Providing Real Opportunities and Lifelong Investments For Everyone Act of 2022 or the PRO-LIFE Act of 2022
This bill establishes new, and modifies existing, programs related to maternal and child health, tax credits and other benefits for parents and caregivers, and support for childcare infrastructure.
The bill requires multi-agency efforts to improve maternal health and reduce maternal mortality, particularly among racial and ethnic minority groups, veterans, and other vulnerable populations, by addressing both health-related factors and the social determinants of health (i.e., nonmedical factors that influence health outcomes, such as housing, food security, transportation, and environmental conditions). Additionally, the bill permanently extends the Children's Health Insurance Program (CHIP) and related measures.
Further, the bill (1) sets up a family medical leave insurance benefit that entitles employees to a monthly benefit payment for a period of qualified caregiving; and (2) imposes a tax on employers, employees, and self-employed individuals to fund the benefits. The bill also increases the amount of the child tax credit and makes the credit fully refundable and payable in advance on a monthly basis.
In addition, the Department of Labor must carry out a program to certify and recognize employers that implement family-friendly workplace programs (e.g., providing paid family and sick leave or subsidizing childcare).
The bill also requires support for childcare infrastructure, for example by establishing grants for childcare facilities and scholarship and loan repayment programs for childcare educators.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8862 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 8862
To invest in real pro-life policies that support the American family,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 15, 2022
Mr. Phillips (for himself, Ms. DeLauro, Ms. Barragan, Ms. Meng, Ms.
Kelly of Illinois, Mr. Carson, Ms. Porter, Ms. Norton, Ms. Wilson of
Florida, Mr. Nadler, Mr. Michael F. Doyle of Pennsylvania, Mr. Khanna,
Mrs. Kirkpatrick, Mr. Neguse, Mr. Cicilline, Ms. Velazquez, Mr. Evans,
Ms. Adams, Ms. Lofgren, Mr. Connolly, Ms. McCollum, Ms. Schakowsky,
Mrs. Torres of California, Ms. Escobar, Mr. Grijalva, Mr. Cohen, Ms.
Moore of Wisconsin, Ms. Titus, and Mr. Lieu) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committees on Financial Services, Transportation and
Infrastructure, Education and Labor, the Judiciary, Natural Resources,
Agriculture, Veterans' Affairs, and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To invest in real pro-life policies that support the American family,
and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Providing Real Opportunities and
Lifelong Investments For Everyone Act of 2022'' or the ``PRO-LIFE Act
of 2022''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--BLACK MATERNAL HEALTH MOMNIBUS
Sec. 1000. Definitions; sense of Congress.
Subtitle A--Social Determinants for Moms
Sec. 1001. Task force to develop a strategy to address social
determinants of maternal health.
Sec. 1002. Housing for Moms grant program.
Sec. 1003. Department of Transportation.
Sec. 1004. Department of Agriculture.
Sec. 1005. Environmental study through National Academies.
Sec. 1006. Child care access.
Sec. 1007. Grants to local entities addressing social determinants of
maternal health.
Subtitle B--Honoring Kira Johnson
Sec. 1101. Investments in community-based organizations to improve
Black maternal health outcomes.
Sec. 1102. Investments in community-based organizations to improve
maternal health outcomes in underserved
communities.
Sec. 1103. Respectful maternity care training for all employees in
maternity care settings.
Sec. 1104. Study on reducing and preventing bias, racism, and
discrimination in maternity care settings.
Sec. 1105. Respectful maternity care compliance program.
Sec. 1106. GAO report.
Subtitle C--Protecting Moms Who Served
Sec. 1201. Support for maternity care coordination.
Sec. 1202. Report on maternal mortality and severe maternal morbidity
among pregnant and postpartum veterans.
Subtitle D--Perinatal Workforce
Sec. 1301. HHS agency directives.
Sec. 1302. Grants to grow and diversify the perinatal workforce.
Sec. 1303. Grants to grow and diversify the nursing workforce in
maternal and perinatal health.
Sec. 1304. GAO report.
Subtitle E--Data to Save Moms
Sec. 1401. Funding for maternal mortality review committees to promote
representative community engagement.
Sec. 1402. Data collection and review.
Sec. 1403. Review of maternal health data collection processes and
quality measures.
Sec. 1404. Indian Health Service study on maternal mortality and severe
maternal morbidity.
Sec. 1405. Grants to minority-serving institutions to study maternal
mortality, severe maternal morbidity, and
other adverse maternal health outcomes.
Subtitle F--Moms Matter
Sec. 1501. Maternal mental health equity grant program.
Sec. 1502. Grants to grow and diversify the maternal mental and
behavioral health care workforce.
Subtitle G--Justice for Incarcerated Moms
Sec. 1601. Ending the shackling of pregnant individuals.
Sec. 1602. Creating model programs for the care of incarcerated
individuals in the prenatal and postpartum
periods.
Sec. 1603. Grant program to improve maternal health outcomes for
individuals in State and local prisons and
jails.
Sec. 1604. GAO report.
Sec. 1605. MACPAC report.
Subtitle H--Tech to Save Moms
Sec. 1701. Integrated telehealth models in maternity care services.
Sec. 1702. Grants to expand the use of technology-enabled collaborative
learning and capacity models for pregnant
and postpartum individuals.
Sec. 1703. Grants to promote equity in maternal health outcomes through
digital tools.
Sec. 1704. Report on the use of technology in maternity care.
Subtitle I--Impact to Save Moms
Sec. 1801. Perinatal Care Alternative Payment Model Demonstration
Project.
Sec. 1802. MACPAC report.
Subtitle J--Maternal Health Pandemic Response
Sec. 1901. Definitions.
Sec. 1902. Funding for data collection, surveillance, and research on
maternal health outcomes during the COVID-
19 public health emergency.
Sec. 1903. COVID-19 maternal health data collection and disclosure.
Sec. 1904. Inclusion of pregnant individuals and lactating individuals
in vaccine and therapeutic development for
COVID-19.
Sec. 1905. Public health communication regarding maternal care during
COVID-19.
Sec. 1906. Task force on birthing experience and safe maternity care
during a public health emergency.
Sec. 1907. GAO report on maternal health and public health emergency
preparedness.
Subtitle K--Protecting Moms and Babies Against Climate Change
Sec. 1911. Definitions.
Sec. 1912. Grant program to protect vulnerable mothers and babies from
climate change risks.
Sec. 1913. Grant program for education and training at health
profession schools.
Sec. 1914. NIH Consortium on Birth and Climate Change Research.
Sec. 1915. Strategy for identifying climate change risk zones for
vulnerable mothers and babies.
Subtitle L--Maternal Vaccinations
Sec. 1921. Maternal vaccination awareness and equity campaign.
TITLE II--CHILDREN'S HEALTH INSURANCE PROGRAM PERMANENCY
Sec. 2001. Permanent extension of children's health insurance program.
Sec. 2002. Permanent extensions of other programs and demonstration
projects.
Sec. 2003. State option to increase children's eligibility for Medicaid
and CHIP.
TITLE III--FAMILY AND MEDICAL LEAVE
Sec. 3001. Definitions.
Sec. 3002. Office of Paid Family and Medical Leave.
Sec. 3003. Family and Medical Leave Insurance benefit payments.
Sec. 3004. Establishment of Family and Medical Leave Insurance Trust
Fund.
Sec. 3005. Internal Revenue Code provisions.
Sec. 3006. Regulations.
Sec. 3007. GAO Study.
TITLE IV--FULLY REFUNDABLE CHILD TAX CREDIT
Sec. 4001. Establishment of fully refundable child tax credit.
Sec. 4002. Payments to possessions.
TITLE V--CHILD CARE IS INFRASTRUCTURE
Sec. 5001. Infrastructure grants to improve child care safety.
Sec. 5002. Early childhood educator loan assistance program.
Sec. 5003. Grants for early childhood educators.
Sec. 5004. CCAMPIS Reauthorization.
Sec. 5005. Evaluation of applications for assistance under Choice
Neighborhoods Initiative.
TITLE VI--HONORING FAMILY-FRIENDLY WORKPLACES
Sec. 6001. Definitions.
Sec. 6002. Certification program established.
TITLE VII--MOTHERS AND OFFSPRING MORTALITY AND MORBIDITY AWARENESS
Sec. 7001. Improving Federal efforts with respect to prevention of
maternal mortality.
Sec. 7002. Increasing excise taxes on cigarettes and establishing
excise tax equity among all tobacco product
tax rates.
TITLE I--BLACK MATERNAL HEALTH MOMNIBUS
SEC. 1000. DEFINITIONS; SENSE OF CONGRESS.
(a) Definitions.--In this title:
(1) Culturally congruent.--The term ``culturally
congruent'', with respect to care or maternity care, means care
that is in agreement with the preferred cultural values,
beliefs, worldview, language, and practices of the health care
consumer and other stakeholders.
(2) Maternity care provider.--The term ``maternity care
provider'' means a health care provider who--
(A) is a physician, physician assistant, midwife
who meets at a minimum the international definition of
the midwife and global standards for midwifery
education as established by the International
Confederation of Midwives, nurse practitioner, or
clinical nurse specialist; and
(B) has a focus on maternal or perinatal health.
(3) Maternal mortality.--The term ``maternal mortality''
means a death occurring during or within a one-year period
after pregnancy, caused by pregnancy-related or childbirth
complications, including a suicide, overdose, or other death
resulting from a mental health or substance use disorder
attributed to or aggravated by pregnancy-related or childbirth
complications.
