Title: Pathways to Health Careers Act
Policy area: Health

Summary:
Pathways to Health Careers Act
This bill extends, revises, and funds certain demonstration grant programs to train low-income individuals for jobs considered part of the health care career pathway. The Department of Health and Human Services also must provide targeted technical assistance to grantees and conduct an evaluation of the demonstration projects.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3398 Introduced in House (IH)]

<DOC>






116th CONGRESS
  1st Session
                                H. R. 3398

   To provide low-income individuals with opportunities to enter and 
follow a career pathway in the health professions, to extend and expand 
            demonstration projects, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2019

Mr. Danny K. Davis of Illinois introduced the following bill; which was 
              referred to the Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
   To provide low-income individuals with opportunities to enter and 
follow a career pathway in the health professions, to extend and expand 
            demonstration projects, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Pathways to Health Careers Act''.

SEC. 2. EXTENSION THROUGH FISCAL YEAR 2020 OF FUNDING FOR DEMONSTRATION 
              PROJECTS TO ADDRESS HEALTH PROFESSIONS WORKFORCE NEEDS.

    Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking ``2019.'' and inserting ``2020, and 
to provide technical assistance and cover administrative costs 
associated with implementing the successor to this section $15,000,000 
for fiscal year 2020.''.

SEC. 3. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY GRANTS.

    Effective October 1, 2020, section 2008 of the Social Security Act 
(42 U.S.C. 1397g) is amended to read as follows:

``SEC. 2008. CAREER PATHWAYS THROUGH HEALTH PROFESSION OPPORTUNITY 
              GRANTS.

    ``(a) Application Requirements.--An eligible entity desiring a 
grant under this section for a project shall submit to the Secretary an 
application for the grant, that includes the following:
            ``(1) A description of how the applicant will use a career 
        pathways approach to train eligible individuals for health 
        professions that pay well or will put eligible individuals on a 
        career path to an occupation that pays well, under the project.
            ``(2) A description of the basic skills education 
        activities, work readiness activities, training activities, and 
        case management and career coaching services that the applicant 
        will use to assist eligible individuals to gain work 
        experience, connection to employers, and job placement, and a 
        description of the plan for recruiting, hiring, and training 
        staff to provide the case management, mentoring, and career 
        coaching services, under the project directly or through local 
        governmental, apprenticeship, educational, or charitable 
        institutions.
            ``(3) In the case of an application for a grant under this 
        section for a demonstration project described in subsection 
        (c)(2)(B)(i)(I)--
                    ``(A) a demonstration that the State in which the 
                demonstration project is to be conducted has in effect 
                policies or laws that permit certain allied health and 
                behavioral health care credentials to be awarded to 
                people with certain arrest or conviction records (which 
                policies or laws shall include appeals processes and 
                other opportunities to demonstrate rehabilitation to 
                obtain licensure and approval to work in the proposed 
                health careers), and a plan described in the 
                application which will use a career pathway to train 
                people with such a record to be trained and employed in 
                such a career;
                    ``(B) a discussion of how the project or future 
                strategic hiring decisions will demonstrate the 
                experience and expertise of the project in working with 
                job seekers who have arrest or conviction records or 
                employers with experience working with people with 
                arrest or conviction records;
                    ``(C) an identification of promising innovations or 
                best practices that can be used to provide the 
                training;
                    ``(D) a proof of concept or demonstration that the 
                applicant has done sufficient research on workforce 
                shortage or in-demand jobs for which people with 
                certain types of arrest or conviction records can be 
                hired;
                    ``(E) a plan for recruiting students who are 
                eligible individuals into the project; and
                    ``(F) a plan for providing post-employment support 
                and ongoing training as part of a career pathway under 
                the project.
            ``(4) In the case of an application for a grant under this 
        section for a demonstration project described in subsection 
        (c)(2)(B)(i)(II)--
                    ``(A) a description of the partnerships, strategic 
                staff hiring decisions, tailored program activities, or 
                other programmatic elements of the project that are 
                designed to support a strong career pathway in 
                pregnancy, birth, or post-partum services; and
                    ``(B) a demonstration that the State in which the 
                demonstration project is to be conducted recognizes and 
                permits doulas and midwives to practice in the State.
