraph (N), by striking 
‘‘or subsection (o)’’ each place it appears. 
(C) Section 7(i)(1) of the Food and Nutri-
tion Act of 2008 (7 U.S.C. 2016(i)(1)) is 
amended by striking ‘‘section 6(o)(2) of this 
Act or’’. 
(D) Section 16(h)(1) of the Food and Nu-
trition Act of 2008 (7 U.S.C. 2025(h)) is 
amended— 
(i) in subparagraph (B), in the matter 
preceding clause (i), by striking ‘‘that—’’ 
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957 
(G) Section 121(b)(2)(B) of the Workforce 
Innovation and Opportunity Act (29 U.S.C. 
3151) is amended— 
(i) by striking clause (iv); and 
(ii) 
by 
redesignating 
clauses 
(v) 
through (vii) as clauses (iv) through (vi), 
respectively. 
(b) PARTICIPATION
OF PUERTO RICO, AMERICAN 
SAMOA, AND THE NORTHERN MARIANA ISLANDS IN SUP-
PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 
(1) DEFINITION OF STATE.—Subsection (r) of 
section 3 of the Food and Nutrition Act of 2008 (7 
U.S.C. 2012) is amended by inserting ‘‘the Com-
monwealth of Puerto Rico, American Samoa, the 
Commonwealth of the Northern Mariana Islands,’’ 
after ‘‘Guam,’’. 
(2) ELIGIBLE HOUSEHOLDS.—Section 5 of the 
Food and Nutrition Act of 2008 (7 U.S.C. 2014) is 
amended— 
(A) in subsection (c), in the undesignated 
matter at the end, by striking ‘‘States or 
Guam’’ and inserting ‘‘States, Guam, the Com-
monwealth of Puerto Rico, American Samoa, or 
the Commonwealth of the Northern Mariana Is-
lands’’; and 
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958 
(B) by adding at the end the following: 
‘‘(o) PUERTO RICO, AMERICAN SAMOA, AND THE 
NORTHERN MARIANA ISLANDS.—Notwithstanding any 
other provision of this Act, including the requirements 
under this section, the Commonwealth of Puerto Rico, 
American Samoa, and the Commonwealth of the Northern 
Mariana Islands shall each establish their own standards 
of eligibility for participation by households in the supple-
mental nutrition assistance program.’’. 
(3) EFFECTIVE DATE.— 
(A) IN GENERAL.—The amendments made 
by paragraphs (1) and (2) shall be effective 
with respect to the Commonwealth of Puerto 
Rico, American Samoa, and the Commonwealth 
of the Northern Mariana Islands, as applicable, 
on the date described in subparagraph (B) if 
the Secretary of Agriculture submits to Con-
gress a certification under subsection (f)(2)(B) 
of section 19 of the Food and Nutrition Act of 
2008 (7 U.S.C. 2028). 
(B) DATE DESCRIBED.—The date referred 
to in subparagraph (A) is, with respect to the 
Commonwealth of Puerto Rico, American 
Samoa, and the Commonwealth of the Northern 
Mariana Islands, the date established by the 
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959 
Commonwealth of Puerto Rico, American 
Samoa, or the Commonwealth of the Northern 
Mariana Islands, respectively, in the applicable 
plan of operation submitted to the Secretary of 
Agriculture under subsection (f)(1)(A) of sec-
tion 19 of the Food and Nutrition Act of 2008 
(7 U.S.C. 2028). 
(c) TRANSITION
OF
PUERTO
RICO, AMERICAN 
SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP-
PLEMENTAL NUTRITION ASSISTANCE PROGRAM.—Section 
19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) 
is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(C) the Commonwealth of the Northern 
Mariana Islands.’’; and 
(2) by adding at the end the following: 
‘‘(f) TRANSITION
OF
PUERTO
RICO, AMERICAN 
SAMOA, AND THE NORTHERN MARIANA ISLANDS TO SUP-
PLEMENTAL NUTRITION ASSISTANCE PROGRAM.— 
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960 
‘‘(1) REQUEST FOR PARTICIPATION.—A govern-
mental entity may submit to the Secretary a request 
to participate in the supplemental nutrition assist-
ance program, which shall include a plan of oper-
ation described in section 11(d), which shall include 
the date on which the governmental entity intends to 
begin participation in the program. 