(4) Perinatal health worker.--The term ``perinatal health
worker'' means a doula, community health worker, peer
supporter, breastfeeding and lactation educator or counselor,
nutritionist or dietitian, childbirth educator, social worker,
home visitor, language interpreter, or navigator.
(5) Postpartum and postpartum period.--The terms
``postpartum'' and ``postpartum period'' refer to the 1-year
period beginning on the last day of the pregnancy of an
individual.
(6) Pregnancy-associated death.--The term ``pregnancy-
associated death'' means a death of a pregnant or postpartum
individual, by any cause, that occurs during, or within 1 year
following, the individual's pregnancy, regardless of the
outcome, duration, or site of the pregnancy.
(7) Pregnancy-related death.--The term ``pregnancy-related
death'' means a death of a pregnant or postpartum individual
that occurs during, or within 1 year following, the
individual's pregnancy, from a pregnancy complication, a chain
of events initiated by pregnancy, or the aggravation of an
unrelated condition by the physiologic effects of pregnancy.
(8) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term in
section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
300u-6(g)(1)).
(9) Severe maternal morbidity.--The term ``severe maternal
morbidity'' means a health condition, including mental health
conditions and substance use disorders, attributed to or
aggravated by pregnancy or childbirth that results in
significant short-term or long-term consequences to the health
of the individual who was pregnant.
(10) Social determinants of maternal health defined.--The
term ``social determinants of maternal health'' means non-
clinical factors that impact maternal health outcomes,
including--
(A) economic factors, which may include poverty,
employment, food security, support for and access to
lactation and other infant feeding options, housing
stability, and related factors;
(B) neighborhood factors, which may include quality
of housing, access to transportation, access to child
care, availability of healthy foods and nutrition
counseling, availability of clean water, air and water
quality, ambient temperatures, neighborhood crime and
violence, access to broadband, and related factors;
(C) social and community factors, which may include
systemic racism, gender discrimination or
discrimination based on other protected classes,
workplace conditions, incarceration, and related
factors;
(D) household factors, which may include ability to
conduct lead testing and abatement, car seat
installation, indoor air temperatures, and related
factors;
(E) education access and quality factors, which may
include educational attainment, language and literacy,
and related factors; and
(F) health care access factors, including health
insurance coverage, access to culturally congruent
health care services, providers, and non-clinical
support, access to home visiting services, access to
wellness and stress management programs, health
literacy, access to telehealth and items required to
receive telehealth services, and related factors.
(b) Sense of Congress.--It is the sense of Congress that--
(1) the respect and proper care that birthing people
deserve is inclusive; and
(2) regardless of race, ethnicity, gender identity, sexual
orientation, religion, marital status, familial status,
socioeconomic status, immigration status, incarceration status,
or disability, all deserve dignity.
Subtitle A--Social Determinants for Moms
SEC. 1001. TASK FORCE TO DEVELOP A STRATEGY TO ADDRESS SOCIAL
DETERMINANTS OF MATERNAL HEALTH.
(a) In General.--The Secretary of Health and Human Services shall
convene a task force (in this section referred to as the ``Task
Force'') to develop a strategy to coordinate efforts between Federal
agencies to address social determinants of maternal health with respect
to pregnant and postpartum individuals.
(b) Ex Officio Members.--The ex officio members of the Task Force
shall consist of the following:
(1) The Secretary of Health and Human Services (or a
designee thereof).
(2) The Secretary of Housing and Urban Development (or a
designee thereof).
(3) The Secretary of Transportation (or a designee
thereof).
(4) The Secretary of Agriculture (or a designee thereof).
(5) The Secretary of Labor (or a designee thereof).
(6) The Administrator of the Environmental Protection
Agency (or a designee thereof).
(7) The Assistant Secretary for the Administration for
Children and Families (or a designee thereof).
(8) The Administrator of the Centers for Medicare &
Medicaid Services (or a designee thereof).
(9) The Director of the Indian Health Service (or a
designee thereof).
(10) The Director of the National Institutes of Health (or
a designee thereof).
(11) The Administrator of the Health Resources and Services
Administration (or a designee thereof).
(12) The Deputy Assistant Secretary for Minority Health of
the Department of Health and Human Services (or a designee
thereof).
(13) The Deputy Assistant Secretary for Women's Health of
the Department of Health and Human Services (or a designee
thereof).
(14) The Director of the Centers for Disease Control and
Prevention (or a designee thereof).
(15) The Director of the Office on Violence Against Women
at the Department of Justice (or a designee thereof).
(c) Appointed Members.--In addition to the ex officio members of
the Task Force, the Secretary of Health and Human Services shall
appoint the following members of the Task Force:
(1) At least two representatives of patients, to include--
(A) a representative of patients who have suffered
from severe maternal morbidity; or
(B) a representative of patients who is a family
member of an individual who suffered a pregnancy-
related death.
(2) At least two leaders of community-based organizations
that address maternal mortality and severe maternal morbidity
with a specific focus on racial and ethnic disparities. In
appointing such leaders under this paragraph, the Secretary of
Health and Human Services shall give priority to individuals
who are leaders of organizations led by individuals from racial
and ethnic minority groups.
(3) At least two perinatal health workers.
(4) A professionally diverse panel of maternity care
providers.
(d) Chair.--The Secretary of Health and Human Services shall select
the chair of the Task Force from among the members of the Task Force.
(e) Report.--Not later than 2 years after the date of the enactment
of this Act, the Task Force shall submit to Congress a report on--
(1) the strategy developed under subsection (a);
(2) recommendations on funding amounts with respect to
implementing such strategy; and
(3) recommendations for how to expand coverage of social
services to address social determinants of maternal health
under Medicaid managed care organizations and State Medicaid
programs.
(f) Termination.--Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Task Force with respect to
termination.
SEC. 1002. HOUSING FOR MOMS GRANT PROGRAM.
(a) In General.--The Secretary of Housing and Urban Development
shall establish a Housing for Moms grant program under this section to
make grants to eligible entities to increase access to safe, stable,
affordable, and adequate housing for pregnant and postpartum
individuals and their families.
(b) Application.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may provide.
(c) Priority.--In awarding grants under this section, the Secretary
shall give priority to an eligible entity that--
(1) is a community-based organization or will partner with
a community-based organization to implement initiatives to
increase access to safe, stable, affordable, and adequate
housing for pregnant and postpartum individuals and their
families;
(2) is operating in an area with high rates of adverse
maternal health outcomes or significant racial or ethnic
disparities in maternal health outcomes, to the extent such
data are available; and
(3) is operating in an area with a high poverty rate or
significant number of individuals who lack consistent access to
safe, stable, affordable, and adequate housing.
(d) Use of Funds.--An eligible entity that receives a grant under
this section shall use funds under the grant for the purposes of--
(1) identifying and conducting outreach to pregnant and
postpartum individuals who are low-income and lack consistent
access to safe, stable, affordable, and adequate housing;
(2) providing safe, stable, affordable, and adequate
housing options to such individuals;
(3) connecting such individuals with local organizations
offering safe, stable, affordable, and adequate housing
options;
(4) providing application assistance to such individuals
seeking to enroll in programs offering safe, stable,
affordable, and adequate housing options;
(5) providing direct financial assistance to such
individuals for the purposes of maintaining safe, stable, and
adequate housing for the duration of the individual's pregnancy
and postpartum periods; and
(6) working with relevant stakeholders to ensure that local
housing and homeless shelter infrastructure is supportive to
pregnant and postpartum individuals, including through--
(A) health-promoting housing codes;
(B) enforcement of housing codes;
(C) proactive rental inspection programs;
(D) code enforcement officer training; and
(E) partnerships between regional offices of the
Department of Housing and Urban Development and
community-based organizations to ensure housing laws
are understood and violations are discovered.
(e) Reporting.--
(1) Eligible entities.--The Secretary shall require each
eligible entity receiving a grant under this section to
annually submit to the Secretary and make publicly available a
report on the status of activities conducted using the grant.
(2) Secretary.--Not later than the end of each fiscal year
in which grants are made under this section, the Secretary
shall submit to the Congress and make publicly available a
report that--
(A) summarizes the reports received under paragraph
(1);
(B) evaluates the effectiveness of grants awarded
under this section in increasing access to safe,
stable, affordable, and adequate housing for pregnant
and postpartum individuals and their families; and
(C) makes recommendations with respect to ensuring
activities described subsection (d) continue after
grant amounts made available under this section are
expended.
(f) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) a community-based organization;
(B) a State or local governmental entity, including
a State or local public health department;
(C) an Indian tribe or tribal organization (as such
terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
5304)); or
(D) an Urban Indian organization (as such term is
defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Housing and Urban Development.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for fiscal year
2023, which shall remain available until expended.
SEC. 1003. DEPARTMENT OF TRANSPORTATION.
(a) Report.--Not later than one year after the date of enactment of
this Act, the Secretary of Transportation shall submit to Congress and
make publicly available a report containing--
(1) an assessment of transportation barriers preventing
individuals from attending prenatal and postpartum
appointments, accessing maternal health care services, or
accessing services and resources related to social determinants
maternal of health;
(2) recommendations on how to overcome the barriers
assessed under paragraph (1); and
(3) an assessment of transportation safety risks for
pregnant individuals and recommendations on how to mitigate
such risks.
