[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5163 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 5163

To facilitate support and services to women who find themselves with an 
    unexpected pregnancy, to meet the emotional, physical, social, 
     financial, and other needs women encounter during pregnancy, 
         childbirth, and child-rearing, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 3, 2021

 Mr. Fortenberry (for himself, Ms. Salazar, Mrs. Wagner, Ms. Stefanik, 
Ms. Cheney, Ms. Tenney, Mrs. Kim of California, Mr. Moore of Utah, Ms. 
 Malliotakis, and Miss Gonzalez-Colon) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
  addition to the Committees on Ways and Means, Education and Labor, 
Agriculture, the Judiciary, and Financial Services, 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 facilitate support and services to women who find themselves with an 
    unexpected pregnancy, to meet the emotional, physical, social, 
     financial, and other needs women encounter during pregnancy, 
         childbirth, and child-rearing, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Care for Her 
Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Sense of Congress.
Sec. 3. Definitions.
Sec. 4. Applicability of certain provisions.
Sec. 5. Religious and moral objections.
         TITLE I--PREGNANCY AND PARENTING SUPPORT COLLABORATIVE

Sec. 101. Establishment.
Sec. 102. Pregnant and Parenting Women's Care Information Service.
Sec. 103. Education and training support.
Sec. 104. Toll-free number.
Sec. 105. Annual review of successful models.
Sec. 106. Recognizing successful workplace policies and practices.
Sec. 107. Public Health Service Act programs.
           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

Sec. 201. Pregnancy and parenting support and services.
Sec. 202. Housing.
Sec. 203. Assessing outcomes and applying optimal incentives to improve 
                            maternal and child health outcomes.
                  TITLE III--INTERNAL REVENUE SERVICE