            ``(5) A demonstration that the applicant has experience 
        working with low-income populations, or a description of the 
        plan of the applicant to work with a partner organization that 
        has the experience.
            ``(6) A plan for providing post-employment support and 
        ongoing training as part of a career pathway under the project.
            ``(7) A description of the support services that the 
        applicant will provide under the project, including a plan for 
        how child care and transportation support services will be 
        guaranteed and, if the applicant will provide a cash stipend, 
        how the stipend would be calculated and distributed.
            ``(8) A certification by the applicant that the project 
        development included--
                    ``(A) consultation with a local workforce 
                development board established under section 107 of the 
                Workforce Innovation and Opportunity Act;
                    ``(B) consideration of apprenticeship models 
                registered under the Act of August 16, 1937 (also known 
                as the `National Apprenticeship Act');
                    ``(C) consideration of career pathway programs in 
                the State in which the project is to be conducted; and
                    ``(D) a review of the State plan under section 102 
                or 103 of the Workforce Innovation and Opportunity Act.
            ``(9) A description of the availability and relevance of 
        recent labor market information and other pertinent evidence of 
        in-demand jobs or worker shortages.
            ``(10) A certification that the applicant will directly 
        provide or contract for the training services described in the 
        application.
            ``(11) A commitment by the applicant that, if the grant is 
        made to the applicant, the applicant will--
                    ``(A) during the planning period for the project, 
                provide the Secretary with any information needed by 
                the Secretary to establish adequate data reporting and 
                administrative structure for the project;
                    ``(B) hire a person to direct the project not later 
                than the end of the planning period applicable to the 
                project;
                    ``(C) accept all technical assistance offered by 
                the Secretary with respect to the grant; and
                    ``(D) participate in such in-person grantee 
                conferences as are regularly scheduled by the 
                Secretary.
    ``(b) Preferences in Considering Applications.--In considering 
applications for a grant under this section, the Secretary shall give 
preference to--
            ``(1) applications submitted by applicants to whom a grant 
        was made for fiscal year 2020 under the immediate predecessor 
        to this section, and who are in full compliance with the 
        conditions of the grant;
            ``(2) applications submitted by applicants who have 
        completed a demonstration project funded under the immediate 
        predecessor to this section or under subsection (c)(2) of this 
        section, if an evaluation of the project, which was funded by 
        the Secretary, found the project to have positive outcomes in 
        the categories of--
                    ``(A) graduation and credential attainment;
                    ``(B) job placement and retention; and
                    ``(C) evidence of addressing the worker shortage or 
                in-demand jobs described in the original application 
                for funding for the completed demonstration project;
            ``(3) applications submitted by applicants who have 
        business and community partners in each of the following 
        categories:
                    ``(A) State and local government agencies and 
                social service providers, including a State or local 
                entity that administers a State program funded under 
                part A of this title;
                    ``(B) institutions of higher education, 
                apprenticeship programs, and local workforce 
                development boards established under section 107 of the 
                Workforce Innovation and Opportunity Act; and
                    ``(C) health care employers, labor unions, and 
                labor-management partnerships;
            ``(4) applications that include opportunities for mentoring 
        or peer support, and make career coaching available, as part of 
        the case management plan;
            ``(5) applications which describe a project that will serve 
        a rural area in which--
                    ``(A) the community in which the individuals to be 
                enrolled in the project reside is located;
                    ``(B) the project will be conducted; or
                    ``(C) an employer partnership that has committed to 
                hiring individuals who successfully complete all 
                activities under the project is located;
            ``(6) applications that include a commitment to providing 
        project participants with a cash stipend of at least 50 percent 
        of the Federal poverty level applicable to a family of the same 
        size as the family of the participant; and
            ``(7) applications which have an emergency cash fund to 
        assist project participants financially in emergency 
        situations.
