Title: PRO–LIFE Act of 2022
Policy area: Health

Summary:
Providing Real Opportunities and Lifelong Investments For Everyone Act of 2022 or the PRO-LIFE Act of 2022
This bill establishes new, and modifies existing, programs related to maternal and child health, tax credits and other benefits for parents and caregivers, and support for childcare infrastructure.
The bill requires multi-agency efforts to improve maternal health and reduce maternal mortality, particularly among racial and ethnic minority groups, veterans, and other vulnerable populations, by addressing both health-related factors and the social determinants of health (i.e., nonmedical factors that influence health outcomes, such as housing, food security, transportation, and environmental conditions). Additionally, the bill permanently extends the Children's Health Insurance Program (CHIP) and related measures.
Further, the bill (1) sets up a family medical leave insurance benefit that entitles employees to a monthly benefit payment for a period of qualified caregiving; and (2) imposes a tax on employers, employees, and self-employed individuals to fund the benefits. The bill also increases the amount of the child tax credit and makes the credit fully refundable and payable in advance on a monthly basis.
In addition, the Department of Labor must carry out a program to certify and recognize employers that implement family-friendly workplace programs (e.g., providing paid family and sick leave or subsidizing childcare).
The bill also requires support for childcare infrastructure, for example by establishing grants for childcare facilities and scholarship and loan repayment programs for childcare educators.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8862 Introduced in House (IH)]

<DOC>






117th CONGRESS
  2d Session
                                H. R. 8862

 To invest in real pro-life policies that support the American family, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 15, 2022

  Mr. Phillips (for himself, Ms. DeLauro, Ms. Barragan, Ms. Meng, Ms. 
 Kelly of Illinois, Mr. Carson, Ms. Porter, Ms. Norton, Ms. Wilson of 
Florida, Mr. Nadler, Mr. Michael F. Doyle of Pennsylvania, Mr. Khanna, 
Mrs. Kirkpatrick, Mr. Neguse, Mr. Cicilline, Ms. Velazquez, Mr. Evans, 
  Ms. Adams, Ms. Lofgren, Mr. Connolly, Ms. McCollum, Ms. Schakowsky, 
 Mrs. Torres of California, Ms. Escobar, Mr. Grijalva, Mr. Cohen, Ms. 
 Moore of Wisconsin, Ms. Titus, and Mr. Lieu) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committees on Financial Services, Transportation and 
Infrastructure, Education and Labor, the Judiciary, Natural Resources, 
Agriculture, Veterans' Affairs, and Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
 To invest in real pro-life policies that support the American family, 
                        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 ``Providing Real Opportunities and 
Lifelong Investments For Everyone Act of 2022'' or the ``PRO-LIFE Act 
of 2022''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
                TITLE I--BLACK MATERNAL HEALTH MOMNIBUS

Sec. 1000. Definitions; sense of Congress.
                Subtitle A--Social Determinants for Moms

Sec. 1001. Task force to develop a strategy to address social 
                            determinants of maternal health.
Sec. 1002. Housing for Moms grant program.
Sec. 1003. Department of Transportation.
Sec. 1004. Department of Agriculture.
Sec. 1005. Environmental study through National Academies.
Sec. 1006. Child care access.
Sec. 1007. Grants to local entities addressing social determinants of 
                            maternal health.
                   Subtitle B--Honoring Kira Johnson

Sec. 1101. Investments in community-based organizations to improve 
                            Black maternal health outcomes.
Sec. 1102. Investments in community-based organizations to improve 
                            maternal health outcomes in underserved 
                            communities.
Sec. 1103. Respectful maternity care training for all employees in 
                            maternity care settings.
Sec. 1104. Study on reducing and preventing bias, racism, and 
                            discrimination in maternity care settings.
Sec. 1105. Respectful maternity care compliance program.
Sec. 1106. GAO report.
                 Subtitle C--Protecting Moms Who Served

Sec. 1201. Support for maternity care coordination.
Sec. 1202. Report on maternal mortality and severe maternal morbidity 
                            among pregnant and postpartum veterans.
                    Subtitle D--Perinatal Workforce

Sec. 1301. HHS agency directives.
Sec. 1302. Grants to grow and diversify the perinatal workforce.
Sec. 1303. Grants to grow and diversify the nursing workforce in 
                            maternal and perinatal health.
Sec. 1304. GAO report.
                     Subtitle E--Data to Save Moms

Sec. 1401. Funding for maternal mortality review committees to promote 
                            representative community engagement.
Sec. 1402. Data collection and review.
Sec. 1403. Review of maternal health data collection processes and 
                            quality measures.
Sec. 1404. Indian Health Service study on maternal mortality and severe 
                            maternal morbidity.
Sec. 1405. Grants to minority-serving institutions to study maternal 
                            mortality, severe maternal morbidity, and 
                            other adverse maternal health outcomes.
                        Subtitle F--Moms Matter

Sec. 1501. Maternal mental health equity grant program.
Sec. 1502. Grants to grow and diversify the maternal mental and 
                            behavioral health care workforce.
               Subtitle G--Justice for Incarcerated Moms

Sec. 1601. Ending the shackling of pregnant individuals.
Sec. 1602. Creating model programs for the care of incarcerated 
                            individuals in the prenatal and postpartum 
                            periods.
Sec. 1603. Grant program to improve maternal health outcomes for 
                            individuals in State and local prisons and 
                            jails.
Sec. 1604. GAO report.
Sec. 1605. MACPAC report.
                     Subtitle H--Tech to Save Moms

Sec. 1701. Integrated telehealth models in maternity care services.
Sec. 1702. Grants to expand the use of technology-enabled collaborative 
                            learning and capacity models for pregnant 
                            and postpartum individuals.
Sec. 1703. Grants to promote equity in maternal health outcomes through 
                            digital tools.
Sec. 1704. Report on the use of technology in maternity care.
                    Subtitle I--Impact to Save Moms

Sec. 1801. Perinatal Care Alternative Payment Model Demonstration 
                            Project.
Sec. 1802. MACPAC report.
             Subtitle J--Maternal Health Pandemic Response

Sec. 1901. Definitions.
Sec. 1902. Funding for data collection, surveillance, and research on 
                            maternal health outcomes during the COVID-
                            19 public health emergency.
Sec. 1903. COVID-19 maternal health data collection and disclosure.
Sec. 1904. Inclusion of pregnant individuals and lactating individuals 
                            in vaccine and therapeutic development for 
                            COVID-19.
Sec. 1905. Public health communication regarding maternal care during 
                            COVID-19.
Sec. 1906. Task force on birthing experience and safe maternity care 
                            during a public health emergency.
Sec. 1907. GAO report on maternal health and public health emergency 
                            preparedness.
     Subtitle K--Protecting Moms and Babies Against Climate Change

Sec. 1911. Definitions.
Sec. 1912. Grant program to protect vulnerable mothers and babies from 
                            climate change risks.
Sec. 1913. Grant program for education and training at health 
                            profession schools.
Sec. 1914. NIH Consortium on Birth and Climate Change Research.
Sec. 1915. Strategy for identifying climate change risk zones for 
                            vulnerable mothers and babies.
                   Subtitle L--Maternal Vaccinations

Sec. 1921. Maternal vaccination awareness and equity campaign.
        TITLE II--CHILDREN'S HEALTH INSURANCE PROGRAM PERMANENCY

Sec. 2001. Permanent extension of children's health insurance program.
Sec. 2002. Permanent extensions of other programs and demonstration 
                            projects.
Sec. 2003. State option to increase children's eligibility for Medicaid 
                            and CHIP.
                  TITLE III--FAMILY AND MEDICAL LEAVE

Sec. 3001. Definitions.
Sec. 3002. Office of Paid Family and Medical Leave.
Sec. 3003. Family and Medical Leave Insurance benefit payments.
Sec. 3004. Establishment of Family and Medical Leave Insurance Trust 
                            Fund.
Sec. 3005. Internal Revenue Code provisions.
Sec. 3006. Regulations.
Sec. 3007. GAO Study.
              TITLE IV--FULLY REFUNDABLE CHILD TAX CREDIT

Sec. 4001. Establishment of fully refundable child tax credit.
Sec. 4002. Payments to possessions.
                 TITLE V--CHILD CARE IS INFRASTRUCTURE

Sec. 5001. Infrastructure grants to improve child care safety.
Sec. 5002. Early childhood educator loan assistance program.
Sec. 5003. Grants for early childhood educators.
Sec. 5004. CCAMPIS Reauthorization.
Sec. 5005. Evaluation of applications for assistance under Choice 
                            Neighborhoods Initiative.
             TITLE VI--HONORING FAMILY-FRIENDLY WORKPLACES

Sec. 6001. Definitions.
Sec. 6002. Certification program established.
   TITLE VII--MOTHERS AND OFFSPRING MORTALITY AND MORBIDITY AWARENESS

Sec. 7001. Improving Federal efforts with respect to prevention of 
                            maternal mortality.
Sec. 7002. Increasing excise taxes on cigarettes and establishing 
                            excise tax equity among all tobacco product 
                            tax rates.

                TITLE I--BLACK MATERNAL HEALTH MOMNIBUS

SEC. 1000. DEFINITIONS; SENSE OF CONGRESS.

    (a) Definitions.--In this title:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (5) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (6) Pregnancy-associated death.--The term ``pregnancy-
        associated death'' means a death of a pregnant or postpartum 
        individual, by any cause, that occurs during, or within 1 year 
        following, the individual's pregnancy, regardless of the 
        outcome, duration, or site of the pregnancy.
            (7) Pregnancy-related death.--The term ``pregnancy-related 
        death'' means a death of a pregnant or postpartum individual 
        that occurs during, or within 1 year following, the 
        individual's pregnancy, from a pregnancy complication, a chain 
        of events initiated by pregnancy, or the aggravation of an 
        unrelated condition by the physiologic effects of pregnancy.
            (8) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (9) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (10) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) the respect and proper care that birthing people 
        deserve is inclusive; and
            (2) regardless of race, ethnicity, gender identity, sexual 
        orientation, religion, marital status, familial status, 
        socioeconomic status, immigration status, incarceration status, 
        or disability, all deserve dignity.

                Subtitle A--Social Determinants for Moms

SEC. 1001. TASK FORCE TO DEVELOP A STRATEGY TO ADDRESS SOCIAL 
              DETERMINANTS OF MATERNAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services shall 
convene a task force (in this section referred to as the ``Task 
Force'') to develop a strategy to coordinate efforts between Federal 
agencies to address social determinants of maternal health with respect 
to pregnant and postpartum individuals.
    (b) Ex Officio Members.--The ex officio members of the Task Force 
shall consist of the following:
            (1) The Secretary of Health and Human Services (or a 
        designee thereof).
            (2) The Secretary of Housing and Urban Development (or a 
        designee thereof).
            (3) The Secretary of Transportation (or a designee 
        thereof).
            (4) The Secretary of Agriculture (or a designee thereof).
            (5) The Secretary of Labor (or a designee thereof).
            (6) The Administrator of the Environmental Protection 
        Agency (or a designee thereof).
            (7) The Assistant Secretary for the Administration for 
        Children and Families (or a designee thereof).
            (8) The Administrator of the Centers for Medicare & 
        Medicaid Services (or a designee thereof).
            (9) The Director of the Indian Health Service (or a 
        designee thereof).
            (10) The Director of the National Institutes of Health (or 
        a designee thereof).
            (11) The Administrator of the Health Resources and Services 
        Administration (or a designee thereof).
            (12) The Deputy Assistant Secretary for Minority Health of 
        the Department of Health and Human Services (or a designee 
        thereof).
            (13) The Deputy Assistant Secretary for Women's Health of 
        the Department of Health and Human Services (or a designee 
        thereof).
            (14) The Director of the Centers for Disease Control and 
        Prevention (or a designee thereof).
            (15) The Director of the Office on Violence Against Women 
        at the Department of Justice (or a designee thereof).
    (c) Appointed Members.--In addition to the ex officio members of 
the Task Force, the Secretary of Health and Human Services shall 
appoint the following members of the Task Force:
            (1) At least two representatives of patients, to include--
                    (A) a representative of patients who have suffered 
                from severe maternal morbidity; or
                    (B) a representative of patients who is a family 
                member of an individual who suffered a pregnancy-
                related death.
            (2) At least two leaders of community-based organizations 
        that address maternal mortality and severe maternal morbidity 
        with a specific focus on racial and ethnic disparities. In 
        appointing such leaders under this paragraph, the Secretary of 
        Health and Human Services shall give priority to individuals 
        who are leaders of organizations led by individuals from racial 
        and ethnic minority groups.
            (3) At least two perinatal health workers.
            (4) A professionally diverse panel of maternity care 
        providers.
    (d) Chair.--The Secretary of Health and Human Services shall select 
the chair of the Task Force from among the members of the Task Force.
    (e) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Task Force shall submit to Congress a report on--
            (1) the strategy developed under subsection (a);
            (2) recommendations on funding amounts with respect to 
        implementing such strategy; and
            (3) recommendations for how to expand coverage of social 
        services to address social determinants of maternal health 
        under Medicaid managed care organizations and State Medicaid 
        programs.
    (f) Termination.--Section 14 of the Federal Advisory Committee Act 
(5 U.S.C. App.) shall not apply to the Task Force with respect to 
termination.

SEC. 1002. HOUSING FOR MOMS GRANT PROGRAM.

    (a) In General.--The Secretary of Housing and Urban Development 
shall establish a Housing for Moms grant program under this section to 
make grants to eligible entities to increase access to safe, stable, 
affordable, and adequate housing for pregnant and postpartum 
individuals and their families.
    (b) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may provide.
    (c) Priority.--In awarding grants under this section, the Secretary 
shall give priority to an eligible entity that--
            (1) is a community-based organization or will partner with 
        a community-based organization to implement initiatives to 
        increase access to safe, stable, affordable, and adequate 
        housing for pregnant and postpartum individuals and their 
        families;
            (2) is operating in an area with high rates of adverse 
        maternal health outcomes or significant racial or ethnic 
        disparities in maternal health outcomes, to the extent such 
        data are available; and
            (3) is operating in an area with a high poverty rate or 
        significant number of individuals who lack consistent access to 
        safe, stable, affordable, and adequate housing.
    (d) Use of Funds.--An eligible entity that receives a grant under 
this section shall use funds under the grant for the purposes of--
            (1) identifying and conducting outreach to pregnant and 
        postpartum individuals who are low-income and lack consistent 
        access to safe, stable, affordable, and adequate housing;
            (2) providing safe, stable, affordable, and adequate 
        housing options to such individuals;
            (3) connecting such individuals with local organizations 
        offering safe, stable, affordable, and adequate housing 
        options;
            (4) providing application assistance to such individuals 
        seeking to enroll in programs offering safe, stable, 
        affordable, and adequate housing options;
            (5) providing direct financial assistance to such 
        individuals for the purposes of maintaining safe, stable, and 
        adequate housing for the duration of the individual's pregnancy 
        and postpartum periods; and
            (6) working with relevant stakeholders to ensure that local 
        housing and homeless shelter infrastructure is supportive to 
        pregnant and postpartum individuals, including through--
                    (A) health-promoting housing codes;
                    (B) enforcement of housing codes;
                    (C) proactive rental inspection programs;
                    (D) code enforcement officer training; and
                    (E) partnerships between regional offices of the 
                Department of Housing and Urban Development and 
                community-based organizations to ensure housing laws 
                are understood and violations are discovered.
    (e) Reporting.--
            (1) Eligible entities.--The Secretary shall require each 
        eligible entity receiving a grant under this section to 
        annually submit to the Secretary and make publicly available a 
        report on the status of activities conducted using the grant.
            (2) Secretary.--Not later than the end of each fiscal year 
        in which grants are made under this section, the Secretary 
        shall submit to the Congress and make publicly available a 
        report that--
                    (A) summarizes the reports received under paragraph 
                (1);
                    (B) evaluates the effectiveness of grants awarded 
                under this section in increasing access to safe, 
                stable, affordable, and adequate housing for pregnant 
                and postpartum individuals and their families; and
                    (C) makes recommendations with respect to ensuring 
                activities described subsection (d) continue after 
                grant amounts made available under this section are 
                expended.
    (f) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) a community-based organization;
                    (B) a State or local governmental entity, including 
                a State or local public health department;
                    (C) an Indian tribe or tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304)); or
                    (D) an Urban Indian organization (as such term is 
                defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Housing and Urban Development.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 
2023, which shall remain available until expended.

SEC. 1003. DEPARTMENT OF TRANSPORTATION.

    (a) Report.--Not later than one year after the date of enactment of 
this Act, the Secretary of Transportation shall submit to Congress and 
make publicly available a report containing--
            (1) an assessment of transportation barriers preventing 
        individuals from attending prenatal and postpartum 
        appointments, accessing maternal health care services, or 
        accessing services and resources related to social determinants 
        maternal of health;
            (2) recommendations on how to overcome the barriers 
        assessed under paragraph (1); and
            (3) an assessment of transportation safety risks for 
        pregnant individuals and recommendations on how to mitigate 
        such risks.
    (b) Considerations.--In carrying out subsection (a), the Secretary 
shall give special consideration to solutions for--
            (1) pregnant and postpartum individuals living in a health 
        professional shortage area designated under section 332 of the 
        Public Health Service Act (42 U.S.C. 254e);
            (2) pregnant and postpartum individuals living in areas 
        with high maternal mortality or severe morbidity rates or 
        significant racial or ethnic disparities in maternal health 
        outcomes; or
            (3) pregnant and postpartum individuals with a disability 
        that impacts mobility.

SEC. 1004. DEPARTMENT OF AGRICULTURE.

    (a) Special Supplemental Nutrition Program.--
            (1) Extension of postpartum period.--Section 17(b)(10) of 
        the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(10)) is 
        amended by striking ``six months'' and inserting ``24 months''.
            (2) Extension of breastfeeding period.--Section 
        17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (7 U.S.C. 
        1431(d)(3)(A)(ii)) is amended by striking ``1 year'' and 
        inserting ``24 months''.
            (3) Report.--Not later than 2 years after the date of the 
        enactment of this section, the Secretary shall submit to 
        Congress a report that includes an evaluation of the effect of 
        each of the amendments made by this subsection on--
                    (A) maternal and infant health outcomes, including 
                racial and ethnic disparities with respect to such 
                outcomes;
                    (B) breastfeeding rates among postpartum 
                individuals;
                    (C) qualitative evaluations of family experiences 
                under the special supplemental nutrition program under 
                section 17 of the Child Nutrition Act of 1966 (42 
                U.S.C. 1786); and
                    (D) other relevant information as determined by the 
                Secretary.
    (b) Grant Program for Healthy Food and Clean Water for Pregnant and 
Postpartum Individuals.--
            (1) In general.--The Secretary shall establish a program to 
        award grants, on a competitive basis, to eligible entities to 
        carry out the activities described in paragraph (4).
            (2) Application.--To be eligible for a grant under this 
        subsection, an eligible entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary determines appropriate.
            (3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to an eligible entity that--
                    (A) is, or will partner with, a community-based 
                organization; and
                    (B) is operating in an area with high rates of--
                            (i) adverse maternal health outcomes; or
                            (ii) significant racial or ethnic 
                        disparities in maternal health outcomes.
            (4) Use of funds.--An eligible entity shall use grant funds 
        awarded under this subsection to deliver healthy food, infant 
        formula, clean water, or diapers to pregnant and postpartum 
        individuals located in areas that are food deserts, as 
        determined by the Secretary using data from the Food Access 
        Research Atlas of the Department of Agriculture.
            (5) Reports.--
                    (A) Eligible entity.--Not later than 1 year after 
                an eligible entity first receives a grant under this 
                subsection, and annually thereafter, an eligible entity 
                shall submit to the Secretary a report on the status of 
                activities conducted using the grant, which shall 
                contain such information as the Secretary may require.
                    (B) Secretary.--
                            (i) In general.--Not later than 2 years 
                        after the date on which the first grant is 
                        awarded under this subsection, the Secretary 
                        shall submit to Congress a report that 
                        includes--
                                    (I) a summary of the reports 
                                submitted under subparagraph (A);
                                    (II) an assessment of the extent to 
                                which food distributed through the 
                                grant program was purchased from local 
                                and regional food systems;
                                    (III) an evaluation of the effect 
                                of the grant program under this 
                                subsection on maternal and infant 
                                health outcomes, including racial and 
                                ethnic disparities with respect to such 
                                outcomes; and
                                    (IV) recommendations with respect 
                                to ensuring the activities described in 
                                paragraph (4) continue after the grant 
                                period funding such activities expires.
                            (ii) Publication.--The Secretary shall make 
                        the report submitted under clause (i) publicly 
                        available on the website of the Department of 
                        Agriculture.
            (6) Authorization of appropriations.--There are authorized 
        to be appropriated $5,000,000 to carry out this subsection for 
        fiscal years 2023 through 2025.
    (c) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) a community-based organization;
                    (B) a State or local governmental entity, including 
                a State or local public health department;
                    (C) an Indian tribe or tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304)); or
                    (D) an Urban Indian organization (as such term is 
                defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Agriculture.

SEC. 1005. ENVIRONMENTAL STUDY THROUGH NATIONAL ACADEMIES.

    (a) In General.--The Administrator of the Environmental Protection 
Agency shall seek to enter an agreement, not later than 60 days after 
the date of enactment of this Act, with the National Academies of 
Sciences, Engineering, and Medicine (referred to in this section as the 
``National Academies'') under which the National Academies agree to 
conduct a study on the impacts of water and air quality, exposure to 
extreme temperatures, environmental chemicals, environmental risks in 
the workplace and the home, and pollution levels, on maternal and 
infant health outcomes.
    (b) Study Requirements.--The agreement under subsection (a) shall 
direct the National Academies to make recommendations for--
            (1) improving environmental conditions to improve maternal 
        and infant health outcomes; and
            (2) reducing or eliminating racial and ethnic disparities 
        in such outcomes.
    (c) Report.--The agreement under subsection (a) shall direct the 
National Academies to complete the study under this section, and 
transmit to the Congress and make publicly available a report on the 
results of the study, not later than 12 months after the date of 
enactment of this Act.

SEC. 1006. CHILD CARE ACCESS.

    (a) Grant Program.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall award grants to 
eligible organizations to provide pregnant and postpartum individuals 
with free and accessible drop-in child care services during prenatal 
and postpartum appointments.
    (b) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require.
    (c) Eligible Organizations.--
            (1) Eligibility.--To be eligible to receive a grant under 
        this section, an organization shall be an organization that 
        provides child care services and can carry out programs 
        providing pregnant and postpartum individuals with free and 
        accessible drop-in child care services during prenatal and 
        postpartum appointments.
            (2) Prioritization.--In selecting grant recipients under 
        this section, the Secretary shall give priority to eligible 
        organizations that operate in an area with high rates of 
        adverse maternal health outcomes or significant racial or 
        ethnic disparities in maternal health outcomes, to the extent 
        such data are available.
    (d) Timing.--The Secretary shall commence the grant program under 
subsection (a) not later than 1 year after the date of enactment of 
this Act.
    (e) Reporting.--
            (1) Grantees.--Each recipient of a grant under this section 
        shall annually submit to the Secretary and make publicly 
        available a report on the status of activities conducted using 
        the grant. Each such report shall include--
                    (A) an analysis of the effect of the funded program 
                on prenatal and postpartum appointment attendance 
                rates;
                    (B) summaries of qualitative assessments of the 
                funded program from--
                            (i) pregnant and postpartum individuals 
                        participating in the program; and
                            (ii) the families of such individuals; and
                    (C) such additional information as the Secretary 
                may require.
            (2) Secretary.--Not later than the end of fiscal year 2025, 
        the Secretary shall submit to the Congress and make publicly 
        available a report containing the following:
                    (A) A summary of the reports under paragraph (1).
                    (B) An assessment of the effects, if any, of the 
                funded programs on maternal health outcomes, with a 
                specific focus on racial and ethnic disparities in such 
                outcomes.
                    (C) A description of actions the Secretary can take 
                to ensure that pregnant and postpartum individuals 
                eligible for medical assistance under a State plan 
                under title XIX of the Social Security Act (42 U.S.C. 
                1936 et seq.) have access to free and accessible drop-
                in child care services during prenatal and postpartum 
                appointments, including identification of the funding 
                necessary to carry out such actions.
    (f) Drop-In Child Care Services Defined.--In this section, the term 
``drop-in child care services'' means child care and early childhood 
education services that are--
            (1) delivered at a facility that meets the requirements of 
        all applicable laws and regulations of the State or local 
        government in which it is located, including the licensing of 
        the facility as a child care facility; and
            (2) provided in single encounters without requiring full-
        time enrollment of a person in a child care program.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for the period of 
fiscal years 2023 through 2025.

SEC. 1007. GRANTS TO LOCAL ENTITIES ADDRESSING SOCIAL DETERMINANTS OF 
              MATERNAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall award grants to 
eligible entities to--
            (1) address social determinants of maternal health for 
        pregnant and postpartum individuals; and
            (2) eliminate racial and ethnic disparities in maternal 
        health outcomes.
    (b) Application.--To be eligible to receive a grant under this 
subsection an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may provide.
    (c) Prioritization.--In awarding grants under subsection (a), the 
Secretary shall give priority to an eligible entity that--
            (1) is, or will partner with, a community-based 
        organization to carrying out the activities under subsection 
        (d);
            (2) is operating in an area with high rates of adverse 
        maternal health outcomes or significant racial or ethnic 
        disparities in maternal health outcomes; and
            (3) is operating in an area with a high poverty rate.
    (d) Activities.--An eligible entity that receives a grant under 
this section may--
            (1) hire and retain staff;
            (2) develop and distribute a list of available resources 
        with respect to social service programs in a community;
            (3) establish a resource center that provides multiple 
        social service programs in a single location;
            (4) offer programs and resources in the communities in 
        which the respective eligible entities are located to address 
        social determinants of health for pregnant and postpartum 
        individuals; and
            (5) consult with such pregnant and postpartum individuals 
        to conduct an assessment of the activities under this 
        subsection.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance to plan for 
sustaining programs to address social determinants of maternal health 
among pregnant and postpartum individuals after the period of the 
grant.
    (f) Reporting.--
            (1) Grantees.--Not later than 1 year after an eligible 
        entity first receives a grant under this section, and annually 
        thereafter, an eligible entity shall submit to the Secretary, 
        and make publicly available, a report on the status of 
        activities conducted using the grant. Each such report shall 
        include data on the effects of such activities, disaggregated 
        by race, ethnicity, gender, and other relevant factors.
            (2) Secretary.--Not later than the end of fiscal year 2027, 
        the Secretary shall submit to Congress a report that includes--
                    (A) a summary of the reports under paragraph (1); 
                and
                    (B) recommendations for--
                            (i) improving maternal health outcomes; and
                            (ii) reducing or eliminating racial and 
                        ethnic disparities in maternal health outcomes.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $15,000,000 for each of fiscal 
years 2023 through 2027.

                   Subtitle B--Honoring Kira Johnson

SEC. 1101. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE 
              BLACK MATERNAL HEALTH OUTCOMES.

    (a) Awards.--Following the 1-year period described in subsection 
(c), the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall award grants to eligible 
entities to establish or expand programs to prevent maternal mortality 
and severe maternal morbidity among Black pregnant and postpartum 
individuals.
    (b) Eligibility.--To be eligible to seek a grant under this 
section, an entity shall be a community-based organization offering 
programs and resources aligned with evidence-based practices for 
improving maternal health outcomes for Black pregnant and postpartum 
individuals.
    (c) Outreach and Technical Assistance Period.--During the 1-year 
period beginning on the date of enactment of this Act, the Secretary 
shall--
            (1) conduct outreach to encourage eligible entities to 
        apply for grants under this section; and
            (2) provide technical assistance to eligible entities on 
        best practices for applying for grants under this section.
    (d) Special Consideration.--
            (1) Outreach.--In conducting outreach under subsection (c), 
        the Secretary shall give special consideration to eligible 
        entities that--
                    (A) are based in, and provide support for, 
                communities with high rates of adverse maternal health 
                outcomes or significant racial and ethnic disparities 
                in maternal health outcomes, to the extent such data 
                are available;
                    (B) are led by Black women; and
                    (C) offer programs and resources that are aligned 
                with evidence-based practices for improving maternal 
                health outcomes for Black pregnant and postpartum 
                individuals.
            (2) Awards.--In awarding grants under this section, the 
        Secretary shall give special consideration to eligible entities 
        that--
                    (A) are described in subparagraphs (A), (B), and 
                (C) of paragraph (1);
                    (B) offer programs and resources designed in 
                consultation with and intended for Black pregnant and 
                postpartum individuals; and
                    (C) offer programs and resources in the communities 
                in which the respective eligible entities are located 
                that--
                            (i) promote maternal mental health and 
                        maternal substance use disorder treatments and 
                        supports that are aligned with evidence-based 
                        practices for improving maternal mental and 
                        behavioral health outcomes for Black pregnant 
                        and postpartum individuals;
                            (ii) address social determinants of 
                        maternal health for pregnant and postpartum 
                        individuals;
                            (iii) promote evidence-based health 
                        literacy and pregnancy, childbirth, and 
                        parenting education for pregnant and postpartum 
                        individuals;
                            (iv) provide support from perinatal health 
                        workers to pregnant and postpartum individuals;
                            (v) provide culturally congruent training 
                        to perinatal health workers;
                            (vi) conduct or support research on 
                        maternal health issues disproportionately 
                        impacting Black pregnant and postpartum 
                        individuals;
                            (vii) provide support to family members of 
                        individuals who suffered a pregnancy-associated 
                        death or pregnancy-related death;
                            (viii) operate midwifery practices that 
                        provide culturally congruent maternal health 
                        care and support, including for the purposes 
                        of--
                                    (I) supporting additional 
                                education, training, and certification 
                                programs, including support for 
                                distance learning;
                                    (II) providing financial support to 
                                current and future midwives to address 
                                education costs, debts, and other 
                                needs;
                                    (III) clinical site investments;
                                    (IV) supporting preceptor 
                                development trainings;
                                    (V) expanding the midwifery 
                                practice; or
                                    (VI) related needs identified by 
                                the midwifery practice and described in 
                                the practice's application; or
                            (ix) have developed other programs and 
                        resources that address community-specific needs 
                        for pregnant and postpartum individuals and are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for Black 
                        pregnant and postpartum individuals.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance on--
            (1) capacity building to establish or expand programs to 
        prevent adverse maternal health outcomes among Black pregnant 
        and postpartum individuals;
            (2) best practices in data collection, measurement, 
        evaluation, and reporting; and
            (3) planning for sustaining programs to prevent maternal 
        mortality and severe maternal morbidity among Black pregnant 
        and postpartum individuals after the period of the grant.
    (f) Evaluation.--Not later than the end of fiscal year 2027, the 
Secretary shall submit to the Congress an evaluation of the grant 
program under this section that--
            (1) assesses the effectiveness of outreach efforts during 
        the application process in diversifying the pool of grant 
        recipients;
            (2) makes recommendations for future outreach efforts to 
        diversify the pool of grant recipients for Department of Health 
        and Human Services grant programs and funding opportunities 
        related to maternal health;
            (3) assesses the effectiveness of programs funded by grants 
        under this section in improving maternal health outcomes for 
        Black pregnant and postpartum individuals, to the extent 
        practicable; and
            (4) makes recommendations for future Department of Health 
        and Human Services grant programs and funding opportunities 
        that deliver funding to community-based organizations that 
        provide programs and resources that are aligned with evidence-
        based practices for improving maternal health outcomes for 
        Black pregnant and postpartum individuals.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2023 through 2027.

SEC. 1102. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE 
              MATERNAL HEALTH OUTCOMES IN UNDERSERVED COMMUNITIES.

    (a) Awards.--Following the 1-year period described in subsection 
(c), the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall award grants to eligible 
entities to establish or expand programs to prevent maternal mortality 
and severe maternal morbidity among underserved groups.
    (b) Eligibility.--To be eligible to seek a grant under this 
section, an entity shall be a community-based organization offering 
programs and resources aligned with evidence-based practices for 
improving maternal health outcomes for pregnant and postpartum 
individuals.
    (c) Outreach and Technical Assistance Period.--During the 1-year 
period beginning on the date of enactment of this Act, the Secretary 
shall--
            (1) conduct outreach to encourage eligible entities to 
        apply for grants under this section; and
            (2) provide technical assistance to eligible entities on 
        best practices for applying for grants under this section.
    (d) Special Consideration.--
            (1) Outreach.--In conducting outreach under subsection (c), 
        the Secretary shall give special consideration to eligible 
        entities that--
                    (A) are based in, and provide support for, 
                communities with high rates of adverse maternal health 
                outcomes or significant racial and ethnic disparities 
                in maternal health outcomes, to the extent such data 
                are available;
                    (B) are led by individuals from racially, 
                ethnically, and geographically diverse backgrounds; and
                    (C) offer programs and resources that are aligned 
                with evidence-based practices for improving maternal 
                health outcomes for pregnant and postpartum 
                individuals.
            (2) Awards.--In awarding grants under this section, the 
        Secretary shall give special consideration to eligible entities 
        that--
                    (A) are described in subparagraphs (A), (B), and 
                (C) of paragraph (1);
                    (B) offer programs and resources designed in 
                consultation with and intended for pregnant and 
                postpartum individuals from underserved groups; and
                    (C) offer programs and resources in the communities 
                in which the respective eligible entities are located 
                that--
                            (i) promote maternal mental health and 
                        maternal substance use disorder treatments and 
                        support that are aligned with evidence-based 
                        practices for improving maternal mental and 
                        behavioral health outcomes for pregnant and 
                        postpartum individuals;
                            (ii) address social determinants of 
                        maternal health for pregnant and postpartum 
                        individuals;
                            (iii) promote evidence-based health 
                        literacy and pregnancy, childbirth, and 
                        parenting education for pregnant and postpartum 
                        individuals;
                            (iv) provide support from perinatal health 
                        workers to pregnant and postpartum individuals;
                            (v) provide culturally congruent training 
                        to perinatal health workers;
                            (vi) conduct or support research on 
                        maternal health outcomes and disparities;
                            (vii) provide support to family members of 
                        individuals who suffered a pregnancy-associated 
                        death or pregnancy-related death;
                            (viii) operate midwifery practices that 
                        provide culturally congruent maternal health 
                        care and support, including for the purposes 
                        of--
                                    (I) supporting additional 
                                education, training, and certification 
                                programs, including support for 
                                distance learning;
                                    (II) providing financial support to 
                                current and future midwives to address 
                                education costs, debts, and other 
                                needs;
                                    (III) clinical site investments;
                                    (IV) supporting preceptor 
                                development trainings;
                                    (V) expanding the midwifery 
                                practice; or
                                    (VI) related needs identified by 
                                the midwifery practice and described in 
                                the practice's application; or
                            (ix) have developed other programs and 
                        resources that address community-specific needs 
                        for pregnant and postpartum individuals and are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for pregnant 
                        and postpartum individuals.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance on--
            (1) capacity building to establish or expand programs to 
        prevent adverse maternal health outcomes among pregnant and 
        postpartum individuals from underserved groups;
            (2) best practices in data collection, measurement, 
        evaluation, and reporting; and
            (3) planning for sustaining programs to prevent maternal 
        mortality and severe maternal morbidity among pregnant and 
        postpartum individuals from underserved groups after the period 
        of the grant.
    (f) Evaluation.--Not later than the end of fiscal year 2027, the 
Secretary shall submit to the Congress an evaluation of the grant 
program under this section that--
            (1) assesses the effectiveness of outreach efforts during 
        the application process in diversifying the pool of grant 
        recipients;
            (2) makes recommendations for future outreach efforts to 
        diversify the pool of grant recipients for Department of Health 
        and Human Services grant programs and funding opportunities 
        related to maternal health;
            (3) assesses the effectiveness of programs funded by grants 
        under this section in improving maternal health outcomes for 
        pregnant and postpartum individuals from underserved groups, to 
        the extent practicable; and
            (4) makes recommendations for future Department of Health 
        and Human Services grant programs and funding opportunities 
        that deliver funding to community-based organizations that 
        provide programs and resources that are aligned with evidence-
        based practices for improving maternal health outcomes for 
        pregnant and postpartum individuals.
    (g) Definition.--In this section, the term ``underserved groups'' 
refers to pregnant and postpartum individuals--
            (1) from racial and ethnic minority groups (as such term is 
        defined in section 1707(g)(1) of the Public Health Service Act 
        (42 U.S.C. 300u-6(g)(1)));
            (2) whose household income is equal to or less than 150 
        percent of the Federal poverty line;
            (3) who live in health professional shortage areas (as such 
        term is defined in section 332 of the Public Health Service Act 
        (42 U.S.C. 254e(a)(1)));
            (4) who live in counties with no hospital offering 
        obstetric care, no birth center, and no obstetric provider; or
            (5) who live in counties with a level of vulnerability of 
        moderate-to-high or higher, according to the Social 
        Vulnerability Index of the Centers for Disease Control and 
        Prevention.
    (h) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2023 through 2027.