Sec. 301. Child tax credit improvements.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) many women find themselves with an unexpected pregnancy 
        without knowledge of what resources might be available to them 
        at the local, State, and Federal levels to support emotional, 
        physical, social, financial, and other needs that they may 
        encounter during pregnancy, childbirth, and child-rearing;
            (2) gaps exist in support and services provided throughout 
        communities;
            (3) Federal and State governments, according to the Supreme 
        Court ruling in Harris v. McRae, 448 U.S. 297 (1980), have a 
        vested interest in assuring optimal support and outcomes for 
        women and their children, and this ruling supports the decided 
        interest of the United States Government to help a woman 
        through childbirth and child-rearing;
            (4) women and communities alike have universally voiced the 
        need for safe, affordable, and supportive housing for expectant 
        mothers;
            (5) maternity housing needs in rural and urban communities 
        differ, and, as a result, community needs should be evaluated 
        and gaps filled where lack of housing support and services 
        exist;
            (6) group housing has been shown to be valuable to improve 
        health outcomes;
            (7) institutions of higher education should provide 
        information regarding resources available for parenting and 
        pregnant students;
            (8) communities should work together to provide support and 
        services, and fulfill unmet needs of pregnant and parenting 
        students;
            (9) expectant mothers begin to provide for their child as 
        soon as they come to learn of their pregnancy, and expenses may 
        include clothing, furniture, toys, and food, and, for this 
        reason, a child tax credit for women who are pregnant should be 
        applied;
            (10) information on support and services available should 
        be readily available to women during pregnancy, birth, and 
        child-rearing;
            (11) health care services are covered through various 
        insurances including the Medicaid program;
            (12) linking health care services to broader support and 
        services for a mother and her child, including housing, 
        nutrition, education, job training, job placement, and 
        childcare, is critical to help facilitate a woman through her 
        journey;
            (13) a committed community of care working with State and 
        Federal governments has an opportunity to build comprehensive 
        support systems that improve pregnancy outcomes significantly;
            (14) a community of care can help with--
                    (A) health care and material support;
                    (B) mentorship and parenting resources during 
                pregnancy and following the birth of a child;
                    (C) opportunities for completion of education, 
                employment, and job training;
                    (D) safe, affordable, and supportive housing during 
                pregnancy; and
                    (E) workplace and college campus accommodation, 
                including child care and lactation support; and
            (15) to assure consistent access to information about 
        available support and services for a woman with an unexpected 
        pregnancy, to fill additional gaps that exist in support and 
        services, and to support expectant mothers, Congress proposes--
                    (A) a new Federal-State entity to assure all 
                parties are satisfied with the context of support and 
                services;
                    (B) a clearinghouse with geographically relevant 
                programs for women seeking support during pregnancy;
                    (C) an assessment of gaps within support and 
                services;
                    (D) an assessment and sharing of successful models 
                in local, State, and Federal programs;
                    (E) provision of grants to support certain services 
                such as maternity housing, mentorship programs, job-
                training programs, and childcare;
                    (F) engagement with women who have experienced 
                available support and services to understand what 
                services are useful and gaps that exist in services and 
                support;
                    (G) an annual report from the Department of Health 
                and Human Services on successes and opportunities for 
                improvement;
                    (H) a pregnancy child tax credit; and
                    (I) establishing new incentives structures to 
                improve maternal and child outcomes.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) The terms ``Collaborative'' and ``State Pregnancy 
        Collaborative'' mean the Pregnancy Support Collaborative 
        established under section 101.
            (2) The terms ``pregnancy and parenting support and 
        services'' and ``pregnancy or parenting support or services'' 
        refer to support or services, as applicable, offered during or 
        after pregnancy to pregnant women or new mothers in order to 
        help such women to alleviate the physical, financial, social, 
        emotional, and other difficulties that may be encountered 
        during or after pregnancy, including the following:
                    (A) Material assistance, including maternity and 
                baby clothing, diapers and wipes, food supporting a 
                child's nutrition, baby furniture, and car seats.
                    (B) Housing for women and children.
                    (C) Provision of information on available resources 
                regarding pregnancy and childbirth, infant feeding, 
                time management, parenting special needs children, and 
                nutrition during and after pregnancy.
                    (D) Referrals for secondary and postsecondary 
                education, including with respect to vocational 
                training and community college, job training and 
                placement, housing, personal safety, food stamps, 
                adoption, and other governmental assistance.
                    (E) Wrap-around health care and social support 
                services for a woman carrying a child to term, and 
                neonatal care services.
                    (F) Access to nutrition programs for pregnant women 
                and mothers, including the program under section 17 of 
                the Child Nutrition Act of 1966 (42 U.S.C. 1786; 
                commonly known as ``WIC''), the program under section 4 
                of the Food and Nutrition Act of 2008 (7 U.S.C. 2013; 
                commonly known as ``SNAP''), the consolidated block 
                grants for Puerto Rico and American Samoa under section 
                19 of the Food and Nutrition Act of 2008 (7 U.S.C. 
                2028), and similar programs for the Commonwealth of the 
                Northern Mariana Islands.
                    (G) Legal services, including pro bono, to assist 
                women who wish to give birth and parents with newborn 
                children.
                    (H) Childcare services.
                    (I) Pursuing collection of child support and 
                alimony from uncooperative parents.
                    (J) Services to assist parents--
                            (i) to care for, and prepare to care for, a 
                        newborn, including a newborn with Down syndrome 
                        or another prenatally diagnosed condition or 
                        disability; and
                            (ii) to facilitate the adoption of such 
                        children according to the desire of the mother.
                    (K) Life-skills mentoring, including to enhance the 
                following competencies:
                            (i) Strengthening capacities for fostering 
                        long-term relationships with others.
                            (ii) Communication and conflict management.
                            (iii) Decision-making and relationship-
                        building skills prior to marriage.
                            (iv) High-risk behavior awareness.
                    (L) Life-skills counseling.
                    (M) Mammograms and services for postpartum 
                depression treatment.
                    (N) Provision of any of the services identified in 
                subparagraphs (A) through (M) through pregnancy support 
                centers.
            (3) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (4) The term ``State'' includes, in addition to the several 
        States, the District of Columbia, and each territory or 
        possession of the United States.

SEC. 4. APPLICABILITY OF CERTAIN PROVISIONS.

    Sections 506 and 507 of division A of the Further Consolidated 
Appropriations Act, 2020 (Public Law 116-94; 133 Stat. 2534, 2606-2607) 
apply with respect to any funds made available to carry out this Act to 
the same extent and in the same manner as such sections apply with 
respect to funds appropriated to carry out such division A.