    ``(c) Grants.--
            ``(1) Competitive grants.--
                    ``(A) Grant authority.--
                            ``(i) In general.--The Secretary, in 
                        consultation with the Secretary of Labor and 
                        the Secretary of Education, may make a grant in 
                        accordance with this paragraph to an eligible 
                        entity whose application for the grant is 
                        approved by the Secretary, to conduct a project 
                        designed to train low-income individuals for 
                        allied health professions using a career 
                        pathways model.
                            ``(ii) Guarantee of grantees in each state 
                        and the district of columbia.--For each grant 
                        cycle, the Secretary shall award a grant under 
                        this paragraph to at least 2 eligible entities 
                        in each State that is not a territory, to the 
                        extent there are a sufficient number of 
                        applications submitted by the entities that 
                        meet the requirements applicable with respect 
                        to such a grant. If, for a grant cycle, there 
                        are fewer than 2 such eligible entities in a 
                        State, the Secretary shall include that 
                        information in the report required by 
                        subsection (g)(2) that covers the fiscal year.
                    ``(B) Guarantee of grants for indian populations.--
                From the amount reserved under subsection (i)(2)(B) for 
                each fiscal year, the Secretary shall award a grant 
                under this paragraph to at least 10 eligible entities 
                that are an Indian tribe, a tribal organization, or a 
                tribal college or university, to the extent there are a 
                sufficient number of applications submitted by the 
                entities that meet the requirements applicable with 
                respect to such a grant.
                    ``(C) Guarantee of grantees in the territories.--
                From the amount reserved under subsection (i)(2)(C) for 
                each fiscal year, the Secretary shall award a grant 
                under this paragraph to at least 2 eligible entities 
                that are located in a territory, to the extent there 
                are a sufficient number of applications submitted by 
                the entities that meet the requirements applicable with 
                respect to such a grant.
            ``(2) Grants for demonstration projects.--
                    ``(A) Grant authority.--The Secretary, in 
                consultation with the Secretary of Labor and the 
                Secretary of Education (and, with respect to 
                demonstration projects of the type described in 
                subparagraph (B)(i)(I), the Attorney General) shall 
                make a grant in accordance with this subsection to an 
                eligible entity whose application for the grant is 
                approved by the Secretary, to conduct a demonstration 
                project that meets the requirements of subparagraph 
                (B).
                    ``(B) Requirements.--The requirements of this 
                subparagraph are the following:
                            ``(i) Type of project.--The demonstration 
                        project shall be of 1 of the following types:
                                    ``(I) Individuals with arrest or 
                                conviction records demonstration.--The 
                                demonstration project shall be of a 
                                type designed to provide education and 
                                training for eligible individuals with 
                                arrest or conviction records to enter 
                                and follow a career pathway in the 
                                health professions through occupations 
                                that pay well and are expected to 
                                experience a labor shortage or be in 
                                high demand.
                                    ``(II) Pregnancy and childbirth 
                                career pathway demonstration.--The 
                                demonstration project shall be of a 
                                type designed to provide education and 
                                training for eligible individuals to 
                                enter and follow a career pathway in 
                                the field of pregnancy, childbirth, or 
                                post-partum, in a State that recognizes 
                                doulas or midwives as health care 
                                providers and that provides payment for 
                                services provided by doulas or 
                                midwives, as the case may be, under the 
                                State plan approved under title XIX.
                            ``(ii) Duration.--The demonstration project 
                        shall be conducted for not less than 3 years.
                    ``(C) Minimum allocation of funds for each type of 
                demonstration project.--
                            ``(i) Individuals with arrest or conviction 
                        records demonstrations.--Not less than 25 
                        percent of the amounts made available for 
                        grants under this paragraph shall be used to 
                        make grants for demonstration projects of the 
                        type described in subparagraph (B)(i)(I).
                            ``(ii) Pregnancy and childbirth career 
                        pathway demonstrations.--Not less than 25 
                        percent of the amounts made available for 
                        grants under this paragraph shall be used to 
                        make grants for demonstration projects of the 
                        type described in subparagraph (B)(i)(II).
