115 HR 8862 IH: Providing Real Opportunities and Lifelong Investments For Everyone Act of 2022
U.S. House of Representatives
2022-09-15
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
I
117th CONGRESS
2d Session
H. R. 8862
IN THE HOUSE OF REPRESENTATIVES
September 15, 2022
Mr. Phillips (for himself, Ms. DeLauro, Ms. Barragán, 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. Velázquez, 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.
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”.
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.
I

Black Maternal Health Momnibus
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.
A

Social determinants for moms
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.
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.
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.
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.
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.
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.
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.
B

Honoring Kira Johnson
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.
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.
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:
“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.”.
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.
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.
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.
C

Protecting moms who served
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.
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.
D

Perinatal workforce
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.
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:
“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.”.
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:
“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.”.
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.
E

Data to save moms
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))”.
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;”.
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.
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.
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.
F

Moms matter
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.
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:
“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.”.
G

Justice for incarcerated moms
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.
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.
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.
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.
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.
H

Tech to save moms
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.
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:
“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.”.
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.
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.
I

Impact to save moms
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)).
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.
J

Maternal health pandemic response
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.
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.
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.
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.
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.
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.
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.
K

Protecting moms and babies against climate change
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.
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.
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.
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.
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.
L

Maternal vaccinations
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.
II

Children’s Health Insurance Program Permanency
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.
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”.
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”.
III

Family and Medical Leave
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.
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).
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.
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.
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.
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.
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.
IV

Fully Refundable Child Tax Credit
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:
“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:
“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.
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.
V

Child Care Is Infrastructure
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:
“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),”.
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:
“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.”.
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.
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”.
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.
VI

Honoring Family-Friendly Workplaces
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).
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.
VII

Mothers and Offspring Mortality and Morbidity Awareness
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:
“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.
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.