SEC. 5. RELIGIOUS AND MORAL OBJECTIONS.

    A provider, including a faith-based provider, that is otherwise 
eligible to be listed in the clearinghouse under section 102, or to 
receive assistance under this Act--
            (1) shall not be required, as a condition of such listing 
        or receiving such assistance, to endorse, utilize, make a 
        referral to, become integrated with, or otherwise participate 
        in any program or activity to which the provider has a 
        religious or moral objection; and
            (2) shall not be discriminated against in the solicitation 
        or issuance of grants, contracts, or cooperative agreements 
        under this Act for refusing to meet any requirement described 
        in paragraph (1).

         TITLE I--PREGNANCY AND PARENTING SUPPORT COLLABORATIVE

SEC. 101. ESTABLISHMENT.

    (a) In General.--The Secretary shall establish within the 
Department of Health and Human Services a Federal-State collaborative, 
to be known as the Pregnancy Support Collaborative.
    (b) Membership.--The members of the Collaborative shall consist of 
the following:
            (1) The Secretary (or the Secretary's designee), who shall 
        serve as the chair of the Collaborative.
            (2) The chief executive officer of each State that chooses 
        to participate in the Collaborative (or the chief executive 
        officer's designee).
    (c) Staff; Single Point of Contact; Federal Experts.--The 
Secretary--
            (1) shall assign to the Collaborative such personnel as the 
        Secretary determines appropriate to assist the Collaborative in 
        carrying out its duties under this Act;
            (2) from among the personnel assigned pursuant to paragraph 
        (1), shall designate an Executive Director of the 
        Collaborative;
            (3) may request that Federal departments and agencies 
        detail relevant experts to the Collaborative to assist the 
        Collaborative in carrying out its duties under this Act; and
            (4) on an annual basis, shall publish a list of the members 
        of the Collaborative.
    (d) Two-Thirds Vote Required.--The Collaborative may not take any 
action or make any recommendation or decision unless such action, 
decision, or recommendation is authorized by a vote of at least two-
thirds of the members of the Collaborative.
    (e) Responsibilities.--The Collaborative shall--
            (1) work with States and localities to learn about existing 
        successful models for pregnancy and parenting support and 
        services;
            (2) on an annual basis, submit a report to the Congress--
                    (A) describing the activities of the Collaborative, 
                the funds expended on such activities, and the results 
                achieved through such activities; and
                    (B) recommending--
                            (i) how to fill gaps experienced by women 
                        who have benefited from pregnancy and parenting 
                        support and services; and
                            (ii) how to maintain and expand Federal 
                        funding levels for pregnancy and parenting 
                        support and services;
            (3) develop and maintain the Pregnant and Parenting Women's 
        Care Information Service, in accordance with section 102;
            (4) provide educational support in accordance with section 
        103;
            (5) provide for a toll-free number in accordance with 
        section 104;
            (6) conduct an annual review of nationwide successful 
        models in accordance with section 105; and
            (7) recognize successful workplace policies and practices 
        in accordance with section 106.
    (f) Avoiding Duplication of Effort.--The Collaborative shall, where 
possible, avoid duplicating the programs and activities of other 
entities.

SEC. 102. PREGNANT AND PARENTING WOMEN'S CARE INFORMATION SERVICE.