            ``(3) Grant periods.--A grant award under this section for 
        a project shall be in the form of--
                    ``(A) in the case of any such grant, equal annual 
                grants for 3 years, not more than the first 120 days of 
                which shall be the planning period for the project; or
                    ``(B) in the case of a grant under paragraph (2), 
                equal annual grants for 4 years, except that the amount 
                of the grant for the 1st year shall be in such lesser 
                amount as the Secretary determines appropriate, and the 
                1st year shall be the planning period for the project.
    ``(d) Use of Grant.--
            ``(1) In general.--An entity to which a grant is made under 
        this section shall use the grant in accordance with the 
        approved application for the grant.
            ``(2) Support to be provided.--
                    ``(A) Required support.--A project for which a 
                grant is made under this section shall include the 
                following:
                            ``(i) An assessment for adult basic skill 
                        competency, and provision of adult basic skills 
                        education if necessary for lower-skilled 
                        eligible individuals to enroll in the project 
                        and go on to enter and complete post-secondary 
                        training, through means including the 
                        following:
                                    ``(I) Establishing a network of 
                                partners that offer pre-training 
                                activities for project participants who 
                                need to improve basic academic skills 
                                or English language proficiency before 
                                entering a health occupational training 
                                career pathway program.
                                    ``(II) Offering resources to enable 
                                project participants to continue 
                                advancing adult basic skill proficiency 
                                while enrolled in a career pathway 
                                program.
                                    ``(III) Embedding adult basic skill 
                                maintenance as part of ongoing post-
                                graduation career coaching and 
                                mentoring.
                            ``(ii) A guarantee that child care is an 
                        available and affordable support service for 
                        project participants through means such as the 
                        following:
                                    ``(I) Referral to, and assistance 
                                with, enrollment in a subsidized child 
                                care program.
                                    ``(II) Direct payment to a child 
                                care provider if a slot in a subsidized 
                                child care program is not available or 
                                reasonably accessible.
                                    ``(III) Payment of co-payments or 
                                associated fees for child care.
                            ``(iii) Case management plans that include 
                        career coaching (with the option to offer 
                        appropriate peer support and mentoring 
                        opportunities to help develop soft skills and 
                        social capital), which may be offered on an 
                        ongoing basis before, during, and after initial 
                        training as part of a career pathway model.
                            ``(iv) A plan to provide project 
                        participants with transportation through means 
                        such as the following:
                                    ``(I) Referral to, and assistance 
                                with enrollment in, a subsidized 
                                transportation program.
                                    ``(II) If a subsidized 
                                transportation program is not 
                                reasonably available, direct payments 
                                to subsidize transportation costs.
                        For purposes of this clause, the term 
                        `transportation' includes public transit, or 
                        gasoline for a personal vehicle if public 
                        transit is not reasonably accessible or 
                        available.
                            ``(v) In the case of a demonstration 
                        project of the type described in subsection 
                        (c)(2)(B)(i)(I), access to legal assistance for 
                        project participants for the purpose of 
                        addressing arrest or conviction records and 
                        associated workforce barriers.
                    ``(B) Allowed support.--The goods and services 
                provided under a project for which a grant is made 
                under this section may include the following:
                            ``(i) A cash stipend that is at least 
                        monthly.
                            ``(ii) A reserve fund for financial 
                        assistance to project participants in emergency 
                        situations.
                            ``(iii) Tuition, and training materials 
                        such as books, software, uniforms, shoes, and 
                        hair nets.
                            ``(iv) In-kind resource donations such as 
                        interview clothing and conference attendance 
                        fees.
                            ``(v) Assistance with accessing and 
                        completing high school equivalency or adult 
                        basic education courses as necessary to achieve 
                        success in the project and make progress toward 
                        career goals.
                            ``(vi) Assistance with programs and 
                        activities, including legal assistance, deemed 
                        necessary to address arrest or conviction 
                        records as an employment barrier.
                            ``(vii) Other support services as deemed 
                        necessary for family well-being, success in the 
                        project, and progress toward career goals.