SEC. 1103. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN 
              MATERNITY CARE SETTINGS.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by adding at the end the following new section:

``SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN 
              MATERNITY CARE SETTINGS.

    ``(a) Grants.--The Secretary shall award grants for programs to 
reduce and prevent bias, racism, and discrimination in maternity care 
settings and to advance respectful, culturally congruent, trauma-
informed care.
    ``(b) Special Consideration.--In awarding grants under subsection 
(a), the Secretary shall give special consideration to applications for 
programs that would--
            ``(1) apply to all maternity care providers and any 
        employees who interact with pregnant and postpartum individuals 
        in the provider setting, including front desk employees, 
        sonographers, schedulers, health care professionals, hospital 
        or health system administrators, security staff, and other 
        employees;
            ``(2) emphasize periodic, as opposed to one-time, trainings 
        for all birthing professionals and employees described in 
        paragraph (1);
            ``(3) address implicit bias, racism, and cultural humility;
            ``(4) be delivered in ongoing education settings for 
        providers maintaining their licenses, with a preference for 
        trainings that provide continuing education units;
            ``(5) include trauma-informed care best practices and an 
        emphasis on shared decision making between providers and 
        patients;
            ``(6) include antiracism training and programs;
            ``(7) be delivered in undergraduate programs that funnel 
        into health professions schools;
            ``(8) be delivered in settings that apply to providers of 
        the special supplemental nutrition program for women, infants, 
        and children under section 17 of the Child Nutrition Act of 
        1966;
            ``(9) integrate bias training in obstetric emergency 
        simulation trainings or related trainings;
            ``(10) include training for emergency department employees 
        and emergency medical technicians on recognizing warning signs 
        for severe pregnancy-related complications;
            ``(11) offer training to all maternity care providers on 
        the value of racially, ethnically, and professionally diverse 
        maternity care teams to provide culturally congruent care; or
            ``(12) be based on one or more programs designed by a 
        historically Black college or university or other minority-
        serving institution.
    ``(c) Application.--To seek a grant under subsection (a), an entity 
shall submit an application at such time, in such manner, and 
containing such information as the Secretary may require.
    ``(d) Reporting.--Each recipient of a grant under this section 
shall annually submit to the Secretary a report on the status of 
activities conducted using the grant, including, as applicable, a 
description of the impact of training provided through the grant on 
patient outcomes and patient experience for pregnant and postpartum 
individuals from racial and ethnic minority groups and their families.
    ``(e) Best Practices.--Based on the annual reports submitted 
pursuant to subsection (d), the Secretary--
            ``(1) shall produce an annual report on the findings 
        resulting from programs funded through this section;
            ``(2) shall disseminate such report to all recipients of 
        grants under this section and to the public; and
            ``(3) may include in such report findings on best practices 
        for improving patient outcomes and patient experience for 
        pregnant and postpartum individuals from racial and ethnic 
        minority groups and their families in maternity care settings.
    ``(f) Definitions.--In this section:
            ``(1) The term `postpartum' means the one-year period 
        beginning on the last day of an individual's pregnancy.
            ``(2) The term `culturally congruent' means in agreement 
        with the preferred cultural values, beliefs, world view, 
        language, and practices of the health care consumer and other 
        stakeholders.
            ``(3) The term `racial and ethnic minority group' has the 
        meaning given such term in section 1707(g)(1).
    ``(g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2023 through 2027.''.

SEC. 1104. STUDY ON REDUCING AND PREVENTING BIAS, RACISM, AND 
              DISCRIMINATION IN MATERNITY CARE SETTINGS.

    (a) In General.--The Secretary of Health and Human Services shall 
seek to enter into an agreement, not later than 90 days after the date 
of enactment of this Act, with the National Academies of Sciences, 
Engineering, and Medicine (referred to in this section as the 
``National Academies'') under which the National Academies agree to--
            (1) conduct a study on the design and implementation of 
        programs to reduce and prevent bias, racism, and discrimination 
        in maternity care settings and to advance respectful, 
        culturally congruent, trauma-informed care; and
            (2) not later than 24 months after the date of enactment of 
        this Act--
                    (A) complete the study; and
                    (B) transmit a report on the results of the study 
                to the Congress.
    (b) Possible Topics.--The agreement entered into pursuant to 
subsection (a) may provide for the study of any of the following:
            (1) The development of a scorecard or other evaluation 
        standards for programs designed to reduce and prevent bias, 
        racism, and discrimination in maternity care settings to assess 
        the effectiveness of such programs in improving patient 
        outcomes and patient experience for pregnant and postpartum 
        individuals from racial and ethnic minority groups and their 
        families.
            (2) Determination of the types and frequency of training to 
        reduce and prevent bias, racism, and discrimination in 
        maternity care settings that are demonstrated to improve 
        patient outcomes or patient experience for pregnant and 
        postpartum individuals from racial and ethnic minority groups 
        and their families.

SEC. 1105. RESPECTFUL MATERNITY CARE COMPLIANCE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award grants 
to accredited hospitals, health systems, and other maternity care 
settings to establish as an integral part of quality implementation 
initiatives within one or more hospitals or other birth settings a 
respectful maternity care compliance program.
    (b) Program Requirements.--A respectful maternity care compliance 
program funded through a grant under this section shall--
            (1) institutionalize mechanisms to allow patients receiving 
        maternity care services, the families of such patients, or 
        perinatal health workers supporting such patients to report 
        instances of racism or evidence of bias on the basis of race, 
        ethnicity, or another protected class;
            (2) institutionalize response mechanisms through which 
        representatives of the program can directly follow up with the 
        patient, if possible, and the patient's family in a timely 
        manner;
            (3) prepare and make publicly available a hospital- or 
        health system-wide strategy to reduce bias on the basis of 
        race, ethnicity, or another protected class in the delivery of 
        maternity care that includes--
                    (A) information on the training programs to reduce 
                and prevent bias, racism, and discrimination on the 
                basis of race, ethnicity, or another protected class 
                for all employees in maternity care settings;
                    (B) information on the number of cases reported to 
                the compliance program; and
                    (C) the development of methods to routinely assess 
                the extent to which bias, racism, or discrimination on 
                the basis of race, ethnicity, or another protected 
                class are present in the delivery of maternity care to 
                patients from racial and ethnic minority groups;
            (4) develop mechanisms to routinely collect and publicly 
        report hospital-level data related to patient-reported 
        experience of care; and
            (5) provide annual reports to the Secretary with 
        information about each case reported to the compliance program 
        over the course of the year containing such information as the 
        Secretary may require, such as--
                    (A) de-identified demographic information on the 
                patient in the case, such as race, ethnicity, gender 
                identity, and primary language;
                    (B) the content of the report from the patient or 
                the family of the patient to the compliance program;
                    (C) the response from the compliance program; and
                    (D) to the extent applicable, institutional changes 
                made as a result of the case.
    (c) Secretary Requirements.--
            (1) Processes.--Not later than 180 days after the date of 
        enactment of this Act, the Secretary shall establish processes 
        for--
                    (A) disseminating best practices for establishing 
                and implementing a respectful maternity care compliance 
                program within a hospital or other birth setting;
                    (B) promoting coordination and collaboration 
                between hospitals, health systems, and other maternity 
                care delivery settings on the establishment and 
                implementation of respectful maternity care compliance 
                programs; and
                    (C) evaluating the effectiveness of respectful 
                maternity care compliance programs on maternal health 
                outcomes and patient and family experiences, especially 
                for patients from racial and ethnic minority groups and 
                their families.
            (2) Study.--
                    (A) In general.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary shall, 
                through a contract with an independent research 
                organization, conduct a study on strategies to 
                address--
                            (i) racism or bias on the basis of race, 
                        ethnicity, or another protected class in the 
                        delivery of maternity care services; and
                            (ii) successful implementation of 
                        respectful care initiatives.
                    (B) Components of study.--The study shall include 
                the following:
                            (i) An assessment of the reports submitted 
                        to the Secretary from the respectful maternity 
                        care compliance programs pursuant to subsection 
                        (b)(5).
                            (ii) Based on such assessment, 
                        recommendations for potential accountability 
                        mechanisms related to cases of racism or bias 
                        on the basis of race, ethnicity, or another 
                        protected class in the delivery of maternity 
                        care services at hospitals and other birth 
                        settings. Such recommendations shall take into 
                        consideration medical and non-medical factors 
                        that contribute to adverse patient experiences 
                        and maternal health outcomes.
                    (C) Report.--The Secretary shall submit to the 
                Congress and make publicly available a report on the 
                results of the study under this paragraph.
    (d) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2028.

SEC. 1106. GAO REPORT.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act and annually thereafter, the Comptroller General of the 
United States shall submit to the Congress and make publicly available 
a report on the establishment of respectful maternity care compliance 
programs within hospitals, health systems, and other maternity care 
settings.
    (b) Matters Included.--The report under paragraph (1) shall include 
the following:
            (1) Information regarding the extent to which hospitals, 
        health systems, and other maternity care settings have elected 
        to establish respectful maternity care compliance programs, 
        including--
                    (A) which hospitals and other birth settings elect 
                to establish compliance programs and when such programs 
                are established;
                    (B) to the extent practicable, impacts of the 
                establishment of such programs on maternal health 
                outcomes and patient and family experiences in the 
                hospitals and other birth settings that have 
                established such programs, especially for patients from 
                racial and ethnic minority groups and their families;
                    (C) information on geographic areas, and types of 
                hospitals or other birth settings, where respectful 
                maternity care compliance programs are not being 
                established and information on factors contributing to 
                decisions to not establish such programs; and
                    (D) recommendations for establishing respectful 
                maternity care compliance programs in geographic areas, 
                and types of hospitals or other birth settings, where 
                such programs are not being established.
            (2) Whether the funding made available to carry out this 
        section has been sufficient and, if applicable, recommendations 
        for additional appropriations to carry out this section.
            (3) Such other information as the Comptroller General 
        determines appropriate.

                 Subtitle C--Protecting Moms Who Served

SEC. 1201. SUPPORT FOR MATERNITY CARE COORDINATION.

    (a) Program on Maternity Care Coordination.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        carry out the maternity care coordination program described in 
        Veterans Health Administration Handbook 1330.03, or any 
        successor handbook.
            (2) Training and support.--In carrying out the program 
        under paragraph (1), the Secretary shall provide to community 
        maternity care providers training and support with respect to 
        the unique needs of pregnant and postpartum veterans, 
        particularly regarding mental and behavioral health conditions 
        relating to the service of the veterans in the Armed Forces.
    (b) Authorization of Appropriations.--There is authorized to be 
appropriated to the Secretary $15,000,000 for fiscal year 2023 for the 
maternity care coordination program. Such amounts are authorized in 
addition to any other amounts authorized for such purpose.
    (c) Definitions.--In this section:
            (1) The term ``community maternity care providers'' means 
        maternity care providers located at non-Department facilities 
        who provide maternity care to veterans under section 1703 of 
        title 38, United States Code, or other provisions of law 
        administered by the Secretary of Veterans Affairs.
            (2) The term ``non-Department facilities'' has the meaning 
        given that term in section 1701 of title 38, United States 
        Code.

SEC. 1202. REPORT ON MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY 
              AMONG PREGNANT AND POSTPARTUM VETERANS.

    (a) GAO Report.--Not later than two years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committees on Veterans' Affairs of the Senate and 
the House of Representatives, and make publicly available, a report on 
maternal mortality and severe maternal morbidity among pregnant and 
postpartum veterans, with a particular focus on racial and ethnic 
disparities in maternal health outcomes for veterans.
    (b) Matters Included.--The report under subsection (a) shall 
include the following:
            (1) To the extent practicable--
                    (A) the number of pregnant and postpartum veterans 
                who have experienced a pregnancy-related death or 
                pregnancy-associated death in the most recent 10 years 
                of available data;
                    (B) the rate of pregnancy-related deaths per 
                100,000 live births for pregnant and postpartum 
                veterans;
                    (C) the number of cases of severe maternal 
                morbidity among pregnant and postpartum veterans in the 
                most recent year of available data;
                    (D) the racial and ethnic disparities in maternal 
                mortality and severe maternal morbidity rates among 
                pregnant and postpartum veterans;
                    (E) identification of the causes of maternal 
                mortality and severe maternal morbidity that are unique 
                to veterans, including post-traumatic stress disorder, 
                military sexual trauma, and infertility or miscarriages 
                that may be caused by such service;
                    (F) identification of the causes of maternal 
                mortality and severe maternal morbidity that are unique 
                to veterans from racial and ethnic minority groups;
                    (G) identification of any correlations between the 
                former rank of veterans and their maternal health 
                outcomes;
                    (H) the number of veterans who have been diagnosed 
                with infertility by Veterans Health Administration 
                providers each year in the most recent five years, 
                disaggregated by age, race, ethnicity, sex, marital 
                status, sexual orientation, gender identity, and 
                geographical location;
                    (I) the number of veterans who receive a clinical 
                diagnosis of unexplained infertility by Veterans Health 
                Administration providers each year in the most recent 
                five years; and
                    (J) the extent to which the rate of incidence of 
                clinically diagnosed infertility among veterans compare 
                or differ to the rate of incidence of clinically 
                diagnosed infertility among the civilian population.
            (2) An assessment of the barriers to determining the 
        information required under paragraph (1) and recommendations 
        for improvements in tracking maternal health outcomes among 
        pregnant and postpartum veterans--
                    (A) who have health care coverage through the 
                Department;
                    (B) enrolled in the TRICARE program;
                    (C) with employer-based or private insurance;
                    (D) enrolled in the Medicaid program; and
                    (E) who are uninsured.
            (3) Recommendations for legislative and administrative 
        actions to increase access to mental and behavioral health care 
        for pregnant and postpartum veterans who screen positively for 
        maternal mental or behavioral health conditions.
            (4) Recommendations to address homelessness, food 
        insecurity, poverty, and related issues among pregnant and 
        postpartum veterans.
            (5) Recommendations on how to effectively educate maternity 
        care providers on best practices for providing maternity care 
        services to veterans that addresses the unique maternal health 
        care needs of veteran populations.
            (6) Recommendations to reduce maternal mortality and severe 
        maternal morbidity among pregnant and postpartum veterans and 
        to address racial and ethnic disparities in maternal health 
        outcomes for each of the groups described in subparagraphs (A) 
        through (E) of paragraph (2).
            (7) Recommendations to improve coordination of care between 
        the Department and non-Department facilities for pregnant and 
        postpartum veterans, including recommendations to improve--
                    (A) health record interoperability; and
                    (B) training for the directors of the Veterans 
                Integrated Service Networks, directors of medical 
                facilities of the Department, chiefs of staff of such 
                facilities, maternity care coordinators, and staff of 
                relevant non-Department facilities.
            (8) An assessment of the authority of the Secretary of 
        Veterans Affairs to access maternal health data collected by 
        the Department of Health and Human Services and, if applicable, 
        recommendations to increase such authority.
            (9) Any other information the Comptroller General 
        determines appropriate with respect to the reduction of 
        maternal mortality and severe maternal morbidity among pregnant 
        and postpartum veterans and to address racial and ethnic 
        disparities in maternal health outcomes for veterans.

                    Subtitle D--Perinatal Workforce

SEC. 1301. HHS AGENCY DIRECTIVES.

    (a) Guidance to States.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall issue and disseminate guidance to States to 
        educate providers, managed care entities, and other insurers 
        about the value and process of delivering respectful maternal 
        health care through diverse and multidisciplinary care provider 
        models.
            (2) Contents.--The guidance required by paragraph (1) shall 
        address how States can encourage and incentivize hospitals, 
        health systems, midwifery practices, freestanding birth 
        centers, other maternity care provider groups, managed care 
        entities, and other insurers--
                    (A) to recruit and retain maternity care providers, 
                mental and behavioral health care providers acting in 
                accordance with State law, registered dietitians or 
                nutrition professionals (as such term is defined in 
                section 1861(vv)(2) of the Social Security Act (42 
                U.S.C. 1395x(vv)(2))), and lactation consultants 
                certified by the International Board of Lactation 
                Consultants Examiners--
                            (i) from racially, ethnically, and 
                        linguistically diverse backgrounds;
                            (ii) with experience practicing in racially 
                        and ethnically diverse communities; and
                            (iii) who have undergone training on 
                        implicit bias and racism;
                    (B) to incorporate into maternity care teams--
                            (i) midwives who meet at a minimum the 
                        international definition of the midwife and 
                        global standards for midwifery education as 
                        established by the International Confederation 
                        of Midwives; and
                            (ii) perinatal health workers;
                    (C) to provide collaborative, culturally congruent 
                care; and
                    (D) to provide opportunities for individuals 
                enrolled in accredited midwifery education programs to 
                participate in job shadowing with maternity care teams 
                in hospitals, health systems, midwifery practices, and 
                freestanding birth centers.
    (b) Study on Respectful and Culturally Congruent Maternity Care.--
            (1) Study.--The Secretary of Health and Human Services 
        acting through the Director of the National Institutes of 
        Health (in this subsection referred to as the ``Secretary'') 
        shall conduct a study on best practices in respectful and 
        culturally congruent maternity care.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall--
                    (A) complete the study required by paragraph (1);
                    (B) submit to the Congress and make publicly 
                available a report on the results of such study; and
                    (C) include in such report--
                            (i) a compendium of examples of hospitals, 
                        health systems, midwifery practices, 
                        freestanding birth centers, other maternity 
                        care provider groups, managed care entities, 
                        and other insurers that are delivering 
                        respectful and culturally congruent maternal 
                        health care;
                            (ii) a compendium of examples of hospitals, 
                        health systems, midwifery practices, 
                        freestanding birth centers, other maternity 
                        care provider groups, managed care entities, 
                        and other insurers that have made progress in 
                        reducing disparities in maternal health 
                        outcomes and improving birthing experiences for 
                        pregnant and postpartum individuals from racial 
                        and ethnic minority groups; and
                            (iii) recommendations to hospitals, health 
                        systems, midwifery practices, freestanding 
                        birth centers, other maternity care provider 
                        groups, managed care entities, and other 
                        insurers, for best practices in respectful and 
                        culturally congruent maternity care.

SEC. 1302. GRANTS TO GROW AND DIVERSIFY THE PERINATAL WORKFORCE.

    Title VII of the Public Health Service Act is amended by inserting 
after section 757 (42 U.S.C. 294f) the following new section:

``SEC. 758. PERINATAL WORKFORCE GRANTS.

    ``(a) In General.--The Secretary shall award grants to entities to 
establish or expand programs described in subsection (b) to grow and 
diversify the perinatal workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the perinatal workforce by--
            ``(1) establishing schools or programs that provide 
        education and training to individuals seeking appropriate 
        licensing or certification as--
                    ``(A) physician assistants who will complete 
                clinical training in the field of maternal and 
                perinatal health; or
                    ``(B) perinatal health workers; and
            ``(2) expanding the capacity of existing schools or 
        programs described in paragraph (1), for the purposes of 
        increasing the number of students enrolled in such schools or 
        programs, including by awarding scholarships for students.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any entity that--
            ``(1) has demonstrated a commitment to recruiting and 
        retaining students and faculty from racial and ethnic minority 
        groups;
            ``(2) has developed a strategy to recruit and retain a 
        diverse pool of students into the perinatal workforce program 
        or school supported by funds received through the grant, 
        particularly from racial and ethnic minority groups and other 
        underserved populations;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in a health professional shortage 
        area designated under section 332;
            ``(4) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic disparities in maternal health outcomes, to 
        the extent practicable; and
            ``(5) includes in the standard curriculum for all students 
        within the perinatal workforce program or school a bias, 
        racism, or discrimination training program that includes 
        training on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section for a perinatal workforce program or school, an entity shall 
agree to submit to the Secretary an annual report on the activities 
conducted through the grant, including--
            ``(1) the number and demographics of students participating 
        in the program or school;
            ``(2) the extent to which students in the program or school 
        are entering careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                disparities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the program or school has included in the 
        standard curriculum for all students a bias, racism, or 
        discrimination training program that includes explicit and 
        implicit bias, and if so the effectiveness of such training 
        program.
    ``(e) Period of Grants.--The period of a grant under this section 
shall be up to 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to entities seeking or receiving a 
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the perinatal workforce programs or 
schools proposed to be, or being, established or expanded through the 
grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups;
            ``(2) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, from racial and 
        ethnic minority groups and other underserved populations;
            ``(3) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, working in 
        health professional shortage areas designated under section 
        332; and
            ``(4) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, working in 
        areas with significant racial and ethnic disparities in 
        maternal health outcomes, to the extent such data are 
        available.
    ``(i) Definition.--In this section, the term `racial and ethnic 
minority group' has the meaning given such term in section 1707(g).
    ``(j) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2023 through 2027.''.

SEC. 1303. GRANTS TO GROW AND DIVERSIFY THE NURSING WORKFORCE IN 
              MATERNAL AND PERINATAL HEALTH.

    Title VIII of the Public Health Service Act is amended by inserting 
after section 811 of that Act (42 U.S.C. 296j) the following:

``SEC. 812. PERINATAL NURSING WORKFORCE GRANTS.

    ``(a) In General.--The Secretary shall award grants to schools of 
nursing to grow and diversify the perinatal nursing workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the perinatal nursing workforce by 
providing scholarships to students seeking to become--
            ``(1) nurse practitioners whose education includes a focus 
        on maternal and perinatal health; or
            ``(2) clinical nurse specialists whose education includes a 
        focus on maternal and perinatal health.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any school of nursing that--
            ``(1) has developed a strategy to recruit and retain a 
        diverse pool of students seeking to enter careers focused on 
        maternal and perinatal health, particularly students from 
        racial and ethnic minority groups and other underserved 
        populations;
            ``(2) has developed a partnership with a practice setting 
        in a health professional shortage area designated under section 
        332 for the clinical placements of the school's students;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic disparities in maternal health outcomes, to 
        the extent practicable; and
            ``(4) includes in the standard curriculum for all students 
        seeking to enter careers focused on maternal and perinatal 
        health a bias, racism, or discrimination training program that 
        includes education on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section, a school of nursing shall agree to submit to the Secretary an 
annual report on the activities conducted through the grant, including, 
to the extent practicable--
            ``(1) the number and demographics of students in the school 
        of nursing seeking to enter careers focused on maternal and 
        perinatal health;
            ``(2) the extent to which such students are preparing to 
        enter careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                disparities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the standard curriculum for all students 
        seeking to enter careers focused on maternal and perinatal 
        health includes a bias, racism, or discrimination training 
        program that includes education on implicit bias and racism.
    ``(e) Period of Grants.--The period of a grant under this section 
shall be up to 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application, at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to schools of nursing seeking or 
receiving a grant under this section on the processes of awarding and 
evaluating scholarships through the grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups and other underserved populations;
            ``(2) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health from racial and ethnic minority groups and 
        other underserved populations;
            ``(3) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health working in health professional shortage 
        areas designated under section 332; and
            ``(4) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health working in areas with significant racial 
        and ethnic disparities in maternal health outcomes, to the 
        extent such data are available.
    ``(i) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2023 through 2027.''.

SEC. 1304. GAO REPORT.

    (a) In General.--Not later than two years after the date of 
enactment of this Act and every five years thereafter, the Comptroller 
General of the United States shall submit to Congress a report on 
barriers to maternal health education and access to care in the United 
States. Such report shall include the information and recommendations 
described in subsection (b).
    (b) Content of Report.--The report under subsection (a) shall 
include--
            (1) an assessment of current barriers to entering 
        accredited midwifery education programs, and recommendations 
        for addressing such barriers, particularly for low-income women 
        and women from racial and ethnic minority groups;
            (2) an assessment of current barriers to entering and 
        successfully completing accredited education programs for other 
        health professional careers related to maternity care, 
        including maternity care providers, mental and behavioral 
        health care providers acting in accordance with State law, 
        registered dietitians or nutrition professionals (as such term 
        is defined in section 1861(vv)(2) of the Social Security Act 
        (42 U.S.C. 1395x(vv)(2))), and lactation consultants certified 
        by the International Board of Lactation Consultants Examiners, 
        particularly for low-income women and women from racial and 
        ethnic minority groups;
            (3) an assessment of current barriers that prevent midwives 
        from meeting the international definition of the midwife and 
        global standards for midwifery education as established by the 
        International Confederation of Midwives, and recommendations 
        for addressing such barriers, particularly for low-income women 
        and women from racial and ethnic minority groups;
            (4) an assessment of disparities in access to maternity 
        care providers, mental or behavioral health care providers 
        acting in accordance with State law, registered dietitians or 
        nutrition professionals (as such term is defined in section 
        1861(vv)(2) of the Social Security Act (42 U.S.C. 
        1395x(vv)(2))), lactation consultants certified by the 
        International Board of Lactation Consultants Examiners, and 
        perinatal health workers, stratified by race, ethnicity, gender 
        identity, geographic location, and insurance type and 
        recommendations to promote greater access equity; and
            (5) recommendations to promote greater equity in 
        compensation for perinatal health workers under public and 
        private insurers, particularly for such individuals from 
        racially and ethnically diverse backgrounds.

                     Subtitle E--Data to Save Moms

SEC. 1401. FUNDING FOR MATERNAL MORTALITY REVIEW COMMITTEES TO PROMOTE 
              REPRESENTATIVE COMMUNITY ENGAGEMENT.

    (a) In General.--Section 317K(d) of the Public Health Service Act 
(42 U.S.C. 247b-12(d)) is amended by adding at the end the following:
            ``(9) Grants to promote representative community engagement 
        in maternal mortality review committees.--
                    ``(A) In general.--The Secretary may, using funds 
                made available pursuant to subparagraph (C), provide 
                assistance to an applicable maternal mortality review 
                committee of a State, Indian tribe, tribal 
                organization, or urban Indian organization (as such 
                term is defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603))--
                            ``(i) to select for inclusion in the 
                        membership of such a committee community 
                        members from the State, Indian tribe, tribal 
                        organization, or urban Indian organization by--
                                    ``(I) prioritizing community 
                                members who can increase the diversity 
                                of the committee's membership with 
                                respect to race and ethnicity, 
                                location, and professional background, 
                                including members with non-clinical 
                                experiences; and
                                    ``(II) to the extent applicable, 
                                using funds reserved under subsection 
                                (f), to address barriers to maternal 
                                mortality review committee 
                                participation for community members, 
                                including required training, 
                                transportation barriers, compensation, 
                                and other supports as may be necessary;
                            ``(ii) to establish initiatives to conduct 
                        outreach and community engagement efforts 
                        within communities throughout the State or 
                        Tribe to seek input from community members on 
                        the work of such maternal mortality review 
                        committee, with a particular focus on outreach 
                        to minority women; and
                            ``(iii) to release public reports 
                        assessing--
                                    ``(I) the pregnancy-related death 
                                and pregnancy-associated death review 
                                processes of the maternal mortality 
                                review committee, with a particular 
                                focus on the maternal mortality review 
                                committee's sensitivity to the unique 
                                circumstances of pregnant and 
                                postpartum individuals from racial and 
                                ethnic minority groups (as such term is 
                                defined in section 1707(g)(1)) who have 
                                suffered pregnancy-related deaths; and
                                    ``(II) the impact of the use of 
                                funds made available pursuant to 
                                paragraph (C) on increasing the 
                                diversity of the maternal mortality 
                                review committee membership and 
                                promoting community engagement efforts 
                                throughout the State or Tribe.
                    ``(B) Technical assistance.--The Secretary shall 
                provide (either directly through the Department of 
                Health and Human Services or by contract) technical 
                assistance to any maternal mortality review committee 
                receiving a grant under this paragraph on best 
                practices for increasing the diversity of the maternal 
                mortality review committee's membership and for 
                conducting effective community engagement throughout 
                the State or Tribe.
                    ``(C) Authorization of appropriations.--In addition 
                to any funds made available under subsection (f), there 
                are authorized to be appropriated to carry out this 
                paragraph $10,000,000 for each of fiscal years 2023 
                through 2027.''.
    (b) Reservation of Funds.--Section 317K(f) of the Public Health 
Service Act (42 U.S.C. 247b-12(f)) is amended by adding at the end the 
following: ``Of the amount made available under the preceding sentence 
for a fiscal year, not less than $1,500,000 shall be reserved for 
grants to Indian tribes, tribal organizations, or urban Indian 
organizations (as those terms are defined in section 4 of the Indian 
Health Care Improvement Act (25 U.S.C. 1603))''.

SEC. 1402. DATA COLLECTION AND REVIEW.

    Section 317K(d)(3)(A)(i) of the Public Health Service Act (42 
U.S.C. 247b-12(d)(3)(A)(i)) is amended--
            (1) by redesignating subclauses (II) and (III) as 
        subclauses (V) and (VI), respectively; and
            (2) by inserting after subclause (I) the following:
                                    ``(II) to the extent practicable, 
                                reviewing cases of severe maternal 
                                morbidity, according to the most up-to-
                                date indicators;
                                    ``(III) to the extent practicable, 
                                reviewing deaths during pregnancy or up 
                                to 1 year after the end of a pregnancy 
                                from suicide, overdose, or other death 
                                from a mental health condition or 
                                substance use disorder attributed to or 
                                aggravated by pregnancy or childbirth 
                                complications;
                                    ``(IV) to the extent practicable, 
                                consulting with local community-based 
                                organizations representing pregnant and 
                                postpartum individuals from demographic 
                                groups disproportionately impacted by 
                                poor maternal health outcomes to ensure 
                                that, in addition to clinical factors, 
                                non-clinical factors that might have 
                                contributed to a pregnancy-related 
                                death are appropriately considered;''.

SEC. 1403. REVIEW OF MATERNAL HEALTH DATA COLLECTION PROCESSES AND 
              QUALITY MEASURES.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Administrator for Centers for Medicare & Medicaid Services 
and the Director of the Agency for Healthcare Research and Quality, 
shall consult with relevant stakeholders--
            (1) to review existing maternal health data collection 
        processes and quality measures; and
            (2) make recommendations to improve such processes and 
        measures, including topics described under subsection (c).
    (b) Collaboration.--In carrying out this section, the Secretary 
shall consult with a diverse group of maternal health stakeholders, 
which may include--
            (1) pregnant and postpartum individuals and their family 
        members, and nonprofit organizations representing such 
        individuals, with a particular focus on patients from racial 
        and ethnic minority groups;
            (2) community-based organizations that provide support for 
        pregnant and postpartum individuals, with a particular focus on 
        patients from racial and ethnic minority groups;
            (3) membership organizations for maternity care providers;
            (4) organizations representing perinatal health workers;
            (5) organizations that focus on maternal mental or 
        behavioral health;
            (6) organizations that focus on intimate partner violence;
            (7) institutions of higher education, with a particular 
        focus on minority-serving institutions;
            (8) licensed and accredited hospitals, birth centers, 
        midwifery practices, or other medical practices that provide 
        maternal health care services to pregnant and postpartum 
        patients;
            (9) relevant State and local public agencies, including 
        State maternal mortality review committees; and
            (10) the National Quality Forum, or such other standard-
        setting organizations specified by the Secretary.
    (c) Topics.--The review of maternal health data collection 
processes and recommendations to improve such processes and measures 
required under subsection (a) shall assess all available relevant 
information, including information from State-level sources, and shall 
consider at least the following:
            (1) Current State and Tribal practices for maternal health, 
        maternal mortality, and severe maternal morbidity data 
        collection and dissemination, including consideration of--
                    (A) the timeliness of processes for amending a 
                death certificate when new information pertaining to 
                the death becomes available to reflect whether the 
                death was a pregnancy-related death;
                    (B) relevant data collected with electronic health 
                records, including data on race, ethnicity, 
                socioeconomic status, insurance type, and other 
                relevant demographic information;
                    (C) maternal health data collected and publicly 
                reported by hospitals, health systems, midwifery 
                practices, and birth centers;
                    (D) the barriers preventing States from correlating 
                maternal outcome data with race and ethnicity data;
                    (E) processes for determining the cause of a 
                pregnancy-associated death in States that do not have a 
                maternal mortality review committee;
                    (F) whether maternal mortality review committees 
                include multidisciplinary and diverse membership (as 
                described in section 317K(d)(1)(A) of the Public Health 
                Service Act (42 U.S.C. 247b-12(d)(1)(A)));
                    (G) whether members of maternal mortality review 
                committees participate in trainings on bias, racism, or 
                discrimination, and the quality of such trainings;
                    (H) the extent to which States have implemented 
                systematic processes of listening to the stories of 
                pregnant and postpartum individuals and their family 
                members, with a particular focus on pregnant and 
                postpartum individuals from racial and ethnic minority 
                groups (as such term is defined in section 1707(g)(1) 
                of the Public Health Service Act (42 U.S.C. 300u-
                6(g)(1))) and their family members, to fully understand 
                the causes of, and inform potential solutions to, the 
                maternal mortality and severe maternal morbidity crisis 
                within their respective States;
                    (I) the extent to which maternal mortality review 
                committees are considering social determinants of 
                maternal health when examining the causes of pregnancy-
                associated and pregnancy-related deaths;
                    (J) the extent to which maternal mortality review 
                committees are making actionable recommendations based 
                on their reviews of adverse maternal health outcomes 
                and the extent to which such recommendations are being 
                implemented by appropriate stakeholders;
                    (K) the legal and administrative barriers 
                preventing the collection, collation, and dissemination 
                of State maternity care data;
                    (L) the effectiveness of data collection and 
                reporting processes in separating pregnancy-associated 
                deaths from pregnancy-related deaths; and
                    (M) the current Federal, State, local, and Tribal 
                funding support for the activities referred to in 
                subparagraphs (A) through (L).
            (2) Whether the funding support referred to in paragraph 
        (1)(M) is adequate for States to carry out optimal data 
        collection and dissemination processes with respect to maternal 
        health, maternal mortality, and severe maternal morbidity.
            (3) Current quality measures for maternity care, including 
        prenatal measures, labor and delivery measures, and postpartum 
        measures, including topics such as--
                    (A) effective quality measures for maternity care 
                used by hospitals, health systems, midwifery practices, 
                birth centers, health plans, and other relevant 
                entities;
                    (B) the sufficiency of current outcome measures 
                used to evaluate maternity care for driving improved 
                care, experiences, and outcomes in maternity care 
                payment and delivery system models;
                    (C) maternal health quality measures that other 
                countries effectively use;
                    (D) validated measures that have been used for 
                research purposes that could be tested, refined, and 
                submitted for national endorsement;
                    (E) barriers preventing maternity care providers 
                and insurers from implementing quality measures that 
                are aligned with best practices;
                    (F) the frequency with which maternity care quality 
                measures are reviewed and revised;
                    (G) the strengths and weaknesses of the Prenatal 
                and Postpartum Care measures of the Health Plan 
                Employer Data and Information Set measures established 
                by the National Committee for Quality Assurance;
                    (H) the strengths and weaknesses of maternity care 
                quality measures under the Medicaid program under title 
                XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
                and the Children's Health Insurance Program under title 
                XXI of such Act (42 U.S.C. 1397 et seq.), including the 
                extent to which States voluntarily report relevant 
                measures;
                    (I) the extent to which maternity care quality 
                measures are informed by patient experiences that 
                include measures of patient-reported experience of 
                care;
                    (J) the current processes for collecting stratified 
                data on the race and ethnicity of pregnant and 
                postpartum individuals in hospitals, health systems, 
                midwifery practices, and birth centers, and for 
                incorporating such racially and ethnically stratified 
                data in maternity care quality measures;
                    (K) the extent to which maternity care quality 
                measures account for the unique experiences of pregnant 
                and postpartum individuals from racial and ethnic 
                minority groups (as such term is defined in section 
                1707(g)(1) of the Public Health Service Act (42 U.S.C. 
                300u-6(g)(1))); and
                    (L) the extent to which hospitals, health systems, 
                midwifery practices, and birth centers are implementing 
                existing maternity care quality measures.
            (4) Recommendations on authorizing additional funds and 
        providing additional technical assistance to improve maternal 
        mortality review committees and State and Tribal maternal 
        health data collection and reporting processes.
            (5) Recommendations for new authorities that may be granted 
        to maternal mortality review committees to be able to--
                    (A) access records from other Federal and State 
                agencies and departments that may be necessary to 
                identify causes of pregnancy-associated and pregnancy-
                related deaths that are unique to pregnant and 
                postpartum individuals from specific populations, such 
                as veterans and individuals who are incarcerated; and
                    (B) work with relevant experts who are not members 
                of the maternal mortality review committee to assist in 
                the review of pregnancy-associated deaths of pregnant 
                and postpartum individuals from specific populations, 
                such as veterans and individuals who are incarcerated.
            (6) Recommendations to improve and standardize current 
        quality measures for maternity care, with a particular focus on 
        racial and ethnic disparities in maternal health outcomes.
            (7) Recommendations to improve the coordination by the 
        Department of Health and Human Services of the efforts 
        undertaken by the agencies and organizations within the 
        Department related to maternal health data and quality 
        measures.
    (d) Report.--Not later than 1 year after the enactment of this Act, 
the Secretary shall submit to the Congress and make publicly available 
a report on the results of the review of maternal health data 
collection processes and quality measures and recommendations to 
improve such processes and measures required under subsection (a).
    (e) Definitions.--In this section:
            (1) Maternal mortality review committee.--The term 
        ``maternal mortality review committee'' means a maternal 
        mortality review committee duly authorized by a State and 
        receiving funding under section 317k(a)(2)(D) of the Public 
        Health Service Act (42 U.S.C. 247b-12(a)(2)(D)).
            (2) Pregnancy-associated death.--The term ``pregnancy-
        associated'', with respect to a death, means a death of a 
        pregnant or postpartum individual, by any cause, that occurs 
        during, or within 1 year following, the individual's pregnancy, 
        regardless of the outcome, duration, or site of the pregnancy.
            (3) Pregnancy-related death.--The term ``pregnancy-
        related'', with respect to a death, means a death of a pregnant 
        or postpartum individual that occurs during, or within 1 year 
        following, the individual's pregnancy, from a pregnancy 
        complication, a chain of events initiated by pregnancy, or the 
        aggravation of an unrelated condition by the physiologic 
        effects of pregnancy.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section 
for fiscal years 2023 through 2026.