    (a) In General.--The Collaborative shall develop and maintain a 
comprehensive, publicly accessible, and user-friendly clearinghouse to 
be known as the Pregnant and Parenting Women's Care Information Service 
(in this section referred to as the ``clearinghouse'') to serve as a 
consolidated source of information on qualified public and private 
service providers that provide pregnancy and parenting support and 
services, including in low-income, urban, suburban, and rural areas.
    (b) Identification of Providers, Support, and Services.--The 
Collaborative--
            (1) shall request that each State identify, and enter into 
        a template provided by the Collaborative, each provider, 
        support, and service in the State to be included in the 
        clearinghouse; and
            (2) shall not include in the clearinghouse any provider, 
        support, or service in a State unless the State involved has 
        requested pursuant to paragraph (1) (and not withdrawn its 
        request) to include such provider, support, or service in the 
        clearinghouse.
    (c) Qualified Providers.--For a provider to be qualified to be 
listed in the clearinghouse--
            (1) the provider shall have been engaged in providing 
        pregnancy or parenting support or services for mothers and 
        infants for a minimum of 3 consecutive years; and
            (2) pregnancy support or services for mothers and infants 
        shall be the primary focus of the provider's work.
    (d) Input.--In developing and maintaining the clearinghouse, the 
Collaborative shall seek the input of--
            (1) qualified experts involved in providing pregnancy and 
        parenting support and services; and
            (2) relevant State officials.
    (e) Contents.--Subject to subsections (b)(2) and (c), the 
clearinghouse shall include each of the following:
            (1) A complete list of Federal, State, and local programs 
        that provide pregnancy and parenting support and services.
            (2) A rating system that allows clients to rate qualified 
        providers of pregnancy and parenting support and services after 
        receiving such services.
            (3) Information on qualified providers of pregnancy and 
        parenting resources, including--
                    (A) contact information;
                    (B) years in service;
                    (C) qualifications;
                    (D) references;
                    (E) women's ratings under the system under 
                paragraph (2); and
                    (F) links to the providers' websites.
            (4) Information on the education and training opportunities 
        identified pursuant to section 103.

SEC. 103. EDUCATION AND TRAINING SUPPORT.

    (a) In General.--The Collaborative, in collaboration with State and 
local governments, shall--
            (1) identify, assess, and increase understanding and 
        awareness of--
                    (A) appropriate education and training 
                opportunities to ensure that women have access to all 
                available programs, funding, and support to maximize 
                their employment opportunities; and
                    (B) specific supports and services for women during 
                pregnancy, nursing, and child-rearing; and
            (2) direct individuals to information on such 
        opportunities, and such supports and services, in a manner that 
        is geographically relevant.
    (b) Support for Students.--The Collaborative shall work with 
secondary schools, institutions of higher education, and other entities 
providing education or job training to maximize support within the 
learning setting, including with respect to--
            (1) childcare services, family housing, health insurance 
        (for students and their families), flexible academic scheduling 
        (such as telecommuting programs), parenting classes and 
        programs, and postpartum counseling and support groups;
            (2) access to locations designated for breastfeeding within 
        the learning setting;
            (3) identifying scholarships, financial and in-kind 
        resources, grants, and loans for which such students may be 
        eligible;
            (4) job placement and apprenticeship;
            (5) working with employers to optimize work site support 
        for child care and breastfeeding, transportation, or other 
        services to assist a mother to achieve successful employment; 
        and
            (6) options for tele-education.
    (c) Provision of Information.--As a condition on receipt of Federal 
funds for providing education or job training, an entity shall agree to 
provide to the Collaborative such information as the Collaborative may 
request on education and training opportunities for purposes of 
carrying out subsections (a) and (b).

SEC. 104. TOLL-FREE NUMBER.

    If approved by a vote of at least two-thirds of the members of the 
Collaborative, as described in section 101(d), the Collaborative shall 
enter into a contract, through the use of competitive procedures, with 
an entity to establish and operate a toll-free number to provide women 
with referrals for obtaining pregnancy and parenting support and 
services, including services to support mental and emotional health.

SEC. 105. ANNUAL REVIEW OF SUCCESSFUL MODELS.

    (a) Annual Review.--The Collaborative shall conduct an annual 
review of nationwide successful models in women's pregnancy and 
parenting support and services.
    (b) Input.--In conducting each annual review under subsection (a), 
the Collaborative shall--
            (1) gather input from qualified providers listed in the 
        clearinghouse under section 102 and qualified experts referred 
        to in section 102(d), including such providers and experts 
        from--
                    (A) State and local governments;
                    (B) the private and faith-based sectors;
                    (C) prenatal and parenting care centers; and
                    (D) other qualified providers; and
            (2) in gathering such input, encourage such qualified 
        providers and experts--
                    (A) to share information on successful models in 
                pregnancy and parenting support and services; and
                    (B) to identify and address--
                            (i) key burdens or adverse circumstances 
                        facing pregnant women; and
                            (ii) the challenges for providers.