                    ``(C) Treatment of support for purposes of means-
                tested programs.--Any goods or services provided to an 
                eligible individual participating in a project for 
                which a grant is made under this section shall not be 
                considered income, and shall not be taken into account 
                for purposes of determining the eligibility of the 
                individual for, or amount of benefits to be provided to 
                the individual, under any means-tested program.
            ``(3) Training.--The number of hours of training provided 
        to an eligible individual under a project for which a grant is 
        made under this section, for a credential recognized by an 
        employer or industry, which is awarded in recognition of 
        attainment of measurable technical or occupational skills 
        necessary to gain employment or advance within an occupation 
        (including a certificate awarded by a local workforce 
        development board established under section 107 of the 
        Workforce Innovation and Opportunity Act), shall be--
                    ``(A) not less than the number of hours of training 
                required for certification in that level of skill by 
                the State in which the project is conducted; or
                    ``(B) if there is no such requirement, such number 
                of hours of training as the Secretary finds is 
                necessary to achieve that skill level.
            ``(4) Income limitation.--An entity to which a grant is 
        made under this section shall not use the grant to provide 
        support to a person who is not an eligible individual.
            ``(5) Inclusion of tanf recipients.--In the case of a 
        project for which a grant is made under this section that is 
        conducted in a State that has a program funded under part A of 
        title IV, at least 10 percent of the eligible individuals to 
        whom support is provided under the project shall be a recipient 
        of assistance under that program.
            ``(6) Prohibition.--An entity to which a grant is made 
        under this section shall not use the grant for purposes of 
        entertainment, except that case management and career coaching 
        services may include celebrations of specific career-based 
        milestones such as completing a semester, graduation, or job 
        placement.
    ``(e) Technical Assistance.--
            ``(1) In general.--The Secretary shall provide technical 
        assistance--
                    ``(A) to assist eligible entities in applying for 
                grants under this section;
                    ``(B) that is tailored to meet the needs of 
                grantees at each stage of the administration of 
                projects for which grants are made under this section;
                    ``(C) that is tailored to meet the specific needs 
                of Indian tribes, tribal organizations, and tribal 
                colleges and universities;
                    ``(D) that is tailored to meet the specific needs 
                of the territories;
                    ``(E) that is tailored to meet the specific needs 
                of eligible entities in carrying out demonstration 
                projects for which a grant is made under this section; 
                and
                    ``(F) to facilitate the exchange of information 
                among eligible entities regarding best practices and 
                promising practices used in the projects.
            ``(2) Continuation of peer technical assistance 
        conferences.--The Secretary shall continue to hold peer 
        technical assistance conferences for entities to which a grant 
        is made under this section or was made under the immediate 
        predecessor of this section.
    ``(f) Evaluation of Demonstration Projects.--
            ``(1) In general.--The Secretary shall, by grant, contract, 
        or interagency agreement, conduct rigorous and well-designed 
        evaluations of the demonstration projects for which a grant is 
        made under this section.
            ``(2) Requirement applicable to individuals with arrest or 
        conviction records demonstration.--In the case of a project of 
        the type described in subsection (c)(2)(B)(i)(I), the 
        evaluation shall include identification of successful 
        activities for creating opportunities for developing and 
        sustaining, particularly with respect to low-income individuals 
        with arrest or conviction records, a health professions 
        workforce that has accessible entry points, that meets high 
        standards for education, training, certification, and 
        professional development, and that provides increased wages and 
        affordable benefits, including health care coverage, that are 
        responsive to the needs of the workforce.
            ``(3) Requirement applicable to pregnancy and childbirth 
        career pathway demonstration.--In the case of a project of the 
        type described in subsection (c)(2)(B)(i)(II), the evaluation 
        shall include identification of successful activities for 
        creating opportunities for developing and sustaining, 
        particularly with respect to low-income individuals and other 
        entry-level workers, a career pathway that has accessible entry 
        points, that meets high standards for education, training, 
        certification, and professional development, and that provides 
        increased wages and affordable benefits, including health care 
        coverage, that are responsive to the needs of the birth, 
        pregnancy, and post-partum workforce.
            ``(4) Rule of interpretation.--Evaluations conducted 
        pursuant to this subsection may include a randomized controlled 
        trial, but this subsection shall not be interpreted to require 
        an evaluation to include such a trial.