SEC. 1404. INDIAN HEALTH SERVICE STUDY ON MATERNAL MORTALITY AND SEVERE 
              MATERNAL MORBIDITY.

    (a) In General.--The Director of the Indian Health Service 
(referred to in this section as the ``Director'') shall, in 
coordination with entities described in subsection (b)--
            (1) not later than 90 days after the enactment of this Act, 
        enter into a contract with an independent research organization 
        or Tribal Epidemiology Center to conduct a comprehensive study 
        on maternal mortality and severe maternal morbidity in the 
        populations of American Indian and Alaska Native individuals; 
        and
            (2) not later than 3 years after the date of the enactment 
        of this Act, submit to Congress a report on such study that 
        contains recommendations for policies and practices that can be 
        adopted to improve maternal health outcomes for pregnant and 
        postpartum American Indian and Alaska Native individuals.
    (b) Participating Entities.--The entities described in this 
subsection shall consist of 12 members, selected by the Director from 
among individuals nominated by Indian tribes and tribal organizations 
(as such terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304)), and urban 
Indian organizations (as such term is defined in section 4 of the 
Indian Health Care Improvement Act (25 U.S.C. 1603)). In selecting such 
members, the Director shall ensure that each of the 12 service areas of 
the Indian Health Service is represented.
    (c) Contents of Study.--The study conducted pursuant to subsection 
(a) shall--
            (1) examine the causes of maternal mortality and severe 
        maternal morbidity that are unique to American Indian and 
        Alaska Native individuals;
            (2) include a systematic process of listening to the 
        stories of American Indian and Alaska Native pregnant and 
        postpartum individuals to fully understand the causes of, and 
        inform potential solutions to, the maternal mortality and 
        severe maternal morbidity crisis within their respective 
        communities;
            (3) distinguish between the causes of, landscape of 
        maternity care at, and recommendations to improve maternal 
        health outcomes within, the different settings in which 
        American Indian and Alaska Native pregnant and postpartum 
        individuals receive maternity care, such as--
                    (A) facilities operated by the Indian Health 
                Service;
                    (B) an Indian health program operated by an Indian 
                tribe or tribal organization pursuant to a contract, 
                grant, cooperative agreement, or compact with the 
                Indian Health Service pursuant to the Indian Self-
                Determination Act; and
                    (C) an urban Indian health program operated by an 
                urban Indian organization pursuant to a grant or 
                contract with the Indian Health Service pursuant to 
                title V of the Indian Health Care Improvement Act;
            (4) review processes for coordinating programs of the 
        Indian Health Service with social services provided through 
        other programs administered by the Secretary of Health and 
        Human Services (other than the Medicare program under title 
        XVIII of the Social Security Act, the Medicaid program under 
        title XIX of such Act, and the Children's Health Insurance 
        Program under title XXI of such Act), including coordination 
        with the efforts of the Task Force established under section 
        1403;
            (5) review current data collection and quality measurement 
        processes and practices;
            (6) assess causes and frequency of maternal mental health 
        conditions and substance use disorders;
            (7) consider social determinants of health, including 
        poverty, lack of health insurance, unemployment, sexual 
        violence, and environmental conditions in Tribal areas;
            (8) consider the role that historical mistreatment of 
        American Indian and Alaska Native women has played in causing 
        currently high rates of maternal mortality and severe maternal 
        morbidity;
            (9) consider how current funding of the Indian Health 
        Service affects the ability of the Service to deliver quality 
        maternity care;
            (10) consider the extent to which the delivery of maternity 
        care services is culturally appropriate for American Indian and 
        Alaska Native pregnant and postpartum individuals;
            (11) make recommendations to reduce misclassification of 
        American Indian and Alaska Native pregnant and postpartum 
        individuals, including consideration of best practices in 
        training for maternal mortality review committee members to be 
        able to correctly classify American Indian and Alaska Native 
        individuals; and
            (12) make recommendations informed by the stories shared by 
        American Indian and Alaska Native pregnant and postpartum 
        individuals in paragraph (2) to improve maternal health 
        outcomes for such individuals.
    (d) Report.--The agreement entered into under subsection (a) with 
an independent research organization or Tribal Epidemiology Center 
shall require that the organization or center transmit to Congress a 
report on the results of the study conducted pursuant to that agreement 
not later than 36 months after the date of the enactment of this Act.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,000,000 for each of fiscal 
years 2023 through 2025.

SEC. 1405. GRANTS TO MINORITY-SERVING INSTITUTIONS TO STUDY MATERNAL 
              MORTALITY, SEVERE MATERNAL MORBIDITY, AND OTHER ADVERSE 
              MATERNAL HEALTH OUTCOMES.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a program under which the Secretary shall award grants to 
research centers, health professions schools and programs, and other 
entities at minority-serving institutions to study specific aspects of 
the maternal health crisis among pregnant and postpartum individuals 
from racial and ethnic minority groups. Such research may--
            (1) include the development and implementation of 
        systematic processes of listening to the stories of pregnant 
        and postpartum individuals from racial and ethnic minority 
        groups, and perinatal health workers supporting such 
        individuals, to fully understand the causes of, and inform 
        potential solutions to, the maternal mortality and severe 
        maternal morbidity crisis within their respective communities;
            (2) assess the potential causes of relatively low rates of 
        maternal mortality among Hispanic individuals, including 
        potential racial misclassification and other data collection 
        and reporting issues that might be misrepresenting maternal 
        mortality rates among Hispanic individuals in the United 
        States; and
            (3) assess differences in rates of adverse maternal health 
        outcomes among subgroups identifying as Hispanic.
    (b) Application.--To be eligible to receive a grant under 
subsection (a), an entity described in such subsection shall submit to 
the Secretary an application at such time, in such manner, and 
containing such information as the Secretary may require.
    (c) Technical Assistance.--The Secretary may use not more than 10 
percent of the funds made available under subsection (f)--
            (1) to conduct outreach to minority-serving institutions to 
        raise awareness of the availability of grants under this 
        subsection (a);
            (2) to provide technical assistance in the application 
        process for such a grant; and
            (3) to promote capacity building as needed to enable 
        entities described in such subsection to submit such an 
        application.
    (d) Reporting Requirement.--Each entity awarded a grant under this 
section shall periodically submit to the Secretary a report on the 
status of activities conducted using the grant.
    (e) Evaluation.--Beginning one year after the date on which the 
first grant is awarded under this section, the Secretary shall submit 
to Congress an annual report summarizing the findings of research 
conducted using funds made available under this section.
    (f) Minority-Serving Institutions Defined.--In this section, the 
term ``minority-serving institution'' has the meaning given the term in 
section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 
1067q(a)).
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2023 through 2027.

                        Subtitle F--Moms Matter

SEC. 1501. MATERNAL MENTAL HEALTH EQUITY GRANT PROGRAM.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Assistant Secretary for Mental Health and Substance Use, 
shall establish a program to award grants to eligible entities to 
address maternal mental health conditions and substance use disorders 
with respect to pregnant and postpartum individuals, with a focus on 
racial and ethnic minority groups.
    (b) Application.--To be eligible to receive a grant under this 
section an eligible entity shall submit to the Secretary an application 
at such time, in such manner, and containing such information as the 
Secretary may provide, including how such entity will use funds for 
activities described in subsection (d) that are culturally congruent.
    (c) Priority.--In awarding grants under this section, the Secretary 
shall give priority to an eligible entity that--
            (1) is, or will partner with, a community-based 
        organization to address maternal mental health conditions and 
        substance use disorders described in subsection (a);
            (2) is operating in an area with high rates of--
                    (A) adverse maternal health outcomes; or
                    (B) significant racial or ethnic disparities in 
                maternal health outcomes; and
            (3) is operating in a health professional shortage area 
        designated under section 332 of the Public Health Service Act 
        (42 U.S.C. 254e).
    (d) Use of Funds.--An eligible entity that receives a grant under 
this section shall use funds for the following:
            (1) Establishing or expanding maternity care programs to 
        improve the integration of maternal health and behavioral 
        health care services into primary care settings where pregnant 
        individuals regularly receive health care services.
            (2) Establishing or expanding group prenatal care programs 
        or postpartum care programs.
            (3) Expanding existing programs that improve maternal 
        mental and behavioral health during the prenatal and postpartum 
        periods, with a focus on individuals from racial and ethnic 
        minority groups.
            (4) Providing services and support for pregnant and 
        postpartum individuals with maternal mental health conditions 
        and substance use disorders, including referrals to addiction 
        treatment centers that offer evidence-based treatment options.
            (5) Addressing stigma associated with maternal mental 
        health conditions and substance use disorders, with a focus on 
        racial and ethnic minority groups.
            (6) Raising awareness of warning signs of maternal mental 
        health conditions and substance use disorders, with a focus on 
        pregnant and postpartum individuals from racial and ethnic 
        minority groups.
            (7) Establishing or expanding programs to prevent suicide 
        or self-harm among pregnant and postpartum individuals.
            (8) Offering evidence-aligned programs at freestanding 
        birth centers that provide maternal mental and behavioral 
        health care education, treatments, and services, and other 
        services for individuals throughout the prenatal and postpartum 
        period.
            (9) Establishing or expanding programs to provide education 
        and training to maternity care providers with respect to--
                    (A) identifying potential warning signs for 
                maternal mental health conditions or substance use 
                disorders in pregnant and postpartum individuals, with 
                a focus on individuals from racial and ethnic minority 
                groups; and
                    (B) in the case where such providers identify such 
                warning signs, offering referrals to mental and 
                behavioral health care professionals.
            (10) Developing a website, or other source, that includes 
        information on health care providers who treat maternal mental 
        health conditions and substance use disorders.
            (11) Establishing or expanding programs in communities to 
        improve coordination between maternity care providers and 
        mental and behavioral health care providers who treat maternal 
        mental health conditions and substance use disorders, including 
        through the use of toll-free hotlines.
            (12) Carrying out other programs aligned with evidence-
        based practices for addressing maternal mental health 
        conditions and substance use disorders for pregnant and 
        postpartum individuals from racial and ethnic minority groups.
    (e) Reporting.--
            (1) Eligible entities.--An eligible entity that receives a 
        grant under subsection (a) shall submit annually to the 
        Secretary, and make publicly available, a report on the 
        activities conducted using funds received through a grant under 
        this section. Such reports shall include quantitative and 
        qualitative evaluations of such activities, including the 
        experience of individuals who received health care through such 
        grant.
            (2) Secretary.--Not later than the end of fiscal year 2025, 
        the Secretary shall submit to Congress a report that includes--
                    (A) a summary of the reports received under 
                paragraph (1);
                    (B) an evaluation of the effectiveness of grants 
                awarded under this section;
                    (C) recommendations with respect to expanding 
                coverage of evidence-based screenings and treatments 
                for maternal mental health conditions and substance use 
                disorders; and
                    (D) recommendations with respect to ensuring 
                activities described under subsection (d) continue 
                after the end of a grant period.
    (f) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) a community-based organization serving pregnant 
                and postpartum individuals, including such 
                organizations serving individuals from racial and 
                ethnic minority groups and other underserved 
                populations;
                    (B) a nonprofit or patient advocacy organization 
                with expertise in maternal mental and behavioral 
                health;
                    (C) a maternity care provider;
                    (D) a mental or behavioral health care provider who 
                treats maternal mental health conditions or substance 
                use disorders;
                    (E) a State or local governmental entity, including 
                a State or local public health department;
                    (F) an Indian Tribe or Tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304)); and
                    (G) an Urban Indian organization (as such term is 
                defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)).
            (2) Freestanding birth center.--The term ``freestanding 
        birth center'' has the meaning given that term under section 
        1905(l) of the Social Security Act (42 U.S.C. 1396d(1)).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $25,000,000 for each of fiscal 
years 2023 through 2026.

SEC. 1502. GRANTS TO GROW AND DIVERSIFY THE MATERNAL MENTAL AND 
              BEHAVIORAL HEALTH CARE WORKFORCE.

    Title VII of the Public Health Service Act (42 U.S.C. 292 et seq.) 
is amended by inserting after section 758 of such Act, as added by 
section 1302 of this title, the following new section:

``SEC. 758A. MATERNAL MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE 
              GRANTS.

    ``(a) In General.--The Secretary may award grants to entities to 
establish or expand programs described in subsection (b) to grow and 
diversify the maternal mental and behavioral health care workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the maternal mental and behavioral 
health care workforce by--
            ``(1) establishing schools or programs that provide 
        education and training to individuals seeking appropriate 
        licensing or certification as mental or behavioral health care 
        providers who will specialize in maternal mental health 
        conditions or substance use disorders; or
            ``(2) expanding the capacity of existing schools or 
        programs described in paragraph (1), for the purposes of 
        increasing the number of students enrolled in such schools or 
        programs, including by awarding scholarships for students.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any entity that--
            ``(1) has demonstrated a commitment to recruiting and 
        retaining students and faculty from racial and ethnic minority 
        groups;
            ``(2) has developed a strategy to recruit and retain a 
        diverse pool of students into the maternal mental or behavioral 
        health care workforce program or school supported by funds 
        received through the grant, particularly from racial and ethnic 
        minority groups and other underserved populations;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in a health professional shortage 
        area designated under section 332;
            ``(4) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic disparities in maternal health outcomes, to 
        the extent practicable; and
            ``(5) includes in the standard curriculum for all students 
        within the maternal mental or behavioral health care workforce 
        program or school a bias, racism, or discrimination training 
        program that includes training on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section for a maternal mental or behavioral health care workforce 
program or school, an entity shall agree to submit to the Secretary an 
annual report on the activities conducted through the grant, 
including--
            ``(1) the number and demographics of students participating 
        in the program or school;
            ``(2) the extent to which students in the program or school 
        are entering careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                disparities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the program or school has included in the 
        standard curriculum for all students a bias, racism, or 
        discrimination training program that includes training on 
        implicit bias and racism, and if so the effectiveness of such 
        training program.
    ``(e) Period of Grants.--The period of a grant under this section 
shall be up to 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to entities seeking or receiving a 
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the maternal mental or behavioral health 
care workforce programs or schools proposed to be, or being, 
established or expanded through the grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups and other underserved populations;
            ``(2) increasing the number of mental or behavioral health 
        care providers specializing in maternal mental health 
        conditions or substance use disorders from racial and ethnic 
        minority groups and other underserved populations;
            ``(3) increasing the number of mental or behavioral health 
        care providers specializing in maternal mental health 
        conditions or substance use disorders working in health 
        professional shortage areas designated under section 332; and
            ``(4) increasing the number of mental or behavioral health 
        care providers specializing in maternal mental health 
        conditions or substance use disorders working in areas with 
        significant racial and ethnic disparities in maternal health 
        outcomes, to the extent such data are available.
    ``(i) Definitions.--In this section:
            ``(1) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' has the meaning given such term in 
        section 1707(g)(1).
            ``(2) Mental or behavioral health care provider.--The term 
        `mental or behavioral health care provider' refers to a health 
        care provider in the field of mental and behavioral health, 
        including substance use disorders, acting in accordance with 
        State law.
    ``(j) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2023 through 2027.''.

               Subtitle G--Justice for Incarcerated Moms

SEC. 1601. ENDING THE SHACKLING OF PREGNANT INDIVIDUALS.

    (a) In General.--Beginning on the date that is 6 months after the 
date of enactment of this Act, and annually thereafter, in 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 (34 U.S.C. 10151 et 
seq.) (commonly referred to as the ``Edward Byrne Memorial Justice 
Grant Program'') and that does not have in effect throughout the State 
for such fiscal year laws restricting the use of restraints on pregnant 
individuals in prison that are substantially similar to the rights, 
procedures, requirements, effects, and penalties set forth in section 
4322 of title 18, United States Code, the amount of such grant that 
would otherwise be allocated to such State under such subpart for the 
fiscal year shall be decreased by 25 percent.
    (b) Reallocation.--Amounts not allocated to a State for failure to 
comply with subsection (a) shall be reallocated in accordance with 
subpart 1 of part E of title I of the Omnibus Crime Control and Safe 
Streets Act of 1968 (34 U.S.C. 10151 et seq.) to States that have 
complied with such subsection.

SEC. 1602. CREATING MODEL PROGRAMS FOR THE CARE OF INCARCERATED 
              INDIVIDUALS IN THE PRENATAL AND POSTPARTUM PERIODS.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Attorney General, acting through the Director of the 
Bureau of Prisons, shall establish, in not fewer than 6 Bureau of 
Prisons facilities, programs to optimize maternal health outcomes for 
pregnant and postpartum individuals incarcerated in such facilities. 
The Attorney General shall establish such programs in consultation with 
stakeholders such as--
            (1) relevant community-based organizations, particularly 
        organizations that represent incarcerated and formerly 
        incarcerated individuals and organizations that seek to improve 
        maternal health outcomes for pregnant and postpartum 
        individuals from racial and ethnic minority groups;
            (2) relevant organizations representing patients, with a 
        particular focus on patients from racial and ethnic minority 
        groups;
            (3) organizations representing maternity care providers and 
        maternal health care education programs;
            (4) perinatal health workers; and
            (5) researchers and policy experts in fields related to 
        maternal health care for incarcerated individuals.
    (b) Start Date.--Each selected facility shall begin facility 
programs not later than 18 months after the date of enactment of this 
Act.
    (c) Facility Priority.--In carrying out subsection (a), the 
Director shall give priority to a facility based on--
            (1) the number of pregnant and postpartum individuals 
        incarcerated in such facility and, among such individuals, the 
        number of pregnant and postpartum individuals from racial and 
        ethnic minority groups; and
            (2) the extent to which the leaders of such facility have 
        demonstrated a commitment to developing exemplary programs for 
        pregnant and postpartum individuals incarcerated in such 
        facility.
    (d) Program Duration.--The programs established under this section 
shall be for a 5-year period.
    (e) Programs.--Bureau of Prisons facilities selected by the 
Director shall establish programs for pregnant and postpartum 
incarcerated individuals, and such programs may--
            (1) provide access to perinatal health workers from 
        pregnancy through the postpartum period;
            (2) provide access to healthy foods and counseling on 
        nutrition, recommended activity levels, and safety measures 
        throughout pregnancy;
            (3) train correctional officers to ensure that pregnant 
        incarcerated individuals receive safe and respectful treatment;
            (4) train medical personnel to ensure that pregnant 
        incarcerated individuals receive trauma-informed, culturally 
        congruent care that promotes the health and safety of the 
        pregnant individuals;
            (5) provide counseling and treatment for individuals who 
        have suffered from--
                    (A) diagnosed mental or behavioral health 
                conditions, including trauma and substance use 
                disorders;
                    (B) trauma or violence, including domestic 
                violence;
                    (C) human immunodeficiency virus;
                    (D) sexual abuse;
                    (E) pregnancy or infant loss; or
                    (F) chronic conditions;
            (6) provide evidence-based pregnancy and childbirth 
        education, parenting support, and other relevant forms of 
        health literacy;
            (7) provide clinical education opportunities to maternity 
        care providers in training to expand pathways into maternal 
        health care careers serving incarcerated individuals;
            (8) offer opportunities for postpartum individuals to 
        maintain contact with the individual's newborn child to promote 
        bonding, including enhanced visitation policies, access to 
        prison nursery programs, or breastfeeding support;
            (9) provide reentry assistance, particularly to--
                    (A) ensure access to health insurance coverage and 
                transfer of health records to community providers if an 
                incarcerated individual exits the criminal justice 
                system during such individual's pregnancy or in the 
                postpartum period; and
                    (B) connect individuals exiting the criminal 
                justice system during pregnancy or in the postpartum 
                period to community-based resources, such as referrals 
                to health care providers, substance use disorder 
                treatments, and social services that address social 
                determinants maternal of health; or
            (10) establish partnerships with local public entities, 
        private community entities, community-based organizations, 
        Indian Tribes and tribal organizations (as such terms are 
        defined in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 5304)), and urban Indian 
        organizations (as such term is defined in section 4 of the 
        Indian Health Care Improvement Act (25 U.S.C. 1603)) to 
        establish or expand pretrial diversion programs as an 
        alternative to incarceration for pregnant and postpartum 
        individuals. Such programs may include--
                    (A) evidence-based childbirth education or 
                parenting classes;
                    (B) prenatal health coordination;
                    (C) family and individual counseling;
                    (D) evidence-based screenings, education, and, as 
                needed, treatment for mental and behavioral health 
                conditions, including drug and alcohol treatments;
                    (E) family case management services;
                    (F) domestic violence education and prevention;
                    (G) physical and sexual abuse counseling; and
                    (H) programs to address social determinants of 
                health such as employment, housing, education, 
                transportation, and nutrition.
    (f) Implementation and Reporting.--A selected facility shall be 
responsible for--
            (1) implementing programs, which may include the programs 
        described in subsection (e); and
            (2) not later than 3 years after the date of enactment of 
        this Act, and 6 years after the date of enactment of this Act, 
        reporting results of the programs to the Director, including 
        information describing--
                    (A) relevant quantitative indicators of success in 
                improving the standard of care and health outcomes for 
                pregnant and postpartum incarcerated individuals in the 
                facility, including data stratified by race, ethnicity, 
                sex, gender, age, geography, disability status, the 
                category of the criminal charge against such 
                individual, rates of pregnancy-related deaths, 
                pregnancy-associated deaths, cases of infant mortality 
                and morbidity, rates of preterm births and low-
                birthweight births, cases of severe maternal morbidity, 
                cases of violence against pregnant or postpartum 
                individuals, diagnoses of maternal mental or behavioral 
                health conditions, and other such information as 
                appropriate;
                    (B) relevant qualitative and quantitative 
                evaluations from pregnant and postpartum incarcerated 
                individuals who participated in such programs, 
                including measures of patient-reported experience of 
                care; and
                    (C) strategies to sustain such programs after 
                fiscal year 2027 and expand such programs to other 
                facilities.
    (g) Report.--Not later than 6 years after the date of enactment of 
this Act, the Director shall submit to the Attorney General and to the 
Congress a report describing the results of the programs funded under 
this section.
    (h) Oversight.--Not later than 1 year after the date of enactment 
of this Act, the Attorney General shall award a contract to an 
independent organization or independent organizations to conduct 
oversight of the programs described in subsection (e).
    (i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2023 through 2027.

SEC. 1603. GRANT PROGRAM TO IMPROVE MATERNAL HEALTH OUTCOMES FOR 
              INDIVIDUALS IN STATE AND LOCAL PRISONS AND JAILS.

    (a) Establishment.--Not later than 1 year after the date of 
enactment of this Act, the Attorney General, acting through the 
Director of the Bureau of Justice Assistance, shall award Justice for 
Incarcerated Moms grants to States to establish or expand programs in 
State and local prisons and jails for pregnant and postpartum 
incarcerated individuals. The Attorney General shall award such grants 
in consultation with stakeholders such as--
            (1) relevant community-based organizations, particularly 
        organizations that represent incarcerated and formerly 
        incarcerated individuals and organizations that seek to improve 
        maternal health outcomes for pregnant and postpartum 
        individuals from racial and ethnic minority groups;
            (2) relevant organizations representing patients, with a 
        particular focus on patients from racial and ethnic minority 
        groups;
            (3) organizations representing maternity care providers and 
        maternal health care education programs;
            (4) perinatal health workers; and
            (5) researchers and policy experts in fields related to 
        maternal health care for incarcerated individuals.
    (b) Applications.--Each applicant for a grant under this section 
shall submit to the Director of the Bureau of Justice Assistance an 
application at such time, in such manner, and containing such 
information as the Director may require.
    (c) Use of Funds.--A State that is awarded a grant under this 
section shall use such grant to establish or expand programs for 
pregnant and postpartum incarcerated individuals, and such programs 
may--
            (1) provide access to perinatal health workers from 
        pregnancy through the postpartum period;
            (2) provide access to healthy foods and counseling on 
        nutrition, recommended activity levels, and safety measures 
        throughout pregnancy;
            (3) train correctional officers to ensure that pregnant 
        incarcerated individuals receive safe and respectful treatment;
            (4) train medical personnel to ensure that pregnant 
        incarcerated individuals receive trauma-informed, culturally 
        congruent care that promotes the health and safety of the 
        pregnant individuals;
            (5) provide counseling and treatment for individuals who 
        have suffered from--
                    (A) diagnosed mental or behavioral health 
                conditions, including trauma and substance use 
                disorders;
                    (B) trauma or violence, including domestic 
                violence;
                    (C) human immunodeficiency virus;
                    (D) sexual abuse;
                    (E) pregnancy or infant loss; or
                    (F) chronic conditions;
            (6) provide evidence-based pregnancy and childbirth 
        education, parenting support, and other relevant forms of 
        health literacy;
            (7) provide clinical education opportunities to maternity 
        care providers in training to expand pathways into maternal 
        health care careers serving incarcerated individuals;
            (8) offer opportunities for postpartum individuals to 
        maintain contact with the individual's newborn child to promote 
        bonding, including enhanced visitation policies, access to 
        prison nursery programs, or breastfeeding support;
            (9) provide reentry assistance, particularly to--
                    (A) ensure access to health insurance coverage and 
                transfer of health records to community providers if an 
                incarcerated individual exits the criminal justice 
                system during such individual's pregnancy or in the 
                postpartum period; and
                    (B) connect individuals exiting the criminal 
                justice system during pregnancy or in the postpartum 
                period to community-based resources, such as referrals 
                to health care providers, substance use disorder 
                treatments, and social services that address social 
                determinants of maternal health; or
            (10) establish partnerships with local public entities, 
        private community entities, community-based organizations, 
        Indian Tribes and tribal organizations (as such terms are 
        defined in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 5304)), and urban Indian 
        organizations (as such term is defined in section 4 of the 
        Indian Health Care Improvement Act (25 U.S.C. 1603)) to 
        establish or expand pretrial diversion programs as an 
        alternative to incarceration for pregnant and postpartum 
        individuals. Such programs may include--
                    (A) evidence-based childbirth education or 
                parenting classes;
                    (B) prenatal health coordination;
                    (C) family and individual counseling;
                    (D) evidence-based screenings, education, and, as 
                needed, treatment for mental and behavioral health 
                conditions, including drug and alcohol treatments;
                    (E) family case management services;
                    (F) domestic violence education and prevention;
                    (G) physical and sexual abuse counseling; and
                    (H) programs to address social determinants of 
                health such as employment, housing, education, 
                transportation, and nutrition.
    (d) Priority.--In awarding grants under this section, the Director 
of the Bureau of Justice Assistance shall give priority to applicants 
based on--
            (1) the number of pregnant and postpartum individuals 
        incarcerated in the State and, among such individuals, the 
        number of pregnant and postpartum individuals from racial and 
        ethnic minority groups; and
            (2) the extent to which the State has demonstrated a 
        commitment to developing exemplary programs for pregnant and 
        postpartum individuals incarcerated in the prisons and jails in 
        the State.
    (e) Grant Duration.--A grant awarded under this section shall be 
for a 5-year period.
    (f) Implementing and Reporting.--A State that receives a grant 
under this section shall be responsible for--
            (1) implementing the program funded by the grant; and
            (2) not later than 3 years after the date of enactment of 
        this Act, and 6 years after the date of enactment of this Act, 
        reporting results of such program to the Attorney General, 
        including information describing--
                    (A) relevant quantitative indicators of the 
                program's success in improving the standard of care and 
                health outcomes for pregnant and postpartum 
                incarcerated individuals in the facility, including 
                data stratified by race, ethnicity, sex, gender, age, 
                geography, disability status, category of the criminal 
                charge against such individual, incidence rates of 
                pregnancy-related deaths, pregnancy-associated deaths, 
                cases of infant mortality and morbidity, rates of 
                preterm births and low-birthweight births, cases of 
                severe maternal morbidity, cases of violence against 
                pregnant or postpartum individuals, diagnoses of 
                maternal mental or behavioral health conditions, and 
                other such information as appropriate;
                    (B) relevant qualitative and quantitative 
                evaluations from pregnant and postpartum incarcerated 
                individuals who participated in such programs, 
                including measures of patient-reported experience of 
                care; and
                    (C) strategies to sustain such programs beyond the 
                duration of the grant and expand such programs to other 
                facilities.
    (g) Report.--Not later than 6 years after the date of enactment of 
this Act, the Attorney General shall submit to the Congress a report 
describing the results of such grant programs.
    (h) Oversight.--Not later than 1 year after the date of enactment 
of this Act, the Attorney General shall award a contract to an 
independent organization or independent organizations to conduct 
oversight of the programs described in subsection (c).
    (i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2023 through 2027.

SEC. 1604. GAO REPORT.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Comptroller General of the United States shall submit 
to Congress a report on adverse maternal and infant health outcomes 
among incarcerated individuals and infants born to such individuals, 
with a particular focus on racial and ethnic disparities in maternal 
and infant health outcomes for incarcerated individuals.
    (b) Contents of Report.--The report described in this section shall 
include--
            (1) to the extent practicable--
                    (A) the number of pregnant individuals who are 
                incarcerated in Bureau of Prisons facilities;
                    (B) the number of incarcerated individuals, 
                including those incarcerated in Federal, State, and 
                local correctional facilities, who have experienced a 
                pregnancy-related death, pregnancy-associated death, or 
                the death of an infant in the most recent 10 years of 
                available data;
                    (C) the number of cases of severe maternal 
                morbidity among incarcerated individuals, including 
                those incarcerated in Federal, State, and local 
                detention facilities, in the most recent 10 years of 
                available data;
                    (D) the number of preterm and low-birthweight 
                births of infants born to incarcerated individuals, 
                including those incarcerated in Federal, State, and 
                local correctional facilities, in the most recent 10 
                years of available data; and
                    (E) statistics on the racial and ethnic disparities 
                in maternal and infant health outcomes and severe 
                maternal morbidity rates among incarcerated 
                individuals, including those incarcerated in Federal, 
                State, and local detention facilities;
            (2) in the case that the Comptroller General of the United 
        States is unable determine the information required in 
        subparagraphs (A) through (C) of paragraph (1), an assessment 
        of the barriers to determining such information and 
        recommendations for improvements in tracking maternal health 
        outcomes among incarcerated individuals, including those 
        incarcerated in Federal, State, and local detention facilities;
            (3) causes of adverse maternal health outcomes that are 
        unique to incarcerated individuals, including those 
        incarcerated in Federal, State, and local detention facilities;
            (4) causes of adverse maternal health outcomes and severe 
        maternal morbidity that are unique to incarcerated individuals 
        from racial and ethnic minority groups;
            (5) recommendations to reduce maternal mortality and severe 
        maternal morbidity among incarcerated individuals and to 
        address racial and ethnic disparities in maternal health 
        outcomes for incarcerated individuals in Bureau of Prisons 
        facilities and State and local prisons and jails; and
            (6) such other information as may be appropriate to reduce 
        the occurrence of adverse maternal health outcomes among 
        incarcerated individuals and to address racial and ethnic 
        disparities in maternal health outcomes for such individuals.

SEC. 1605. MACPAC REPORT.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Medicaid and CHIP Payment and Access Commission 
(referred to in this section as ``MACPAC'') shall publish a report on 
the implications of pregnant and postpartum incarcerated individuals 
being ineligible for medical assistance under a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) that contains 
the information described in subsection.
    (b) Information Described.--For purposes of subsection (a), the 
information described in this subsection includes--
            (1) information on the effect of ineligibility for medical 
        assistance under a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) on maternal health 
        outcomes for pregnant and postpartum incarcerated individuals, 
        concentrating on the effects of such ineligibility for pregnant 
        and postpartum individuals from racial and ethnic minority 
        groups; and
            (2) the potential implications on maternal health outcomes 
        resulting from suspending eligibility for medical assistance 
        under a State plan under such title of such Act when a pregnant 
        or postpartum individual is incarcerated.