‘‘(2) CERTIFICATION BY SECRETARY.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
certify a governmental entity that submits a re-
quest under paragraph (1) as qualified to par-
ticipate in the supplemental nutrition assistance 
program if the Secretary— 
‘‘(i) approves the plan of operation 
submitted with the request, in accordance 
with this subsection; and 
‘‘(ii) approves the applications de-
scribed in paragraph (4) in accordance 
with that paragraph. 
‘‘(B) SUBMISSION OF CERTIFICATION TO 
CONGRESS.—The Secretary shall submit each 
certification under subparagraph (A) to Con-
gress. 
‘‘(3) DETERMINATION
OF
PLAN
OF
OPER-
ATION.— 
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961 
‘‘(A) APPROVAL.—The Secretary shall ap-
prove a plan of operation submitted with a re-
quest under paragraph (1) if the plan satisfies 
the requirements under this Act for a plan of 
operation. 
‘‘(B) DISAPPROVAL.—If the Secretary does 
not approve a plan of operation submitted with 
a request under paragraph (1), the Secretary 
shall provide to the governmental entity a state-
ment that describes each requirement under 
this Act that is not satisfied by the plan. 
‘‘(4) APPROVAL OF RETAIL FOOD STORES.— 
‘‘(A) SOLICITATION OF APPLICATIONS.—If 
the Secretary approves a plan of operation 
under paragraph (3)(A) for a governmental en-
tity, the Secretary shall accept applications 
from retail food stores located in that govern-
mental entity to be authorized under section 9 
to participate in the supplemental nutrition as-
sistance program. 
‘‘(B) 
DETERMINATION.—The 
Secretary 
shall authorize a retail food store applying to 
participate in the supplemental nutrition assist-
ance program under subparagraph (A) if the 
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962 
application satisfies the requirements under this 
Act for authorization of a retail food store. 
‘‘(5) PUERTO RICO.—In the case of a request 
under paragraph (1) by the Commonwealth of Puer-
to Rico, notwithstanding subsection (g), the Sec-
retary shall allow the Commonwealth of Puerto Rico 
to continue to carry out under the supplemental nu-
trition assistance program the Family Market Pro-
gram established pursuant to this section. 
‘‘(6) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to the Sec-
retary to carry out this subsection such sums as are 
necessary for fiscal year 2023, to remain available 
until expended. 
‘‘(g) TERMINATION OF EFFECTIVENESS.— 
‘‘(1) IN GENERAL.—Subsections (a) through (e) 
shall cease to be effective with respect to the Com-
monwealth of Puerto Rico, American Samoa, and 
the Commonwealth of the Northern Mariana Is-
lands, as applicable, on the date described in para-
graph (2) if the Secretary submits to Congress a 
certification under subsection (f)(2)(B) for that gov-
ernmental entity. 
‘‘(2) DATE DESCRIBED.—The date referred to 
in paragraph (1) is, with respect to the Common-
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1166 
the Secretary, for each renewal, a report on the 
progress of such agency in retaining and hiring 
school social workers to achieve the ratio of not less 
than 1 school social worker for every 250 students 
served by the agency, and shall include— 
‘‘(A) a description of the staffing expan-
sion of school social workers funded through the 
original grant received under this section; and 
‘‘(B) a description of the work conducted 
by such social workers for higher risk students. 
‘‘(f) TECHNICAL ASSISTANCE.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
technical assistance to high-need local educational 
agencies, including such agencies that do not have 
adequate staff, in applying for grants under this sec-
tion. 
‘‘(2) EXTENSION
OF
APPLICATION
PERIOD.— 
The Secretary shall extend any application period 
for a grant under this section for any high-need local 
educational agency that— 
‘‘(A) submits to the Secretary a written 
notification of the intent to apply for a grant 
under this section before requesting technical 
assistance under paragraph (1); and 
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consultation with the Secretary of Education, shall award 
grants, contracts, or cooperative agreements to eligible en-
tities to increase the number of mental health and sub-
stance use disorder care providers in schools and health 
centers served by such entities. 
‘‘(b) APPLICATION.—An eligible entity seeking an 
award under this section shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require, in-
cluding a description of— 
‘‘(1) the mental health and substance use dis-
order needs of the student population served by the 
eligible entity; and 
‘‘(2) with respect to the student population 
served by the eligible entity, how the eligible entity 
will ensure that the mental health and substance use 
disorder care providers supported by the eligible en-
tity, and the services administered by such pro-
viders, are culturally competent and linguistically 
appropriate. 
‘‘(c) REPORTING.— 
‘‘(1) ELIGIBLE
ENTITY
REPORTING.—Eligible 
entities receiving an award under this section shall 
submit an annual report to the Secretary accom-
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