(b) Considerations.--In carrying out subsection (a), the Secretary
shall give special consideration to solutions for--
(1) pregnant and postpartum individuals living in a health
professional shortage area designated under section 332 of the
Public Health Service Act (42 U.S.C. 254e);
(2) pregnant and postpartum individuals living in areas
with high maternal mortality or severe morbidity rates or
significant racial or ethnic disparities in maternal health
outcomes; or
(3) pregnant and postpartum individuals with a disability
that impacts mobility.
SEC. 1004. DEPARTMENT OF AGRICULTURE.
(a) Special Supplemental Nutrition Program.--
(1) Extension of postpartum period.--Section 17(b)(10) of
the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(10)) is
amended by striking ``six months'' and inserting ``24 months''.
(2) Extension of breastfeeding period.--Section
17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (7 U.S.C.
1431(d)(3)(A)(ii)) is amended by striking ``1 year'' and
inserting ``24 months''.
(3) Report.--Not later than 2 years after the date of the
enactment of this section, the Secretary shall submit to
Congress a report that includes an evaluation of the effect of
each of the amendments made by this subsection on--
(A) maternal and infant health outcomes, including
racial and ethnic disparities with respect to such
outcomes;
(B) breastfeeding rates among postpartum
individuals;
(C) qualitative evaluations of family experiences
under the special supplemental nutrition program under
section 17 of the Child Nutrition Act of 1966 (42
U.S.C. 1786); and
(D) other relevant information as determined by the
Secretary.
(b) Grant Program for Healthy Food and Clean Water for Pregnant and
Postpartum Individuals.--
(1) In general.--The Secretary shall establish a program to
award grants, on a competitive basis, to eligible entities to
carry out the activities described in paragraph (4).
(2) Application.--To be eligible for a grant under this
subsection, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary determines appropriate.
(3) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to an eligible entity that--
(A) is, or will partner with, a community-based
organization; and
(B) is operating in an area with high rates of--
(i) adverse maternal health outcomes; or
(ii) significant racial or ethnic
disparities in maternal health outcomes.
(4) Use of funds.--An eligible entity shall use grant funds
awarded under this subsection to deliver healthy food, infant
formula, clean water, or diapers to pregnant and postpartum
individuals located in areas that are food deserts, as
determined by the Secretary using data from the Food Access
Research Atlas of the Department of Agriculture.
(5) Reports.--
(A) Eligible entity.--Not later than 1 year after
an eligible entity first receives a grant under this
subsection, and annually thereafter, an eligible entity
shall submit to the Secretary a report on the status of
activities conducted using the grant, which shall
contain such information as the Secretary may require.
(B) Secretary.--
(i) In general.--Not later than 2 years
after the date on which the first grant is
awarded under this subsection, the Secretary
shall submit to Congress a report that
includes--
(I) a summary of the reports
submitted under subparagraph (A);
(II) an assessment of the extent to
which food distributed through the
grant program was purchased from local
and regional food systems;
(III) an evaluation of the effect
of the grant program under this
subsection on maternal and infant
health outcomes, including racial and
ethnic disparities with respect to such
outcomes; and
(IV) recommendations with respect
to ensuring the activities described in
paragraph (4) continue after the grant
period funding such activities expires.
(ii) Publication.--The Secretary shall make
the report submitted under clause (i) publicly
available on the website of the Department of
Agriculture.
(6) Authorization of appropriations.--There are authorized
to be appropriated $5,000,000 to carry out this subsection for
fiscal years 2023 through 2025.
(c) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) a community-based organization;
(B) a State or local governmental entity, including
a State or local public health department;
(C) an Indian tribe or tribal organization (as such
terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
5304)); or
(D) an Urban Indian organization (as such term is
defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Agriculture.
SEC. 1005. ENVIRONMENTAL STUDY THROUGH NATIONAL ACADEMIES.
(a) In General.--The Administrator of the Environmental Protection
Agency shall seek to enter an agreement, not later than 60 days after
the date of enactment of this Act, with the National Academies of
Sciences, Engineering, and Medicine (referred to in this section as the
``National Academies'') under which the National Academies agree to
conduct a study on the impacts of water and air quality, exposure to
extreme temperatures, environmental chemicals, environmental risks in
the workplace and the home, and pollution levels, on maternal and
infant health outcomes.
(b) Study Requirements.--The agreement under subsection (a) shall
direct the National Academies to make recommendations for--
(1) improving environmental conditions to improve maternal
and infant health outcomes; and
(2) reducing or eliminating racial and ethnic disparities
in such outcomes.
(c) Report.--The agreement under subsection (a) shall direct the
National Academies to complete the study under this section, and
transmit to the Congress and make publicly available a report on the
results of the study, not later than 12 months after the date of
enactment of this Act.
SEC. 1006. CHILD CARE ACCESS.
(a) Grant Program.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall award grants to
eligible organizations to provide pregnant and postpartum individuals
with free and accessible drop-in child care services during prenatal
and postpartum appointments.
(b) Application.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
(c) Eligible Organizations.--
(1) Eligibility.--To be eligible to receive a grant under
this section, an organization shall be an organization that
provides child care services and can carry out programs
providing pregnant and postpartum individuals with free and
accessible drop-in child care services during prenatal and
postpartum appointments.
(2) Prioritization.--In selecting grant recipients under
this section, the Secretary shall give priority to eligible
organizations that operate in an area with high rates of
adverse maternal health outcomes or significant racial or
ethnic disparities in maternal health outcomes, to the extent
such data are available.
(d) Timing.--The Secretary shall commence the grant program under
subsection (a) not later than 1 year after the date of enactment of
this Act.
(e) Reporting.--
(1) Grantees.--Each recipient of a grant under this section
shall annually submit to the Secretary and make publicly
available a report on the status of activities conducted using
the grant. Each such report shall include--
(A) an analysis of the effect of the funded program
on prenatal and postpartum appointment attendance
rates;
(B) summaries of qualitative assessments of the
funded program from--
(i) pregnant and postpartum individuals
participating in the program; and
(ii) the families of such individuals; and
(C) such additional information as the Secretary
may require.
(2) Secretary.--Not later than the end of fiscal year 2025,
the Secretary shall submit to the Congress and make publicly
available a report containing the following:
(A) A summary of the reports under paragraph (1).
(B) An assessment of the effects, if any, of the
funded programs on maternal health outcomes, with a
specific focus on racial and ethnic disparities in such
outcomes.
(C) A description of actions the Secretary can take
to ensure that pregnant and postpartum individuals
eligible for medical assistance under a State plan
under title XIX of the Social Security Act (42 U.S.C.
1936 et seq.) have access to free and accessible drop-
in child care services during prenatal and postpartum
appointments, including identification of the funding
necessary to carry out such actions.
(f) Drop-In Child Care Services Defined.--In this section, the term
``drop-in child care services'' means child care and early childhood
education services that are--
(1) delivered at a facility that meets the requirements of
all applicable laws and regulations of the State or local
government in which it is located, including the licensing of
the facility as a child care facility; and
(2) provided in single encounters without requiring full-
time enrollment of a person in a child care program.
(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $5,000,000 for the period of
fiscal years 2023 through 2025.
SEC. 1007. GRANTS TO LOCAL ENTITIES ADDRESSING SOCIAL DETERMINANTS OF
MATERNAL HEALTH.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall award grants to
eligible entities to--
(1) address social determinants of maternal health for
pregnant and postpartum individuals; and
(2) eliminate racial and ethnic disparities in maternal
health outcomes.
(b) Application.--To be eligible to receive a grant under this
subsection an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may provide.
(c) Prioritization.--In awarding grants under subsection (a), the
Secretary shall give priority to an eligible entity that--
(1) is, or will partner with, a community-based
organization to carrying out the activities under subsection
(d);
(2) is operating in an area with high rates of adverse
maternal health outcomes or significant racial or ethnic
disparities in maternal health outcomes; and
(3) is operating in an area with a high poverty rate.
(d) Activities.--An eligible entity that receives a grant under
this section may--
(1) hire and retain staff;
(2) develop and distribute a list of available resources
with respect to social service programs in a community;
(3) establish a resource center that provides multiple
social service programs in a single location;
(4) offer programs and resources in the communities in
which the respective eligible entities are located to address
social determinants of health for pregnant and postpartum
individuals; and
(5) consult with such pregnant and postpartum individuals
to conduct an assessment of the activities under this
subsection.
(e) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance to plan for
sustaining programs to address social determinants of maternal health
among pregnant and postpartum individuals after the period of the
grant.
(f) Reporting.--
(1) Grantees.--Not later than 1 year after an eligible
entity first receives a grant under this section, and annually
thereafter, an eligible entity shall submit to the Secretary,
and make publicly available, a report on the status of
activities conducted using the grant. Each such report shall
include data on the effects of such activities, disaggregated
by race, ethnicity, gender, and other relevant factors.
(2) Secretary.--Not later than the end of fiscal year 2027,
the Secretary shall submit to Congress a report that includes--
(A) a summary of the reports under paragraph (1);
and
(B) recommendations for--
(i) improving maternal health outcomes; and
(ii) reducing or eliminating racial and
ethnic disparities in maternal health outcomes.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $15,000,000 for each of fiscal
years 2023 through 2027.
Subtitle B--Honoring Kira Johnson
SEC. 1101. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE
BLACK MATERNAL HEALTH OUTCOMES.
(a) Awards.--Following the 1-year period described in subsection
(c), the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall award grants to eligible
entities to establish or expand programs to prevent maternal mortality
and severe maternal morbidity among Black pregnant and postpartum
individuals.