                     Subtitle H--Tech to Save Moms

SEC. 1701. INTEGRATED TELEHEALTH MODELS IN MATERNITY CARE SERVICES.

    (a) In General.--Section 1115A(b)(2)(B) of the Social Security Act 
(42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the 
following:
                            ``(xxviii) Focusing on title XIX, providing 
                        for the adoption of and use of telehealth tools 
                        that allow for screening, monitoring, and 
                        management of common health complications with 
                        respect to an individual receiving medical 
                        assistance during such individual's pregnancy 
                        and for not more than a 1-year period beginning 
                        on the last day of the pregnancy.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect 1 year after the date of the enactment of this Act.

SEC. 1702. GRANTS TO EXPAND THE USE OF TECHNOLOGY-ENABLED COLLABORATIVE 
              LEARNING AND CAPACITY MODELS FOR PREGNANT AND POSTPARTUM 
              INDIVIDUALS.

    Title III of the Public Health Service Act is amended by inserting 
after section 330P (42 U.S.C. 254c-22) the following:

``SEC. 330Q. EXPANDING CAPACITY FOR MATERNAL HEALTH OUTCOMES.

    ``(a) Establishment.--Beginning not later than 1 year after the 
date of enactment of this section, the Secretary shall award grants to 
eligible entities to evaluate, develop, and expand the use of 
technology-enabled collaborative learning and capacity building models 
and improve maternal health outcomes--
            ``(1) in health professional shortage areas;
            ``(2) in areas with high rates of maternal mortality and 
        severe maternal morbidity;
            ``(3) in areas with significant racial and ethnic 
        disparities in maternal health outcomes; and
            ``(4) for medically underserved populations and American 
        Indians and Alaska Natives, including Indian Tribes, Tribal 
        organizations, and Urban Indian organizations.
    ``(b) Use of Funds.--
            ``(1) Required uses.--Recipients of grants under this 
        section shall use the grants to--
                    ``(A) train maternal health care providers, 
                students, and other similar professionals through 
                models that include--
                            ``(i) methods to increase safety and health 
                        care quality;
                            ``(ii) implicit bias, racism, and 
                        discrimination;
                            ``(iii) best practices in screening for 
                        and, as needed, evaluating and treating 
                        maternal mental health conditions and substance 
                        use disorders;
                            ``(iv) training on best practices in 
                        maternity care for pregnant and postpartum 
                        individuals during the COVID-19 public health 
                        emergency or future public health emergencies;
                            ``(v) methods to screen for social 
                        determinants of maternal health risks in the 
                        prenatal and postpartum; and
                            ``(vi) the use of remote patient monitoring 
                        tools for pregnancy-related complications 
                        described in section 1115A(b)(2)(B)(xxviii);
                    ``(B) evaluate and collect information on the 
                effect of such models on--
                            ``(i) access to and quality of care;
                            ``(ii) outcomes with respect to the health 
                        of an individual; and
                            ``(iii) the experience of individuals who 
                        receive pregnancy-related health care;
                    ``(C) develop qualitative and quantitative measures 
                to identify best practices for the expansion and use of 
                such models;
                    ``(D) study the effect of such models on patient 
                outcomes and maternity care providers; and
                    ``(E) conduct any other activity determined by the 
                Secretary.
            ``(2) Permissible uses.--Recipients of grants under this 
        section may use grants to support--
                    ``(A) the use and expansion of technology-enabled 
                collaborative learning and capacity building models, 
                including hardware and software that--
                            ``(i) enables distance learning and 
                        technical support; and
                            ``(ii) supports the secure exchange of 
                        electronic health information; and
                    ``(B) maternity care providers, students, and other 
                similar professionals in the provision of maternity 
                care through such models.
    ``(c) Application.--
            ``(1) In general.--An eligible entity seeking a grant under 
        subsection (a) shall submit to the Secretary an application, at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            ``(2) Assurance.--An application under paragraph (1) shall 
        include an assurance that such entity shall collect information 
        on and assess the effect of the use of technology-enabled 
        collaborative learning and capacity building models, including 
        with respect to--
                    ``(A) maternal health outcomes;
                    ``(B) access to maternal health care services;
                    ``(C) quality of maternal health care; and
                    ``(D) retention of maternity care providers serving 
                areas and populations described in subsection (a).
    ``(d) Limitations.--
            ``(1) Number.--The Secretary may not award more than 1 
        grant under this section.
            ``(2) Duration.--A grant awarded under this section shall 
        be for a 5-year period.
    ``(e) Access to Broadband.--In administering grants under this 
section, the Secretary may coordinate with other agencies to ensure 
that funding opportunities are available to support access to reliable, 
high-speed internet for grantees.
    ``(f) Technical Assistance.--The Secretary shall provide (either 
directly or by contract) technical assistance to eligible entities, 
including recipients of grants under subsection (a), on the 
development, use, and sustainability of technology-enabled 
collaborative learning and capacity building models to expand access to 
maternal health care services provided by such entities, including--
            ``(1) in health professional shortage areas;
            ``(2) in areas with high rates of maternal mortality and 
        severe maternal morbidity or significant racial and ethnic 
        disparities in maternal health outcomes; and
            ``(3) for medically underserved populations or American 
        Indians and Alaska Natives.
    ``(g) Research and Evaluation.--The Secretary, in consultation with 
experts, shall develop a strategic plan to research and evaluate the 
evidence for such models.
    ``(h) Reporting.--
            ``(1) Eligible entities.--An eligible entity that receives 
        a grant under subsection (a) shall submit to the Secretary a 
        report, at such time, in such manner, and containing such 
        information as the Secretary may require.
            ``(2) Secretary.--Not later than 4 years after the date of 
        enactment of this section, the Secretary shall submit to the 
        Congress, and make available on the website of the Department 
        of Health and Human Services, a report that includes--
                    ``(A) a description of grants awarded under 
                subsection (a) and the purpose and amounts of such 
                grants;
                    ``(B) a summary of--
                            ``(i) the evaluations conducted under 
                        subsection (b)(B);
                            ``(ii) any technical assistance provided 
                        under subsection (g); and
                            ``(iii) the activities conducted under 
                        subsection (a); and
                    ``(C) a description of any significant findings 
                with respect to--
                            ``(i) patient outcomes; and
                            ``(ii) best practices for expanding, using, 
                        or evaluating technology-enabled collaborative 
                        learning and capacity building models.
    ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $6,000,000 for each of fiscal 
years 2023 through 2027.
    ``(j) Definitions.--In this section:
            ``(1) Eligible entity.--
                    ``(A) In general.--The term `eligible entity' means 
                an entity that provides, or supports the provision of, 
                maternal health care services or other evidence-based 
                services for pregnant and postpartum individuals--
                            ``(i) in health professional shortage 
                        areas;
                            ``(ii) in areas with high rates of adverse 
                        maternal health outcomes or significant racial 
                        and ethnic disparities in maternal health 
                        outcomes; and
                            ``(iii) who are--
                                    ``(I) members of medically 
                                underserved populations; or
                                    ``(II) American Indians and Alaska 
                                Natives, including Indian Tribes, 
                                Tribal organizations, and urban Indian 
                                organizations.
                    ``(B) Inclusions.--An eligible entity may include 
                entities that lead, or are capable of leading a 
                technology-enabled collaborative learning and capacity 
                building model.
            ``(2) Health professional shortage area.--The term `health 
        professional shortage area' means a health professional 
        shortage area designated under section 332.
            ``(3) Indian tribe.--The term `Indian Tribe' has the 
        meaning given such term in section 4 of the Indian Self-
        Determination and Education Assistance Act.
            ``(4) Maternal mortality.--The term `maternal mortality' 
        means a death occurring during or within 1-year period after 
        pregnancy caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy or childbirth 
        complications.
            ``(5) Medically underserved population.--The term 
        `medically underserved population' has the meaning given such 
        term in section 330(b)(3).
            ``(6) Postpartum.--The term `postpartum' means the 1-year 
        period beginning on the last date of an individual's pregnancy.
            ``(7) Severe maternal morbidity.--The term `severe maternal 
        morbidity' means a health condition, including a mental health 
        or substance use disorder, attributed to or aggravated by 
        pregnancy or childbirth that results in significant short-term 
        or long-term consequences to the health of the individual who 
        was pregnant.
            ``(8) Technology-enabled collaborative learning and 
        capacity building model.--The term `technology-enabled 
        collaborative learning and capacity building model' means a 
        distance health education model that connects health care 
        professionals, and other specialists, through simultaneous 
        interactive videoconferencing for the purpose of facilitating 
        case-based learning, disseminating best practices, and 
        evaluating outcomes in the context of maternal health care.
            ``(9) Tribal organization.--The term `Tribal organization' 
        has the meaning given such term in section 4 of the Indian 
        Self-Determination and Education Assistance Act.
            ``(10) Urban indian organization.--The term `urban Indian 
        organization' has the meaning given such term in section 4 of 
        the Indian Health Care Improvement Act.''.

SEC. 1703. GRANTS TO PROMOTE EQUITY IN MATERNAL HEALTH OUTCOMES THROUGH 
              DIGITAL TOOLS.

    (a) In General.--Beginning not later than 1 year after the date of 
the enactment of this Act, the Secretary of Health and Human Services 
shall make grants to eligible entities to reduce racial and ethnic 
disparities in maternal health outcomes by increasing access to digital 
tools related to maternal health care.
    (b) Applications.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require.
    (c) Prioritization.--In awarding grants under this section, the 
Secretary shall prioritize an eligible entity--
            (1) in an area with high rates of adverse maternal health 
        outcomes or significant racial and ethnic disparities in 
        maternal health outcomes;
            (2) in a health professional shortage area designated under 
        section 332 of the Public Health Service Act (42 U.S.C. 254e); 
        and
            (3) that promotes technology that addresses racial and 
        ethnic disparities in maternal health outcomes.
    (d) Limitations.--
            (1) Number.--The Secretary may award not more than 1 grant 
        under this section.
            (2) Duration.--A grant awarded under this section shall be 
        for a 5-year period.
    (e) Technical Assistance.--The Secretary shall provide technical 
assistance to an eligible entity on the development, use, evaluation, 
and post-grant sustainability of digital tools for purposes of 
promoting equity in maternal health outcomes.
    (f) Reporting.--
            (1) Eligible entities.--An eligible entity that receives a 
        grant under subsection (a) shall submit to the Secretary a 
        report, at such time, in such manner, and containing such 
        information as the Secretary may require.
            (2) Secretary.--Not later than 4 years after the date of 
        the enactment of this Act, the Secretary shall submit to 
        Congress a report that includes--
                    (A) an evaluation on the effectiveness of grants 
                awarded under this section to improve health outcomes 
                for pregnant and postpartum individuals from racial and 
                ethnic minority groups;
                    (B) recommendations on new grant programs that 
                promote the use of technology to improve such maternal 
                health outcomes; and
                    (C) recommendations with respect to--
                            (i) technology-based privacy and security 
                        safeguards in maternal health care;
                            (ii) reimbursement rates for maternal 
                        telehealth services;
                            (iii) the use of digital tools to analyze 
                        large data sets to identify potential 
                        pregnancy-related complications;
                            (iv) barriers that prevent maternity care 
                        providers from providing telehealth services 
                        across States;
                            (v) the use of consumer digital tools such 
                        as mobile phone applications, patient portals, 
                        and wearable technologies to improve maternal 
                        health outcomes;
                            (vi) barriers that prevent access to 
                        telehealth services, including a lack of access 
                        to reliable, high-speed internet or electronic 
                        devices;
                            (vii) barriers to data sharing between the 
                        Special Supplemental Nutrition Program for 
                        Women, Infants, and Children program and 
                        maternity care providers, and recommendations 
                        for addressing such barriers; and
                            (viii) lessons learned from expanded access 
                        to telehealth related to maternity care during 
                        the COVID-19 public health emergency.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $6,000,000 for each of fiscal 
years 2023 through 2027.

SEC. 1704. REPORT ON THE USE OF TECHNOLOGY IN MATERNITY CARE.

    (a) In General.--Not later than 60 days after the date of enactment 
of this Act, the Secretary of Health and Human Services shall seek to 
enter an agreement with the National Academies of Sciences, 
Engineering, and Medicine (referred to in this title as the ``National 
Academies'') under which the National Academies shall conduct a study 
on the use of technology and patient monitoring devices in maternity 
care.
    (b) Content.--The agreement entered into pursuant to subsection (a) 
shall provide for the study of the following:
            (1) The use of innovative technology (including artificial 
        intelligence) in maternal health care, including the extent to 
        which such technology has affected racial or ethnic biases in 
        maternal health care.
            (2) The use of patient monitoring devices (including pulse 
        oximeter devices) in maternal health care, including the extent 
        to which such devices have affected racial or ethnic biases in 
        maternal health care.
            (3) Best practices for reducing and preventing racial or 
        ethnic biases in the use of innovative technology and patient 
        monitoring devices in maternity care.
            (4) Best practices in the use of innovative technology and 
        patient monitoring devices for pregnant and postpartum 
        individuals from racial and ethnic minority groups.
            (5) Best practices with respect to privacy and security 
        safeguards in such use.
    (c) Report.--The agreement under subsection (a) shall direct the 
National Academies to complete the study under this section, and 
transmit to Congress a report on the results of the study, not later 
than 24 months after the date of enactment of this Act.

                    Subtitle I--Impact to Save Moms

SEC. 1801. PERINATAL CARE ALTERNATIVE PAYMENT MODEL DEMONSTRATION 
              PROJECT.

    (a) In General.--For the period of fiscal years 2023 through 2027, 
the Secretary of Health and Human Services (referred to in this section 
as the ``Secretary''), acting through the Administrator of the Centers 
for Medicare & Medicaid Services, shall establish and implement, in 
accordance with the requirements of this section, a demonstration 
project, to be known as the Perinatal Care Alternative Payment Model 
Demonstration Project (referred to in this section as the 
``Demonstration Project''), for purposes of allowing States to test 
payment models under their State plans under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) and State child health plans 
under title XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to 
maternity care provided to pregnant and postpartum individuals enrolled 
in such State plans and State child health plans.
    (b) Coordination.--In establishing the Demonstration Project, the 
Secretary shall coordinate with stakeholders such as--
            (1) State Medicaid programs;
            (2) maternity care providers and organizations representing 
        maternity care providers;
            (3) relevant organizations representing patients, with a 
        particular focus on patients from racial and ethnic minority 
        groups;
            (4) relevant community-based organizations, particularly 
        organizations that seek to improve maternal health outcomes for 
        pregnant and postpartum individuals from racial and ethnic 
        minority groups;
            (5) perinatal health workers;
            (6) relevant health insurance issuers;
            (7) hospitals, health systems, midwifery practices, 
        freestanding birth centers (as such term is defined in 
        paragraph (3)(B) of section 1905(l) of the Social Security Act 
        (42 U.S.C. 1396d(l))), Federally-qualified health centers (as 
        such term is defined in paragraph (2)(B) of such section), and 
        rural health clinics (as such term is defined in section 
        1861(aa) of such Act (42 U.S.C. 1395x(aa)));
            (8) researchers and policy experts in fields related to 
        maternity care payment models; and
            (9) any other stakeholders as the Secretary determines 
        appropriate, with a particular focus on stakeholders from 
        racial and ethnic minority groups.
    (c) Considerations.--In establishing the Demonstration Project, the 
Secretary shall consider any alternative payment model that--
            (1) is designed to improve maternal health outcomes for 
        racial and ethnic groups with disproportionate rates of adverse 
        maternal health outcomes;
            (2) includes methods for stratifying patients by pregnancy 
        risk level and, as appropriate, adjusting payments under such 
        model to take into account pregnancy risk level;
            (3) establishes evidence-based quality metrics for such 
        payments;
            (4) includes consideration of non-hospital birth settings 
        such as freestanding birth centers (as so defined);
            (5) includes consideration of social determinants of 
        maternal health; or
            (6) includes diverse maternity care teams that include--
                    (A) maternity care providers, mental and behavioral 
                health care providers acting in accordance with State 
                law, registered dietitians or nutrition professionals 
                (as such term is defined in 42 U.S.C. 1395x(vv)(2)), 
                and International Board Certified Lactation 
                Consultants--
                            (i) from racially, ethnically, and 
                        professionally diverse backgrounds;
                            (ii) with experience practicing in racially 
                        and ethnically diverse communities; or
                            (iii) who have undergone training on 
                        implicit bias and racism; and
                    (B) perinatal health workers.
    (d) Eligibility.--To be eligible to participate in the 
Demonstration Project, a State shall submit an application to the 
Secretary at such time, in such manner, and containing such information 
as the Secretary may require.
    (e) Evaluation.--The Secretary shall conduct an evaluation of the 
Demonstration Project to determine the impact of the Demonstration 
Project on--
            (1) maternal health outcomes, with data stratified by race, 
        ethnicity, socioeconomic indicators, and any other factors as 
        the Secretary determines appropriate;
            (2) spending on maternity care by States participating in 
        the Demonstration Project;
            (3) to the extent practicable, qualitative and quantitative 
        measures of patient experience; and
            (4) any other areas of assessment that the Secretary 
        determines relevant.
    (f) Report.--Not later than one year after the completion or 
termination date of the Demonstration Project, the Secretary shall 
submit to the Congress, and make publicly available, a report 
containing--
            (1) the results of any evaluation conducted under 
        subsection (e); and
            (2) a recommendation regarding whether the Demonstration 
        Project should be continued after fiscal year 2027 and expanded 
        on a national basis.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out this section.
    (h) Definitions.--In this section:
            (1) Alternative payment model.--The term ``alternative 
        payment model'' has the meaning given such term in section 
        1833(z)(3)(C) of the Social Security Act (42 U.S.C. 
        1395l(z)(3)(C)).
            (2) Perinatal.--The term ``perinatal'' means the period 
        beginning on the day an individual becomes pregnant and ending 
        on the last day of the 1-year period beginning on the last day 
        of such individual's pregnancy.
            (3) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).

SEC. 1802. MACPAC REPORT.

    Not later than two years after the date of the enactment of this 
Act, the Medicaid and CHIP Payment and Access Commission shall publish 
a report on issues relating to the continuity of coverage under State 
plans under title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) and State child health plans under title XXI of such Act (42 
U.S.C. 1397aa et seq.) for pregnant and postpartum individuals. Such 
report shall, at a minimum, include the following:
            (1) An assessment of any existing policies under such State 
        plans and such State child health plans regarding presumptive 
        eligibility for pregnant individuals while their application 
        for enrollment in such a State plan or such a State child 
        health plan is being processed.
            (2) An assessment of any existing policies under such State 
        plans and such State child health plans regarding measures to 
        ensure continuity of coverage under such a State plan or such a 
        State child health plan for pregnant and postpartum 
        individuals, including such individuals who need to change 
        their health insurance coverage during their pregnancy or the 
        postpartum period following their pregnancy.
            (3) An assessment of any existing policies under such State 
        plans and such State child health plans regarding measures to 
        automatically reenroll individuals who are eligible to enroll 
        under such a State plan or such a State child health plan as a 
        parent.
            (4) If determined appropriate by the Commission, any 
        recommendations for the Department of Health and Human 
        Services, or such State plans and such State child health 
        plans, to ensure continuity of coverage under such a State plan 
        or such a State child health plan for pregnant and postpartum 
        individuals.

             Subtitle J--Maternal Health Pandemic Response

SEC. 1901. DEFINITIONS.

    In this subtitle:
            (1) COVID-19 public health emergency.--The term ``COVID-19 
        public health emergency'' means the period--
                    (A) beginning on the date that the Secretary of 
                Health and Human Services declared a public health 
                emergency under section 319 of the Public Health 
                Service Act (42 U.S.C. 247d), with respect to COVID-19; 
                and
                    (B) ending on the later of the end of such public 
                health emergency, or January 1, 2023.
            (2) Respectful maternity care.--The term ``respectful 
        maternity care'' refers to care organized for, and provided to, 
        pregnant and postpartum individuals in a manner that--
                    (A) is culturally congruent;
                    (B) maintains their dignity, privacy, and 
                confidentiality;
                    (C) ensures freedom from harm and mistreatment; and
                    (D) enables informed choice and continuous support.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 1902. FUNDING FOR DATA COLLECTION, SURVEILLANCE, AND RESEARCH ON 
              MATERNAL HEALTH OUTCOMES DURING THE COVID-19 PUBLIC 
              HEALTH EMERGENCY.

    To conduct or support data collection, surveillance, and research 
on maternal health as a result of the COVID-19 public health emergency, 
including support to assist in the capacity building for State, Tribal, 
territorial, and local public health departments to collect and 
transmit racial, ethnic, and other demographic data related to maternal 
health, there are authorized to be appropriated--
            (1) $100,000,000 for the Surveillance for Emerging Threats 
        to Mothers and Babies program of the Centers for Disease 
        Control and Prevention, to support the Centers for Disease 
        Control and Prevention in its efforts to--
                    (A) work with public health, clinical, and 
                community-based organizations to provide timely, 
                continually updated guidance to families and health 
                care providers on ways to reduce risk to pregnant and 
                postpartum individuals and their newborns and tailor 
                interventions to improve their long-term health;
                    (B) partner with more State, Tribal, territorial, 
                and local public health programs in the collection and 
                analysis of clinical data on the impact of COVID-19 on 
                pregnant and postpartum patients and their newborns, 
                particularly among patients from racial and ethnic 
                minority groups; and
                    (C) establish regionally based centers of 
                excellence to offer medical, public health, and other 
                knowledge to ensure communities, especially communities 
                with large populations of individuals from racial and 
                ethnic minority groups, can help pregnant and 
                postpartum individuals and newborns get the care and 
                support they need;
            (2) $30,000,000 for the Enhancing Reviews and Surveillance 
        to Eliminate Maternal Mortality program (commonly known as the 
        ``ERASE MM program'') of the Centers for Disease Control and 
        Prevention, to support the Centers for Disease Control and 
        Prevention in expanding its partnerships with States and Indian 
        Tribes and provide technical assistance to existing Maternal 
        Mortality Review Committees;
            (3) $45,000,000 for the Pregnancy Risk Assessment 
        Monitoring System (commonly known as the ``PRAMS'') of the 
        Centers for Disease Control and Prevention, to support the 
        Centers for Disease Control and Prevention in its efforts to--
                    (A) create a COVID-19 supplement to its PRAMS 
                questionnaire;
                    (B) add questions around experiences of respectful 
                maternity care in prenatal, intrapartum, and postpartum 
                care;
                    (C) conduct a rapid assessment of COVID-19 
                awareness, impact on care and experiences, and use of 
                preventive measures among pregnant, laboring and 
                birthing, and postpartum individuals during the COVID-
                19 public health emergency; and
                    (D) work to transition the survey to an electronic 
                platform and expand the survey to a larger population, 
                with a special focus on reaching underrepresented 
                communities; and
            (4) $15,000,000 for the National Institute of Child Health 
        and Human Development, to conduct or support research for 
        interventions to mitigate the effects of the COVID-19 public 
        health emergency on pregnant and postpartum individuals, with a 
        particular focus on individuals from racial and ethnic minority 
        groups.

SEC. 1903. COVID-19 MATERNAL HEALTH DATA COLLECTION AND DISCLOSURE.

    (a) Availability of Collected Data.--The Secretary, acting through 
the Director of the Centers for Disease Control and Prevention and the 
Administrator of the Centers for Medicare & Medicaid Services, shall 
make publicly available on the website of the Centers for Disease 
Control and Prevention data described in subsection (b).
    (b) Data Described.--The data under subsection (a) means data 
collected through Federal surveillance systems under the Centers for 
Disease Control and Prevention with respect to COVID-19 and individuals 
who are pregnant or in a postpartum period. Such data shall include the 
following:
            (1) Diagnostic testing, including the number of pregnant 
        and postpartum individuals who are tested for COVID-19 and the 
        number of positive cases.
            (2) Suspected cases of COVID-19 in pregnant and birthing 
        individuals and individuals in a postpartum period.
            (3) Serologic testing, including the number of pregnant and 
        postpartum individuals tested and the number of such serologic 
        tests that were positive.
            (4) Health care treatment for individuals who were infected 
        with the virus, including hospitalizations, emergency room 
        visits, and intensive care unit admissions.
            (5) Health outcomes for pregnant individuals and infants 
        confirmed or suspected of being infected with the virus, 
        including--
                    (A) the number of fatalities and case fatalities 
                (expressed as the proportion of individuals who were 
                infected with the virus to individuals who died from 
                the virus); and
                    (B) the number of stillbirths, infant mortality, 
                pre-term births, infants born with a low-birth weight, 
                and cesarean section births.
    (c) Indian Health Service.--In carrying out subsection (a), the 
Secretary shall consult with Indian Tribes and confer with urban Indian 
organizations.
    (d) Disaggregated Information.--In carrying out subsection (a), the 
Secretary shall disaggregate data by race, ethnicity, and location.
    (e) Update.--During the COVID-19 public health emergency, the 
Secretary shall update the data made available under this section--
            (1) at least on a monthly basis; and
            (2) not less than one month after the end of such public 
        health emergency.
    (f) Privacy.--In carrying out subsection (a), the Secretary shall 
take steps to protect the privacy of individuals pursuant to 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note).
    (g) Guidance.--
            (1) In general.--Not later than 30 days after the date of 
        enactment of this Act, the Secretary shall issue guidance to 
        States and local public health departments to ensure that--
                    (A) laboratories that test specimens for COVID-19 
                receive all relevant demographic data on race, 
                ethnicity, pregnancy status, and other demographic data 
                as determined by the Secretary; and
                    (B) data described in subsection (b) is 
                disaggregated by race, ethnicity, and location.
            (2) Consultation.--In carrying out paragraph (1), the 
        Secretary shall consult with Indian Tribes--
                    (A) to ensure that such guidance includes Tribally 
                developed best practices; and
                    (B) to reduce misclassification of American Indians 
                and Alaska Natives.

SEC. 1904. INCLUSION OF PREGNANT INDIVIDUALS AND LACTATING INDIVIDUALS 
              IN VACCINE AND THERAPEUTIC DEVELOPMENT FOR COVID-19.

    The Director of the National Institutes of Health shall when safe 
and appropriate, support and advance the inclusion of pregnant and 
lactating individuals in therapeutic and vaccine clinical trials with 
respect to the treatment or prevention of COVID-19, including 
prioritizing recommendations made by the Task Force on Research 
Specific to Pregnant Women and Lactating Women established under 
section 2041 of the 21st Century Cures Act (42 U.S.C. 289a-2 note) with 
respect to including such individuals in such clinical trials.

SEC. 1905. PUBLIC HEALTH COMMUNICATION REGARDING MATERNAL CARE DURING 
              COVID-19.

    The Director of the Centers for Disease Control and Prevention 
shall conduct a public health education campaign to increase access by 
pregnant individuals, their employers, and their health care providers 
to accurate, evidence-based information on COVID-19 and pregnancy 
risks, with a particular focus pregnant individuals in underserved 
communities.

SEC. 1906. TASK FORCE ON BIRTHING EXPERIENCE AND SAFE MATERNITY CARE 
              DURING A PUBLIC HEALTH EMERGENCY.

    (a) Establishment.--The Secretary, in consultation with the 
Director of the Centers for Disease Control and Prevention and the 
Administrator of the Health Resources and Services Administration, 
shall convene a task force (in this subsection referred to as the 
``Task Force'') to develop recommendations, and make such 
recommendations publicly available in multiple languages, on respectful 
maternity care during the COVID-19 public health emergency and other 
public health emergencies, with a particular focus on outcomes for 
individuals from racial and ethnic minority groups and other 
underserved communities.
    (b) Content.--In developing recommendations under paragraph (1), 
the Task Force shall address the following:
            (1) Measures to facilitate respectful maternity care.
            (2) Strategies to increase access to specialized care for 
        individuals with high-risk pregnancies.
            (3) COVID-19 diagnostic testing for pregnant individuals 
        and individuals in labor.
            (4) The designation of a companion during birthing.
            (5) The ability to communicate using an electronic mobile 
        device during birthing.
            (6) With respect to an individual who has the virus that 
        causes COVID-19--
                    (A) separation from a newborn after birth; and
                    (B) ensuring safety while breastfeeding.
            (7) Licensing, training, and reimbursement for midwives 
        from racial and ethnic minority groups and underserved 
        communities.
            (8) Financial support for perinatal health workers who 
        provide nonclinical support to pregnant individuals and 
        postpartum individuals from underserved communities.
            (9) The identification and treatment of prenatal and 
        postpartum mental and behavioral health conditions may have 
        developed during or worsened because of the COVID-19 public 
        health emergency or future public health emergencies, including 
        anxiety, substance use disorder, and depression.
            (10) Strategies to address hospital capacity issues in 
        communities with an increase in COVID-19 cases, or cases of 
        other infectious diseases.
            (11) Options for maternal care that reduce cross-
        contamination and maintain safety and quality of care, 
        including auxiliary maternity units and freestanding birth 
        centers.
            (12) Methods to identify and address racism, bias, and 
        discrimination in treatment and support to pregnant and 
        postpartum individuals, including--
                    (A) evaluating the training of hospital staff on 
                implicit bias and racism and respectful maternity care; 
                and
                    (B) the collection of demographic data.
            (13) Other matters the Task Force determines appropriate.
    (c) Membership.--
            (1) Chair.--The Secretary shall select the chair of the 
        Task Force from among the members of the Task Force.
            (2) Composition.--The Task Force shall be composed of--
                    (A) representatives of Federal agencies, including 
                the agencies listed in paragraph (3);
                    (B) three or more representatives of State, local, 
                or territorial public health departments from different 
                areas in the United States that have a large 
                historically marginalized population;
                    (C) one or more representatives of Tribal public 
                health departments;
                    (D) one or more obstetrician-gynecologists or other 
                physicians who provide obstetric care, with 
                consideration for physicians who are from, or work in, 
                communities experiencing a high rate of mortality and 
                morbidity from COVID-19;
                    (E) one or more nurses who provide obstetric care, 
                with consideration for physicians who are from, or work 
                in, communities experiencing a high rate of mortality 
                and morbidity from COVID-19;
                    (F) one or more perinatal health workers;
                    (G) one or more individuals who were pregnant or 
                gave birth during the COVID-19 public health emergency;
                    (H) one or more individuals who had the virus that 
                causes COVID-19 and later gave birth;
                    (I) one or more individuals who have received 
                support from a perinatal health; and
                    (J) three or more independent experts who are 
                racially and ethnically diverse with knowledge on 
                racial and ethnic disparities in--
                            (i) public health;
                            (ii) maternal health; or
                            (iii) maternal mortality and severe 
                        maternal morbidity.
            (3) Federal agencies.--The agencies represented under 
        paragraph (2)(A) shall include the following:
                    (A) The Department of Health and Human Services.
                    (B) The Centers for Disease Control and Prevention.
                    (C) The Centers for Medicare & Medicaid Services.
                    (D) The Health Resources and Services 
                Administration.
                    (E) The Indian Health Service.
                    (F) The National Institutes of Health.

SEC. 1907. GAO REPORT ON MATERNAL HEALTH AND PUBLIC HEALTH EMERGENCY 
              PREPAREDNESS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to Congress a report on maternal health and public health 
emergency preparedness. Such report shall include the information and 
recommendations described in subsection (b).
    (b) Content of Report.--The report under subsection (b) shall 
include the following:
            (1) A review of prenatal, labor and delivery, and 
        postpartum experiences of individuals during such public health 
        emergency, including--
                    (A) barriers to accessing pregnancy, birth, and 
                postpartum care during a pandemic;
                    (B) public and private insurance coverage with 
                respect to maternal health care, including telehealth 
                services;
                    (C) to the extent practicable, maternal and infant 
                health outcomes by race and ethnicity (including 
                quality of care, mortality, morbidity, cesarean section 
                rates, preterm birth, prevalence of prenatal and 
                postpartum mental health conditions and substance use 
                disorders);
                    (D) with respect to such health outcomes, the 
                impact of Federal and State policy changes during such 
                public health emergency;
                    (E) contributing factors to population-based 
                disparities in health outcomes, including bias and 
                discrimination toward individuals from racial and 
                ethnic minority groups; and
                    (F) the effect of increased unemployment, paid 
                family leave, changes in health care coverage, and 
                other social determinants of health for pregnant and 
                postpartum individuals during the public health 
                emergency.
            (2) Recommendations on improving the public health 
        emergency response and preparedness efforts of the Federal 
        Government with respect to maternal health, with a focus on 
        outcomes for pregnant and postpartum individuals from racial 
        and ethnic minority groups, including--
                    (A) improving research, surveillance, and data 
                collection with respect to maternal health;
                    (B) factoring maternal health outcomes and 
                disparities into decisions regarding distribution of 
                resources;
                    (C) improving the distribution of public health 
                funds, data, and information to Indian Tribes and 
                Tribal organizations with regard to maternal health 
                during a public health emergency; and
                    (D) improving communications during a public health 
                emergency with--
                            (i) maternity care providers;
                            (ii) maternal mental and behavioral health 
                        care providers;
                            (iii) researchers who specialize in 
                        maternal health, maternal mortality, or severe 
                        maternal morbidity;
                            (iv) individuals who experienced pregnancy 
                        or childbirth during the COVID-19 public health 
                        emergency;
                            (v) representatives from community-based 
                        organizations that address maternal health; and
                            (vi) perinatal health workers.

     Subtitle K--Protecting Moms and Babies Against Climate Change

SEC. 1911. DEFINITIONS.

    In this subtitle, the following definitions apply:
            (1) Adverse maternal and infant health outcomes.--The term 
        ``adverse maternal and infant health outcomes'' includes the 
        outcomes of preterm birth, low birth weight, stillbirth, infant 
        or maternal mortality, and severe maternal morbidity.
            (2) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given such 
        term in section 101 of the Higher Education Act of 1965 (20 
        U.S.C. 1001).
            (3) Minority-serving institution.--The term ``minority-
        serving institution'' means an entity specified in any of 
        paragraphs (1) through (7) of section 371(a) of the Higher 
        Education Act of 1965 (20 U.S.C. 1067q(a)).
            (4) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)).
            (5) Risks associated with climate change.--The term ``risks 
        associated with climate change'' includes risks associated with 
        extreme heat, air pollution, extreme weather events, and other 
        environmental issues associated with climate change that can 
        result in adverse maternal and infant health outcomes.
            (6) Stakeholder organization.--The term ``stakeholder 
        organization'' means--
                    (A) a community-based organization with expertise 
                in providing assistance to vulnerable individuals;
                    (B) a nonprofit organization with expertise in 
                maternal or infant health or environmental justice; and
                    (C) a patient advocacy organization representing 
                vulnerable individuals.
            (7) Vulnerable individual.--The term ``vulnerable 
        individual'' means--
                    (A) an individual who is pregnant;
                    (B) an individual who was pregnant during any 
                portion of the preceding 1-year period; and
                    (C) an individual under 3 years of age.