SEC. 106. RECOGNIZING SUCCESSFUL WORKPLACE POLICIES AND PRACTICES.

    (a) In General.--The Collaborative shall--
            (1) recognize employers that successfully implement 
        innovative policies and practices to meet the needs of pregnant 
        and parenting employees with respect to children below school 
        age;
            (2) make recommendations regarding such innovative policies 
        and practices; and
            (3) publicize such policies and practices that prove to be 
        successful.
    (b) Policies and Practices.--The innovative policies and practices 
referred to in subsection (a) may include--
            (1) family friendly policies proposed by both employees and 
        the employer;
            (2) childcare facilities;
            (3) family cafeterias and separate areas for those who do 
        not have children and may prefer not to eat with other 
        families;
            (4) small employer family leave policies not covered by the 
        Family and Medical Leave Act of 1993 (29 U.S.C. 2601 et seq.);
            (5) paid family leave policies for larger employers with a 
        sliding scale for medium-sized companies;
            (6) rooms set aside for mothers to breastfeed in comfort, 
        with refrigerators for the storage of breast milk;
            (7) telecommuting and flexible work schedules for jobs that 
        do not require being on-site, and meeting times set for the 
        convenience of caregivers, implemented in a manner that is not 
        at the expense of traditional full-time employees; and
            (8) establishment of a committee comprised of employers, 
        human resource staff, and employees at all levels to discuss 
        matters related to employer support for employees who are 
        pregnant or parenting.

SEC. 107. PUBLIC HEALTH SERVICE ACT PROGRAMS.

    (a) Safe Motherhood.--Section 317K of the Public Health Service Act 
(42 U.S.C. 247b-12) is amended--
            (1) in subsection (a)(2), by adding at the end the 
        following:
                    ``(E) Assessment of the role of the State Pregnancy 
                Collaborative in--
                            ``(i) improving perinatal outcomes, 
                        including maternal and infant morbidity and 
                        mortality; and
                            ``(ii) data collection for the community 
                        shared savings accounts under section 203(c) of 
                        the Care for Her Act.'';
            (2) in subsection (b)(2)--
                    (A) in subparagraph (L), by striking ``and'' at the 
                end;
                    (B) in subparagraph (M), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(N) the prevention role of the State Pregnancy 
                Collaborative for mothers and children based on the 
                support of the whole community.'';
            (3) by amending subsection (c)(3) to read as follows:
            ``(3) activities to promote community support services for 
        pregnant women, including providers listed in the clearinghouse 
        of the State Pregnancy Collaborative under section 102 of the 
        Care for Her Act; and''; and
            (4) in subsection (e), by adding at the end the following:
            ``(4) The term `State Pregnancy Collaborative' has the 
        meaning given to that term in section 3 of the Care for Her 
        Act.''.
    (b) Infant Mortality Grants.--Section 330(f) of the Public Health 
Service Act (42 U.S.C. 254b(f)) is amended--
            (1) in the matter before subparagraph (A) in paragraph (1), 
        by striking ``health centers'' each place it appears and 
        inserting ``health centers and providers listed in the 
        clearinghouse of the State Pregnancy Collaborative under 
        section 102 of the Care for Her Act (in this subsection 
        referred to as `listed providers')'';
            (2) except in the matter before subparagraph (A) in 
        paragraph (1), by striking ``health centers'' each place it 
        appears and inserting ``health centers and listed providers'';
            (3) by striking ``such centers'' each place it appears and 
        inserting ``such centers and providers'';
            (4) by striking ``the health center'' each place it appears 
        and inserting ``the health center or listed provider'';
            (5) by striking ``the center'' each place it appears and 
        inserting ``the center or listed provider''; and
            (6) in paragraph (2)--
                    (A) by striking ``shall give priority to health 
                centers'' and inserting ``shall give priority to--
                    ``(A) health centers'';
                    (B) by striking the period at the end and inserting 
                ``; and''; and
                    (C) by adding at the end the following:
                    ``(B) listed providers that offer support services 
                for a mother and infant as a known benefit for 
                improving pregnancy outcomes.''.
    (c) Certain Services for Pregnant Women.--Section 330F(a)(1) of the 
Public Health Service Act (42 U.S.C. 254c-6(a)(1)) is amended by 
striking ``to train the designated staff of eligible health centers'' 
and inserting ``to train the designated staff of eligible health 
centers and providers listed in the clearinghouse of the State 
Pregnancy Collaborative under section 102 of the Care for Her Act''.
    (d) Projects To Improve Maternal, Infant, and Child Health.--
            (1) In general.--Section 399(a)(1) of the Public Health 
        Service Act (42 U.S.C. 280c-6(a)(1)) is amended by striking 
        ``shall make grants to eligible entities to pay the Federal 
        share of the cost of providing'' and inserting ``shall make 
        grants to eligible entities, including providers listed in the 
        clearinghouse of the State Pregnancy Collaborative under 
        section 102 of the Care for Her Act, to pay the Federal share 
        of the cost of providing''.
            (2) Requirement of status as medicaid provider.--Section 
        399(a)(3) of the Public Health Service Act (42 U.S.C. 280c-
        6(a)(3)) is amended by inserting after ``only if, in the case 
        of any service under such paragraph that is covered in the 
        State plan approved under title XIX of the Social Security Act 
        for the State involved'' the following: ``, the State plan 
        includes providers listed in the clearinghouse of the State 
        Pregnancy Collaborative under section 102 of the Care for Her 
        Act, and''.
            (3) Home visiting services for eligible families.--The 
        matter before paragraph (1) is section 399(b) of the Public 
        Health Service Act (42 U.S.C. 280c-6(b)) is amended by 
        inserting after ``directly or through arrangement with other 
        public or nonprofit private entities,'' the following: 
        ``including providers listed in the clearinghouse of the State 
        Pregnancy Collaborative under section 102 of the Care for Her 
        Act,''.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