    ``(g) Reports.--
            ``(1) To the secretary.--An eligible entity awarded a grant 
        to conduct a project under this section shall submit interim 
        reports to the Secretary on the activities carried out under 
        the project, and, on the conclusion of the project, a final 
        report on the activities. Each such report shall include data 
        on participant outcomes related to earnings, employment in 
        health professions, graduation rate, graduation timeliness, 
        credential attainment, participant demographics, and other data 
        specified by the Secretary.
            ``(2) To the congress.--During each Congress, the Secretary 
        shall submit to the Committee on Ways and Means of the House of 
        Representatives and the Committee on Finance of the Senate a 
        report--
                    ``(A) on the demographics of the participants in 
                the projects for which a grant is made under this 
                section;
                    ``(B) on the rate of which project participants 
                completed all activities under the projects;
                    ``(C) on the employment credentials acquired by 
                project participants;
                    ``(D) on the employment of project participants on 
                completion of activities under the projects, and the 
                earnings of project participants at entry into 
                employment;
                    ``(E) on best practices and promising practices 
                used in the projects;
                    ``(F) on the nature of any technical assistance 
                provided to grantees under this section;
                    ``(G) on, with respect to the period since the 
                period covered in the most recent prior report 
                submitted under this paragraph--
                            ``(i) the number of applications submitted 
                        under this section, with a separate statement 
                        of the number of applications referred to in 
                        subsection (b)(5);
                            ``(ii) the number of applications that were 
                        approved, with a separate statement of the 
                        number of such applications referred to in 
                        subsection (b)(5); and
                            ``(iii) a description of how grants were 
                        made in any case described in the last sentence 
                        of subsection (c)(1)(A)(ii); and
                    ``(H) that includes an assessment of the 
                effectiveness of the projects with respect to 
                addressing health professions workforce shortages or 
                in-demand jobs.
    ``(h) Definitions.--In this section:
            ``(1) Career pathway.--The term `career pathway' has the 
        meaning given that term in section 3(7) of the Workforce 
        Innovation and Opportunity Act.
            ``(2) Doula.--The term `doula' means an individual who--
                    ``(A) is certified by an organization that has been 
                established for not less than 5 years and that requires 
                the completion of continuing education to maintain the 
                certification, to provide non-medical advice, 
                information, emotional support, and physical comfort to 
                an individual during the individual's pregnancy, 
                childbirth, and post-partum period; and
                    ``(B) maintains the certification by completing the 
                required continuing education.
            ``(3) Eligible entity.--The term `eligible entity' means 
        any of the following entities that demonstrates in an 
        application submitted under this section that the entity has 
        the capacity to fully develop and administer the project 
        described in the application:
                    ``(A) A local workforce development board 
                established under section 107 of the Workforce 
                Innovation and Opportunity Act.
                    ``(B) A State or territory, a political subdivision 
                of a State or territory, or an agency of a State, 
                territory, or such a political subdivision, including a 
                State or local entity that administers a State program 
                funded under part A of this title.
                    ``(C) An Indian tribe, a tribal organization, or a 
                tribal college or university.
                    ``(D) An institution of higher education (as 
                defined in the Higher Education Act of 1965).
                    ``(E) A hospital (as defined in section 1861(e)).
                    ``(F) A skilled nursing facility (as defined in 
                section 1819(h)(1)(A)).
                    ``(G) A Federally qualified health center (as 
                defined in section 1861(aa)(4)).
                    ``(H) A nonprofit organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986, a labor 
                organization, or an entity with shared labor-management 
                oversight, that has a demonstrated history of providing 
                health profession training to eligible individuals.
                    ``(I) In the case of a demonstration project of the 
                type provided for in subsection (c)(2)(B)(i)(II) of 
                this section, an entity recognized by a State, Indian 
                tribe, or tribal organization as qualified to train 
                doulas or midwives, if midwives or doulas, as the case 
                may be, are permitted to practice in the State 
                involved.
                    ``(J) An opioid treatment program (as defined in 
                section 1861(iii)(2)).