SEC. 1912. GRANT PROGRAM TO PROTECT VULNERABLE MOTHERS AND BABIES FROM 
              CLIMATE CHANGE RISKS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
establish a grant program (in this section referred to as the 
``Program'') to protect vulnerable individuals from risks associated 
with climate change.
    (b) Grant Authority.--In carrying out the Program, the Secretary 
may award, on a competitive basis, grants to 10 covered entities.
    (c) Applications.--To be eligible for a grant under the Program, a 
covered entity shall submit to the Secretary an application at such 
time, in such form, and containing such information as the Secretary 
may require, which shall include, at a minimum, a description of the 
following:
            (1) Plans for the use of grant funds awarded under the 
        Program and how patients and stakeholder organizations were 
        involved in the development of such plans.
            (2) How such grant funds will be targeted to geographic 
        areas that have disproportionately high levels of risks 
        associated with climate change for vulnerable individuals.
            (3) How such grant funds will be used to address racial and 
        ethnic disparities in--
                    (A) adverse maternal and infant health outcomes; 
                and
                    (B) exposure to risks associated with climate 
                change for vulnerable individuals.
            (4) Strategies to prevent an initiative assisted with such 
        grant funds from causing--
                    (A) adverse environmental impacts;
                    (B) displacement of residents and businesses;
                    (C) rent and housing price increases; or
                    (D) disproportionate adverse impacts on racial and 
                ethnic minority groups and other underserved 
                populations.
    (d) Selection of Grant Recipients.--
            (1) Timing.--Not later than 270 days after the date of the 
        enactment of this Act, the Secretary shall select the 
        recipients of grants under the Program.
            (2) Consultation.--In selecting covered entities for grants 
        under the Program, the Secretary shall consult with--
                    (A) representatives of stakeholder organizations;
                    (B) the Administrator of the Environmental 
                Protection Agency;
                    (C) the Administrator of the National Oceanic and 
                Atmospheric Administration; and
                    (D) from the Department of Health and Human 
                Services--
                            (i) the Deputy Assistant Secretary for 
                        Minority Health;
                            (ii) the Administrator of the Centers for 
                        Medicare & Medicaid Services;
                            (iii) the Administrator of the Health 
                        Resources and Services Administration;
                            (iv) the Director of the National 
                        Institutes of Health; and
                            (v) the Director of the Centers for Disease 
                        Control and Prevention.
            (3) Priority.--In selecting a covered entity to be awarded 
        a grant under the Program, the Secretary shall give priority to 
        covered entities that serve a county--
                    (A) designated, or located in an area designated, 
                as a nonattainment area pursuant to section 107 of the 
                Clean Air Act (42 U.S.C. 7407) for any air pollutant 
                for which air quality criteria have been issued under 
                section 108(a) of such Act (42 U.S.C. 7408(a));
                    (B) with a level of vulnerability of moderate-to-
                high or higher, according to the Social Vulnerability 
                Index of the Centers for Disease Control and 
                Prevention; or
                    (C) with temperatures that pose a risk to human 
                health, as determined by the Secretary, in consultation 
                with the Administrator of the National Oceanic and 
                Atmospheric Administration and the Chair of the United 
                States Global Change Research Program, based on the 
                best available science.
            (4) Limitation.--A recipient of grant funds under the 
        Program may not use such grant funds to serve a county that is 
        served by any other recipient of a grant under the Program.
    (e) Use of Funds.--A covered entity awarded grant funds under the 
Program may only use such grant funds for the following:
            (1) Initiatives to identify risks associated with climate 
        change for vulnerable individuals and to provide services and 
        support to such individuals that address such risks, which may 
        include--
                    (A) training for health care providers, doulas, and 
                other employees in hospitals, birth centers, midwifery 
                practices, and other health care practices that provide 
                prenatal or labor and delivery services to vulnerable 
                individuals on the identification of, and patient 
                counseling relating to, risks associated with climate 
                change for vulnerable individuals;
                    (B) hiring, training, or providing resources to 
                community health workers and perinatal health workers 
                who can help identify risks associated with climate 
                change for vulnerable individuals, provide patient 
                counseling about such risks, and carry out the 
                distribution of relevant services and support;
                    (C) enhancing the monitoring of risks associated 
                with climate change for vulnerable individuals, 
                including by--
                            (i) collecting data on such risks in 
                        specific census tracts, neighborhoods, or other 
                        geographic areas; and
                            (ii) sharing such data with local health 
                        care providers, doulas, and other employees in 
                        hospitals, birth centers, midwifery practices, 
                        and other health care practices that provide 
                        prenatal or labor and delivery services to 
                        local vulnerable individuals; and
                    (D) providing vulnerable individuals--
                            (i) air conditioning units, residential 
                        weatherization support, filtration systems, 
                        household appliances, or related items;
                            (ii) direct financial assistance; and
                            (iii) services and support, including 
                        housing and transportation assistance, to 
                        prepare for or recover from extreme weather 
                        events, which may include floods, hurricanes, 
                        wildfires, droughts, and related events.
            (2) Initiatives to mitigate levels of and exposure to risks 
        associated with climate change for vulnerable individuals, 
        which shall be based on the best available science and which 
        may include initiatives to--
                    (A) develop, maintain, or expand urban or community 
                forestry initiatives and tree canopy coverage 
                initiatives;
                    (B) improve infrastructure, including buildings and 
                paved surfaces;
                    (C) develop or improve community outreach networks 
                to provide culturally and linguistically appropriate 
                information and notifications about risks associated 
                with climate change for vulnerable individuals; and
                    (D) provide enhanced services to racial and ethnic 
                minority groups and other underserved populations.
    (f) Length of Award.--A grant under this section shall be disbursed 
over 4 fiscal years.
    (g) Technical Assistance.--The Secretary shall provide technical 
assistance to a covered entity awarded a grant under the Program to 
support the development, implementation, and evaluation of activities 
funded with such grant.
    (h) Reports to Secretary.--
            (1) Annual report.--For each fiscal year during which a 
        covered entity is disbursed grant funds under the Program, such 
        covered entity shall submit to the Secretary a report that 
        summarizes the activities carried out by such covered entity 
        with such grant funds during such fiscal year, which shall 
        include a description of the following:
                    (A) The involvement of stakeholder organizations in 
                the implementation of initiatives assisted with such 
                grant funds.
                    (B) Relevant health and environmental data, 
                disaggregated, to the extent practicable, by race, 
                ethnicity, gender, and pregnancy status.
                    (C) Qualitative feedback received from vulnerable 
                individuals with respect to initiatives assisted with 
                such grant funds.
                    (D) Criteria used in selecting the geographic areas 
                assisted with such grant funds.
                    (E) Efforts to address racial and ethnic 
                disparities in adverse maternal and infant health 
                outcomes and in exposure to risks associated with 
                climate change for vulnerable individuals.
                    (F) Any negative and unintended impacts of 
                initiatives assisted with such grant funds, including--
                            (i) adverse environmental impacts;
                            (ii) displacement of residents and 
                        businesses;
                            (iii) rent and housing price increases; and
                            (iv) disproportionate adverse impacts on 
                        racial and ethnic minority groups and other 
                        underserved populations.
                    (G) How the covered entity will address and prevent 
                any impacts described in subparagraph (F).
            (2) Publication.--Not later than 30 days after the date on 
        which a report is submitted under paragraph (1), the Secretary 
        shall publish such report on a public website of the Department 
        of Health and Human Services.
    (i) Report to Congress.--Not later than the date that is 5 years 
after the date on which the Program is established, the Secretary shall 
submit to Congress and publish on a public website of the Department of 
Health and Human Services a report on the results of the Program, 
including the following:
            (1) Summaries of the annual reports submitted under 
        subsection (h).
            (2) Evaluations of the initiatives assisted with grant 
        funds under the Program.
            (3) An assessment of the effectiveness of the Program in--
                    (A) identifying risks associated with climate 
                change for vulnerable individuals;
                    (B) providing services and support to such 
                individuals;
                    (C) mitigating levels of and exposure to such 
                risks; and
                    (D) addressing racial and ethnic disparities in 
                adverse maternal and infant health outcomes and in 
                exposure to such risks.
            (4) A description of how the Program could be expanded, 
        including--
                    (A) monitoring efforts or data collection that 
                would be required to identify areas with high levels of 
                risks associated with climate change for vulnerable 
                individuals;
                    (B) how such areas could be identified using the 
                strategy developed under section 1915; and
                    (C) recommendations for additional funding.
    (j) Covered Entity Defined.--In this section, the term ``covered 
entity'' means a consortium of organizations serving a county that--
            (1) shall include a community-based organization; and
            (2) may include--
                    (A) another stakeholder organization;
                    (B) the government of such county;
                    (C) the governments of one or more municipalities 
                within such county;
                    (D) a State or local public health department or 
                emergency management agency;
                    (E) a local health care practice, which may include 
                a licensed and accredited hospital, birth center, 
                midwifery practice, or other health care practice that 
                provides prenatal or labor and delivery services to 
                vulnerable individuals;
                    (F) an Indian tribe or tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304));
                    (G) an Urban Indian organization (as defined in 
                section 4 of the Indian Health Care Improvement Act (25 
                U.S.C. 1603)); and
                    (H) an institution of higher education.
    (k) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $100,000,000 for the period of 
fiscal years 2023 through 2026.

SEC. 1913. GRANT PROGRAM FOR EDUCATION AND TRAINING AT HEALTH 
              PROFESSION SCHOOLS.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
establish a grant program (in this section referred to as the 
``Program'') to provide funds to health profession schools to support 
the development and integration of education and training programs for 
identifying and addressing risks associated with climate change for 
vulnerable individuals.
    (b) Grant Authority.--In carrying out the Program, the Secretary 
may award, on a competitive basis, grants to health profession schools.
    (c) Application.--To be eligible for a grant under the Program, a 
health profession school shall submit to the Secretary an application 
at such time, in such form, and containing such information as the 
Secretary may require, which shall include, at a minimum, a description 
of the following:
            (1) How such health profession school will engage with 
        vulnerable individuals, and stakeholder organizations 
        representing such individuals, in developing and implementing 
        the education and training programs supported by grant funds 
        awarded under the Program.
            (2) How such health profession school will ensure that such 
        education and training programs will address racial and ethnic 
        disparities in exposure to, and the effects of, risks 
        associated with climate change for vulnerable individuals.
    (d) Use of Funds.--A health profession school awarded a grant under 
the Program shall use the grant funds to develop, and integrate into 
the curriculum and continuing education of such health profession 
school, education and training on each of the following:
            (1) Identifying risks associated with climate change for 
        vulnerable individuals and individuals with the intent to 
        become pregnant.
            (2) How risks associated with climate change affect 
        vulnerable individuals and individuals with the intent to 
        become pregnant.
            (3) Racial and ethnic disparities in exposure to, and the 
        effects of, risks associated with climate change for vulnerable 
        individuals and individuals with the intent to become pregnant.
            (4) Patient counseling and mitigation strategies relating 
        to risks associated with climate change for vulnerable 
        individuals.
            (5) Relevant services and support for vulnerable 
        individuals relating to risks associated with climate change 
        and strategies for ensuring vulnerable individuals have access 
        to such services and support.
            (6) Implicit and explicit bias, racism, and discrimination.
            (7) Related topics identified by such health profession 
        school based on the engagement of such health profession school 
        with vulnerable individuals and stakeholder organizations 
        representing such individuals.
    (e) Partnerships.--In carrying out activities with grant funds, a 
health profession school awarded a grant under the Program may partner 
with one or more of the following:
            (1) A State or local public health department.
            (2) A health care professional membership organization.
            (3) A stakeholder organization.
            (4) A health profession school.
            (5) An institution of higher education.
    (f) Reports to Secretary.--
            (1) Annual report.--For each fiscal year during which a 
        health profession school is disbursed grant funds under the 
        Program, such health profession school shall submit to the 
        Secretary a report that describes the activities carried out 
        with such grant funds during such fiscal year.
            (2) Final report.--Not later than the date that is 1 year 
        after the end of the last fiscal year during which a health 
        profession school is disbursed grant funds under the Program, 
        the health profession school shall submit to the Secretary a 
        final report that summarizes the activities carried out with 
        such grant funds.
    (g) Report to Congress.--Not later than the date that is 6 years 
after the date on which the Program is established, the Secretary shall 
submit to Congress and publish on a public website of the Department of 
Health and Human Services a report that includes the following:
            (1) A summary of the reports submitted under subsection 
        (f).
            (2) Recommendations to improve education and training 
        programs at health profession schools with respect to 
        identifying and addressing risks associated with climate change 
        for vulnerable individuals.
    (h) Health Profession School Defined.--In this section, the term 
``health profession school'' means an accredited--
            (1) medical school;
            (2) school of nursing;
            (3) midwifery program;
            (4) physician assistant education program;
            (5) teaching hospital;
            (6) residency or fellowship program; or
            (7) other school or program determined appropriate by the 
        Secretary.
    (i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for the period of 
fiscal years 2023 through 2026.

SEC. 1914. NIH CONSORTIUM ON BIRTH AND CLIMATE CHANGE RESEARCH.

    (a) Establishment.--Not later than one year after the date of the 
enactment of this Act, the Director of the National Institutes of 
Health shall establish the Consortium on Birth and Climate Change 
Research (in this section referred to as the ``Consortium'').
    (b) Duties.--
            (1) In general.--The Consortium shall coordinate, across 
        the institutes, centers, and offices of the National Institutes 
        of Health, research on the risks associated with climate change 
        for vulnerable individuals.
            (2) Required activities.--In carrying out paragraph (1), 
        the Consortium shall--
                    (A) establish research priorities, including by 
                prioritizing research that--
                            (i) identifies the risks associated with 
                        climate change for vulnerable individuals with 
                        a particular focus on disparities in such risks 
                        among racial and ethnic minority groups and 
                        other underserved populations; and
                            (ii) identifies strategies to reduce levels 
                        of, and exposure to, such risks, with a 
                        particular focus on risks among racial and 
                        ethnic minority groups and other underserved 
                        populations;
                    (B) identify gaps in available data related to such 
                risks;
                    (C) identify gaps in, and opportunities for, 
                research collaborations;
                    (D) identify funding opportunities for community-
                based organizations and researchers from racially, 
                ethnically, and geographically diverse backgrounds; and
                    (E) publish annual reports on the work and findings 
                of the Consortium on a public website of the National 
                Institutes of Health.
    (c) Membership.--The Director shall appoint to the Consortium 
representatives of such institutes, centers, and offices of the 
National Institutes of Health as the Director considers appropriate, 
including, at a minimum, representatives of--
            (1) the National Institute of Environmental Health 
        Sciences;
            (2) the National Institute on Minority Health and Health 
        Disparities;
            (3) the Eunice Kennedy Shriver National Institute of Child 
        Health and Human Development;
            (4) the National Institute of Nursing Research; and
            (5) the Office of Research on Women's Health.
    (d) Chairperson.--The Chairperson of the Consortium shall be 
designated by the Director and selected from among the representatives 
appointed under subsection (c).
    (e) Consultation.--In carrying out the duties described in 
subsection (b), the Consortium shall consult with--
            (1) the heads of relevant Federal agencies, including--
                    (A) the Environmental Protection Agency;
                    (B) the National Oceanic and Atmospheric 
                Administration;
                    (C) the Occupational Safety and Health 
                Administration; and
                    (D) from the Department of Health and Human 
                Services--
                            (i) the Office of Minority Health in the 
                        Office of the Secretary;
                            (ii) the Centers for Medicare & Medicaid 
                        Services;
                            (iii) the Health Resources and Services 
                        Administration;
                            (iv) the Centers for Disease Control and 
                        Prevention;
                            (v) the Indian Health Service; and
                            (vi) the Administration for Children and 
                        Families; and
            (2) representatives of--
                    (A) stakeholder organizations;
                    (B) health care providers and professional 
                membership organizations with expertise in maternal 
                health or environmental justice;
                    (C) State and local public health departments;
                    (D) licensed and accredited hospitals, birth 
                centers, midwifery practices, or other health care 
                practices that provide prenatal or labor and delivery 
                services to vulnerable individuals; and
                    (E) institutions of higher education, including 
                such institutions that are minority-serving 
                institutions or have expertise in maternal health or 
                environmental justice.

SEC. 1915. STRATEGY FOR IDENTIFYING CLIMATE CHANGE RISK ZONES FOR 
              VULNERABLE MOTHERS AND BABIES.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall develop a strategy (in this section referred to as the 
``Strategy'') for designating areas that the Secretary determines to 
have a high risk of adverse maternal and infant health outcomes among 
vulnerable individuals as a result of risks associated with climate 
change.
    (b) Strategy Requirements.--
            (1) In general.--In developing the Strategy, the Secretary 
        shall establish a process to identify areas where vulnerable 
        individuals are exposed to a high risk of adverse maternal and 
        infant health outcomes as a result of risks associated with 
        climate change in conjunction with other factors that can 
        impact such health outcomes, including--
                    (A) the incidence of diseases associated with air 
                pollution, extreme heat, and other environmental 
                factors;
                    (B) the availability and accessibility of maternal 
                and infant health care providers;
                    (C) English-language proficiency among women of 
                reproductive age;
                    (D) the health insurance status of women of 
                reproductive age;
                    (E) the number of women of reproductive age who are 
                members of racial or ethnic groups with 
                disproportionately high rates of adverse maternal and 
                infant health outcomes;
                    (F) the socioeconomic status of women of 
                reproductive age, including with respect to--
                            (i) poverty;
                            (ii) unemployment;
                            (iii) household income; and
                            (iv) educational attainment; and
                    (G) access to quality housing, transportation, and 
                nutrition.
            (2) Resources.--In developing the Strategy, the Secretary 
        shall identify, and incorporate a description of, the 
        following:
                    (A) Existing mapping tools or Federal programs that 
                identify--
                            (i) risks associated with climate change 
                        for vulnerable individuals; and
                            (ii) other factors that can influence 
                        maternal and infant health outcomes, including 
                        the factors described in paragraph (1).
                    (B) Environmental, health, socioeconomic, and 
                demographic data relevant to identifying risks 
                associated with climate change for vulnerable 
                individuals.
                    (C) Existing monitoring networks that collect data 
                described in subparagraph (B), and any gaps in such 
                networks.
                    (D) Federal, State, and local stakeholders involved 
                in maintaining monitoring networks identified under 
                subparagraph (C), and how such stakeholders are 
                coordinating their monitoring efforts.
                    (E) Additional monitoring networks, and 
                enhancements to existing monitoring networks, that 
                would be required to address gaps identified under 
                subparagraph (C), including at the subcounty and census 
                tract level.
                    (F) Funding amounts required to establish the 
                monitoring networks identified under subparagraph (E) 
                and recommendations for Federal, State, and local 
                coordination with respect to such networks.
                    (G) Potential uses for data collected and generated 
                as a result of the Strategy, including how such data 
                may be used in determining recipients of grants under 
                the program established by section 1912 or other 
                similar programs.
                    (H) Other information the Secretary considers 
                relevant for the development of the Strategy.
    (c) Coordination and Consultation.--In developing the Strategy, the 
Secretary shall--
            (1) coordinate with the Administrator of the Environmental 
        Protection Agency and the Administrator of the National Oceanic 
        and Atmospheric Administration; and
            (2) consult with--
                    (A) stakeholder organizations;
                    (B) health care providers and professional 
                membership organizations with expertise in maternal 
                health or environmental justice;
                    (C) State and local public health departments;
                    (D) licensed and accredited hospitals, birth 
                centers, midwifery practices, or other health care 
                providers that provide prenatal or labor and delivery 
                services to vulnerable individuals; and
                    (E) institutions of higher education, including 
                such institutions that are minority-serving 
                institutions or have expertise in maternal health or 
                environmental justice.
    (d) Notice and Comment.--At least 240 days before the date on which 
the Strategy is published in accordance with subsection (e), the 
Secretary shall provide--
            (1) notice of the Strategy on a public website of the 
        Department of Health and Human Services; and
            (2) an opportunity for public comment of at least 90 days.
    (e) Publication.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall publish on a public website 
of the Department of Health and Human Services--
            (1) the Strategy;
            (2) the public comments received under subsection (d); and
            (3) the responses of the Secretary to such public comments.

                   Subtitle L--Maternal Vaccinations

SEC. 1921. MATERNAL VACCINATION AWARENESS AND EQUITY CAMPAIGN.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Director of the Centers for Disease Control and Prevention, shall carry 
out a national campaign to--
            (1) increase awareness of the importance of maternal 
        vaccinations for the health of pregnant and postpartum 
        individuals and their children; and
            (2) increase maternal vaccination rates, with a focus on 
        communities with historically high rates of unvaccinated 
        individuals.
    (b) Consultation.--In carrying out the campaign under this 
subtitle, the Secretary shall consult with relevant community-based 
organizations, health care professional associations and public health 
associations, State public health departments and local public health 
departments, Tribal-serving organizations, nonprofit organizations, and 
nationally recognized private entities.
    (c) Activities.--The campaign under this section shall--
            (1) focus on increasing maternal vaccination rates in 
        communities with historically high rates of unvaccinated 
        individuals, including for pregnant and postpartum individuals 
        from racial and ethnic minority groups;
            (2) include efforts to engage with pregnant and postpartum 
        individuals in communities with historically high rates of 
        unvaccinated individuals to seek input on the development and 
        effectiveness of the campaign;
            (3) provide evidence-based, culturally congruent resources 
        and communications efforts; and
            (4) be carried out in partnership with trusted individuals 
        and entities in communities with historically high rates of 
        unvaccinated individuals, including community-based 
        organizations, community health centers, perinatal health 
        workers, and maternity care providers.
    (d) Collaboration.--The Secretary shall ensure that the information 
and resources developed for the campaign under this section are made 
publicly available and shared with relevant Federal, State, and local 
entities.
    (e) Evaluation.--Not later than the end of fiscal year 2026, the 
Secretary shall--
            (1) establish quantitative and qualitative metrics to 
        evaluate the campaign under this section; and
            (2) submit a report detailing the campaign's impact to the 
        Congress.
    (f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $2,000,000 for each of fiscal 
years 2023 through 2027.

        TITLE II--CHILDREN'S HEALTH INSURANCE PROGRAM PERMANENCY

SEC. 2001. PERMANENT EXTENSION OF CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) 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).''.
    (b) Allotments.--
            (1) In general.--Section 2104(m) of the Social Security Act 
        (42 U.S.C. 1397dd(m)) is amended--
                    (A) in paragraph (2)(B)(i), by striking ``,, 2023, 
                and 2027'' and inserting ``and 2023'';
                    (B) in paragraph (5)--
                            (i) by striking ``for a fiscal year'' and 
                        inserting ``for a fiscal year before 2027''; 
                        and
                            (ii) by striking ``2023, or 2027'' and 
                        inserting ``or 2023'';
                    (C) in paragraph (7)--
                            (i) in subparagraph (A), by striking ``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'';
                    (D) 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
                    (E) by striking paragraph (11).
            (2) Conforming amendment.--Section 50101(b)(2) of the 
        Bipartisan Budget Act of 2018 (Public Law 115-123) is repealed.

SEC. 2002. PERMANENT EXTENSIONS OF OTHER PROGRAMS AND DEMONSTRATION 
              PROJECTS.

    (a) Pediatric Quality Measures Program.--Section 1139A(i)(1) of the 
Social Security Act (42 U.S.C. 1320b-9a(i)(1)) is amended--
            (1) in subparagraph (C), by striking at the end ``and'';
            (2) in subparagraph (D), by striking the period at the end 
        and insert a semicolon; and
            (3) 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 percentage 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)).''.
    (b) Express Lane Eligibility Option.--Section 1902(e)(13) of the 
Social Security Act (42 U.S.C. 1396a(e)(13)) is amended by striking 
subparagraph (I).
    (c) Assurance of Affordability Standard for Children and 
Families.--
            (1) In general.--Section 2105(d)(3) of the Social Security 
        Act (42 U.S.C. 1397ee(d)(3)) is amended--
                    (A) in the paragraph heading, by striking ``through 
                september 30, 2027''; and
                    (B) in subparagraph (A), in the matter preceding 
                clause (i)--
                            (i) by striking ``During the period that 
                        begins on the date of enactment of the Patient 
                        Protection and Affordable Care Act and ends on 
                        September 30, 2027'' and inserting ``Beginning 
                        on the date of the enactment of the Patient 
                        Protection and Affordable Care Act'';
                            (ii) by striking ``During the period 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 preceding sentences shall not be 
                        construed as preventing a State from''.
            (2) Conforming amendments.--Section 1902(gg)(2) of the 
        Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
                    (A) in the paragraph heading, by striking ``through 
                september 30, 2027''; and
                    (B) by striking ``through September 30'' and all 
                that follows through ``ends on September 30, 2027'' and 
                inserting ``(but beginning on October 1, 2019,''.
    (d) Qualifying States Option.--Section 2105(g)(4) of the Social 
Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
            (1) in the paragraph heading, by striking ``for fiscal 
        years 2009 through 2027'' and inserting ``after fiscal year 
        2008''; and
            (2) in subparagraph (A), by striking ``for any of fiscal 
        years 2009 through 2027'' and inserting ``for any fiscal year 
        after fiscal year 2008''.
    (e) Outreach and Enrollment Program.--Section 2113 of the Social 
Security Act (42 U.S.C. 1397mm) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``during the 
                period of fiscal years 2009 through 2027'' and 
                inserting ``, beginning with fiscal year 2009,'';
                    (B) in paragraph (2)--
                            (i) by striking ``10 percent of such 
                        amounts'' and inserting ``10 percent of such 
                        amounts for the period or the fiscal year for 
                        which such amounts are appropriated''; and
                            (ii) by striking ``during such period'' and 
                        inserting ``, during such period or such fiscal 
                        year,''; and
                    (C) in paragraph (3), by striking ``For the period 
                of fiscal years 2024 through 2027, an amount equal to 
                10 percent of such amounts'' and inserting ``Beginning 
                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
            (2) in subsection (g)--
                    (A) by striking ``2017,,'' and inserting ``2017,'';
                    (B) by striking ``and $48,000,000'' and inserting 
                ``$48,000,000''; and
                    (C) 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 
                appropriated under this subsection for the previous 
                fiscal year, increased by the percentage increase in 
                the consumer price index for all urban consumers (all 
                items; United States city average) over such previous 
                fiscal year''.
    (f) Child Enrollment Contingency Fund.--Section 2104(n) of the 
Social Security Act (42 U.S.C. 1397dd(n)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (A)(ii)--
                            (i) by striking ``and 2024 through 2026'' 
                        and inserting ``beginning with fiscal year 
                        2024''; and
                            (ii) by striking ``2023, and 2027'' and 
                        inserting ``, and 2023''; and
                    (B) in subparagraph (B)--
                            (i) by striking ``2024 through 2026'' and 
                        inserting ``beginning with fiscal year 2024''; 
                        and
                            (ii) by striking ``2023, and 2027'' and 
                        inserting ``, and 2023''; and
            (2) in paragraph (3)(A)--
                    (A) by striking ``fiscal years 2024 through 2026'' 
                and inserting ``fiscal year 2024 or any subsequent 
                fiscal year''; and
                    (B) by striking ``2023, or 2027'' and inserting ``, 
                or 2023''.

SEC. 2003. STATE OPTION TO INCREASE CHILDREN'S ELIGIBILITY FOR MEDICAID 
              AND CHIP.

    Section 2110(b)(1)(B)(ii) of the Social Security Act (42 U.S.C. 
1397jj(b)(1)(B)(ii)) is amended--
            (1) in subclause (II), by striking ``or'' at the end;
            (2) in subclause (III), by striking ``and'' at the end and 
        inserting ``or''; and
            (3) by inserting after subclause (III) the following new 
        subclause:
                            ``(IV) at the option of the State, whose 
                        family income exceeds the maximum income level 
                        otherwise established for children under the 
                        State child health plan as of the date of the 
                        enactment of this subclause; and''.

                  TITLE III--FAMILY AND MEDICAL LEAVE

SEC. 3001. DEFINITIONS.

    In this title, the following definitions apply:
            (1) Caregiving day.--The term ``caregiving day'' means, 
        with respect to an individual, a calendar day in which the 
        individual engaged in qualified caregiving.
            (2) Commissioner.--The term ``Commissioner'' means the 
        Commissioner of Social Security.
            (3) Deputy commissioner.--The term ``Deputy Commissioner'' 
        means the Deputy Commissioner who heads the Office of Paid 
        Family and Medical Leave established under section 3002(a).
            (4) Eligible individual.--The term ``eligible individual'' 
        means an individual who is entitled to a benefit under section 
        3003 for a particular month, upon filing an application for 
        such benefit for such month.
            (5) Initial waiting period.--The term ``initial waiting 
        period'' means a period beginning with the first caregiving day 
        of an individual occurring during the individual's benefit 
        period and ending after the earlier of--
                    (A) the fifth caregiving day of the individual 
                occurring during the benefit period; or
                    (B) the month preceding the first month in the 
                benefit period during which occur not less than 15 
                caregiving days of the individual.
            (6) Qualified caregiving.--The term ``qualified 
        caregiving'' means any activity engaged in by an individual, 
        other than regular employment, for a reason for which an 
        eligible employee would be entitled to leave under 
        subparagraphs (A) through (E) of paragraph (1) of section 
        102(a) of the Family and Medical Leave Act of 1993 (29 U.S.C. 
        2612(a)).
            (7) Self-employment income.--The term ``self-employment 
        income'' has the same meaning as such term in section 211(b) of 
        the Social Security Act (42 U.S.C. 411(b)).
            (8) State.--The term ``State'' means any State of the 
        United States or the District of Columbia or any territory or 
        possession of the United States.
            (9) Wages.--The term ``wages'', except as such term is used 
        in subsection (h)(2) of section 3003, has the same meaning as 
        such term in section 209 of the Social Security Act (42 U.S.C. 
        409).
            (10) 60-day limitation period.--The term ``60-day 
        limitation period'' means a period--
                    (A) beginning with the first caregiving day of an 
                individual occurring during the individual's benefit 
                period and after the expiration of the individual's 5-
                day waiting period, if applicable; and
                    (B) ending with the 60th caregiving day of the 
                individual occurring during the benefit period and 
                after the expiration of the 5-day waiting period,
        disregarding any caregiving day of the individual occurring 
        during any month in the benefit period after the first 20 
        caregiving days of the individual occurring during such month.

SEC. 3002. OFFICE OF PAID FAMILY AND MEDICAL LEAVE.

    (a) Establishment of Office.--There is established within the 
Social Security Administration an office to be known as the Office of 
Paid Family and Medical Leave. The Office shall be headed by a Deputy 
Commissioner who shall be appointed by the Commissioner.
    (b) Responsibilities of Deputy Commissioner.--The Commissioner, 
acting through the Deputy Commissioner, shall be responsible for--
            (1) hiring personnel and making employment decisions with 
        regard to such personnel;
            (2) issuing such regulations as may be necessary to carry 
        out the purposes of this title;
            (3) entering into cooperative agreements with other 
        agencies and departments to ensure the efficiency of the 
        administration of the program;
            (4) determining eligibility for family and medical leave 
        insurance benefits under section 3003;
            (5) determining benefit amounts for each month of such 
        eligibility and making timely payments of such benefits to 
        entitled individuals in accordance with such section;
            (6) establishing and maintaining a system of records 
        relating to the administration of such section;
            (7) preventing fraud and abuse relating to such benefits;
            (8) providing information on request regarding eligibility 
        requirements, the claims process, benefit amounts, maximum 
        benefits payable, notice requirements, nondiscrimination 
        rights, confidentiality, coordination of leave under this title 
        and other laws, collective bargaining agreements, and employer 
        policies;
            (9) annually providing employers a notice informing 
        employees of the availability of such benefits;
            (10) annually making available to the public a report that 
        includes the number of individuals who received such benefits, 
        the purposes for which such benefits were received, and an 
        analysis of utilization rates of such benefits by gender, race, 
        ethnicity, and income levels; and
            (11) tailoring culturally and linguistically competent 
        education and outreach toward increasing utilization rates of 
        benefits under such section.
    (c) Availability of Data.--The Commissioner shall make available to 
the Deputy Commissioner such data as the Commissioner determines 
necessary to enable the Deputy Commissioner to effectively carry out 
the responsibilities described in subsection (b).

SEC. 3003. FAMILY AND MEDICAL LEAVE INSURANCE BENEFIT PAYMENTS.