SEC. 201. PREGNANCY AND PARENTING SUPPORT AND SERVICES.

    (a) Healthy Birth and Healthy Life Grants.--
            (1) In general.--The Secretary, with the approval of the 
        Collaborative, may award grants to qualified providers listed 
        in the clearinghouse under section 102 to provide pregnancy and 
        parenting support and services.
            (2) Supplement, not supplant.--The Secretary may award a 
        grant to a qualified provider under this subsection only if the 
        qualified provider agrees that the grant will be used to 
        supplement, and not supplant, pregnancy and parenting support 
        and services.
    (b) Mentorship and Job Training Grants.--The Secretary, with the 
approval of the Collaborative, shall award grants to qualified 
providers listed in the clearinghouse under section 102 for the 
exclusive purpose of providing mentorships or job training to pregnant 
women and new mothers.

SEC. 202. HOUSING.

    (a) Identification of Gaps.--The Secretary, with the approval of 
the Collaborative, shall identify gaps in maternity housing within 
rural and urban communities.
    (b) Grants.--The Secretary, with approval of the Collaborative, 
shall award grants to qualified public and private service providers 
listed in the clearinghouse under section 102 for addressing gaps in 
maternity housing identified pursuant to subsection (a).

SEC. 203. ASSESSING OUTCOMES AND APPLYING OPTIMAL INCENTIVES TO IMPROVE 
              MATERNAL AND CHILD HEALTH OUTCOMES.