(b) Eligibility.--To be eligible to seek a grant under this
section, an entity shall be a community-based organization offering
programs and resources aligned with evidence-based practices for
improving maternal health outcomes for Black pregnant and postpartum
individuals.
(c) Outreach and Technical Assistance Period.--During the 1-year
period beginning on the date of enactment of this Act, the Secretary
shall--
(1) conduct outreach to encourage eligible entities to
apply for grants under this section; and
(2) provide technical assistance to eligible entities on
best practices for applying for grants under this section.
(d) Special Consideration.--
(1) Outreach.--In conducting outreach under subsection (c),
the Secretary shall give special consideration to eligible
entities that--
(A) are based in, and provide support for,
communities with high rates of adverse maternal health
outcomes or significant racial and ethnic disparities
in maternal health outcomes, to the extent such data
are available;
(B) are led by Black women; and
(C) offer programs and resources that are aligned
with evidence-based practices for improving maternal
health outcomes for Black pregnant and postpartum
individuals.
(2) Awards.--In awarding grants under this section, the
Secretary shall give special consideration to eligible entities
that--
(A) are described in subparagraphs (A), (B), and
(C) of paragraph (1);
(B) offer programs and resources designed in
consultation with and intended for Black pregnant and
postpartum individuals; and
(C) offer programs and resources in the communities
in which the respective eligible entities are located
that--
(i) promote maternal mental health and
maternal substance use disorder treatments and
supports that are aligned with evidence-based
practices for improving maternal mental and
behavioral health outcomes for Black pregnant
and postpartum individuals;
(ii) address social determinants of
maternal health for pregnant and postpartum
individuals;
(iii) promote evidence-based health
literacy and pregnancy, childbirth, and
parenting education for pregnant and postpartum
individuals;
(iv) provide support from perinatal health
workers to pregnant and postpartum individuals;
(v) provide culturally congruent training
to perinatal health workers;
(vi) conduct or support research on
maternal health issues disproportionately
impacting Black pregnant and postpartum
individuals;
(vii) provide support to family members of
individuals who suffered a pregnancy-associated
death or pregnancy-related death;
(viii) operate midwifery practices that
provide culturally congruent maternal health
care and support, including for the purposes
of--
(I) supporting additional
education, training, and certification
programs, including support for
distance learning;
(II) providing financial support to
current and future midwives to address
education costs, debts, and other
needs;
(III) clinical site investments;
(IV) supporting preceptor
development trainings;
(V) expanding the midwifery
practice; or
(VI) related needs identified by
the midwifery practice and described in
the practice's application; or
(ix) have developed other programs and
resources that address community-specific needs
for pregnant and postpartum individuals and are
aligned with evidence-based practices for
improving maternal health outcomes for Black
pregnant and postpartum individuals.
(e) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance on--
(1) capacity building to establish or expand programs to
prevent adverse maternal health outcomes among Black pregnant
and postpartum individuals;
(2) best practices in data collection, measurement,
evaluation, and reporting; and
(3) planning for sustaining programs to prevent maternal
mortality and severe maternal morbidity among Black pregnant
and postpartum individuals after the period of the grant.
(f) Evaluation.--Not later than the end of fiscal year 2027, the
Secretary shall submit to the Congress an evaluation of the grant
program under this section that--
(1) assesses the effectiveness of outreach efforts during
the application process in diversifying the pool of grant
recipients;
(2) makes recommendations for future outreach efforts to
diversify the pool of grant recipients for Department of Health
and Human Services grant programs and funding opportunities
related to maternal health;
(3) assesses the effectiveness of programs funded by grants
under this section in improving maternal health outcomes for
Black pregnant and postpartum individuals, to the extent
practicable; and
(4) makes recommendations for future Department of Health
and Human Services grant programs and funding opportunities
that deliver funding to community-based organizations that
provide programs and resources that are aligned with evidence-
based practices for improving maternal health outcomes for
Black pregnant and postpartum individuals.
(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for each of fiscal
years 2023 through 2027.
SEC. 1102. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE
MATERNAL HEALTH OUTCOMES IN UNDERSERVED COMMUNITIES.
(a) Awards.--Following the 1-year period described in subsection
(c), the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall award grants to eligible
entities to establish or expand programs to prevent maternal mortality
and severe maternal morbidity among underserved groups.
(b) Eligibility.--To be eligible to seek a grant under this
section, an entity shall be a community-based organization offering
programs and resources aligned with evidence-based practices for
improving maternal health outcomes for pregnant and postpartum
individuals.
(c) Outreach and Technical Assistance Period.--During the 1-year
period beginning on the date of enactment of this Act, the Secretary
shall--
(1) conduct outreach to encourage eligible entities to
apply for grants under this section; and
(2) provide technical assistance to eligible entities on
best practices for applying for grants under this section.
(d) Special Consideration.--
(1) Outreach.--In conducting outreach under subsection (c),
the Secretary shall give special consideration to eligible
entities that--
(A) are based in, and provide support for,
communities with high rates of adverse maternal health
outcomes or significant racial and ethnic disparities
in maternal health outcomes, to the extent such data
are available;
(B) are led by individuals from racially,
ethnically, and geographically diverse backgrounds; and
(C) offer programs and resources that are aligned
with evidence-based practices for improving maternal
health outcomes for pregnant and postpartum
individuals.
(2) Awards.--In awarding grants under this section, the
Secretary shall give special consideration to eligible entities
that--
(A) are described in subparagraphs (A), (B), and
(C) of paragraph (1);
(B) offer programs and resources designed in
consultation with and intended for pregnant and
postpartum individuals from underserved groups; and
(C) offer programs and resources in the communities
in which the respective eligible entities are located
that--
(i) promote maternal mental health and
maternal substance use disorder treatments and
support that are aligned with evidence-based
practices for improving maternal mental and
behavioral health outcomes for pregnant and
postpartum individuals;
(ii) address social determinants of
maternal health for pregnant and postpartum
individuals;
(iii) promote evidence-based health
literacy and pregnancy, childbirth, and
parenting education for pregnant and postpartum
individuals;
(iv) provide support from perinatal health
workers to pregnant and postpartum individuals;
(v) provide culturally congruent training
to perinatal health workers;
(vi) conduct or support research on
maternal health outcomes and disparities;
(vii) provide support to family members of
individuals who suffered a pregnancy-associated
death or pregnancy-related death;
(viii) operate midwifery practices that
provide culturally congruent maternal health
care and support, including for the purposes
of--
(I) supporting additional
education, training, and certification
programs, including support for
distance learning;
(II) providing financial support to
current and future midwives to address
education costs, debts, and other
needs;
(III) clinical site investments;
(IV) supporting preceptor
development trainings;
(V) expanding the midwifery
practice; or
(VI) related needs identified by
the midwifery practice and described in
the practice's application; or
(ix) have developed other programs and
resources that address community-specific needs
for pregnant and postpartum individuals and are
aligned with evidence-based practices for
improving maternal health outcomes for pregnant
and postpartum individuals.
(e) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance on--
(1) capacity building to establish or expand programs to
prevent adverse maternal health outcomes among pregnant and
postpartum individuals from underserved groups;
(2) best practices in data collection, measurement,
evaluation, and reporting; and
(3) planning for sustaining programs to prevent maternal
mortality and severe maternal morbidity among pregnant and
postpartum individuals from underserved groups after the period
of the grant.
(f) Evaluation.--Not later than the end of fiscal year 2027, the
Secretary shall submit to the Congress an evaluation of the grant
program under this section that--
(1) assesses the effectiveness of outreach efforts during
the application process in diversifying the pool of grant
recipients;
(2) makes recommendations for future outreach efforts to
diversify the pool of grant recipients for Department of Health
and Human Services grant programs and funding opportunities
related to maternal health;
(3) assesses the effectiveness of programs funded by grants
under this section in improving maternal health outcomes for
pregnant and postpartum individuals from underserved groups, to
the extent practicable; and
(4) makes recommendations for future Department of Health
and Human Services grant programs and funding opportunities
that deliver funding to community-based organizations that
provide programs and resources that are aligned with evidence-
based practices for improving maternal health outcomes for
pregnant and postpartum individuals.
(g) Definition.--In this section, the term ``underserved groups''
refers to pregnant and postpartum individuals--
(1) from racial and ethnic minority groups (as such term is
defined in section 1707(g)(1) of the Public Health Service Act
(42 U.S.C. 300u-6(g)(1)));
(2) whose household income is equal to or less than 150
percent of the Federal poverty line;
(3) who live in health professional shortage areas (as such
term is defined in section 332 of the Public Health Service Act
(42 U.S.C. 254e(a)(1)));
(4) who live in counties with no hospital offering
obstetric care, no birth center, and no obstetric provider; or
(5) who live in counties with a level of vulnerability of
moderate-to-high or higher, according to the Social
Vulnerability Index of the Centers for Disease Control and
Prevention.
(h) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for each of fiscal
years 2023 through 2027.
SEC. 1103. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN
MATERNITY CARE SETTINGS.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended by adding at the end the following new section:
``SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN
MATERNITY CARE SETTINGS.
``(a) Grants.--The Secretary shall award grants for programs to
reduce and prevent bias, racism, and discrimination in maternity care
settings and to advance respectful, culturally congruent, trauma-
informed care.