    (a) In General.--Every individual who--
            (1) is insured for disability insurance benefits (as 
        determined under section 223(c) of the Social Security Act (42 
        U.S.C. 423(c))) at the time such individual's application is 
        filed;
            (2) has earned income from employment during the 12 months 
        prior to the month in which the application is filed;
            (3) has filed an application for a family and medical leave 
        insurance benefit in accordance with subsection (d); and
            (4) was engaged in qualified caregiving, or anticipates 
        being so engaged, during the period that begins 90 days before 
        the date on which such application is filed or within 30 days 
        after such date,
shall be entitled to such a benefit for each month in the benefit 
period specified in subsection (c), not to exceed 60 caregiving days 
per benefit period.
    (b) Benefit Amount.--
            (1) In general.--Except as otherwise provided in this 
        subsection, the benefit amount to which an individual is 
        entitled under this section for a month shall be an amount 
        equal to the greater of--
                    (A) the lesser of \1/18\ of the wages and self-
                employment income of the individual for the calendar 
                year in which such wages and self-employment income are 
                the highest among the most recent three calendar years, 
                or the maximum benefit amount determined under 
                paragraph (2); or
                    (B) the minimum benefit amount determined under 
                paragraph (2),
        multiplied by the quotient (not greater than 1) obtained by 
        dividing the number of caregiving days of the individual in 
        such month by 20.
            (2) Annual increase of maximum and minimum benefit 
        amounts.--
                    (A) For individuals who initially become eligible 
                for family and medical leave insurance benefits in the 
                first full calendar year after the date of enactment of 
                this Act, the maximum monthly benefit amount and the 
                minimum monthly benefit amount shall be $4,000 and 
                $580, respectively.
                    (B) For individuals who initially become eligible 
                for family and medical leave insurance benefits in any 
                calendar year after such first full calendar year the 
                maximum benefit amount and the minimum benefit amount 
                shall be, respectively, the product of the 
                corresponding amount determined with respect to the 
                first calendar year under subparagraph (A) and the 
                quotient obtained by dividing--
                            (i) the national average wage index (as 
                        defined in section 209(k)(1) of the Social 
                        Security Act (42 U.S.C. 409(k)(1))) for the 
                        second calendar year preceding the calendar 
                        year for which the determination is made, by
                            (ii) the national average wage index (as so 
                        defined) for the calendar year immediately 
                        preceding the calendar year in which occurs the 
                        date of enactment of this Act.
            (3) Limitations on benefits paid.--
                    (A) Nonpayable waiting period.--Any calendar day 
                during an individual's benefit period which occurs 
                before the expiration of an initial waiting period 
                shall not be taken into account under this subsection 
                as a caregiving day of the individual.
                    (B) Limitation on total benefits paid.--Any 
                calendar day during an individual's benefit period 
                which occurs after the expiration of a 60-day 
                limitation period shall not be taken into account under 
                this subsection as a caregiving day of the individual.
            (4) Reduction in benefit amount on account of receipt of 
        certain benefits.--A benefit under this section for a month 
        shall be reduced by the amount, if any, in certain benefits (as 
        determined under regulations issued by the Commissioner) as may 
        be otherwise received by an individual. For purposes of the 
        preceding sentence, certain benefits include--
                    (A) periodic benefits on account of such 
                individual's total or partial disability under a 
                workmen's compensation law or plan of the United States 
                or a State; and
                    (B) periodic benefits on account of an individual's 
                employment status under an unemployment law or plan of 
                the United States or a State.
            (5) Coordination of benefit amount with certain state 
        benefits.--A benefit received under this section shall be 
        coordinated, in a manner determined by regulations issued by 
        the Commissioner, with the periodic benefits received from 
        temporary disability insurance or family leave insurance 
        programs under any law or plan of a State, a political 
        subdivision (as that term is used in section 218(b)(2) of the 
        Social Security Act (42 U.S.C. 418(b)(2))), or an 
        instrumentality of two or more States (as that term is used in 
        section 218(g) of such Act of the Social Security Act (42 
        U.S.C. 418(g))).
    (c) Benefit Period.--
            (1) In general.--Except as provided in paragraph (2), the 
        benefit period specified in this subsection shall begin on the 
        1st day of the 1st month in which the individual meets the 
        criteria specified in paragraphs (1), (2), and (3) of 
        subsection (a), and shall end on the date that is 365 days 
        after the 1st day of the benefit period.
            (2) Retroactive benefits.--In the case of an application 
        for benefits under this section for qualified caregiving in 
        which the individual was engaged at any time during the 90-day 
        period preceding the date on which such application is 
        submitted, the benefit period specified in this subsection 
        shall begin on the later of--
                    (A) the 1st day of the 1st month in which the 
                individual engaged in such qualified caregiving; or
                    (B) the 1st day of the 1st month that begins during 
                such 90-day period,
        and shall end on the date that is 365 days after the 1st day of 
        the benefit period.
    (d) Application.--An application for a family and medical leave 
insurance benefit shall include--
            (1) a statement that the individual was engaged in 
        qualified caregiving, or anticipates being so engaged, during 
        the period that begins 90 days before the date on which the 
        application is submitted or within 30 days after such date;
            (2) if the qualified caregiving described in the statement 
        in paragraph (1) is engaged in by the individual because of a 
        serious health condition of the individual or a relative of the 
        individual, a certification, issued by the health care provider 
        treating such serious health condition, that affirms the 
        information specified in paragraph (1) and contains such 
        information as the Commissioner shall specify in regulations, 
        which shall be no more than the information that is required to 
        be stated under section 103(b) of the Family and Medical Leave 
        Act of 1993 (29 U.S.C. 2613(b));
            (3) if such qualified caregiving is engaged in by the 
        individual for any other authorized reason, a certification, 
        issued by a relevant authority determined under regulations 
        issued by the Commissioner, that affirms the circumstances 
        giving rise to such reason; and
            (4) an attestation from the applicant that his or her 
        employer has been provided with written notice of the 
        individual's intention to take family or medical leave, if the 
        individual has an employer, or to the Commissioner in all other 
        cases.
    (e) Ineligibility; Disqualification.--
            (1) Ineligibility for benefit.--An individual shall be 
        ineligible for a benefit under this section for any month for 
        which the individual is entitled to--
                    (A) disability insurance benefits under section 223 
                of the Social Security Act (42 U.S.C. 423) or a similar 
                permanent disability program under any law or plan of a 
                State or political subdivision or instrumentality of a 
                State (as such terms are used in section 218 of the 
                Social Security Act (42 U.S.C. 418));
                    (B) monthly insurance benefits under section 202 of 
                such Act (42 U.S.C. 402) based on such individual's 
                disability (as defined in section 223(d) of such Act 
                (42 U.S.C. 423(d))); or
                    (C) benefits under title XVI of such Act (42 U.S.C. 
                1381 et seq.) based on such individual's status as a 
                disabled individual (as determined under section 1614 
                of such Act (42 U.S.C. 1382c)).
            (2) Disqualification.--An individual who has been convicted 
        of a violation under section 208 of the Social Security Act (42 
        U.S.C. 408) or who has been found to have used false statements 
        to secure benefits under this section, shall be ineligible for 
        benefits under this section for a 1-year period following the 
        date of such conviction.
    (f) Review of Eligibility and Benefit Payment Determinations.--
            (1) Eligibility determinations.--
                    (A) In general.--The Commissioner shall provide 
                notice to an individual applying for benefits under 
                this section of the initial determination of 
                eligibility for such benefits, and the estimated 
                benefit amount for a month in which one caregiving day 
                of the individual occurs, as soon as practicable after 
                the application is received.
                    (B) Review.--An individual may request review of an 
                initial adverse determination with respect to such 
                application at any time before the end of the 20-day 
                period that begins on the date notice of such 
                determination is received, except that such 20-day 
                period may be extended for good cause. As soon as 
                practicable after the individual requests review of the 
                determination, the Commissioner shall provide notice to 
                the individual of a final determination of eligibility 
                for benefits under this section.
            (2) Benefit payment determinations.--
                    (A) In general.--The Commissioner shall make any 
                monthly benefit payment to an individual claiming 
                benefits for a month under this section, or provide 
                notice of the reason such payment will not be made if 
                the Commissioner determines that the individual is not 
                entitled to payment for such month, not later than 20 
                days after the individual's monthly benefit claim 
                report for such month is received. Such monthly report 
                shall be filed with the Commissioner not later than 15 
                days after the end of each month.
                    (B) Review.--If the Commissioner determines that 
                payment will not be made to an individual for a month, 
                or if the Commissioner determines that payment shall be 
                made based on a number of caregiving days in the month 
                inconsistent with the number of caregiving days in the 
                monthly benefit claim report of the individual for such 
                month, the individual may request review of such 
                determination at any time before the end of the 20-day 
                period that begins on the date notice of such 
                determination is received, except that such 20-day 
                period may be extended for good cause. Not later than 
                20 days after the individual requests review of the 
                determination, the Commissioner shall provide notice to 
                the individual of a final determination of payment for 
                such month, and shall make payment to the individual of 
                any additional amount not included in the initial 
                payment to the individual for such month to which the 
                Commissioner determines the individual is entitled.
            (3) Burden of proof.--An application for benefits under 
        this section and a monthly benefit claim report of an 
        individual shall each be presumed to be true and accurate, 
        unless the Commissioner demonstrates by a preponderance of the 
        evidence that information contained in the application is 
        false.
            (4) Definition of monthly benefit claim report.--For 
        purposes of this subsection, the term ``monthly benefit claim 
        report'' means, with respect to an individual for a month, the 
        individual's report to the Commissioner of the number of 
        caregiving days of the individual in such month, which shall be 
        filed no later than 15 days after the end of each month.
            (5) Review.--All final determinations of the Commissioner 
        under this subsection shall be reviewable according to the 
        procedures set out in section 205 of the Social Security Act 
        (42 U.S.C. 405).
    (g) Relationship With State Law; Employer Benefits.--
            (1) In general.--This section does not preempt or supercede 
        any provision of State or local law that authorizes a State or 
        local municipality to provide paid family and medical leave 
        benefits similar to the benefits provided under this section.
            (2) Greater benefits allowed.--Nothing in this title shall 
        be construed to diminish the obligation of an employer to 
        comply with any contract, collective bargaining agreement, or 
        any employment benefit program or plan that provides greater 
        paid leave or other leave rights to employees than the rights 
        established under this title.
    (h) Prohibited Acts; Enforcement.--
            (1) In general.--It shall be unlawful for any person to 
        discharge or in any other manner discriminate against an 
        individual because the individual has applied for, indicated an 
        intent to apply for, or received family and medical leave 
        insurance benefits.
            (2) Civil action by an individual.--
                    (A) Liability.--Any person who violates paragraph 
                (1) shall be liable to any individual employed by such 
                person who is affected by the violation--
                            (i) for damages equal to the sum of--
                                    (I) the amount of--
                                            (aa) any wages, salary, 
                                        employment benefits, or other 
                                        compensation denied or lost to 
                                        such individual by reason of 
                                        the violation; or
                                            (bb) in a case in which 
                                        wages, salary, employment 
                                        benefits, or other compensation 
                                        have not been denied or lost to 
                                        the individual, any actual 
                                        monetary losses sustained by 
                                        the individual as a direct 
                                        result of the violation, such 
                                        as the cost of providing care, 
                                        up to a sum equal to 60 
                                        calendar days of wages or 
                                        salary for the individual;
                                    (II) the interest on the amount 
                                described in subclause (I) calculated 
                                at the prevailing rate; and
                                    (III) an additional amount as 
                                liquidated damages equal to the sum of 
                                the amount described in subclause (I) 
                                and the interest described in subclause 
                                (II), except that if a person who has 
                                violated paragraph (1) proves to the 
                                satisfaction of the court that the act 
                                or omission which violated paragraph 
                                (1) was in good faith and that the 
                                person had reasonable grounds for 
                                believing that the act or omission was 
                                not a violation of paragraph (1), such 
                                court may, in the discretion of the 
                                court, reduce the amount of the 
                                liability to the amount and interest 
                                determined under subclauses (I) and 
                                (II), respectively; and
                            (ii) for such equitable relief as may be 
                        appropriate, including employment, 
                        reinstatement, and promotion.
                    (B) Right of action.--An action to recover the 
                damages or equitable relief prescribed in subparagraph 
                (A) may be maintained against any person in any Federal 
                or State court of competent jurisdiction by any 
                individual for and on behalf of--
                            (i) the individual; or
                            (ii) the individual and other individuals 
                        similarly situated.
                    (C) Fees and costs.--The court in such an action 
                shall, in addition to any judgment awarded to the 
                plaintiff, allow a reasonable attorney's fee, 
                reasonable expert witness fees, and other costs of the 
                action to be paid by the defendant.
                    (D) Limitations.--The right provided by 
                subparagraph (B) to bring an action by or on behalf of 
                any individual shall terminate--
                            (i) on the filing of a complaint by the 
                        Commissioner in an action under paragraph (5) 
                        in which restraint is sought of any further 
                        delay in the payment of the amount described in 
                        subparagraph (A)(I) to such individual by the 
                        person responsible under subparagraph (A) for 
                        the payment; or
                            (ii) on the filing of a complaint by the 
                        Commissioner in an action under paragraph (3) 
                        in which a recovery is sought of the damages 
                        described in subparagraph (A)(I) owing to an 
                        individual by a person liable under 
                        subparagraph (A),
                unless the action described in clause (i) or (ii) is 
                dismissed without prejudice on motion of the 
                Commissioner.
            (3) Action by the commissioner.--
                    (A) Civil action.--The Commissioner may bring an 
                action in any court of competent jurisdiction to 
                recover the damages described in paragraph (2)(A)(I).
                    (B) Sums recovered.--Any sums recovered by the 
                Commissioner pursuant to subparagraph (A) shall be held 
                in a special deposit account and shall be paid, on 
                order of the Commissioner, directly to each individual 
                affected. Any such sums not paid to an individual 
                because of inability to do so within a period of 3 
                years shall be deposited into the Federal Family and 
                Medical Leave Insurance Trust Fund.
            (4) Limitation.--
                    (A) In general.--An action may be brought under 
                this subsection not later than 3 years after the date 
                of the last event constituting the alleged violation 
                for which the action is brought.
                    (B) Commencement.--An action brought by the 
                Commissioner under this subsection shall be considered 
                to be commenced on the date when the complaint is 
                filed.
            (5) Action for injunction by commissioner.--The district 
        courts of the United States shall have jurisdiction, for cause 
        shown, in an action brought by the Commissioner--
                    (A) to restrain violations of paragraph (1), 
                including the restraint of any withholding of payment 
                of wages, salary, employment benefits, or other 
                compensation, plus interest, found by the court to be 
                due to an individual; or
                    (B) to award such other equitable relief as may be 
                appropriate, including employment, reinstatement, and 
                promotion.
    (i) Special Rule for Railroad Employees.--For purposes of 
subsection (a)(1), an individual shall be deemed to be insured for 
disability insurance benefits if the individual would be so insured if 
the individual's service as an employee (as defined in the section 1(b) 
of the Railroad Retirement Act of 1974) after December 31, 1936, were 
included within the meaning of the term ``employment'' for purposes of 
title II of the Social Security Act (42 U.S.C. 401 et seq.).
    (j) Determination of Whether an Activity Constitutes Qualified 
Caregiving.--
            (1) In general.--For purposes of determining whether an 
        activity engaged in by an individual constitutes qualified 
        caregiving under this section--
                    (A) the term ``spouse'' (as used in section 102(a) 
                of the Family and Medical Leave Act (29 U.S.C. 
                2612(a))) includes the individual's domestic partner; 
                and
                    (B) the term ``son or daughter'' (as used in such 
                section) includes a son or daughter (as defined in 
                section 101 of such Act) of the individual's domestic 
                partner.
            (2) Domestic partner.--
                    (A) In general.--For purposes of paragraph (1), the 
                term ``domestic partner'', with respect to an 
                individual, means another individual with whom the 
                individual is in a committed relationship.
                    (B) Committed relationship defined.--The term 
                ``committed relationship'' means a relationship between 
                two individuals (each at least 18 years of age) in 
                which each individual is the other individual's sole 
                domestic partner and both individuals share 
                responsibility for a significant measure of each 
                other's common welfare. The term includes any such 
                relationship between two individuals, including 
                individuals of the same sex, that is granted legal 
                recognition by a State or political subdivision of a 
                State as a marriage or analogous relationship, 
                including a civil union or domestic partnership.
    (k) Applicability of Certain Social Security Act Provisions.--The 
provisions of sections 204, 205, 206, and 208 of the Social Security 
Act shall apply to benefit payments authorized by and paid out pursuant 
to this section in the same way that such provisions apply to benefit 
payments authorized by and paid out pursuant to title II of such Act.
    (l) Effective Date for Applications.--Applications described in 
this section may be filed beginning 18 months after the date of 
enactment of this Act.

SEC. 3004. ESTABLISHMENT OF FAMILY AND MEDICAL LEAVE INSURANCE TRUST 
              FUND.

    (a) In General.--There is hereby created on the books of the 
Treasury of the United States a trust fund to be known as the ``Federal 
Family and Medical Leave Insurance Trust Fund''. The Federal Family and 
Medical Leave Insurance Trust Fund shall consist of such gifts and 
bequests as may be made as provided in section 201(i)(1) of the Social 
Security Act (42 U.S.C. 401(i)(1)) and such amounts as may be 
appropriated to, or deposited in, the Federal Family and Medical Leave 
Insurance Trust Fund as provided in this section.
    (b) Authorization of Appropriations.--
            (1) In general.--There is authorized to be appropriated to 
        the Federal Family and Medical Leave Insurance Trust Fund out 
        of moneys in the Treasury not otherwise appropriated--
                    (A) for the first three fiscal years beginning 
                after the date of enactment of this Act, such sums as 
                may be necessary for the Commissioner to administer the 
                office established under section 3002 and pay the 
                benefits under section 3003;
                    (B) 100 percent of the taxes imposed by sections 
                3101(c) and 3111(c) of the Internal Revenue Code of 
                1986 with respect to wages (as defined in section 3121 
                of such Code) reported to the Secretary of the Treasury 
                pursuant to subtitle F of such Code, as determined by 
                the Secretary of the Treasury by applying the 
                applicable rate of tax under such sections to such 
                wages;
                    (C) 100 percent of the taxes imposed by section 
                1401(c) of such Code with respect to self-employment 
                income (as defined in section 1402 of such Code) 
                reported to the Secretary of the Treasury on tax 
                returns under subtitle F of such Code, as determined by 
                the Secretary of the Treasury by applying the 
                applicable rate of tax under such section to such self-
                employment income; and
                    (D) 100 percent of the taxes imposed by sections 
                3201(c), 3211(c), and 3221(c) of such Code with respect 
                to compensation (as defined in section 3231 of such 
                Code) reported to the Secretary of the Treasury on tax 
                returns under subtitle F of such Code, as determined by 
                the Secretary of the Treasury by applying the 
                applicable rate of tax under such sections to such 
                compensation.
            (2) Repayment of initial appropriation.--Amounts 
        appropriated pursuant to subparagraph (A) of paragraph (1) 
        shall be repaid to the Treasury of the United States not later 
        than 10 years after the first appropriation is made pursuant to 
        such subparagraph.
            (3) Transfer to trust fund.--The amounts described in 
        paragraph (2) shall be transferred from time to time from the 
        general fund in the Treasury to the Federal Family and Medical 
        Leave Insurance Trust Fund, such amounts to be determined on 
        the basis of estimates by the Secretary of the Treasury of the 
        taxes, specified in such paragraph, paid to or deposited into 
        the Treasury. Proper adjustments shall be made in amounts 
        subsequently transferred to the extent prior estimates were 
        inconsistent with the taxes specified in such paragraph.
    (c) Management of Trust Fund.--The provisions of subsections (c), 
(d), (e), (f), (i), and (m) of section 201 of the Social Security Act 
(42 U.S.C. 401) shall apply with respect to the Federal Family and 
Medical Leave Insurance Trust Fund in the same manner as such 
provisions apply to the Federal Old-Age and Survivors Insurance Trust 
Fund and the Disability Insurance Trust Fund.
    (d) Benefits Paid From Trust Fund.--Benefit payments required to be 
made under section 3003 shall be made only from the Federal Family and 
Medical Leave Insurance Trust Fund.
    (e) Administration.--There are authorized to be made available for 
expenditure, out of the Federal Family and Medical Leave Insurance 
Trust Fund, such sums as may be necessary to pay the costs of the 
administration of section 3003, including start-up costs, technical 
assistance, outreach, education, evaluation, and reporting.
    (f) Prohibition.--No funds from the Social Security Trust Fund or 
appropriated to the Social Security Administration to administer Social 
Security programs may be used for Federal Family and Medical Leave 
Insurance benefits or administration set forth under this title.

SEC. 3005. INTERNAL REVENUE CODE PROVISIONS.

    (a) In General.--
            (1) Employee contribution.--Section 3101 of the Internal 
        Revenue Code of 1986 is amended--
                    (A) by redesignating subsection (c) as subsection 
                (d); and
                    (B) by inserting after subsection (b) the 
                following:
    ``(c) Family and Medical Leave Insurance.--
            ``(1) In general.--In addition to other taxes, there is 
        hereby imposed on the income of every individual a tax equal to 
        the applicable percentage of the wages (as defined in section 
        3121(a)) received by the individual with respect to employment 
        (as defined in section 3121(b)).
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1), the term `applicable percentage' means 0.2 percent in the 
        case of wages received in any calendar year.''.
            (2) Employer contribution.--Section 3111 of such Code is 
        amended--
                    (A) by redesignating subsection (c) as subsection 
                (d); and
                    (B) by inserting after subsection (b) the 
                following:
    ``(c) Family and Medical Leave Insurance.--
            ``(1) In general.--In addition to other taxes, there is 
        hereby imposed on every employer an excise tax, with respect to 
        having individuals in his employ, equal to the applicable 
        percentage of the wages (as defined in section 3121(a)) paid by 
        the employer with respect to employment (as defined in section 
        3121(b)).
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1), the term `applicable percentage' means 0.2 percent in the 
        case of wages paid in any calendar year.''.
            (3) Self-employment income contribution.--
                    (A) In general.--Section 1401 of such Code is 
                amended--
                            (i) by redesignating subsection (c) as 
                        subsection (d); and
                            (ii) by inserting after subsection (b) the 
                        following:
    ``(c) Family and Medical Leave Insurance.--
            ``(1) In general.--In addition to other taxes, there is 
        hereby imposed for each taxable year, on the self-employment 
        income of every individual, a tax equal to the applicable 
        percentage of the amount of the self-employment income for such 
        taxable year.
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1), the term `applicable percentage' means 0.4 percent in the 
        case of self-employment income in any taxable year.''.
                    (B) Exclusion of certain net earnings from self-
                employment.--Section 1402(b)(1) of such Code is amended 
                by striking ``tax imposed by section 1401(a)'' and 
                inserting ``taxes imposed by subsections (a) and (c) of 
                section 1401''.
    (b) Railroad Retirement Tax Act.--
            (1) Employee contribution.--Section 3201 of such Code is 
        amended--
                    (A) by redesignating subsection (c) as subsection 
                (d); and
                    (B) by inserting after subsection (b) the 
                following:
    ``(c) Family and Medical Leave Insurance.--
            ``(1) In general.--In addition to other taxes, there is 
        hereby imposed on the income of each employee a tax equal to 
        the applicable percentage of the compensation received during 
        any calendar year by such employee for services rendered by 
        such employee.
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1), the term `applicable percentage' means 0.2 percent in the 
        case of compensation received in any calendar year.''.
            (2) Employee representative contribution.--Section 3211 of 
        such Code is amended--
                    (A) by redesignating subsection (c) as subsection 
                (d); and
                    (B) by inserting after subsection (b) the 
                following:
    ``(c) Family and Medical Leave Insurance.--
            ``(1) In general.--In addition to other taxes, there is 
        hereby imposed on the income of each employee representative a 
        tax equal to the applicable percentage of the compensation 
        received during any calendar year by such employee 
        representative for services rendered by such employee 
        representative.
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1), the term `applicable percentage' means 0.2 percent in the 
        case of compensation received in any calendar year.''.
            (3) Employer contribution.--Section 3221 of such Code is 
        amended--
                    (A) by redesignating subsection (c) as subsection 
                (d); and
                    (B) by inserting after subsection (b) the 
                following:
    ``(c) Family and Medical Leave Insurance.--
            ``(1) In general.--In addition to other taxes, there is 
        hereby imposed on every employer an excise tax, with respect to 
        having individuals in his employ, equal to the applicable 
        percentage of the compensation paid during any calendar year by 
        such employer for services rendered to such employer.
            ``(2) Applicable percentage.--For purposes of paragraph 
        (1), the term `applicable percentage' means 0.2 percent in the 
        case of compensation paid in any calendar year.''.
    (c) Conforming Amendments.--
            (1) Section 6413(c) of the Internal Revenue Code of 1986 is 
        amended--
                    (A) in paragraph (1)--
                            (i) by inserting ``, section 3101(c),'' 
                        after ``by section 3101(a)''; and
                            (ii) by striking ``both'' and inserting 
                        ``each''; and
                    (B) in paragraph (2), by inserting ``or 3101(c)'' 
                after ``3101(a)'' each place it appears.
            (2) Section 15(a) of the Railroad Retirement Act of 1974 
        (45 U.S.C. 231n(a)) is amended by inserting ``(other than 
        sections 3201(c), 3211(c), and 3221(c))'' before the period at 
        the end.
    (d) Effective Date.--The amendments made by this section shall take 
effect 120 days after the date of the enactment of this Act.

SEC. 3006. REGULATIONS.

    The Commissioner, in consultation with the Secretary of Labor, 
shall prescribe regulations necessary to carry out this title. In 
developing such regulations, the Commissioner shall consider the input 
from a volunteer advisory body comprised of not more than 15 
individuals, including experts in the relevant subject matter and 
officials charged with implementing State paid family and medical leave 
insurance programs. The Commissioner shall take such programs into 
account when proposing regulations. Such individuals shall be appointed 
as follows:
            (1) Five individuals to be appointed by the President.
            (2) Three individuals to be appointed by the majority 
        leader of the Senate.
            (3) Two individuals to be appointed by the minority leader 
        of the Senate.
            (4) Three individuals to be appointed by the Speaker of the 
        House of Representatives.
            (5) Two individuals to be appointed by the minority leader 
        of the House of Representatives.

SEC. 3007. GAO STUDY.

    As soon as practicable after calendar year 2025, the Comptroller 
General shall submit to Congress a report on family and medical leave 
insurance benefits paid under section 3003 for any month during the 1-
year period beginning on January 1, 2025. The report shall include the 
following:
            (1) An identification of the total number of applications 
        for such benefits filed for any month during such 1-year 
        period, and the average number of days occurring in the period 
        beginning on the date on which such an application is received 
        and ending on the date on which the initial determination of 
        eligibility with respect to the application is made.
            (2) An identification of the total number of requests for 
        review of an initial adverse determination of eligibility for 
        such benefits made during such 1-year period, and the average 
        number of days occurring in the period beginning on the date on 
        which such review is requested and ending on the date on which 
        the final determination of eligibility with respect to such 
        review is made.
            (3) An identification of the total number of monthly 
        benefit claim reports for such benefits filed during such 1-
        year period, and the average number of days occurring in the 
        period beginning on the date on which such a claim report is 
        received and ending on the date on which the initial 
        determination of eligibility with respect to the claim report 
        is made.
            (4) An identification of the total number of requests for 
        review of an initial adverse determination relating to a 
        monthly benefit claim report for such benefits made during such 
        1-year period, and the average number of days occurring in the 
        period beginning on the date on which such review is requested 
        and ending on the date on which the final determination of 
        eligibility with respect to such review is made.
            (5) An identification of any excessive delay in any of the 
        periods described in paragraphs (1) through (4), and a 
        description of the causes for such delay.

              TITLE IV--FULLY REFUNDABLE CHILD TAX CREDIT

SEC. 4001. ESTABLISHMENT OF FULLY REFUNDABLE CHILD TAX CREDIT.

    (a) Elimination of Existing Child Tax Credit.--Subpart A of part IV 
of subchapter A of chapter 1 of subtitle A of the Internal Revenue Code 
of 1986 is amended by striking section 24.
    (b) Establishment of Fully Refundable Child Tax Credit.--Subpart C 
of part IV of subchapter A of chapter 1 of subtitle A of such Code is 
amended by inserting after section 36B the following new section:

``SEC. 36C. CHILD TAX CREDIT.

    ``(a) Allowance of Credit.--In the case of an eligible individual, 
there shall be allowed as a credit against the tax imposed by this 
chapter for the taxable year an amount equal to the sum of--
            ``(1) with respect to each qualifying child of the taxpayer 
        who has attained 6 years of age before the close of such 
        taxable year and for which the taxpayer is allowed a deduction 
        under section 151, an amount equal to $3,000, and
            ``(2) with respect to each qualifying child of the taxpayer 
        who has not attained 6 years of age before the close of such 
        taxable year and for which the taxpayer is allowed a deduction 
        under section 151, an amount equal to 120 percent of the dollar 
        amount in paragraph (1).
    ``(b) Limitation.--
            ``(1) In general.--The amount of the credit allowable under 
        subsection (a) shall be reduced (but not below zero) by the 
        applicable amount for each $1,000 (or fraction thereof) by 
        which the taxpayer's modified adjusted gross income exceeds the 
        threshold amount. For purposes of the preceding sentence, the 
        term `modified adjusted gross income' means adjusted gross 
        income increased by any amount excluded from gross income under 
        section 911, 931, or 933.
            ``(2) Threshold amount.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the term `threshold amount' means--
                            ``(i) $180,000 in the case of a joint 
                        return,
                            ``(ii) $130,000 in the case of an 
                        individual who is not married, and
                            ``(iii) $90,000 in the case of a married 
                        individual filing a separate return.
                    ``(B) Marital status.--For purposes of this 
                paragraph, marital status shall be determined under 
                section 7703.
            ``(3) Applicable amount.--For purposes of paragraph (1), 
        the term `applicable amount' means an amount equal to the 
        quotient of--
                    ``(A) the amount of the credit allowable under 
                subsection (a), as determined without regard to this 
                subsection, divided by
                    ``(B) an amount equal to the product of--
                            ``(i) $20, multiplied by
                            ``(ii) the total number of qualifying 
                        children of the taxpayer.
    ``(c) Qualifying Child.--For purposes of this section--
            ``(1) In general.--The term `qualifying child' means a 
        qualifying child of the taxpayer (as defined in section 152(c)) 
        who has not attained 18 years of age.
            ``(2) Exception for certain non-citizens.--The term 
        `qualifying child' shall not include any individual who would 
        not be a dependent if subparagraph (A) of section 152(b)(3) 
        were applied without regard to all that follows `resident of 
        the United States'.
    ``(d) Eligible Individual.--For purposes of this section, the term 
`eligible individual' means, with respect to any taxable year, any 
individual if such individual's principal place of abode is in the 
United States (as determined under section 32(c)(4)) for more than one-
half of such taxable year.
    ``(e) Inflation Adjustment.--
            ``(1) In general.--In the case of any taxable year 
        beginning after 2022, the $3,000 amount in subsection (a)(1) 
        shall be increased by an amount equal to--
                    ``(A) such dollar amount, multiplied by
                    ``(B) the cost-of-living adjustment determined 
                under paragraph (2) for the calendar year in which the 
                taxable year begins.
            ``(2) Cost-of-living adjustment.--For purposes of paragraph 
        (1), the cost-of-living adjustment for any calendar year is the 
        percentage (if any) by which--
                    ``(A) the CPI for the preceding calendar year (as 
                determined pursuant to section 1(f)(4)), exceeds
                    ``(B) the CPI for calendar year 2021.
            ``(3) Rounding.--If any increase determined under paragraph 
        (1) is not a multiple of $50, such increase shall be rounded to 
        the nearest multiple of $50.
    ``(f) Partial Non-Refundable Credit Allowed for Certain Other 
Dependents.--
            ``(1) In general.--In the case of a taxable year beginning 
        after December 31, 2021, and before January 1, 2026, the 
        aggregate credits allowed to a taxpayer under subpart A shall 
        be increased by $500 for each dependent of the taxpayer (as 
        defined in section 152) other than a qualifying child described 
        in subsection (c). The amount of the credit allowed under this 
        subsection shall not be treated as a credit allowed under this 
        subpart.
            ``(2) Exception for certain noncitizens.--Paragraph (1) 
        shall not apply with respect to any individual who would not be 
        a dependent if subparagraph (A) of section 152(b)(3) were 
        applied without regard to all that follows `resident of the 
        United States'.
            ``(3) Limitation.--
                    ``(A) In general.--The amount of the credit 
                allowable under paragraph (1) shall be reduced (but not 
                below zero) by $50 for each $1,000 (or fraction 
                thereof) by which the taxpayer's modified adjusted 
                gross income exceeds the threshold amount.
                    ``(B) Modified adjusted gross income.--For purposes 
                of subparagraph (A), the term `modified adjusted gross 
                income' means adjusted gross income increased by any 
                amount excluded from gross income under section 911, 
                931, or 933.
                    ``(C) Threshold amount.--
                            ``(i) In general.--For purposes of 
                        subparagraph (A), the term `threshold amount' 
                        means--
                                    ``(I) $200,000 in the case of a 
                                joint return,
                                    ``(II) $150,000 in the case of an 
                                individual who is not married, and
                                    ``(III) $100,000 in the case of a 
                                married individual filing a separate 
                                return.
                            ``(ii) Marital status.--For purposes of 
                        this subparagraph, marital status shall be 
                        determined under section 7703.
    ``(g) Identification Requirements.--
            ``(1) Qualifying child and dependent identification 
        requirement.--No credit shall be allowed under this section to 
        a taxpayer with respect to any qualifying child or dependent 
        unless the taxpayer includes the name and taxpayer 
        identification number of such qualifying child or dependent on 
        the return of tax for the taxable year and such taxpayer 
        identification number was issued on or before the due date for 
        filing such return.
            ``(2) Taxpayer identification requirement.--No credit shall 
        be allowed under this section if the taxpayer identification 
        number of the taxpayer was issued after the due date for filing 
        the return for the taxable year.
    ``(h) Taxable Year Must Be Full Taxable Year.--Except in the case 
of a taxable year closed by reason of the death of the taxpayer, no 
credit shall be allowable under this section in the case of a taxable 
year covering a period of less than 12 months.
    ``(i) Restrictions on Taxpayers Who Improperly Claimed Credit in 
Prior Year.--
            ``(1) Taxpayers making prior fraudulent or reckless 
        claims.--
                    ``(A) In general.--No credit shall be allowed under 
                this section for any taxable year in the disallowance 
                period.
                    ``(B) Disallowance period.--For purposes of 
                subparagraph (A), the disallowance period is--
                            ``(i) the period of 10 taxable years after 
                        the most recent taxable year for which there 
                        was a final determination that the taxpayer's 
                        claim of credit under this section was due to 
                        fraud, and
                            ``(ii) the period of 2 taxable years after 
                        the most recent taxable year for which there 
                        was a final determination that the taxpayer's 
                        claim of credit under this section was due to 
                        reckless or intentional disregard of rules and 
                        regulations (but not due to fraud).
            ``(2) Taxpayers making improper prior claims.--In the case 
        of a taxpayer who is denied credit under this section for any 
        taxable year as a result of the deficiency procedures under 
        subchapter B of chapter 63, no credit shall be allowed under 
        this section for any subsequent taxable year unless the 
        taxpayer provides such information as the Secretary may require 
        to demonstrate eligibility for such credit.
    ``(j) Reconciliation of Credit and Advance Credit.--
            ``(1) In general.--The amount of the credit allowed under 
        this section to any taxpayer for any taxable year shall be 
        reduced (but not below zero) by the aggregate amount of 
        payments made under section 7527A to such taxpayer during such 
        taxable year.
            ``(2) Excess advance payments.--If the aggregate amount of 
        payments under section 7527A to the taxpayer during the taxable 
        year exceeds the amount of the credit allowed under this 
        section to such taxpayer for such taxable year (determined 
        without regard to paragraph (1)), the tax imposed by this 
        chapter for such taxable year shall be increased by the amount 
        of such excess.''.
    (c) Advance Payment of Credit.--Section 7527A of such Code is 
amended to read as follows:

``SEC. 7527A. ADVANCE PAYMENT OF CHILD TAX CREDIT.

    ``(a) In General.--As soon as practicable after the date of the 
enactment of this section, the Secretary shall establish a program for 
making monthly payments to taxpayers which, in the aggregate during any 
calendar year, equal the annual advance amount determined with respect 
to such taxpayer for such calendar year.
    ``(b) Annual Advance Amount.--For purposes of this section--
            ``(1) In general.--Except as otherwise provided in this 
        subsection, the term `annual advance amount' means, with 
        respect to any taxpayer for any calendar year, the amount of 
        the credit which would be allowed to such taxpayer under 
        section 36C(a) (determined without regard to subsection (j) 
        thereof) for the taxpayer's taxable year beginning in such 
        calendar year if--
                    ``(A) the taxpayer's modified adjusted gross income 
                for such taxable year were equal to the taxpayer's 
                modified adjusted gross income for the reference 
                taxable year,
                    ``(B) the only qualifying children of such taxpayer 
                are qualifying children properly claimed on the 
                taxpayer's return of tax for the reference taxable 
                year, and
                    ``(C) the age of such qualifying children is 
                determined for such taxable year by taking into account 
                the passage of time since the reference taxable year.
            ``(2) Reference taxable year.--Except as provided in 
        paragraph (3)(A), the term `reference taxable year' means, with 
        respect to any taxpayer for any calendar year, the taxpayer's 
        taxable year beginning in the preceding calendar year or, in 
        the case of taxpayer who did not file a return of tax for such 
        taxable year, the taxpayer's taxable year beginning in the 
        second preceding calendar year.
            ``(3) Modifications during calendar year.--The Secretary 
        may modify, during any calendar year, the annual advance amount 
        with respect to any taxpayer for such calendar year to take 
        into account--
                    ``(A) a return of tax filed by such taxpayer during 
                such calendar year (and the taxable year to which such 
                return relates may be taken into account as the 
                reference taxable year), and
                    ``(B) any other information provided by the 
                taxpayer to the Secretary which allows the Secretary to 
                determine payments under subsection (a) which, in the 
                aggregate during any taxable year of the taxpayer, more 
                closely total the Secretary's best estimate of the 
                credit allowed to the taxpayer under section 36C(a) 
                (determined without regard to subsection (i) thereof) 
                for such taxable year.
    ``(c) On-Line Information Portal.--The Secretary shall establish an 
on-line portal which allows taxpayers to--
            ``(1) elect not to receive payments under this section, and
            ``(2) provide information to the Secretary which would be 
        relevant to a modification under subsection (b)(3)(B) of the 
        annual advance amount, including information regarding--
                    ``(A) a change in the number of the taxpayer's 
                qualifying children, including by reason of the birth 
                of a child,
                    ``(B) a change in the taxpayer's marital status,
                    ``(C) a significant change in the taxpayer's 
                modified adjusted gross income, and
                    ``(D) any other factor which the Secretary may 
                provide.
    ``(d) Notice of Payments.--Not later than January 31 of the 
calendar year following any calendar year during which the Secretary 
makes one or more payments to any taxpayer under this section, the 
Secretary shall provide such taxpayer with a written notice which 
includes the taxpayer's taxpayer identity (as defined in section 
6103(b)(6)), the aggregate amount of such payments made to such 
taxpayer during such calendar year, and such other information as the 
Secretary determines appropriate.
    ``(e) Authority To Adjust Interval of Payments.--If the Secretary 
determines that it is not administratively feasible to make monthly 
payments under this section, such payments shall be made on the basis 
of the shortest interval which the Secretary determines is 
administratively feasible.''.
    (d) Conforming Amendments.--
            (1) The table of sections for subpart A of part IV of 
        subchapter A of chapter 1 of subtitle A of the Internal Revenue 
        Code of 1986 is amended by striking the item relating to 
        section 24.
            (2) The table of sections for subpart C of part IV of 
        subchapter A of chapter 1 of subtitle A of such Code is amended 
        by inserting after the item relating to section 36B the 
        following:

``Sec. 36C. Child tax credit.''.
            (3) Subparagraph (B) of section 45R(f)(3) of such Code is 
        amended to read as follows:
                    ``(B) Special rule.--Any amounts paid pursuant to 
                an agreement under section 3121(l) (relating to 
                agreements entered into by American employers with 
                respect to foreign affiliates) which are equivalent to 
                the taxes referred to in subparagraph (A) shall be 
                treated as taxes referred to in such subparagraph.''.
            (4) Section 152(f)(6)(B)(ii) of such Code is amended by 
        striking ``section 24'' and inserting ``section 36C''.
            (5) Paragraph (26) of section 501(c) of such Code is 
        amended in the flush matter at the end by striking ``section 
        24(c))'' and inserting ``section 36C(c))''.
            (6) Section 6211(b)(4)(A) of such Code is amended--
                    (A) by striking ``24(d),''; and
                    (B) by inserting ``36C(a),'' after ``36B,''.
            (7) Section 6213(g)(2) of such Code is amended--
                    (A) in subparagraph (I), by striking ``section 
                24(e)'' and inserting ``section 36C(g)''; and
                    (B) in subparagraph (L), by striking ``24, or 32'' 
                and inserting ``32, or 36C''.
            (8) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting ``36C,'' after ``36B,''.
    (e) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2021.