    (a) Making Epidemiology and Health Encounter Data Relevant to 
Maternal Child Health Improvement.--Beginning not later than April 1, 
2022, the Secretary, acting through the Director of the Centers for 
Disease Control and Prevention in collaboration with the Administrator 
of the Centers for Medicare & Medicaid Services, in conjunction with 
local programs supporting pregnant women, shall provide for the 
maintenance of a database of deidentified epidemiological and claims 
health information for the purpose of making such information available 
in a useful and informative manner to participating communities in 
participating States to assess the outcome impact of maternity homes in 
improving pregnancy outcomes and reducing maternal mortality; and 
improving infant mortality including reduction of preterm deliveries, 
and low-birth-rate incidence. In carrying out this subsection, the 
Secretary shall provide--
            (1) for a mechanism that enables the integration of such 
        epidemiological and claims health information within the 
        Medicaid program under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.);
            (2) that pregnancy and newborns will be assessed based on 
        clinical outcomes and costs related to the Medicaid program 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.);
            (3) that such epidemiological and claims health information 
        is made available to participating States in a manner that 
        enables participating communities within such States to access 
        such information that is relevant to improving maternal child 
        health outcomes in such communities; and
            (4) for a mechanism by which the Secretary, working in 
        collaboration with the Governor of the respective State of each 
        participating community, may--
                    (A) update such information specific to each 
                participating community, to the extent practicable, in 
                real-time or near real-time and as specified by the 
                Secretary;
                    (B) verify the validity of such information and the 
                validity of the changes in such information for each 
                such participating community over a specified period; 
                and
                    (C) assess and measure the extent of such changes 
                for each participating community, including--
                            (i) the amount of any reductions in 
                        expenditures under the State plan under the 
                        Medicaid program under title XIX of the Social 
                        Security Act (42 U.S.C. 1396 et seq.); and
                            (ii) the extent to which such reductions 
                        are attributable to such changes with respect 
                        to each participating community.
    (b) Localized Community Health Improvement Program Grants.--
            (1) In general.--The Collaborative shall award grants to 
        States for purposes of carrying out localized community health 
        improvement programs described in paragraph (3).
            (2) Application.--To be eligible for a grant under this 
        subsection, a State shall--
                    (A) submit to the Collaborative an application in 
                such manner, at such time, and containing such 
                information as specified by the Collaborative; and
                    (B) enter into an arrangement with the 
                Collaborative under which--
                            (i) the State agrees to establish and 
                        maintain a localized community health 
                        improvement program described in paragraph (3);
                            (ii) the Collaborative agrees to provide 
                        the State with integrated epidemiological and 
                        claims health information maintained in the 
                        database established under subsection (a) 
                        specific to each participating community within 
                        the State;
                            (iii) the State and each participating 
                        community in the State will assess the impact 
                        of the localized community health improvement 
                        program on outcomes, including reductions in 
                        cost to the Medicaid program under title XIX of 
                        the Social Security Act (42 U.S.C. 1396 et 
                        seq.);
                            (iv) each participating community in the 
                        State has a community shared savings board that 
                        will establish and maintain a community shared 
                        savings account in accordance with subsection 
                        (c), including the terms listed in subsection 
                        (c)(2);
                            (v) 70 percent of savings from health 
                        improvements and cost reductions will be 
                        verified by the Collaborative and transferred 
                        to the community shared savings account of the 
                        respective participating communities in 
                        accordance with subsection (c)(2)(A); and
                            (vi) savings in a community shared savings 
                        account will be used for pregnancy and 
                        parenting support and services.
            (3) Localized community health improvement program.--For 
        purposes of this section, a localized community health 
        improvement program of a State is a program under which the 
        State--
                    (A) maintains the integrated health information 
                provided to the State by the Collaborative pursuant to 
                the arrangement described in paragraph (2)(B);
                    (B) makes such information available to qualifying 
                communities (as defined in paragraph (4)) within such 
                State which request such information and agree to the 
                terms described in subsection (c), in a secure manner 
                and format that is most informative to such communities 
                in assisting such communities in analyzing and applying 
                such data to the specific needs of such communities to 
                reduce the rates of illness and reduce the costs of 
                health care within such communities;
                    (C) submits such data as is required by the 
                Collaborative to assess the extent to which the health 
                care interventions implemented to address needs of such 
                communities identified through the program are 
                affecting the rates of illness and costs of health care 
                within the State and communities within the State; and
                    (D) requires that in order for communities to 
                participate in such program, the communities agree--
                            (i) to provide for a secure method to make 