            ``(4) Eligible individual.--The term `eligible individual' 
        means an individual whose household income does not exceed 138 
        percent of the Federal poverty level.
            ``(5) Federal poverty level.--The term `Federal poverty 
        level' means the poverty line (as defined in section 673(2) of 
        the Omnibus Budget Reconciliation Act of 1981, including any 
        revision required by such section applicable to a family of the 
        size involved).
            ``(6) Indian tribe; tribal organization.--The terms `Indian 
        tribe' and `tribal organization' have the meaning given the 
        terms in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b).
            ``(7) 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.
            ``(8) Midwife.--
                    ``(A) In general.--The term `midwife' means a 
                certified midwife, certified professional midwife, 
                licensed midwife, and tribally-recognized midwife.
                    ``(B) Certified midwife.--The term `certified 
                midwife' means an individual who is certified by the 
                American Midwifery Certification Board to practice 
                midwifery.
                    ``(C) Certified professional midwife.--The term 
                `certified professional midwife' means an individual 
                who--
                            ``(i) is certified by the North American 
                        Registry of Midwives to practice midwifery for 
                        normal, low-risk pregnancies and childbirths; 
                        and
                            ``(ii) has completed--
                                    ``(I) a midwifery education program 
                                accredited by the Midwifery Education 
                                and Accreditation Council or any other 
                                entity recognized by the Department of 
                                Education; or
                                    ``(II) the requirements to obtain a 
                                Midwifery Bridge Certificate from the 
                                North American Registry of Midwives, 
                                and maintains the certification by 
                                completing any required continuing 
                                education for the certification.
                    ``(D) Licensed midwife.--The term `licensed 
                midwife' means, with respect to a State, an individual 
                who is licensed under State law to practice midwifery.
                    ``(E) Tribally-recognized midwife.--The term 
                `tribally-recognized midwife' means an individual who 
                is recognized by an Indian tribe (as defined in section 
                4 of the Indian Health Care Improvement Act) to 
                practice midwifery for the tribe.
            ``(9) Territory.--The term `territory' means the 
        Commonwealth of Puerto Rico, the United States Virgin Islands, 
        Guam, the Northern Mariana Islands, and American Samoa.
            ``(10) Tribal college or university.--The term `tribal 
        college or university' has the meaning given the term in 
        section 316(b) of the Higher Education Act of 1965.
    ``(i) Funding.--
            ``(1) In general.--Out of any funds in the Treasury of the 
        United States not otherwise appropriated, there are 
        appropriated to the Secretary to carry out this section--
                    ``(A) $350,000,000 for fiscal year 2021;
                    ``(B) $400,000,000 for fiscal year 2022;
                    ``(C) $450,000,000 for fiscal year 2023; and
                    ``(D) $500,000,000 for fiscal year 2024.
            ``(2) Allocation of funds.--Of the amount appropriated for 
        a fiscal year under paragraph (1) of this subsection--
                    ``(A) 75 percent shall be available for grants 
                under subsection (c)(1)(A);
                    ``(B) 2 percent shall be reserved for grants under 
                subsection (c)(1)(B);
                    ``(C) 5 percent shall be reserved for grants under 
                subsection (c)(1)(C);
                    ``(D) 6 percent shall be available for 
                demonstration project grants under subsection (c)(2);
                    ``(E) 9 percent, plus all amounts referred to in 
                subparagraphs (A) through (D) of this paragraph that 
                remain unused after all grant awards are made for the 
                fiscal year, shall be available for the provision of 
                technical assistance and associated staffing; and
                    ``(F) 3 percent shall be available for evaluations 
                and associated staffing.
    ``(j) Nonapplicability of Preceding Sections of This Subtitle.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        preceding sections of this subtitle shall not apply to a grant 
        awarded under this section.
            ``(2) Exception for certain limitations on use of grants.--
        Section 2005(a) (other than paragraphs (2), (5), (6), and (8)) 
        shall apply to a grant awarded under this section to the same 
        extent and in the same manner as such section applies to 
        payments to States under this subtitle.''.
                                 <all>