SEC. 4002. PAYMENTS TO POSSESSIONS.

    (a) Mirror Code Possession.--The Secretary of the Treasury shall 
pay to each possession of the United States with a mirror code tax 
system amounts equal to the loss to that possession by reason of the 
application of section 36C of the Internal Revenue Code of 1986 (as 
added by section 4001) with respect to taxable years beginning after 
2020. Such amounts shall be determined by the Secretary of the Treasury 
based on information provided by the government of the respective 
possession.
    (b) Other Possessions.--The Secretary of the Treasury shall pay to 
each possession of the United States which does not have a mirror code 
tax system amounts estimated by the Secretary of the Treasury as being 
equal to the aggregate benefits that would have been provided to 
residents of such possession by reason of the application of section 
36C of such Code (as so added) for taxable years beginning after 2021 
if a mirror code tax system had been in effect in such possession. The 
preceding sentence shall not apply with respect to any possession of 
the United States unless such possession has a plan, which has been 
approved by the Secretary of the Treasury, under which such possession 
will promptly distribute such payments to the residents of such 
possession.
    (c) Coordination With Credit Allowed Against United States Income 
Taxes.--No credit shall be allowed against United States income taxes 
for any taxable year under section 36C of the Internal Revenue Code of 
1986 (as so added) to any person--
            (1) to whom a credit is allowed against taxes imposed by 
        the possession by reason of the amendments made by this section 
        for such taxable year; or
            (2) who is eligible for a payment under a plan described in 
        subsection (b) with respect to such taxable year.
    (d) Definitions and Special Rules.--
            (1) Possession of the united states.--For purposes of this 
        section, the term ``possession of the United States'' includes 
        the Commonwealth of Puerto Rico and the Commonwealth of the 
        Northern Mariana Islands.
            (2) Mirror code tax system.--For purposes of this section, 
        the term ``mirror code tax system'' means, with respect to any 
        possession of the United States, the income tax system of such 
        possession if the income tax liability of the residents of such 
        possession under such system is determined by reference to the 
        income tax laws of the United States as if such possession were 
        the United States.
            (3) Treatment of payments.--For purposes of section 
        1324(b)(2) of title 31, United States Code, the payments under 
        this section shall be treated in the same manner as a refund 
        due from the credit allowed under section 36C of the Internal 
        Revenue Code of 1986.

                 TITLE V--CHILD CARE IS INFRASTRUCTURE

SEC. 5001. INFRASTRUCTURE GRANTS TO IMPROVE CHILD CARE SAFETY.

    (a) In General.--Part A of title IV of the Social Security Act (42 
U.S.C. 601 et seq.) is amended by inserting after section 418 the 
following:

``SEC. 418A. INFRASTRUCTURE GRANTS TO IMPROVE CHILD CARE SAFETY.

    ``(a) Short Title.--This section may be cited as the 
`Infrastructure Grants To Improve Child Care Safety Act'.
    ``(b) Needs Assessments.--
            ``(1) Immediate needs assessment.--
                    ``(A) In general.--The Secretary shall conduct an 
                immediate needs assessment of the condition of child 
                care facilities throughout the United States (with 
                priority given to child care facilities that receive 
                Federal funds), that--
                            ``(i) determines the extent to which the 
                        COVID-19 pandemic has created immediate 
                        infrastructure needs, including infrastructure-
                        related health and safety needs, which must be 
                        addressed for child care facilities to operate 
                        in compliance with public health guidelines;
                            ``(ii) considers the effects of the 
                        pandemic on a variety of child care centers, 
                        including home-based centers; and
                            ``(iii) considers how the pandemic has 
                        impacted specific metrics, such as--
                                    ``(I) capacity;
                                    ``(II) investments in 
                                infrastructure changes;
                                    ``(III) the types of infrastructure 
                                changes centers need to implement and 
                                their associated costs;
                                    ``(IV) the price of tuition; and
                                    ``(V) any changes or anticipated 
                                changes in the number and demographic 
                                of children attending.
                    ``(B) Timing.--The immediate needs assessment 
                should occur simultaneously with the first grant-making 
                cycle under subsection (c).
                    ``(C) Report.--Not later than 1 year after the date 
                of the enactment of this section, the Secretary shall 
                submit to the Congress a report containing the result 
                of the needs assessment conducted under subparagraph 
                (A), and make the assessment publicly available.
            ``(2) Long-term needs assessment.--
                    ``(A) In general.--The Secretary shall conduct a 
                long-term assessment of the condition of child care 
                facilities throughout the United States (with priority 
                given to child care facilities that receive Federal 
                funds). The assessment may be conducted through 
                representative random sampling.
                    ``(B) Report.--Not later than 4 years after the 
                date of the enactment of this section, the Secretary 
                shall submit to the Congress a report containing the 
                results of the needs assessment conducted under 
                subparagraph (A), and make the assessment publicly 
                available.
    ``(c) Child Care Facilities Grants.--
            ``(1) Grants to states.--
                    ``(A) In general.--The Secretary may award grants 
                to States for the purpose of acquiring, constructing, 
                renovating, or improving child care facilities, 
                including adapting, reconfiguring, or expanding 
                facilities to respond to the COVID-19 pandemic.
                    ``(B) Prioritized facilities.--The Secretary may 
                not award a grant to a State under subparagraph (A) 
                unless the State involved agrees, with respect to the 
                use of grant funds, to prioritize--
                            ``(i) child care facilities primarily 
                        serving low-income populations;
                            ``(ii) child care facilities primarily 
                        serving children who have not attained the age 
                        of 5 years;
                            ``(iii) child care facilities that made 
                        maximum health and safety modifications to 
                        account for the impact of the COVID-19 
                        pandemic;
                            ``(iv) child care facilities that operate 
                        under nontraditional hours; and
                            ``(v) child care facilities located in 
                        rural or underserved communities.
                    ``(C) Duration of grants.--A grant under this 
                subsection shall be awarded for a period of not more 
                than 5 years.
                    ``(D) Application.--To seek a grant under this 
                subsection, a State shall submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require, which information shall--
                            ``(i) be disaggregated as the Secretary may 
                        require; and
                            ``(ii) include a plan to use a portion of 
                        the grant funds to report back to the Secretary 
                        on the impact of using the grant funds to 
                        improve child care facilities.
                    ``(E) Priority.--In selecting States for grants 
                under this subsection, the Secretary shall prioritize 
                States that--
                            ``(i) plan to improve center-based and 
                        home-based child care programs, which may 
                        include a combination of child care and early 
                        Head Start or Head Start programs;
                            ``(ii) aim to meet specific needs across 
                        urban, suburban, or rural areas as determined 
                        by the State; and
                            ``(iii) show evidence of collaboration 
                        with--
                                    ``(I) local government officials;
                                    ``(II) other State agencies;
                                    ``(III) nongovernmental 
                                organizations, such as--
                                            ``(aa) organizations within 
                                        the philanthropic community;
                                            ``(bb) certified community 
                                        development financial 
                                        institutions, as defined in 
                                        section 103 of the Community 
                                        Development Banking and 
                                        Financial Institutions Act of 
                                        1994 (12 U.S.C. 4702); and
                                            ``(cc) organizations that 
                                        have demonstrated experience 
                                        in--

                                                    ``(AA) providing 
                                                technical or financial 
                                                assistance for the 
                                                acquisition, 
                                                construction, 
                                                renovation, or 
                                                improvement of child 
                                                care facilities;

                                                    ``(BB) providing 
                                                technical, financial, 
                                                or managerial 
                                                assistance to child 
                                                care providers; and

                                                    ``(CC) securing 
                                                private sources of 
                                                capital financing for 
                                                child care facilities 
                                                or other low-income 
                                                community development 
                                                projects; and

                                    ``(IV) local community 
                                organizations, such as--
                                            ``(aa) child care 
                                        providers;
                                            ``(bb) community care 
                                        agencies;
                                            ``(cc) resource and 
                                        referral agencies; and
                                            ``(dd) unions.
                    ``(F) Consideration.--In selecting States for 
                grants under this subsection, the Secretary shall 
                consider--
                            ``(i) whether the applicant--
                                    ``(I) has or is developing a plan 
                                to address child care facility needs; 
                                and
                                    ``(II) demonstrates the capacity to 
                                execute such a plan; and
                            ``(ii) after the date the report required 
                        by subsection (b)(1)(C) is submitted to the 
                        Congress, the needs of the applicants based on 
                        the results of the assessment.
                    ``(G) Diversity of awards.--In awarding grants 
                under this section, the Secretary shall give equal 
                consideration to States with varying capacities under 
                subparagraph (F).
                    ``(H) Matching requirement.--
                            ``(i) In general.--As a condition for the 
                        receipt of a grant under subparagraph (A), a 
                        State that is not an Indian tribe shall agree 
                        to make available (directly or through 
                        donations from public or private entities) 
                        contributions with respect to the cost of the 
                        activities to be carried out pursuant to 
                        subparagraph (A), which may be provided in cash 
                        or in kind, in an amount equal to 10 percent of 
                        the funds provided through the grant.
                            ``(ii) Determination of amount 
                        contributed.--Contributions required by clause 
                        (i) may include--
                                    ``(I) amounts provided by the 
                                Federal Government, or services 
                                assisted or subsidized to any 
                                significant extent by the Federal 
                                Government; or
                                    ``(II) philanthropic or private-
                                sector funds.
                    ``(I) Report.--Not later than 6 months after the 
                last day of the grant period, a State receiving a grant 
                under this paragraph shall submit a report to the 
                Secretary as described in subparagraph (D)--
                            ``(i) to determine the effects of the grant 
                        in constructing, renovating, or improving child 
                        care facilities, including any changes in 
                        response to the COVID-19 pandemic and any 
                        effects on access to and quality of child care; 
                        and
                            ``(ii) to provide such other information as 
                        the Secretary may require.
                    ``(J) Amount limit.--The annual amount of a grant 
                under this paragraph may not exceed $35,000,000.
            ``(2) Grants to intermediary organizations.--
                    ``(A) In general.--The Secretary may award grants 
                to intermediary organizations, such as certified 
                community development financial institutions, tribal 
                organizations, or other organizations with demonstrated 
                experience in child care facilities financing, for the 
                purpose of providing technical assistance, capacity 
                building, and financial products to develop or finance 
                child care facilities.
                    ``(B) Application.--A grant under this paragraph 
                may be made only to intermediary organizations that 
                submit to the Secretary an application at such time, in 
                such manner, and containing such information as the 
                Secretary may require.
                    ``(C) Priority.--In selecting intermediary 
                organizations for grants under this subsection, the 
                Secretary shall prioritize intermediary organizations 
                that--
                            ``(i) demonstrate experience in child care 
                        facility financing or related community 
                        facility financing;
                            ``(ii) demonstrate the capacity to assist 
                        States and local governments in developing 
                        child care facilities and programs;
                            ``(iii) demonstrate the ability to leverage 
                        grant funding to support financing tools to 
                        build the capacity of child care providers, 
                        such as through credit enhancements;
                            ``(iv) propose to focus on child care 
                        facilities that operate under nontraditional 
                        hours;
                            ``(v) propose to meet a diversity of needs 
                        across States and across urban, suburban, and 
                        rural areas at varying types of center-based, 
                        home-based, and other child care settings, 
                        including early care programs located in 
                        freestanding buildings or in mixed-use 
                        properties; and
                            ``(vi) propose to focus on child care 
                        facilities primarily serving low-income 
                        populations and children who have not attained 
                        the age of 5 years.
                    ``(D) Amount limit.--The amount of a grant under 
                this paragraph may not exceed $10,000,000.
            ``(3) Report.--Not later than the end of fiscal year 2027, 
        the Secretary shall submit to the Congress a report on the 
        effects of the grants provided under this subsection, and make 
        the report publically accessible.
    ``(d) Labor Standards for All Grants.--The Secretary shall require 
that each entity, including grantees and subgrantees, that applies for 
an infrastructure grant for constructing, renovating, or improving 
child care facilities, including adapting, reconfiguring, or expanding 
such facilities, which is funded in whole or in part under this 
section, shall include in its application written assurance that all 
laborers and mechanics employed by contractors or subcontractors in the 
performance of construction, alternation or repair, as part of such 
project, shall be paid wages at rates not less than those prevailing on 
similar work in the locality as determined by the Secretary of Labor in 
accordance with subchapter IV of chapter 31 of title 40, United States 
Code (commonly referred to as the `Davis-Bacon Act'), and with respect 
to the labor standards specified in this subsection, the Secretary of 
Labor shall have the authority and functions set forth in 
Reorganization Plan Numbered 14 of 1950 (15 Fed. Reg. 3176; 5 U.S.C. 
App.).
    ``(e) Limitations on Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there is 
        authorized to be appropriated $10,000,000,000 for fiscal year 
        2023, which shall remain available through fiscal year 2027.
            ``(2) Reservations of funds.--
                    ``(A) Indian tribes.--The Secretary shall reserve 3 
                percent of the total amount made available to carry out 
                this section, for payments to Indian tribes.
                    ``(B) Territories.--The Secretary shall reserve 3 
                percent of the total amount made available to carry out 
                this section, for payments to territories.
            ``(3) Grants for intermediary organizations.--Not less than 
        10 percent and not more than 15 percent of the total amount 
        made available to carry out this section may be used to carry 
        out subsection (c)(2).
            ``(4) Limitation on use of funds for needs assessments.--
        Not more than $5,000,000 of the amounts made available to carry 
        out this section may be used to carry out subsection (b).
    ``(f) Definition of State.--In this section, the term `State' has 
the meaning provided in section 419, except that it includes the 
Commonwealth of the Northern Mariana Islands and any Indian tribe.''.
    (b) Exemption of Territory Grants From Limitation on Total Payments 
to the Territories.--Section 1108(a)(2) of such Act (42 U.S.C. 
1308(a)(2)) is amended by inserting ``418A(c),'' after ``413(f),''.

SEC. 5002. EARLY CHILDHOOD EDUCATOR LOAN ASSISTANCE PROGRAM.

    Part Q of title III of the Public Health Service Act (42 U.S.C. 
280h) is amended by adding at the end the following:

``SEC. 399Z-3. EARLY CHILDHOOD EDUCATOR LOAN ASSISTANCE PROGRAM.

    ``(a) Authority.--The Secretary may carry out a program of entering 
into contracts with eligible early childhood educators under which such 
educators agree to serve for a period of 5 years as early childhood 
educators with a qualified employer, in consideration of the Federal 
Government agreeing to repay, for each year of such service, not more 
than $6,000 of the principal and interest of the educational loans of 
such educators.
    ``(b) Recertification.--An eligible early childhood educator 
seeking to continue to receive payments under this section shall submit 
on an annual basis to the Secretary such information as the Secretary 
may require to certify that the educator is continuing to meet the 
criteria to be considered an eligible educator.
    ``(c) Maximum Amount of Loan.--The total amount of payments 
received by an eligible early childhood educator under this section may 
not exceed the total amount of the principal and interest of the 
educational loans of such educator.
    ``(d) Applicability of Certain Provisions.--The following 
provisions of the National Health Service Corps Loan Assistance Program 
established in subpart III of part D shall apply to the program 
established under this section in the same manner and to the same 
extent as such provisions apply to the National Health Service Corps 
Loan Assistance Program:
            ``(1) Paragraphs (1) through (3) of section 338B(c) 
        (relating to application information, understandability, and 
        availability).
            ``(2) Section 338B(c)(4) (relating to recruitment and 
        retention).
            ``(3) Section 338B(d) (relating to factors considered in 
        providing contracts).
            ``(4) Section 338(e) (relating to the approval required for 
        participation).
            ``(5) Section 338B(f) (relating to contents of contracts).
            ``(6) Section 338B(g) (relating to payments, including 
        repayment schedule and tax liability).
    ``(e) Report to Congress.--Not later than 5 years after the date of 
the enactment of this section, the Secretary shall submit to Congress a 
report on the implementation of this section.
    ``(f) Definitions.--In this section:
            ``(1) The term `eligible early childhood educator' means an 
        individual that--
                    ``(A) as of the date on which the agreement 
                referred to in subsection (a)(1) is entered into--
                            ``(i) has outstanding Federal direct loans 
                        obtained for purposes of pursuing an 
                        associate's degree, a 4-year bachelor's degree, 
                        a graduate degree, or a combined bachelor and 
                        master's degree, in early childhood education 
                        or a related field from an accredited 
                        institution (including any such loan for which 
                        the individual is enrolled in an income-based 
                        repayment plan); and
                            ``(ii) is in good standing with respect to 
                        the loans referred to in clause (i); and
                    ``(B) agrees to--
                            ``(i) serve as an early childhood educator 
                        with a qualified employer for a period of not 
                        less than 5 years; and
                            ``(ii) make timely payments with respect to 
                        the loans described in subparagraph (A)(i).
            ``(2) The term `qualified employer' means a childcare 
        provider that receives or is eligible to receive vouchers or 
        assistance under the Child Care and Development Block Grant Act 
        of 1990.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $25,000,000 for each of fiscal 
years 2023 through 2028.''.

SEC. 5003. GRANTS FOR EARLY CHILDHOOD EDUCATORS.

    (a) In General.--Beginning not later than 180 days after the date 
of the enactment of this Act, the Secretary of Education (referred to 
in this section as the ``Secretary'') shall carry out a program under 
which the Secretary makes payments to institutions of higher education 
with a qualified early childhood educator program to enable such 
institutions to make grants, on a competitive basis, to eligible 
individuals who file an application and agreement in accordance with 
subsections (b) and (c).
    (b) Applications.--
            (1) In general.--The Secretary shall periodically set dates 
        by which eligible individuals shall file applications for a 
        grant under this section. Each eligible individual desiring a 
        grant under this section shall file an application containing 
        such information and assurances as the Secretary may determine 
        necessary to enable the Secretary to carry out the functions 
        and responsibilities of this section.
            (2) Renewal.--A grant awarded under this section may be 
        renewed for additional one-year periods if--
                    (A) the recipient submits a renewal application 
                containing such information and assurances as the 
                Secretary may determine necessary; and
                    (B) the grant is renewed not more than three times, 
                for a total of not more than four academic years for 
                each eligible recipient.
    (c) Service Obligation.--
            (1) Agreements to serve.--Each application under subsection 
        (b) shall include, or be accompanied by--
                    (A) an agreement by the applicant that--
                            (i) in the event that the applicant 
                        receives a grant under this section, the 
                        applicant shall--
                                    (I) serve as a full-time or part-
                                time educator in a licensed early 
                                learning program for a total of not 
                                less than one academic year, and four 
                                additional months for each subsequent 
                                grant renewal, within two years after 
                                the date on which the period of time 
                                covered by the grant is completed; and
                                    (II) submit a certification of 
                                employment by the employing early 
                                learning program in such form as the 
                                Secretary may determine necessary; and
                            (ii) in the event that the applicant is 
                        determined to have failed or refused to carry 
                        out such service obligation, the sum of the 
                        amounts of any grants received by such 
                        applicant under this section will be treated as 
                        a loan and collected from the applicant in 
                        accordance with paragraph (3) and the 
                        regulations thereunder; and
                    (B) a plain-language disclosure form developed by 
                the Secretary that clearly describes the nature of the 
                grant award, the service obligation, and the loan 
                repayment requirements that are the consequence of the 
                failure to complete the service obligation.
            (2) Treatment of concurrent service.--An individual who 
        serves as a full or part-time educator in a licensed early 
        childhood education program concurrently while enrolled in a 
        qualified early childhood educator program may count such 
        service toward the fulfillment of the service obligation in the 
        agreement under paragraph (1).
            (3) Repayment for failure to complete service.--Except as 
        provided in paragraph (4), in the event that any recipient of a 
        grant under this section fails or refuses to comply with the 
        service obligation in the agreement under paragraph (1), the 
        sum of the amounts of any grants received by such recipient 
        shall, upon a determination of such a failure or refusal in 
        such service obligation, be treated as a Federal Direct 
        Unsubsidized Stafford Loan under part D of title IV of the 
        Higher Education Act of 1965 (20 U.S.C. 1087a et seq.) except 
        that--
                    (A) no interest shall accrue on such amounts; and
                    (B) such amounts shall be subject to repayment in 
                accordance with--
                            (i) an income-contingent or income-based 
                        repayment plan, if the individual meets the 
                        eligibility requirements for such a repayment 
                        plan; and
                            (ii) such other terms and conditions as are 
                        specified by the Secretary in regulations 
                        promulgated under this section.
            (4) Hardship extension.--In the case of a recipient who has 
        made a good faith effort to find employment in a licensed early 
        learning program and has been unable to acquire such 
        employment, the Secretary is authorized to provide a hardship 
        extension for a period of not more than one year to grant 
        recipients who fail to complete their service requirement 
        within a 2-year period.
    (d) Grant Amount.--An eligible individual selected to receive a 
grant or a grant renewal under this section shall receive a grant in an 
amount not to exceed $3,000 for each academic year during which the 
individual is enrolled on a full-time or part-time basis in the 
qualified early childhood educator program for which the grant was 
awarded.
    (e) Grant Disbursement.--Payments under this section shall be made 
in accordance with regulations promulgated by the Secretary for such 
purpose and in such manner as will best accomplish the purposes of this 
section, provided--
            (1) any disbursement made by crediting a grant recipient's 
        account shall be limited to tuition and fees and other 
        materials necessary for the completion of coursework as 
        determined by the Secretary; and
            (2) not less than 85 percent of any funds provided to an 
        eligible institution under subsection (a) shall be advanced to 
        the eligible institution prior to the start of each payment 
        period and shall be based upon an amount requested by the 
        institution as needed to cover the total cost of grants awarded 
        to eligible recipients until such time as the Secretary 
        determines and publishes in the Federal Register with an 
        opportunity for comment, an alternative payment system that 
        provides payments to institutions in an accurate and timely 
        manner, except that this sentence shall not be construed to 
        limit the authority of the Secretary to place an institution on 
        a reimbursement system of payment.
    (f) Direct Payment.--Nothing in this section shall be construed to 
prohibit the Secretary from making a grant directly to an eligible 
individual in a case in which an institution of higher education with a 
qualified early childhood educator program does not participate in the 
program under subsection (a).
    (g) Definitions.--In this section:
            (1) Eligible individual.--The term ``eligible individual'' 
        means an individual who is enrolled on a full-time or part-time 
        basis in a qualified early childhood educator program.
            (2) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given that 
        term in section 102 of the Higher Education Act of 1965 (20 
        U.S.C. 1002).
            (3) Qualified early childhood educator program.--The term 
        ``qualified early childhood educator program'' means a course 
        of study leading to an associate's degree or a certificate in 
        early childhood education or a related field from an 
        institution of higher education.
            (4) Licensed early learning program.--The term ``licensed 
        early learning program'' means any State-licensed or State-
        regulated program or provider, regardless of setting or funding 
        source, that provides early care and education for children 
        from birth to kindergarten entry, including, but not limited 
        to, programs operated by child care centers and in family child 
        care homes.
    (h) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated to 
        carry out this section $10,000,000 for each of fiscal years 
        2023 through 2027.
            (2) Limitation.--Of the amount made available under 
        paragraph (1) in any fiscal year, not more than 3 percent may 
        be used for evaluation, monitoring, salaries, and 
        administrative expenses.

SEC. 5004. CCAMPIS REAUTHORIZATION.

    Section 419N of the Higher Education Act of 1965 (20 U.S.C. 1070e) 
is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``The amount'' and 
                                inserting ``Except as provided in 
                                subparagraph (C), the amount''; and
                                    (II) by striking ``1 percent'' and 
                                inserting ``2 percent'';
                            (ii) in subparagraph (B)(ii), by striking 
                        ``subsection (g)'' and inserting ``subsection 
                        (h)''; and
                            (iii) by adding at the end the following:
                    ``(C) Performance bonus.--
                            ``(i) In general.--Notwithstanding 
                        subparagraph (A), for any fiscal year for which 
                        the amount appropriated under subsection (h) is 
                        not less than $140,000,000, the Secretary may 
                        pay a performance bonus to an eligible 
                        institution of higher education.
                            ``(ii) Maximum amount.--A bonus paid to an 
                        eligible institution of higher education under 
                        clause (i) for a fiscal year shall not exceed 
                        an amount equal to 20 percent of the amount of 
                        the annual grant payment received by the 
                        institution under paragraph (3)(B) for the 
                        fiscal year preceding the fiscal year for which 
                        the bonus is paid.
                            ``(iii) Use of bonus.--A bonus received by 
                        an institution under clause (i) shall be used 
                        by the institution in the same manner as a 
                        grant under this section and shall be treated 
                        as grant funds for purposes of the application 
                        of paragraph (5), except that the Secretary may 
                        extend the grant period as necessary for the 
                        institution to use such bonus.
                            ``(iv) Eligible institution of higher 
                        education.--In this subparagraph, the term 
                        `eligible institution of higher education' 
                        means an institution of higher education that--
                                    ``(I) has received a grant under 
                                this section for not less than the 
                                period of three consecutive fiscal 
                                years preceding the fiscal year in 
                                which the bonus is paid under clause 
                                (i);
                                    ``(II) for each such preceding 
                                fiscal year, has met or exceeded the 
                                performance levels established by the 
                                institution for such year under 
                                subsection (e)(1)(B)(v); and
                                    ``(III) has demonstrated the need 
                                for such bonus.''; and
                    (B) in paragraph (3)--
                            (i) in subparagraph (A), by striking ``4 
                        years'' and inserting ``5 years''; and
                            (ii) in subparagraph (B), by striking 
                        ``subsection (e)(2)'' and inserting 
                        ``subsection (e)(3)'';
            (2) by amending subsection (c) to read as follows:
    ``(c) Applications.--
            ``(1) In general.--An institution of higher education 
        desiring a grant under this section shall submit an application 
        to the Secretary at such time, in such manner, and accompanied 
        by such information as the Secretary may require. Such 
        application shall--
                    ``(A) demonstrate that the institution is an 
                eligible institution described in subsection (b)(4);
                    ``(B) specify the amount of funds requested;
                    ``(C) demonstrate the need of low-income students 
                at the institution for campus-based child care services 
                by including in the application--
                            ``(i) information regarding student 
                        demographics, including whether the student is 
                        a full-time or part-time student;
                            ``(ii) an assessment of child care capacity 
                        on or near campus;
                            ``(iii) information regarding the waiting 
                        lists for child care services on or near 
                        campus;
                            ``(iv) information regarding additional 
                        needs created by concentrations of poverty or 
                        by geographic isolation;
                            ``(v) information about the number of low-
                        income student parents being served through 
                        campus-based child care services; and
                            ``(vi) other relevant data;
                    ``(D) specify the estimated percentage of the 
                institution's grant that will be used directly to 
                subsidize the fee charged for on-campus and off-campus 
                childcare, respectively, for low-income students;
                    ``(E) contain a description of the activities to be 
                assisted, including whether the grant funds will 
                support an existing child care program or a new child 
                care program;
                    ``(F) identify the resources, including technical 
                expertise and financial support, that the institution 
                will draw upon to support the child care program and 
                the participation of low-income students in the program 
                (such as accessing social services funding, using 
                student activity fees to help pay the costs of child 
                care, using resources obtained by meeting the needs of 
                parents who are not low-income students, and accessing 
                foundation, corporate, or other institutional support) 
                and demonstrate that the use of the resources will not 
                result in increases in student tuition;
                    ``(G) contain an assurance that the institution 
                will meet the child care needs of low-income students 
                through the provision of services, or through a 
                contract for the provision of services;
                    ``(H) describe the extent to which the child care 
                program will coordinate with the institution's early 
                childhood education curriculum, to the extent the 
                curriculum is available, to meet the needs of the 
                students in the early childhood education program at 
                the institution, and the needs of the parents and 
                children participating in the child care program 
                assisted under this section;
                    ``(I) in the case of an institution seeking 
                assistance for a new child care program--
                            ``(i) provide a timeline, covering the 
                        period from receipt of the grant through the 
                        provision of the child care services, 
                        delineating the specific steps the institution 
                        will take to achieve the goal of providing low-
                        income students with child care services;
                            ``(ii) specify any measures the institution 
                        will take to assist low-income students with 
                        child care during the period before the 
                        institution provides child care services; and
                            ``(iii) include a plan for identifying 
                        resources needed for the child care services, 
                        including space in which to provide child care 
                        services, and technical assistance if 
                        necessary;
                    ``(J) contain an assurance that any child care 
                facility assisted under this section will meet the 
                applicable State and local government licensing, 
                certification, approval, or registration requirements;
                    ``(K) in the case of an institution that is awarded 
                a grant under this section after the date of the 
                enactment of the PRO-LIFE Act of 2022, provide an 
                assurance that, not later than three years after the 
                date on which such grant is awarded, any child care 
                facility assisted with such grant will--
                            ``(i) meet Head Start performance standards 
                        under subchapter B of chapter 13 of title 45, 
                        Code of Federal Regulations (as in effect on 
                        the date of enactment of the PRO-LIFE Act of 
                        2022) and any successor regulations;
                            ``(ii) be in the top tier of the quality 
                        rating improvement system for such facilities 
                        used by the State in which the facility is 
                        located;
                            ``(iii) meet the licensing requirements of 
                        the State in which the facility is located and 
                        the quality requirements under the Child Care 
                        and Development Block Grant Act of 1990 (42 
                        U.S.C. 9858 et seq.); or
                            ``(iv) be accredited by a national early 
                        childhood accrediting body with demonstrated 
                        valid and reliable program quality standards;
                    ``(L) contain an assurance that the institution, 
                when applicable, will make information available to 
                students receiving child care services provided under 
                this section about the eligibility of such students and 
                their dependents for assistance under the supplemental 
                nutrition assistance program under the Food and 
                Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), the 
                special supplemental nutrition program for women, 
                infants, and children under the Child Nutrition Act of 
                1966 (42 U.S.C. 1786), and the program of block grants 
                for States for temporary assistance for needy families 
                established under part A of title IV of the Social 
                Security Act (42 U.S.C. 601 et seq.); and
                    ``(M) contain an abstract summarizing the contents 
                of such application and how the institution intends to 
                achieve the purpose under subsection (a).
            ``(2) Technical assistance.--The Secretary may provide 
        technical assistance to eligible institutions to help such 
        institutions qualify, apply for, and maintain a grant under 
        this section.'';
            (3) in subsection (d)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``to institutions of higher education that 
                submit applications describing programs that'';
                    (B) by amending paragraph (1) to read as follows:
            ``(1) based on the extent to which institutions of higher 
        education that submit applications for such a grant leverage 
        local or institutional resources, including in-kind 
        contributions, to support the activities assisted under this 
        section;'';
                    (C) by redesignating paragraph (2) as paragraph 
                (3);
                    (D) by inserting after paragraph (1), the 
                following:
            ``(2) to institutions of higher education that, compared to 
        other institutions of higher education that submit applications 
        for such a grant, demonstrate a high likelihood of need for 
        campus-based child care based on student demographics (such as 
        a high proportion of low-income students or independent 
        students); and''; and
                    (E) in paragraph (3) (as redesignated by 
                subparagraph (C)), by inserting ``to institutions of 
                higher education that submit applications describing 
                programs that'' before ``utilize''; and
            (4) in subsection (e)--
                    (A) in paragraph (1)(B)--
                            (i) by redesignating clauses (ii), (iii), 
                        and (iv) as clauses (vi), (vii), and (viii), 
                        respectively; and
                            (ii) by striking the semicolon at the end 
                        of clause (i) and inserting the following: ``, 
                        which shall include--
                                    ``(I) the number of full- and part-
                                time students, respectively, receiving 
                                child care services under this section 
                                at least once per week during the 
                                academic year;
                                    ``(II) the number of credits 
                                accumulated by students receiving such 
                                child care services; and
                                    ``(III) the number of students 
                                receiving child care services under 
                                this section at least once per week 
                                during the academic year who--
                                            ``(aa) remain enrolled at 
                                        the institution during the 
                                        academic year for which they 
                                        received such services;
                                            ``(bb) enroll at the 
                                        institution for the following 
                                        academic year; and
                                            ``(cc) graduate or transfer 
                                        within--

                                                    ``(AA) 150 percent 
                                                of the normal time for 
                                                completion of a 
                                                student's four-year 
                                                degree granting 
                                                program; or

                                                    ``(BB) 200 percent 
                                                of the normal time for 
                                                completion of a 
                                                student's two-year 
                                                degree-granting 
                                                program;

                            ``(ii) with respect to the total student 
                        enrollment at the institution and the total 
                        enrollment of low-income students at the 
                        institution, respectively--
                                    ``(I) the rate at which students 
                                who complete an academic year at the 
                                institution re-enroll in the 
                                institution for the following academic 
                                year; and
                                    ``(II) the percentage of students 
                                graduating or transferring within--
                                            ``(aa) 150 percent of the 
                                        normal time for completion of a 
                                        student's four-year degree 
                                        granting program; or
                                            ``(bb) 200 percent of the 
                                        normal time for completion of a 
                                        student's two-year degree 
                                        granting program;
                            ``(iii) the percentage of the institution's 
                        grant that was used directly to subsidize the 
                        fee charged for on-campus and off-campus 
                        childcare, respectively, for low-income 
                        students;
                            ``(iv) whether the institution restricts 
                        eligibility for child care services to only 
                        full-time students;
                            ``(v) the sufficiently ambitious levels of 
                        performance established for such year by the 
                        institution that demonstrate meaningful 
                        progress and allow for meaningful evaluation of 
                        program quality based on the information in 
                        clauses (i)(III) and (iii);'';
                    (B) by redesignating paragraph (2) as paragraph 
                (3);
                    (C) by inserting after paragraph (1) the following:
            ``(2) Report.--
                    ``(A) Report required.--On an annual basis, the 
                Secretary shall submit to the authorizing committees a 
                report that includes--
                            ``(i) a summary of the information 
                        described in paragraph (1); and
                            ``(ii) each abstract submitted under 
                        subsection (c)(1)(M) by an institution of 
                        higher education that receives a grant under 
                        this section.
                    ``(B) Public availability.--The Secretary shall 
                make each report submitted under subparagraph (A) 
                publicly available.'';
                    (D) in paragraph (3), as so redesignated, by 
                inserting ``(other than the information provided under 
                subparagraph (B)(v) of such paragraph)'' after 
                ``paragraph (1)''; and
                    (E) by adding at the end the following:
            ``(4) Technical assistance.--The Secretary shall provide 
        technical assistance to institutions of higher education 
        receiving grants under this section to help such institutions 
        meet the reporting requirements under this subsection.'';
            (5) by redesignating subsection (g) as subsection (h);
            (6) by inserting after subsection (f) the following:
    ``(g) Nondiscrimination.--No person in the United States shall, on 
the basis of actual or perceived race, color, religion, national 
origin, sex (including sexual orientation, gender identity, pregnancy, 
childbirth, a medical condition related to pregnancy or childbirth, and 
sex stereotype), or disability, be excluded from participation in, be 
denied the benefits of, or be subjected to discrimination by any 
program funded, in whole or in part, with funds made available under 
this section or with amounts appropriated for grants, contracts, or 
certificates administered with such funds.''; and
            (7) in subsection (h), as so redesignated, by striking 
        ``such sums as may be necessary for fiscal year 2009'' and 
        inserting ``$200,000,000 for fiscal year 2023''.