``(b) Special Consideration.--In awarding grants under subsection
(a), the Secretary shall give special consideration to applications for
programs that would--
``(1) apply to all maternity care providers and any
employees who interact with pregnant and postpartum individuals
in the provider setting, including front desk employees,
sonographers, schedulers, health care professionals, hospital
or health system administrators, security staff, and other
employees;
``(2) emphasize periodic, as opposed to one-time, trainings
for all birthing professionals and employees described in
paragraph (1);
``(3) address implicit bias, racism, and cultural humility;
``(4) be delivered in ongoing education settings for
providers maintaining their licenses, with a preference for
trainings that provide continuing education units;
``(5) include trauma-informed care best practices and an
emphasis on shared decision making between providers and
patients;
``(6) include antiracism training and programs;
``(7) be delivered in undergraduate programs that funnel
into health professions schools;
``(8) be delivered in settings that apply to providers of
the special supplemental nutrition program for women, infants,
and children under section 17 of the Child Nutrition Act of
1966;
``(9) integrate bias training in obstetric emergency
simulation trainings or related trainings;
``(10) include training for emergency department employees
and emergency medical technicians on recognizing warning signs
for severe pregnancy-related complications;
``(11) offer training to all maternity care providers on
the value of racially, ethnically, and professionally diverse
maternity care teams to provide culturally congruent care; or
``(12) be based on one or more programs designed by a
historically Black college or university or other minority-
serving institution.
``(c) Application.--To seek a grant under subsection (a), an entity
shall submit an application at such time, in such manner, and
containing such information as the Secretary may require.
``(d) Reporting.--Each recipient of a grant under this section
shall annually submit to the Secretary a report on the status of
activities conducted using the grant, including, as applicable, a
description of the impact of training provided through the grant on
patient outcomes and patient experience for pregnant and postpartum
individuals from racial and ethnic minority groups and their families.
``(e) Best Practices.--Based on the annual reports submitted
pursuant to subsection (d), the Secretary--
``(1) shall produce an annual report on the findings
resulting from programs funded through this section;
``(2) shall disseminate such report to all recipients of
grants under this section and to the public; and
``(3) may include in such report findings on best practices
for improving patient outcomes and patient experience for
pregnant and postpartum individuals from racial and ethnic
minority groups and their families in maternity care settings.
``(f) Definitions.--In this section:
``(1) The term `postpartum' means the one-year period
beginning on the last day of an individual's pregnancy.
``(2) The term `culturally congruent' means in agreement
with the preferred cultural values, beliefs, world view,
language, and practices of the health care consumer and other
stakeholders.
``(3) The term `racial and ethnic minority group' has the
meaning given such term in section 1707(g)(1).
``(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $5,000,000 for each of fiscal
years 2023 through 2027.''.
SEC. 1104. STUDY ON REDUCING AND PREVENTING BIAS, RACISM, AND
DISCRIMINATION IN MATERNITY CARE SETTINGS.
(a) In General.--The Secretary of Health and Human Services shall
seek to enter into an agreement, not later than 90 days after the date
of enactment of this Act, with the National Academies of Sciences,
Engineering, and Medicine (referred to in this section as the
``National Academies'') under which the National Academies agree to--
(1) conduct a study on the design and implementation of
programs to reduce and prevent bias, racism, and discrimination
in maternity care settings and to advance respectful,
culturally congruent, trauma-informed care; and
(2) not later than 24 months after the date of enactment of
this Act--
(A) complete the study; and
(B) transmit a report on the results of the study
to the Congress.
(b) Possible Topics.--The agreement entered into pursuant to
subsection (a) may provide for the study of any of the following:
(1) The development of a scorecard or other evaluation
standards for programs designed to reduce and prevent bias,
racism, and discrimination in maternity care settings to assess
the effectiveness of such programs in improving patient
outcomes and patient experience for pregnant and postpartum
individuals from racial and ethnic minority groups and their
families.
(2) Determination of the types and frequency of training to
reduce and prevent bias, racism, and discrimination in
maternity care settings that are demonstrated to improve
patient outcomes or patient experience for pregnant and
postpartum individuals from racial and ethnic minority groups
and their families.
SEC. 1105. RESPECTFUL MATERNITY CARE COMPLIANCE PROGRAM.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall award grants
to accredited hospitals, health systems, and other maternity care
settings to establish as an integral part of quality implementation
initiatives within one or more hospitals or other birth settings a
respectful maternity care compliance program.
(b) Program Requirements.--A respectful maternity care compliance
program funded through a grant under this section shall--
(1) institutionalize mechanisms to allow patients receiving
maternity care services, the families of such patients, or
perinatal health workers supporting such patients to report
instances of racism or evidence of bias on the basis of race,
ethnicity, or another protected class;
(2) institutionalize response mechanisms through which
representatives of the program can directly follow up with the
patient, if possible, and the patient's family in a timely
manner;
(3) prepare and make publicly available a hospital- or
health system-wide strategy to reduce bias on the basis of
race, ethnicity, or another protected class in the delivery of
maternity care that includes--
(A) information on the training programs to reduce
and prevent bias, racism, and discrimination on the
basis of race, ethnicity, or another protected class
for all employees in maternity care settings;
(B) information on the number of cases reported to
the compliance program; and
(C) the development of methods to routinely assess
the extent to which bias, racism, or discrimination on
the basis of race, ethnicity, or another protected
class are present in the delivery of maternity care to
patients from racial and ethnic minority groups;
(4) develop mechanisms to routinely collect and publicly
report hospital-level data related to patient-reported
experience of care; and
(5) provide annual reports to the Secretary with
information about each case reported to the compliance program
over the course of the year containing such information as the
Secretary may require, such as--
(A) de-identified demographic information on the
patient in the case, such as race, ethnicity, gender
identity, and primary language;
(B) the content of the report from the patient or
the family of the patient to the compliance program;
(C) the response from the compliance program; and
(D) to the extent applicable, institutional changes
made as a result of the case.
(c) Secretary Requirements.--
(1) Processes.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall establish processes
for--
(A) disseminating best practices for establishing
and implementing a respectful maternity care compliance
program within a hospital or other birth setting;
(B) promoting coordination and collaboration
between hospitals, health systems, and other maternity
care delivery settings on the establishment and
implementation of respectful maternity care compliance
programs; and
(C) evaluating the effectiveness of respectful
maternity care compliance programs on maternal health
outcomes and patient and family experiences, especially
for patients from racial and ethnic minority groups and
their families.
(2) Study.--
(A) In general.--Not later than 2 years after the
date of enactment of this Act, the Secretary shall,
through a contract with an independent research
organization, conduct a study on strategies to
address--
(i) racism or bias on the basis of race,
ethnicity, or another protected class in the
delivery of maternity care services; and
(ii) successful implementation of
respectful care initiatives.
(B) Components of study.--The study shall include
the following:
(i) An assessment of the reports submitted
to the Secretary from the respectful maternity
care compliance programs pursuant to subsection
(b)(5).
(ii) Based on such assessment,
recommendations for potential accountability
mechanisms related to cases of racism or bias
on the basis of race, ethnicity, or another
protected class in the delivery of maternity
care services at hospitals and other birth
settings. Such recommendations shall take into
consideration medical and non-medical factors
that contribute to adverse patient experiences
and maternal health outcomes.
(C) Report.--The Secretary shall submit to the
Congress and make publicly available a report on the
results of the study under this paragraph.
(d) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for fiscal years 2023 through 2028.
SEC. 1106. GAO REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act and annually thereafter, the Comptroller General of the
United States shall submit to the Congress and make publicly available
a report on the establishment of respectful maternity care compliance
programs within hospitals, health systems, and other maternity care
settings.
(b) Matters Included.--The report under paragraph (1) shall include
the following:
(1) Information regarding the extent to which hospitals,
health systems, and other maternity care settings have elected
to establish respectful maternity care compliance programs,
including--
(A) which hospitals and other birth settings elect
to establish compliance programs and when such programs
are established;
(B) to the extent practicable, impacts of the
establishment of such programs on maternal health
outcomes and patient and family experiences in the
hospitals and other birth settings that have
established such programs, especially for patients from
racial and ethnic minority groups and their families;
(C) information on geographic areas, and types of
hospitals or other birth settings, where respectful
maternity care compliance programs are not being
established and information on factors contributing to
decisions to not establish such programs; and
(D) recommendations for establishing respectful
maternity care compliance programs in geographic areas,
and types of hospitals or other birth settings, where
such programs are not being established.
(2) Whether the funding made available to carry out this
section has been sufficient and, if applicable, recommendations
for additional appropriations to carry out this section.
(3) Such other information as the Comptroller General
determines appropriate.
Subtitle C--Protecting Moms Who Served
SEC. 1201. SUPPORT FOR MATERNITY CARE COORDINATION.
(a) Program on Maternity Care Coordination.--
(1) In general.--The Secretary of Veterans Affairs shall
carry out the maternity care coordination program described in
Veterans Health Administration Handbook 1330.03, or any
successor handbook.
(2) Training and support.--In carrying out the program
under paragraph (1), the Secretary shall provide to community
maternity care providers training and support with respect to
the unique needs of pregnant and postpartum veterans,
particularly regarding mental and behavioral health conditions
relating to the service of the veterans in the Armed Forces.
(b) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary $15,000,000 for fiscal year 2023 for the
maternity care coordination program. Such amounts are authorized in
addition to any other amounts authorized for such purpose.
(c) Definitions.--In this section:
(1) The term ``community maternity care providers'' means
maternity care providers located at non-Department facilities
who provide maternity care to veterans under section 1703 of
title 38, United States Code, or other provisions of law
administered by the Secretary of Veterans Affairs.