                        such information available to health care and 
                        other relevant community workers, including 
                        through an interactive dashboard system; and
                            (ii) to submit such data as is required by 
                        the State or Collaborative to assess the extent 
                        to which health care interventions implemented 
                        to address needs of such communities identified 
                        through the program are affecting the rates of 
                        illness and costs of health care within the 
                        communities.
    (c) Community Shared Savings Accounts.--
            (1) In general.--For purposes of this section, a community 
        shared savings account shall, with respect to a participating 
        community within a participating State, be a trust created or 
        organized in the United States for the exclusive benefit of the 
        community, as defined by the community shared savings board for 
        such participating community, but only if the written governing 
        instrument creating the trust meets the following requirements:
                    (A) The trustee is--
                            (i) a bank (as defined in section 408(n) of 
                        the Internal Revenue Code of 1986 (26 U.S.C. 
                        408(n)); or
                            (ii) a person who demonstrates to the 
                        satisfaction of the State that the manner in 
                        which such person will administer the trust 
                        will be consistent with the requirements of 
                        this section.
                    (B) Withdrawals may only be made by the fiduciary 
                agent referred to in paragraph (3)(C) pursuant to a 
                plan--
                            (i) developed by the community; and
                            (ii) approved by the State and local 
                        governments.
            (2) Terms.--For purposes of subsection (b)(2)(B)(iv), the 
        terms described in this subsection, with respect to the 
        Collaborative, a participating State, and participating 
        communities within such State, are the following:
                    (A) In the case that the database maintained under 
                subsection (a), through the mechanism provided for 
                under subsection (a)(4), demonstrates for any specified 
                period (as determined by the Collaborative) that there 
                are verified reductions in expenditures under the State 
                plan under title XIX of the Social Security Act (42 
                U.S.C. 1396 et seq.), which results in reductions in 
                expenditures by the Federal Government under such 
                title, and attributes such reductions to one or more of 
                the participating communities within such State, the 
                Collaborative shall transfer to the community shared 
                savings account established pursuant to subparagraph 
                (B) an amount equal to 70 percent of the amount of such 
                reduction so demonstrated for such specified period.
                    (B) The respective community shared savings board 
                establishes such a community shared savings account in 
                accordance with paragraph (1) for receipt of amounts 
                transferred pursuant to subparagraph (A).
                    (C) Each participating community in such State 
                shall--
                            (i) establish a community shared savings 
                        board described in paragraph (3) that 
                        determines how funds transferred to such 
                        community under subparagraph (A) are to be used 
                        for purposes of promoting the health and 
                        wellness of pregnant women, new mothers, and 
                        their children of such community; and
                            (ii) uses such funds only for such purposes 
                        and in accordance with the uses determined by 
                        such board.
            (3) Community shared savings board.--For purposes of this 
        section, a community shared savings board, with respect to a 
        participating community within a participating State, shall be 
        a board--
                    (A) consisting of at least 7 members, appointed by 
                the governing officials of the community through a 
                process that is specified by the community (and 
                approved by the State), including--
                            (i) at least 1 member with public health 
                        experience; and
                            (ii) members with business, civic, 
                        educational, or faith-based experience;
                    (B) that is representative of the geographic 
                components that are included in the community; and
                    (C) that hires a fiduciary agent to manage a 
                community shared savings account on behalf of the 
                board.
    (d) Definitions.--In this section:
            (1) The term ``community shared savings account'' means a 
        community shared savings account meeting the criteria in 
        subsection (c)(1).
            (2) The term ``community shared savings board'' means a 
        community shared savings board meeting the criteria of 
        subsection (c)(4).
            (3) The term ``participating community'' means a qualifying 
        community that enters into an agreement with a participating 
        State as described in subsection (b)(3)(B).
            (4) The term ``participating State'' means a State 
        receiving a grant under subsection (b)(1).
            (5) The term ``qualifying community'' means a local 
        community--
                    (A) that has the capacity to assess health data, 
                including epidemiology and health encounter data, for a 
                census track or block that can be extrapolated into a 
                geographic information system to support analysis of 
                health outcomes; and
                    (B) whose geographic boundary corresponds to the 
                boundary of--
                            (i) a municipality;
                            (ii) a county; or
                            (iii) a high school feeder pattern.

                  TITLE III--INTERNAL REVENUE SERVICE

SEC. 301. CHILD TAX CREDIT IMPROVEMENTS.

    (a) In General.--Section 24(c)(1) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new sentence: ``Such 
term shall include a child of an eligible taxpayer for the taxable year 
immediately preceding the year in which such child is born, if such 
child is born alive on or before the due date of the return of tax for 
such taxable year (not including extensions)''.
    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after December 31, 2020.
                                 <all>