SEC. 5005. EVALUATION OF APPLICATIONS FOR ASSISTANCE UNDER CHOICE 
              NEIGHBORHOODS INITIATIVE.

    In providing assistance for fiscal year 2023 and any fiscal year 
thereafter under the Choice Neighborhoods Initiative of the Secretary 
of Housing and Urban Development (pursuant to section 24 of the United 
States Housing Act of 1937 (42 U.S.C. 1437v)), the Secretary shall 
consider early care and learning facilities for children as a 
neighborhood asset for purposes of evaluating applications for planning 
and implementation grants, shall ensure that any metric for evaluating 
such applications gives credit for the provision of early care and 
learning facilities under a neighborhood plan, and shall include early 
care and learning facilities as such an asset in any Notice of Funding 
Availability for any such fiscal year.

             TITLE VI--HONORING FAMILY-FRIENDLY WORKPLACES

SEC. 6001. DEFINITIONS.

    In this title:
            (1) Employee; employer.--The terms ``employee'' and 
        ``employer'' have the meanings given such terms in section 3 of 
        the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Labor.
            (3) Serious health condition.--The term ``serious health 
        condition'' has the meaning given such term in section 101 of 
        the Family and Medical Leave Act of 1993 (29 U.S.C. 2611).

SEC. 6002. CERTIFICATION PROGRAM ESTABLISHED.

    (a) In General.--The Secretary shall establish a national 
certification program to award certifications to recognize employers 
that have a commitment to helping employees balance employment 
responsibilities and family obligations (referred to in this section as 
``family-friendly certifications'').
    (b) Criteria for Certification.--In order to be eligible to receive 
a family-friendly certification, an employer shall carry out each of 
the following family-friendly employment policies and benefits:
            (1) Assistance paying for, or referring employees to, 
        fertility or adoption services.
            (2) Paid family leave of not less than 12 weeks per year, 
        including the option to use leave for any of the following 
        reasons:
                    (A) The birth of a child of the employee and in 
                order to care for such child.
                    (B) The placement of a child with the employee for 
                adoption or foster care.
                    (C) To address the serious health condition, 
                including pregnancy, childbirth, or pregnancy loss, of 
                the employee.
                    (D) To address the serious health condition of a 
                family member.
                    (E) For specific military caregiving and leave.
            (3) Paid sick days for employees that are separate from 
        time accrued as part of a paid time off policy.
            (4) A subsidy for child care or policies that allow parents 
        to work alongside their infants in safe settings.
            (5) Policies that allow for flexible hours once a parent 
        returns to work after a birth, adoption, or foster care 
        placement.
            (6) If feasible, policies that allow employees to work 
        remotely as needed for reasons related to the care of a child.
            (7) Lactation support, such as reimbursement of expressed 
        breastmilk delivery while on travel, access to pumps, kits, and 
        other lactation supplies and amenities, and access to lactation 
        consultants and support.
    (c) Application.--An employer who desires to receive a family-
friendly certification from the Secretary under this section shall 
submit an application to the Secretary at such time, containing such 
information, and in such manner as the Secretary may require.
    (d) Award of Certification.--The Secretary shall review 
applications submitted under subsection (c) and award a family-friendly 
certification to an employer whose application demonstrates that the 
employer has met the requirements established under subsection (b) 
regarding family-friendly policies and benefits.

   TITLE VII--MOTHERS AND OFFSPRING MORTALITY AND MORBIDITY AWARENESS

SEC. 7001. IMPROVING FEDERAL EFFORTS WITH RESPECT TO PREVENTION OF 
              MATERNAL MORTALITY.

    (a) Technical Assistance for States With Respect to Reporting 
Maternal Mortality.--Not later than one year after the date of 
enactment of this Act, the Director of the Centers for Disease Control 
and Prevention (referred to in this section as the ``Director''), in 
consultation with the Administrator of the Health Resources and 
Services Administration, shall provide technical assistance to States 
that elect to report comprehensive data on maternal mortality and 
factors relating to such mortality (including oral and mental health), 
intimate partner violence, and breastfeeding health information, for 
the purpose of encouraging uniformity in the reporting of such data and 
to encourage the sharing of such data among the respective States.
    (b) Best Practices Relating to Prevention of Maternal Mortality.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act--
                    (A) the Director, in consultation with relevant 
                patient and provider groups, shall issue best practices 
                to State maternal mortality review committees on how 
                best to identify and review maternal mortality cases, 
                taking into account any data made available by States 
                relating to maternal mortality, including data on oral, 
                mental, and breastfeeding health, and utilization of 
                any emergency services; and
                    (B) the Director, working in collaboration with the 
                Health Resources and Services Administration, shall 
                issue best practices to hospitals, State professional 
                society groups, and perinatal quality collaboratives on 
                how best to prevent maternal mortality.
            (2) Authorization of appropriations.--For purposes of 
        carrying out this subsection, there is authorized to be 
        appropriated $5,000,000 for each of fiscal years 2023 through 
        2027.
    (c) Alliance for Innovation on Maternal Health Grant Program.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this subsection as the ``Secretary''), 
        acting through the Associate Administrator of the Maternal and 
        Child Health Bureau of the Health Resources and Services 
        Administration, shall establish a grant program to be known as 
        the Alliance for Innovation on Maternal Health Grant Program 
        (referred to in this subsection as ``AIM'') under which the 
        Secretary shall award grants to eligible entities for the 
        purpose of--
                    (A) directing widespread adoption and 
                implementation of maternal safety bundles through 
                collaborative State-based teams; and
                    (B) collecting and analyzing process, structure, 
                and outcome data to drive continuous improvement in the 
                implementation of such safety bundles by such State-
                based teams with the ultimate goal of eliminating 
                preventable maternal mortality and severe maternal 
                morbidity in the United States.
            (2) Eligible entities.--In order to be eligible for a grant 
        under paragraph (1), an entity shall--
                    (A) submit to the Secretary an application at such 
                time, in such manner, and containing such information 
                as the Secretary may require; and
                    (B) demonstrate in such application that the entity 
                is an interdisciplinary, multi-stakeholder, national 
                organization with a national data-driven maternal 
                safety and quality improvement initiative based on 
                implementation approaches that have been proven to 
                improve maternal safety and outcomes in the United 
                States.
            (3) Use of funds.--An eligible entity that receives a grant 
        under paragraph (1) shall use such grant funds--
                    (A) to develop and implement, through a robust, 
                multi-stakeholder process, maternal safety bundles to 
                assist States, perinatal quality collaboratives, and 
                health care systems in aligning national, State, and 
                hospital-level quality improvement efforts to improve 
                maternal health outcomes, specifically the reduction of 
                maternal mortality and severe maternal morbidity;
                    (B) to ensure, in developing and implementing 
                maternal safety bundles under subparagraph (A), that 
                such maternal safety bundles--
                            (i) satisfy the quality improvement needs 
                        of a State, perinatal quality collaborative, or 
                        health care system by factoring in the results 
                        and findings of relevant data reviews, such as 
                        reviews conducted by a State maternal mortality 
                        review committee; and
                            (ii) address topics which may include--
                                    (I) information on evidence-based 
                                practices to improve the quality and 
                                safety of maternal health care in 
                                hospitals and other health care 
                                settings of a State or health care 
                                system, including by addressing topics 
                                commonly associated with health 
                                complications or risks related to 
                                prenatal care, labor care, birthing, 
                                and postpartum care;
                                    (II) best practices for improving 
                                maternal health care based on data 
                                findings and reviews conducted by a 
                                State maternal mortality review 
                                committee that address topics of 
                                relevance to common complications or 
                                health risks related to prenatal care, 
                                labor care, birthing, and postpartum 
                                care;
                                    (III) information on addressing 
                                determinants of health that impact 
                                maternal health outcomes for women 
                                before, during, and after pregnancy;
                                    (IV) obstetric hemorrhage;
                                    (V) obstetric and postpartum care 
                                for women with substance use disorders, 
                                including opioid use disorder;
                                    (VI) maternal cardiovascular 
                                system;
                                    (VII) maternal mental health;
                                    (VIII) postpartum care basics for 
                                maternal safety;
                                    (IX) reduction of peripartum racial 
                                and ethnic disparities;
                                    (X) reduction of primary caesarean 
                                birth;
                                    (XI) severe hypertension in 
                                pregnancy;
                                    (XII) severe maternal morbidity 
                                reviews;
                                    (XIII) support after a severe 
                                maternal morbidity event;
                                    (XIV) thromboembolism;
                                    (XV) optimization of support for 
                                breastfeeding;
                                    (XVI) maternal oral health; and
                                    (XVII) intimate partner violence; 
                                and
                    (C) to provide ongoing technical assistance at the 
                national and State levels to support implementation of 
                maternal safety bundles under subparagraph (A).
            (4) Maternal safety bundle defined.--For purposes of this 
        subsection, the term ``maternal safety bundle'' means 
        standardized, evidence-informed processes for maternal health 
        care.
            (5) Authorization of appropriations.--For purposes of 
        carrying out this subsection, there is authorized to be 
        appropriated $10,000,000 for each of fiscal years 2023 through 
        2027.
    (d) Funding for State-Based Perinatal Quality Collaboratives 
Development and Sustainability.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this subsection as the ``Secretary''), 
        acting through the Division of Reproductive Health of the 
        Centers for Disease Control and Prevention, shall establish a 
        grant program to be known as the State-Based Perinatal Quality 
        Collaborative grant program under which the Secretary awards 
        grants to eligible entities for the purpose of development and 
        sustainability of perinatal quality collaboratives in every 
        State, the District of Columbia, and eligible territories, in 
        order to measurably improve perinatal care and perinatal health 
        outcomes for pregnant and postpartum women and their infants.
            (2) Grant amounts.--Grants awarded under this subsection 
        shall be in amounts not to exceed $250,000 per year, for the 
        duration of the grant period.
            (3) State-based perinatal quality collaborative defined.--
        For purposes of this subsection, the term ``State-based 
        perinatal quality collaborative'' means a network of teams 
        that--
                    (A) is multidisciplinary in nature and includes the 
                full range of perinatal and maternity care providers;
                    (B) works to improve measurable outcomes for 
                maternal and infant health by advancing evidence-
                informed clinical practices using quality improvement 
                principles;
                    (C) works with hospital-based or outpatient 
                facility-based clinical teams, experts, and 
                stakeholders, including patients and families, to 
                spread best practices and optimize resources to improve 
                perinatal care and outcomes;
                    (D) employs strategies that include the use of the 
                collaborative learning model to provide opportunities 
                for hospitals and clinical teams to collaborate on 
                improvement strategies, rapid-response data to provide 
                timely feedback to hospital and other clinical teams to 
                track progress, and quality improvement science to 
                provide support and coaching to hospital and clinical 
                teams;
                    (E) has the goal of improving population-level 
                outcomes in maternal and infant health; and
                    (F) has the goal of improving outcomes of all 
                birthing people, through the coordination, integration, 
                and collaboration across birth settings.
            (4) Authorization of appropriations.--For purposes of 
        carrying out this subsection, there is authorized to be 
        appropriated $14,000,000 per year for each of fiscal years 2023 
        through 2027.
    (e) Expansion of Medicaid and CHIP Coverage for Pregnant and 
Postpartum Women.--
            (1) Requiring coverage of oral health services for pregnant 
        and postpartum women.--
                    (A) Medicaid.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d) is amended--
                            (i) in subsection (a)(4)--
                                    (I) by striking ``; and (F)'' and 
                                inserting ``; (F)''; and
                                    (II) by inserting ``; and (G) oral 
                                health services for pregnant and 
                                postpartum women (as defined in 
                                subsection (jj))'' after ``if otherwise 
                                covered under the State plan (or waiver 
                                of such plan)''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(jj) Oral Health Services for Pregnant and Postpartum Women.--
            ``(1) In general.--For purposes of this title, the term 
        `oral health services for pregnant and postpartum women' means 
        dental services necessary to prevent disease and promote oral 
        health, restore oral structures to health and function, and 
        treat emergency conditions that are furnished to a woman during 
        pregnancy (or during the 1-year period beginning on the last 
        day of the pregnancy).
            ``(2) Coverage requirements.--To satisfy the requirement to 
        provide oral health services for pregnant and postpartum women, 
        a State shall, at a minimum, provide coverage for preventive, 
        diagnostic, periodontal, and restorative care consistent with 
        recommendations for perinatal oral health care and dental care 
        during pregnancy from the American Academy of Pediatric 
        Dentistry and the American College of Obstetricians and 
        Gynecologists.''.
                    (B) CHIP.--Section 2103(c)(6)(A) of the Social 
                Security Act (42 U.S.C. 1397cc(c)(6)(A)) is amended by 
                inserting ``or a targeted low-income pregnant woman'' 
                after ``targeted low-income child''.
            (2) Extending medicaid coverage for pregnant and postpartum 
        women.--Section 1902 of the Social Security Act (42 U.S.C. 
        1396a) is amended--
                    (A) in subsection (e)--
                            (i) in paragraph (5)--
                                    (I) by inserting ``(including oral 
                                health services for pregnant and 
                                postpartum women (as defined in section 
                                1905(hh)))'' after ``postpartum medical 
                                assistance under the plan''; and
                                    (II) by striking ``60-day'' and 
                                inserting ``1-year''; and
                            (ii) in paragraph (6), by striking ``60-
                        day'' and inserting ``1-year''; and
                    (B) in subsection (l)(1)(A), by striking ``60-day'' 
                and inserting ``1-year''.
            (3) Extending medicaid coverage for lawful residents.--
        Section 1903(v)(4)(A)(i) of the Social Security Act (42 U.S.C. 
        1396b(v)(4)(A)(i)) is amended by striking ``60-day'' and 
        inserting ``1-year''.
            (4) Extending chip coverage for pregnant and postpartum 
        women.--Section 2112(d)(2)(A) of the Social Security Act (42 
        U.S.C. 1397ll(d)(2)(A)) is amended to read as follows:
                    ``(A) during pregnancy and through the end of the 
                month in which the 1-year period (including in the case 
                that subparagraph (A) of section 1902(e)(16) applies to 
                the State child health plan (or waiver of such plan), 
                pursuant to section 2107(e)(1)), beginning on the last 
                day of her pregnancy ends;''.
            (5) Maintenance of effort.--
                    (A) Medicaid.--Section 1902(l) of the Social 
                Security Act (42 U.S.C. 1396a(l)) is amended by adding 
                at the end the following new paragraph:
    ``(5) During the period that begins on the date of enactment of 
this paragraph and ends on the date that is five years after such date 
of enactment, as a condition for receiving any Federal payments under 
section 1903(a) for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to women who are eligible 
for medical assistance under the State plan or under a waiver of such 
plan on the basis of being pregnant or having been pregnant, 
eligibility standards, methodologies, or procedures under the State 
plan or waiver that are more restrictive than the eligibility 
standards, methodologies, or procedures, respectively, under such plan 
or waiver that are in effect on the date of enactment of this 
paragraph.''.
                    (B) CHIP.--Section 2105(d) of the Social Security 
                Act (42 U.S.C. 1397ee(d)) is amended by adding at the 
                end the following new paragraph:
            ``(4) In eligibility standards for targeted low-income 
        pregnant women.--During the period that begins on the date of 
        enactment of this paragraph and ends on the date that is five 
        years after such date of enactment, as a condition of receiving 
        payments under subsection (a) and section 1903(a), a State that 
        elects to provide assistance to women on the basis of being 
        pregnant (including pregnancy-related assistance provided to 
        targeted low-income pregnant women (as defined in section 
        2112(d)), pregnancy-related assistance provided to women who 
        are eligible for such assistance through application of section 
        1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
        assistance under the State child health plan (or a waiver of 
        such plan) which is provided to women on the basis of being 
        pregnant) shall not have in effect, with respect to such women, 
        eligibility standards, methodologies, or procedures under such 
        plan (or waiver) that are more restrictive than the eligibility 
        standards, methodologies, or procedures, respectively, under 
        such plan (or waiver) that are in effect on the date of 
        enactment of this paragraph.''.
            (6) Information on benefits.--The Secretary of Health and 
        Human Services shall make publicly available on the internet 
        website of the Department of Health and Human Services, 
        information regarding benefits available to pregnant and 
        postpartum women and under the Medicaid program and the 
        Children's Health Insurance Program, including information on--
                    (A) benefits that States are required to provide to 
                pregnant and postpartum women under such programs;
                    (B) optional benefits that States may provide to 
                pregnant and postpartum women under such programs; and
                    (C) the availability of different kinds of benefits 
                for pregnant and postpartum women, including oral 
                health and mental health benefits, under such programs.
            (7) Federal funding for cost of extended medicaid and chip 
        coverage for postpartum women.--
                    (A) Medicaid.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d), as amended by paragraph (1), is 
                further amended--
                            (i) in subsection (b), by striking ``and 
                        (ii)'' and inserting ``(ii), and (kk)''; and
                            (ii) by adding at the end the following:
    ``(kk) Increased FMAP for Extended Medical Assistance for 
Postpartum Women.--Notwithstanding subsection (b), the Federal medical 
assistance percentage for a State, with respect to amounts expended by 
such State for medical assistance for a woman who is eligible for such 
assistance on the basis of being pregnant or having been pregnant that 
is provided during the 305-day period that begins on the 60th day after 
the last day of her pregnancy (including any such assistance provided 
during the month in which such period ends), shall be equal to--
            ``(1) 100 percent for the first 20 calendar quarters during 
        which this subsection is in effect; and
            ``(2) 90 percent for calendar quarters thereafter.''.
                    (B) CHIP.--Section 2105(c) of the Social Security 
                Act (42 U.S.C. 1397ee(c)) is amended by adding at the 
                end the following new paragraph:
            ``(13) Enhanced payment for extended assistance provided to 
        pregnant women.--Notwithstanding subsection (b), the enhanced 
        FMAP, with respect to payments under subsection (a) for 
        expenditures under the State child health plan (or a waiver of 
        such plan) for assistance provided under the plan (or waiver) 
        to a woman who is eligible for such assistance on the basis of 
        being pregnant (including pregnancy-related assistance provided 
        to a targeted low-income pregnant woman (as defined in section 
        2112(d)), pregnancy-related assistance provided to a woman who 
        is eligible for such assistance through application of section 
        1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
        assistance under the plan (or waiver) provided to a woman who 
        is eligible for such assistance on the basis of being pregnant) 
        during the 305-day period that begins on the 60th day after the 
        last day of her pregnancy (including any such assistance 
        provided during the month in which such period ends), shall be 
        equal to--
                    ``(A) 100 percent for the first 20 calendar 
                quarters during which this paragraph is in effect; and
                    ``(B) 90 percent for calendar quarters 
                thereafter.''.
            (8) Guidance on state options for medicaid coverage of 
        doula services.--Not later than 1 year after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services, acting through the Administrator of the Centers for 
        Medicare & Medicaid Services, shall issue guidance for the 
        States concerning options for Medicaid coverage and payment for 
        support services provided by doulas.
            (9) Effective date.--
                    (A) In general.--Subject to subparagraph (B), the 
                amendments made by this subsection shall take effect on 
                the first day of the first calendar quarter that begins 
                on or after the date that is one year after the date of 
                enactment of this Act.
                    (B) Exception for state legislation.--In the case 
                of a State plan under title XIX of the Social Security 
                Act or a State child health plan under title XXI of 
                such Act that the Secretary of Health and Human 
                Services determines requires State legislation in order 
                for the respective plan to meet any requirement imposed 
                by amendments made by this subsection, the respective 
                plan shall not be regarded as failing to comply with 
                the requirements of such title solely on the basis of 
                its failure to meet such an additional requirement 
                before the first day of the first calendar quarter 
                beginning after the close of the first regular session 
                of the State legislature that begins after the date of 
                enactment of this Act. For purposes of the previous 
                sentence, in the case of a State that has a 2-year 
                legislative session, each year of the session shall be 
                considered to be a separate regular session of the 
                State legislature.
    (f) Regional Centers of Excellence.--Part P of title III of the 
Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding 
at the end the following new section:

``SEC. 399V-7. REGIONAL CENTERS OF EXCELLENCE ADDRESSING IMPLICIT BIAS 
              AND CULTURAL COMPETENCY IN PATIENT-PROVIDER INTERACTIONS 
              EDUCATION.

    ``(a) In General.--Not later than one year after the date of 
enactment of this section, the Secretary, in consultation with such 
other agency heads as the Secretary determines appropriate, shall award 
cooperative agreements for the establishment or support of regional 
centers of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider interactions 
education for the purpose of enhancing and improving how health care 
professionals are educated in implicit bias and delivering culturally 
competent health care.
    ``(b) Eligibility.--To be eligible to receive a cooperative 
agreement under subsection (a), an entity shall--
            ``(1) be a public or other nonprofit entity specified by 
        the Secretary that provides educational and training 
        opportunities for students and health care professionals, which 
        may be a health system, teaching hospital, community health 
        center, medical school, school of public health, school of 
        nursing, dental school, social work school, school of 
        professional psychology, or any other health professional 
        school or program at an institution of higher education (as 
        defined in section 101 of the Higher Education Act of 1965) 
        focused on the prevention, treatment, or recovery of health 
        conditions that contribute to maternal mortality and the 
        prevention of maternal mortality and severe maternal morbidity;
            ``(2) demonstrate community engagement and participation, 
        such as through partnerships with home visiting and case 
        management programs;
            ``(3) demonstrate engagement with groups engaged in the 
        implementation of health care professional training in implicit 
        bias and delivering culturally competent care, such as 
        departments of public health, perinatal quality collaboratives, 
        hospital systems, and health care professional groups, in order 
        to obtain input on resources needed for effective 
        implementation strategies; and
            ``(4) provide to the Secretary such information, at such 
        time and in such manner, as the Secretary may require.
    ``(c) Diversity.--In awarding a cooperative agreement under 
subsection (a), the Secretary shall take into account any regional 
differences among eligible entities and make an effort to ensure 
geographic diversity among award recipients.
    ``(d) Dissemination of Information.--
            ``(1) Public availability.--The Secretary shall make 
        publicly available on the internet website of the Department of 
        Health and Human Services information submitted to the 
        Secretary under subsection (b)(3).
            ``(2) Evaluation.--The Secretary shall evaluate each 
        regional center of excellence established or supported pursuant 
        to subsection (a) and disseminate the findings resulting from 
        each such evaluation to the appropriate public and private 
        entities.
            ``(3) Distribution.--The Secretary shall share evaluations 
        and overall findings with State departments of health and other 
        relevant State level offices to inform State and local best 
        practices.
    ``(e) Maternal Mortality Defined.--In this section, the term 
`maternal mortality' means death of a woman that occurs during 
pregnancy or within the one-year period following the end of such 
pregnancy.
    ``(f) Authorization of Appropriations.--For purposes of carrying 
out this section, there is authorized to be appropriated $5,000,000 for 
each of fiscal years 2023 through 2027.''.
    (g) Special Supplemental Nutrition Program for Women, Infants, and 
Children.--Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 
(42 U.S.C. 1786(d)(3)(A)(ii)) is amended--
            (1) by striking the clause designation and heading and all 
        that follows through ``A State'' and inserting the following:
                            ``(ii) Women.--
                                    ``(I) Breastfeeding women.--A 
                                State'';
            (2) in subclause (I) (as so designated), by striking ``1 
        year'' and all that follows through ``earlier'' and inserting 
        ``2 years postpartum''; and
            (3) by adding at the end the following:
                                    ``(II) Postpartum women.--A State 
                                may elect to certify a postpartum woman 
                                for a period of 2 years.''.
    (h) Definitions.--In this section:
            (1) Maternal mortality.--The term ``maternal mortality'' 
        means death of a woman that occurs during pregnancy or within 
        the one-year period following the end of such pregnancy.
            (2) Pregnancy related death.--The term ``pregnancy related 
        death'' includes the death of a woman during pregnancy or 
        within one year of the end of pregnancy from a pregnancy 
        complication, a chain of events initiated by pregnancy, or the 
        aggravation of an unrelated condition by the physiologic 
        effects of pregnancy.
            (3) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' includes unexpected outcomes of labor and delivery 
        that result in significant short-term or long-term consequences 
        to a woman's health.

SEC. 7002. INCREASING EXCISE TAXES ON CIGARETTES AND ESTABLISHING 
              EXCISE TAX EQUITY AMONG ALL TOBACCO PRODUCT TAX RATES.

    (a) Tax Parity for Roll-Your-Own Tobacco.--Section 5701(g) of the 
Internal Revenue Code of 1986 is amended by striking ``$24.78'' and 
inserting ``$49.56''.
    (b) Tax Parity for Pipe Tobacco.--Section 5701(f) of the Internal 
Revenue Code of 1986 is amended by striking ``$2.8311 cents'' and 
inserting ``$49.56''.
    (c) Tax Parity for Smokeless Tobacco.--
            (1) Section 5701(e) of the Internal Revenue Code of 1986 is 
        amended--
                    (A) in paragraph (1), by striking ``$1.51'' and 
                inserting ``$26.84'';
                    (B) in paragraph (2), by striking ``50.33 cents'' 
                and inserting ``$10.74''; and
                    (C) by adding at the end the following:
            ``(3) Smokeless tobacco sold in discrete single-use 
        units.--On discrete single-use units, $100.66 per thousand.''.
            (2) Section 5702(m) of such Code is amended--
                    (A) in paragraph (1), by striking ``or chewing 
                tobacco'' and inserting ``, chewing tobacco, or 
                discrete single-use unit'';
                    (B) in paragraphs (2) and (3), by inserting ``that 
                is not a discrete single-use unit'' before the period 
                in each such paragraph; and
                    (C) by adding at the end the following:
            ``(4) Discrete single-use unit.--The term `discrete single-
        use unit' means any product containing, made from, or derived 
        from tobacco or nicotine that--
                    ``(A) is not intended to be smoked; and
                    ``(B) is in the form of a lozenge, tablet, pill, 
                pouch, dissolvable strip, or other discrete single-use 
                or single-dose unit.''.
    (d) Tax Parity for Small Cigars.--Paragraph (1) of section 5701(a) 
of the Internal Revenue Code of 1986 is amended by striking ``$50.33'' 
and inserting ``$100.66''.
    (e) Tax Parity for Large Cigars.--
            (1) In general.--Paragraph (2) of section 5701(a) of the 
        Internal Revenue Code of 1986 is amended by striking ``52.75 
        percent'' and all that follows through the period and inserting 
        the following: ``$49.56 per pound and a proportionate tax at 
        the like rate on all fractional parts of a pound but not less 
        than 10.066 cents per cigar.''.
            (2) Guidance.--The Secretary of the Treasury, or the 
        Secretary's delegate, may issue guidance regarding the 
        appropriate method for determining the weight of large cigars 
        for purposes of calculating the applicable tax under section 
        5701(a)(2) of the Internal Revenue Code of 1986.
    (f) Tax Parity for Roll-Your-Own Tobacco and Certain Processed 
Tobacco.--Subsection (o) of section 5702 of the Internal Revenue Code 
of 1986 is amended by inserting ``, and includes processed tobacco that 
is removed for delivery or delivered to a person other than a person 
with a permit provided under section 5713, but does not include 
removals of processed tobacco for exportation'' after ``wrappers 
thereof''.
    (g) Clarifying Tax Rate for Other Tobacco Products.--
            (1) In general.--Section 5701 of the Internal Revenue Code 
        of 1986 is amended by adding at the end the following new 
        subsection:
    ``(i) Other Tobacco Products.--Any product not otherwise described 
under this section that has been determined to be a tobacco product by 
the Food and Drug Administration through its authorities under the 
Family Smoking Prevention and Tobacco Control Act shall be taxed at a 
level of tax equivalent to the tax rate for cigarettes on an estimated 
per use basis as determined by the Secretary.''.
            (2) Establishing per use basis.--For purposes of section 
        5701(i) of the Internal Revenue Code of 1986, not later than 12 
        months after the later of the date of the enactment of this Act 
        or the date that a product has been determined to be a tobacco 
        product by the Food and Drug Administration, the Secretary of 
        the Treasury (or the Secretary of the Treasury's delegate) 
        shall issue final regulations establishing the level of tax for 
        such product that is equivalent to the tax rate for cigarettes 
        on an estimated per use basis.
    (h) Clarifying Definition of Tobacco Products.--
            (1) In general.--Subsection (c) of section 5702 of the 
        Internal Revenue Code of 1986 is amended to read as follows:
    ``(c) Tobacco Products.--The term `tobacco products' means--
            ``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco, 
        and roll-your-own tobacco, and
            ``(2) any other product subject to tax pursuant to section 
        5701(i).''.
            (2) Conforming amendments.--Subsection (d) of section 5702 
        of such Code is amended by striking ``cigars, cigarettes, 
        smokeless tobacco, pipe tobacco, or roll-your-own tobacco'' 
        each place it appears and inserting ``tobacco products''.
    (i) Increasing Tax on Cigarettes.--
            (1) Small cigarettes.--Section 5701(b)(1) of such Code is 
        amended by striking ``$50.33'' and inserting ``$100.66''.
            (2) Large cigarettes.--Section 5701(b)(2) of such Code is 
        amended by striking ``$105.69'' and inserting ``$211.38''.
    (j) Tax Rates Adjusted for Inflation.--Section 5701 of such Code, 
as amended by subsection (g), is amended by adding at the end the 
following new subsection:
    ``(j) Inflation Adjustment.--
            ``(1) In general.--In the case of any calendar year 
        beginning after 2022, the dollar amounts provided under this 
        chapter shall each be increased by an amount equal to--
                    ``(A) such dollar amount, multiplied by
                    ``(B) the cost-of-living adjustment determined 
                under section 1(f)(3) for the calendar year, determined 
                by substituting `calendar year 2021' for `calendar year 
                2016' in subparagraph (A)(ii) thereof.
            ``(2) Rounding.--If any amount as adjusted under paragraph 
        (1) is not a multiple of $0.01, such amount shall be rounded to 
        the next highest multiple of $0.01.''.
    (k) Floor Stocks Taxes.--
            (1) Imposition of tax.--On tobacco products manufactured in 
        or imported into the United States which are removed before any 
        tax increase date and held on such date for sale by any person, 
        there is hereby imposed a tax in an amount equal to the excess 
        of--
                    (A) the tax which would be imposed under section 
                5701 of the Internal Revenue Code of 1986 on the 
                article if the article had been removed on such date, 
                over
                    (B) the prior tax (if any) imposed under section 
                5701 of such Code on such article.
            (2) Credit against tax.--Each person shall be allowed as a 
        credit against the taxes imposed by paragraph (1) an amount 
        equal to $500. Such credit shall not exceed the amount of taxes 
        imposed by paragraph (1) on such date for which such person is 
        liable.
            (3) Liability for tax and method of payment.--
                    (A) Liability for tax.--A person holding tobacco 
                products on any tax increase date to which any tax 
                imposed by paragraph (1) applies shall be liable for 
                such tax.
                    (B) Method of payment.--The tax imposed by 
                paragraph (1) shall be paid in such manner as the 
                Secretary shall prescribe by regulations.
                    (C) Time for payment.--The tax imposed by paragraph 
                (1) shall be paid on or before the date that is 120 
                days after the effective date of the tax rate increase.
            (4) Articles in foreign trade zones.--Notwithstanding the 
        Act of June 18, 1934 (commonly known as the Foreign Trade Zone 
        Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other 
        provision of law, any article which is located in a foreign 
        trade zone on any tax increase date shall be subject to the tax 
        imposed by paragraph (1) if--
                    (A) internal revenue taxes have been determined, or 
                customs duties liquidated, with respect to such article 
                before such date pursuant to a request made under the 
                first proviso of section 3(a) of such Act, or
                    (B) such article is held on such date under the 
                supervision of an officer of the United States Customs 
                and Border Protection of the Department of Homeland 
                Security pursuant to the second proviso of such section 
                3(a).
            (5) Definitions.--For purposes of this subsection--
                    (A) In general.--Any term used in this subsection 
                which is also used in section 5702 of such Code shall 
                have the same meaning as such term has in such section.
                    (B) Tax increase date.--The term ``tax increase 
                date'' means the effective date of any increase in any 
                tobacco product excise tax rate pursuant to the 
                amendments made by this section (other than subsection 
                (j) thereof).
                    (C) Secretary.--The term ``Secretary'' means the 
                Secretary of the Treasury or the Secretary's delegate.
            (6) Controlled groups.--Rules similar to the rules of 
        section 5061(e)(3) of such Code shall apply for purposes of 
        this subsection.
            (7) Other laws applicable.--All provisions of law, 
        including penalties, applicable with respect to the taxes 
        imposed by section 5701 of such Code shall, insofar as 
        applicable and not inconsistent with the provisions of this 
        subsection, apply to the floor stocks taxes imposed by 
        paragraph (1), to the same extent as if such taxes were imposed 
        by such section 5701. The Secretary may treat any person who 
        bore the ultimate burden of the tax imposed by paragraph (1) as 
        the person to whom a credit or refund under such provisions may 
        be allowed or made.
    (l) Effective Dates.--
            (1) In general.--Except as provided in paragraphs (2) 
        through (4), the amendments made by this section shall apply to 
        articles removed (as defined in section 5702(j) of the Internal 
        Revenue Code of 1986) after the last day of the month which 
        includes the date of the enactment of this Act.
            (2) Discrete single-use units and processed tobacco.--The 
        amendments made by subsections (c)(1)(C), (c)(2), and (f) shall 
        apply to articles removed (as defined in section 5702(j) of the 
        Internal Revenue Code of 1986) after the date that is 6 months 
        after the date of the enactment of this Act.
            (3) Large cigars.--The amendments made by subsection (e) 
        shall apply to articles removed after December 31, 2022.
            (4) Other tobacco products.--The amendments made by 
        subsection (g)(1) shall apply to products removed after the 
        last day of the month which includes the date that the 
        Secretary of the Treasury (or the Secretary of the Treasury's 
        delegate) issues final regulations establishing the level of 
        tax for such product.
                                 <all>