(2) The term ``non-Department facilities'' has the meaning
given that term in section 1701 of title 38, United States
Code.
SEC. 1202. REPORT ON MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY
AMONG PREGNANT AND POSTPARTUM VETERANS.
(a) GAO Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives, and make publicly available, a report on
maternal mortality and severe maternal morbidity among pregnant and
postpartum veterans, with a particular focus on racial and ethnic
disparities in maternal health outcomes for veterans.
(b) Matters Included.--The report under subsection (a) shall
include the following:
(1) To the extent practicable--
(A) the number of pregnant and postpartum veterans
who have experienced a pregnancy-related death or
pregnancy-associated death in the most recent 10 years
of available data;
(B) the rate of pregnancy-related deaths per
100,000 live births for pregnant and postpartum
veterans;
(C) the number of cases of severe maternal
morbidity among pregnant and postpartum veterans in the
most recent year of available data;
(D) the racial and ethnic disparities in maternal
mortality and severe maternal morbidity rates among
pregnant and postpartum veterans;
(E) identification of the causes of maternal
mortality and severe maternal morbidity that are unique
to veterans, including post-traumatic stress disorder,
military sexual trauma, and infertility or miscarriages
that may be caused by such service;
(F) identification of the causes of maternal
mortality and severe maternal morbidity that are unique
to veterans from racial and ethnic minority groups;
(G) identification of any correlations between the
former rank of veterans and their maternal health
outcomes;
(H) the number of veterans who have been diagnosed
with infertility by Veterans Health Administration
providers each year in the most recent five years,
disaggregated by age, race, ethnicity, sex, marital
status, sexual orientation, gender identity, and
geographical location;
(I) the number of veterans who receive a clinical
diagnosis of unexplained infertility by Veterans Health
Administration providers each year in the most recent
five years; and
(J) the extent to which the rate of incidence of
clinically diagnosed infertility among veterans compare
or differ to the rate of incidence of clinically
diagnosed infertility among the civilian population.
(2) An assessment of the barriers to determining the
information required under paragraph (1) and recommendations
for improvements in tracking maternal health outcomes among
pregnant and postpartum veterans--
(A) who have health care coverage through the
Department;
(B) enrolled in the TRICARE program;
(C) with employer-based or private insurance;
(D) enrolled in the Medicaid program; and
(E) who are uninsured.
(3) Recommendations for legislative and administrative
actions to increase access to mental and behavioral health care
for pregnant and postpartum veterans who screen positively for
maternal mental or behavioral health conditions.
(4) Recommendations to address homelessness, food
insecurity, poverty, and related issues among pregnant and
postpartum veterans.
(5) Recommendations on how to effectively educate maternity
care providers on best practices for providing maternity care
services to veterans that addresses the unique maternal health
care needs of veteran populations.
(6) Recommendations to reduce maternal mortality and severe
maternal morbidity among pregnant and postpartum veterans and
to address racial and ethnic disparities in maternal health
outcomes for each of the groups described in subparagraphs (A)
through (E) of paragraph (2).
(7) Recommendations to improve coordination of care between
the Department and non-Department facilities for pregnant and
postpartum veterans, including recommendations to improve--
(A) health record interoperability; and
(B) training for the directors of the Veterans
Integrated Service Networks, directors of medical
facilities of the Department, chiefs of staff of such
facilities, maternity care coordinators, and staff of
relevant non-Department facilities.
(8) An assessment of the authority of the Secretary of
Veterans Affairs to access maternal health data collected by
the Department of Health and Human Services and, if applicable,
recommendations to increase such authority.
(9) Any other information the Comptroller General
determines appropriate with respect to the reduction of
maternal mortality and severe maternal morbidity among pregnant
and postpartum veterans and to address racial and ethnic
disparities in maternal health outcomes for veterans.
Subtitle D--Perinatal Workforce
SEC. 1301. HHS AGENCY DIRECTIVES.
(a) Guidance to States.--
(1) In general.--Not later than 2 years after the date of
enactment of this Act, the Secretary of Health and Human
Services shall issue and disseminate guidance to States to
educate providers, managed care entities, and other insurers
about the value and process of delivering respectful maternal
health care through diverse and multidisciplinary care provider
models.
(2) Contents.--The guidance required by paragraph (1) shall
address how States can encourage and incentivize hospitals,
health systems, midwifery practices, freestanding birth
centers, other maternity care provider groups, managed care
entities, and other insurers--
(A) to recruit and retain maternity care providers,
mental and behavioral health care providers acting in
accordance with State law, registered dietitians or
nutrition professionals (as such term is defined in
section 1861(vv)(2) of the Social Security Act (42
U.S.C. 1395x(vv)(2))), and lactation consultants
certified by the International Board of Lactation
Consultants Examiners--
(i) from racially, ethnically, and
linguistically diverse backgrounds;
(ii) with experience practicing in racially
and ethnically diverse communities; and
(iii) who have undergone training on
implicit bias and racism;
(B) to incorporate into maternity care teams--
(i) midwives who meet at a minimum the
international definition of the midwife and
global standards for midwifery education as
established by the International Confederation
of Midwives; and
(ii) perinatal health workers;
(C) to provide collaborative, culturally congruent
care; and
(D) to provide opportunities for individuals
enrolled in accredited midwifery education programs to
participate in job shadowing with maternity care teams
in hospitals, health systems, midwifery practices, and
freestanding birth centers.
(b) Study on Respectful and Culturally Congruent Maternity Care.--
(1) Study.--The Secretary of Health and Human Services
acting through the Director of the National Institutes of
Health (in this subsection referred to as the ``Secretary'')
shall conduct a study on best practices in respectful and
culturally congruent maternity care.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall--
(A) complete the study required by paragraph (1);
(B) submit to the Congress and make publicly
available a report on the results of such study; and
(C) include in such report--
(i) a compendium of examples of hospitals,
health systems, midwifery practices,
freestanding birth centers, other maternity
care provider groups, managed care entities,
and other insurers that are delivering
respectful and culturally congruent maternal
health care;
(ii) a compendium of examples of hospitals,
health systems, midwifery practices,
freestanding birth centers, other maternity
care provider groups, managed care entities,
and other insurers that have made progress in
reducing disparities in maternal health
outcomes and improving birthing experiences for
pregnant and postpartum individuals from racial
and ethnic minority groups; and
(iii) recommendations to hospitals, health
systems, midwifery practices, freestanding
birth centers, other maternity care provider
groups, managed care entities, and other
insurers, for best practices in respectful and
culturally congruent maternity care.
SEC. 1302. GRANTS TO GROW AND DIVERSIFY THE PERINATAL WORKFORCE.
Title VII of the Public Health Service Act is amended by inserting
after section 757 (42 U.S.C. 294f) the following new section:
``SEC. 758. PERINATAL WORKFORCE GRANTS.
``(a) In General.--The Secretary shall award grants to entities to
establish or expand programs described in subsection (b) to grow and
diversify the perinatal workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the perinatal workforce by--
``(1) establishing schools or programs that provide
education and training to individuals seeking appropriate
licensing or certification as--
``(A) physician assistants who will complete
clinical training in the field of maternal and
perinatal health; or
``(B) perinatal health workers; and
``(2) expanding the capacity of existing schools or
programs described in paragraph (1), for the purposes of
increasing the number of students enrolled in such schools or
programs, including by awarding scholarships for students.
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to any entity that--
``(1) has demonstrated a commitment to recruiting and
retaining students and faculty from racial and ethnic minority
groups;
``(2) has developed a strategy to recruit and retain a
diverse pool of students into the perinatal workforce program
or school supported by funds received through the grant,
particularly from racial and ethnic minority groups and other
underserved populations;
``(3) has developed a strategy to recruit and retain
students who plan to practice in a health professional shortage
area designated under section 332;
``(4) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(5) includes in the standard curriculum for all students
within the perinatal workforce program or school a bias,
racism, or discrimination training program that includes
training on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section for a perinatal workforce program or school, an entity shall
agree to submit to the Secretary an annual report on the activities
conducted through the grant, including--
``(1) the number and demographics of students participating
in the program or school;
``(2) the extent to which students in the program or school
are entering careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with significant racial and ethnic
disparities in maternal health outcomes, to the extent
such data are available; and
``(3) whether the program or school has included in the
standard curriculum for all students a bias, racism, or
discrimination training program that includes explicit and
implicit bias, and if so the effectiveness of such training
program.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to entities seeking or receiving a
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the perinatal workforce programs or
schools proposed to be, or being, established or expanded through the
grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups;
``(2) increasing the number of physician assistants who
will complete clinical training in the field of maternal and
perinatal health, and perinatal health workers, from racial and
ethnic minority groups and other underserved populations;
``(3) increasing the number of physician assistants who
will complete clinical training in the field of maternal and
perinatal health, and perinatal health workers, working in
health professional shortage areas designated under section
332; and
``(4) increasing the number of physician assistants who
will complete clinical training in the field of maternal and
perinatal health, and perinatal health workers, working in
areas with significant racial and ethnic disparities in
maternal health outcomes, to the extent such data are
available.
``(i) Definition.--In this section, the term `racial and ethnic
minority group' has the meaning given such term in section 1707(g).
``(j) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2023 through 2027.''.
SEC. 1303. GRANTS TO GROW AND DIVERSIFY THE NURSING WORKFORCE IN
MATERNAL AND PERINATAL HEALTH.
Title VIII of the Public Health Service Act is amended by inserting
after section 811 of that Act (42 U.S.C. 296j) the following:
``SEC. 812. PERINATAL NURSING WORKFORCE GRANTS.
``(a) In General.--The Secretary shall award grants to schools of
nursing to grow and diversify the perinatal nursing workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the perinatal nursing workforce by
providing scholarships to students seeking to become--
``(1) nurse practitioners whose education includes a focus
on maternal and perinatal health; or
``(2) clinical nurse specialists whose education includes a
focus on maternal and perinatal health.
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to any school of nursing that--
``(1) has developed a strategy to recruit and retain a
diverse pool of students seeking to enter careers focused on
maternal and perinatal health, particularly students from
racial and ethnic minority groups and other underserved
populations;
``(2) has developed a partnership with a practice setting
in a health professional shortage area designated under section
332 for the clinical placements of the school's students;
``(3) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(4) includes in the standard curriculum for all students
seeking to enter careers focused on maternal and perinatal
health a bias, racism, or discrimination training program that
includes education on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section, a school of nursing shall agree to submit to the Secretary an
annual report on the activities conducted through the grant, including,
to the extent practicable--
``(1) the number and demographics of students in the school
of nursing seeking to enter careers focused on maternal and
perinatal health;
``(2) the extent to which such students are preparing to
enter careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with significant racial and ethnic
disparities in maternal health outcomes, to the extent
such data are available; and
``(3) whether the standard curriculum for all students
seeking to enter careers focused on maternal and perinatal
health includes a bias, racism, or discrimination training
program that includes education on implicit bias and racism.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application, at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to schools of nursing seeking or
receiving a grant under this section on the processes of awarding and
evaluating scholarships through the grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups and other underserved populations;
``(2) increasing the number of nurse practitioners and
clinical nurse specialists entering careers focused on maternal
and perinatal health from racial and ethnic minority groups and
other underserved populations;
``(3) increasing the number of nurse practitioners and
clinical nurse specialists entering careers focused on maternal
and perinatal health working in health professional shortage
areas designated under section 332; and
``(4) increasing the number of nurse practitioners and
clinical nurse specialists entering careers focused on maternal
and perinatal health working in areas with significant racial
and ethnic disparities in maternal health outcomes, to the
extent such data are available.
``(i) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2023 through 2027.''.
SEC. 1304. GAO REPORT.
(a) In General.--Not later than two years after the date of
enactment of this Act and every five years thereafter, the Comptroller
General of the United States shall submit to Congress a report on
barriers to maternal health education and access to care in the United
States. Such report shall include the information and recommendations
described in subsection (b).
(b) Content of Report.--The report under subsection (a) shall
include--
(1) an assessment of current barriers to entering
accredited midwifery education programs, and recommendations
for addressing such barriers, particularly for low-income women
and women from racial and ethnic minority groups;
(2) an assessment of current barriers to entering and
successfully completing accredited education programs for other
health professional careers related to maternity care,
including maternity care providers, mental and behavioral
health care providers acting in accordance with State law,
registered dietitians or nutrition professionals (as such term
is defined in section 1861(vv)(2) of the Social Security Act
(42 U.S.C. 1395x(vv)(2))), and lactation consultants certified
by the International Board of Lactation Consultants Examiners,
particularly for low-income women and women from racial and
ethnic minority groups;
(3) an assessment of current barriers that prevent midwives
from meeting the international definition of the midwife and
global standards for midwifery education as established by the
International Confederation of Midwives, and recommendations
for addressing such barriers, particularly for low-income women
and women from racial and ethnic minority groups;
(4) an assessment of disparities in access to maternity
care providers, mental or behavioral health care providers
acting in accordance with State law, registered dietitians or
nutrition professionals (as such term is defined in section
1861(vv)(2) of the Social Security Act (42 U.S.C.
1395x(vv)(2))), lactation consultants certified by the
International Board of Lactation Consultants Examiners, and
perinatal health workers, stratified by race, ethnicity, gender
identity, geographic location, and insurance type and
recommendations to promote greater access equity; and
(5) recommendations to promote greater equity in
compensation for perinatal health workers under public and
private insurers, particularly for such individuals from
racially and ethnically diverse backgrounds.
Subtitle E--Data to Save Moms
SEC. 1401. FUNDING FOR MATERNAL MORTALITY REVIEW COMMITTEES TO PROMOTE
REPRESENTATIVE COMMUNITY ENGAGEMENT.
(a) In General.--Section 317K(d) of the Public Health Service Act
(42 U.S.C. 247b-12(d)) is amended by adding at the end the following:
``(9) Grants to promote representative community engagement
in maternal mortality review committees.--
``(A) In general.--The Secretary may, using funds
made available pursuant to subparagraph (C), provide
assistance to an applicable maternal mortality review
committee of a State, Indian tribe, tribal
organization, or urban Indian organization (as such
term is defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603))--
``(i) to select for inclusion in the
membership of such a committee community
members from the State, Indian tribe, tribal
organization, or urban Indian organization by--
``(I) prioritizing community
members who can increase the diversity
of the committee's membership with
respect to race and ethnicity,
location, and professional background,
including members with non-clinical
experiences; and
``(II) to the extent applicable,
using funds reserved under subsection
(f), to address barriers to maternal
mortality review committee
participation for community members,
including required training,
transportation barriers, compensation,
and other supports as may be necessary;
``(ii) to establish initiatives to conduct
outreach and community engagement efforts
within communities throughout the State or
Tribe to seek input from community members on
the work of such maternal mortality review
committee, with a particular focus on outreach
to minority women; and
``(iii) to release public reports
assessing--
``(I) the pregnancy-related death
and pregnancy-associated death review
processes of the maternal mortality
review committee, with a particular
focus on the maternal mortality review
committee's sensitivity to the unique
circumstances of pregnant and
postpartum individuals from racial and
ethnic minority groups (as such term is
defined in section 1707(g)(1)) who have
suffered pregnancy-related deaths; and
``(II) the impact of the use of
funds made available pursuant to
paragraph (C) on increasing the
diversity of the maternal mortality
review committee membership and
promoting community engagement efforts
throughout the State or Tribe.
``(B) Technical assistance.--The Secretary shall
provide (either directly through the Department of
Health and Human Services or by contract) technical
assistance to any maternal mortality review committee
receiving a grant under this paragraph on best
practices for increasing the diversity of the maternal
mortality review committee's membership and for
conducting effective community engagement throughout
the State or Tribe.
``(C) Authorization of appropriations.--In addition
to any funds made available under subsection (f), there
are authorized to be appropriated to carry out this
paragraph $10,000,000 for each of fiscal years 2023
through 2027.''.
(b) Reservation of Funds.--Section 317K(f) of the Public Health
Service Act (42 U.S.C. 247b-12(f)) is amended by adding at the end the
following: ``Of the amount made available under the preceding sentence
for a fiscal year, not less than $1,500,000 shall be reserved for
grants to Indian tribes, tribal organizations, or urban Indian
organizations (as those terms are defined in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603))''.
SEC. 1402. DATA COLLECTION AND REVIEW.
Section 317K(d)(3)(A)(i) of the Public Health Service Act (42
U.S.C. 247b-12(d)(3)(A)(i)) is amended--
(1) by redesignating subclauses (II) and (III) as
subclauses (V) and (VI), respectively; and
(2) by inserting after subclause (I) the following:
``(II) to the extent practicable,
reviewing cases of severe maternal
morbidity, according to the most up-to-
date indicators;
``(III) to the extent practicable,
reviewing deaths during pregnancy or up
to 1 year after the end of a pregnancy
from suicide, overdose, or other death
from a mental health condition or
substance use disorder attributed to or
aggravated by pregnancy or childbirth
complications;
``(IV) to the extent practicable,
consulting with local community-based
organizations representing pregnant and
postpartum individuals from demographic
groups disproportionately impacted by
poor maternal health outcomes to ensure
that, in addition to clinical factors,
non-clinical factors that might have
contributed to a pregnancy-related
death are appropriately considered;''.
SEC. 1403. REVIEW OF MATERNAL HEALTH DATA COLLECTION PROCESSES AND
QUALITY MEASURES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator for Centers for Medicare & Medicaid Services
and the Director of the Agency for Healthcare Research and Quality,
shall consult with relevant stakeholders--
(1) to review existing maternal health data collection
processes and quality measures; and
(2) make recommendations to improve such processes and
measures, including topics described under subsection (c).
(b) Collaboration.--In carrying out this section, the Secretary
shall consult with a diverse group of maternal health stakeholders,
which may include--
(1) pregnant and postpartum individuals and their family
members, and nonprofit organizations representing such
individuals, with a particular focus on patients from racial
and ethnic minority groups;
(2) community-based organizations that provide support for
pregnant and postpartum individuals, with a particular focus on
patients from racial and ethnic minority groups;
(3) membership organizations for maternity care providers;
(4) organizations representing perinatal health workers;
(5) organizations that focus on maternal mental or
behavioral health;
(6) organizations that focus on intimate partner violence;
(7) institutions of higher education, with a particular
focus on minority-serving institutions;
(8) licensed and accredited hospitals, birth centers,
midwifery practices, or other medical practices that provide
maternal health care services to pregnant and postpartum
patients;
(9) relevant State and local public agencies, including
State maternal mortality review committees; and
(10) the National Quality Forum, or such other standard-
setting organizations specified by the Secretary.
(c) Topics.--The review of maternal health data collection
processes and recommendations to improve such processes and measures
required under subsection (a) shall assess all available relevant
information, including information from State-level sources, and shall
consider at least the following:
(1) Current State and Tribal practices for maternal health,
maternal mortality, and severe maternal morbidity data
collection and dissemination, including consideration of--
(A) the timeliness of processes for amending a
death certificate when new information pertaining to
the death becomes available to reflect whether the
death was a pregnancy-related death;
(B) relevant data collected with electronic health
records, including data on race, ethnicity,
socioeconomic status, insurance type, and other
relevant demographic information;
(C) maternal health data collected and publicly
reported by hospitals, health systems, midwifery
practices, and birth centers;
(D) the barriers preventing States from correlating
maternal outcome data with race and ethnicity data;
(E) processes for determining the cause of a
pregnancy-associated death in States that do not have a
maternal mortality review committee;
(F) whether maternal mortality review committees
include multidisciplinary and diverse membership (as
described in section 317K(d)(1)(A) of the Public Health
Service Act (42 U.S.C. 247b-12(d)(1)(A)));
(G) whether members of maternal mortality review
committees participate in trainings on bias, racism, or
discrimination, and the quality of such trainings;
(H) the extent to which States have implemented
systematic processes of listening to the stories of
pregnant and postpartum individuals and their family
members, with a particular focus on pregnant and
postpartum individuals from racial and ethnic minority
groups (as such term is defined in section 1707(g)(1)
of the Public Health Service Act (42 U.S.C. 300u-
6(g)(1))) and their family members, to fully understand
the causes of, and inform potential solutions to, the
maternal mortality and severe maternal morbidity crisis
within their respective States;
(I) the extent to which maternal mortality review
committees are considering social determinants of
maternal health when examining the causes of pregnancy-
associated and pregnancy-related deaths;
(J) the extent to which maternal mortality review
committees are making actionable recommendations based
on their reviews of adverse maternal health outcomes
and the extent to which such recommendations are being
implemented by appropriate stakeholders;
(K) the legal and administrative barriers
preventing the collection, collation, and dissemination
of State maternity care data;
(L) the effectiveness of data collection and
reporting processes in separating pregnancy-associated
deaths from pregnancy-related deaths; and
(M) the current Federal, State, local, and Tribal
funding support for the activities referred to in
subparagraphs (A) through (L).
(2) Whether the funding support referred to in paragraph
(1)(M) is adequate for States to carry out optimal data
collection and dissemination processes with respect to maternal
health, maternal mortality, and severe maternal morbidity.
(3) Current quality measures for maternity care, including
prenatal measures, labor and delivery measures, and postpartum
measures, including topics such as--
(A) effective quality measures for maternity care
used by hospitals, health systems, midwifery practices,
birth centers, health plans, and other relevant
entities;
(B) the sufficiency of current outcome measures
used to evaluate maternity care for driving improved
care, experiences, and outcomes in maternity care
payment and delivery system models;
(C) maternal health quality measures that other
countries effectively use;
(D) validated measures that have been used for
research purposes that could be tested, refined, and
submitted for national endorsement;
(E) barriers preventing maternity care providers
and insurers from implementing quality measures that
are aligned with best practices;
(F) the frequency with which maternity care quality
measures are reviewed and revised;
(G) the strengths and weaknesses of the Prenatal
and Postpartum Care measures of the Health Plan
Employer Data and Information Set measures established
by the National Committee for Quality Assurance;
(H) the strengths and weaknesses of maternity care
quality measures under the Medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
and the Children's Health Insurance Program under title
XXI of such Act (42 U.S.C. 1397 et seq.), including the
extent to which States voluntarily report relevant
measures;
(I) the extent to which maternity care quality
measures are informed by patient experiences that
include measures of patient-reported experience of
care;
(J) the current processes for collecting stratified
data on the race and ethnicity of pregnant and
postpartum individuals in hospitals, health systems,
midwifery practices, and birth centers, and for
incorporating such racially and ethnically stratified
data in maternity care quality measures;
(K) the extent to which maternity care quality
measures account for the unique experiences of pregnant
and postpartum individuals from racial and ethnic
minority groups (as such term is defined in section
1707(g)(1) of the Public Health Service Act (42 U.S.C.
300u-6(g)(1))); and
(L) the extent to which hospitals, health systems,
midwifery practices, and birth centers are implementing
existing maternity care quality measures.
(4) Recommendations on authorizing additional funds and
providing additional technical assistance to improve maternal
mortality review committees and State and Tribal maternal
health data collection and reporting processes.
(5) Recommendations for new authorities that may be granted
to maternal mortality review committees to be able to--
(A) access records from other Federal and State
agencies and departments that may be necessary to
identify causes of pregnancy-associated and pregnancy-
related deaths that are unique to pregnant and
postpartum individuals from specific populations, such
as veterans and individuals who are incarcerated; and
(B) work with relevant experts who are not members
of the maternal mortality review committee to assist in
the review of pregnancy-associated deaths of pregnant
and postpartum individuals from specific populations,
such as veterans and individuals who are incarcerated.
(6) Recommendations to improve and standardize current
quality measures for maternity care, with a particular focus on
racial and ethnic disparities in maternal health outcomes.
(7) Recommendations to improve the coordination by the
Department of Health and Human Services of the efforts
undertaken by the agencies and organizations within the
Department related to maternal health data and quality
measures.
(d) Report.--Not later than 1 year after the enactment of this Act,
the Secretary shall submit to the Congress and make publicly available
a report on the results of the review of maternal health data
collection processes and quality measures and recommendations to
improve such processes and measures required under subsection (a).
(e) Definitions.--In this section:
(1) Maternal mortality review committee.--The term
``maternal mortality review committee'' means a maternal
mortality review committee duly authorized by a State and
receiving funding under section 317k(a)(2)(D) of the Public
Health Service Act (42 U.S.C. 247b-12(a)(2)(D)).
(2) Pregnancy-associated death.--The term ``pregnancy-
associated'', with respect to a death, means a death of a
pregnant or postpartum individual, by any cause, that occurs
during, or within 1 year following, the individual's pregnancy,
regardless of the outcome, duration, or site of the pregnancy.
(3) Pregnancy-related death.--The term ``pregnancy-
related'', with respect to a death, means a death of a pregnant
or postpartum individual that occurs during, or within 1 year
following, the individual's pregnancy, from a pregnancy
complication, a chain of events initiated by pregnancy, or the
aggravation of an unrelated condition by the physiologic
effects of pregnancy.
(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal years 2023 through 2026.
SEC. 1404. INDIAN HEALTH SERVICE STUDY ON MATERNAL MORTALITY AND SEVERE
MATERNAL MORBIDITY.
(a) In General.--The Director of the Indian Health Service
(referred to in this section as the ``Director'') shall, in
coordination with entities described in subsection (b)--
(1) not later than 90 days after the enactment of this Act,
enter into a contract with an independent research organization
or Tribal Epidemiology Center to conduct a comprehensive study
on maternal mortality and severe maternal morbidity in the
populations of American Indian and Alaska Native individuals;
and
(2) not later than 3 years after the date of the enactment
of this Act, submit to Congress a report on such study that
contains recommendations for policies and practices that can be
adopted to improve maternal health outcomes for pregnant and
postpartum American Indian and Alaska Native individuals.
(b) Participating Entities.--The entities described in this
subsection shall consist of 12 members, selected by the Director from
among individuals nominated by Indian tribes and tribal organizations
(as such terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304)), and urban
Indian organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)). In selecting such
members, the Director shall ensure that each of the 12 service areas of
the Indian Health Service is represented.
(c) Contents of Study.--The study conducted pursuant to subsection
(a) shall--
(1) examine the causes of maternal mortality and severe
maternal morbidity that are unique to American Indian and
Alaska Native individuals;
(2) include a systematic process of listening to the
stories of American Indian and Alaska Native pregnant and
postpartum individuals to fully understand the causes of, and
inform potential solutions to, the maternal mortality and
severe maternal morbidity crisis within their respective
communities;
(3) distinguish between the causes of, landscape of
maternity care at, and recommendations to improve maternal
health outcomes within, the different settings in which
American Indian and Alaska Native pregnant and postpartum
individuals receive maternity care, such as--
(A) facilities operated by the Indian Health
Service;
(B) an Indian health program operated by an Indian
tribe or tribal organization pursuant to a contract,
grant, cooperative agreement, or compact with the
Indian Health Service pursuant to the Indian Self-
Determination Act; and
(C) an urban Indian health program operated by an
urban Indian organization pursuant to a grant or
contract with the Indian Health Service pursuant to
title V of the Indian Health Care Improvement Act;
(4) review processes for coordinating programs of the
Indian Health Service with social services provided through
other programs administered by the Secretary of Health and
Human Services (other than the Medicare program under title
XVIII of the Social Security Act, the Medicaid program under
title XIX of such Act, and the Children's Health Insurance
Program under title XXI of such Act), including coordination
with the efforts of the Task Force established under section
1403;
(5) review current data collection and quality measurement
processes and practices;
(6) assess causes and frequency of maternal mental health
conditions and substance use disorders;
(7) consider social determinants of health, including
poverty, lack of health insurance, unemployment, sexual
violence, and environmental conditions in Tribal areas;
(8) consider the role that historical mistreatment of
American Indian and Alaska Native women has played in causing
currently high rates of maternal mortality and severe maternal
morbidity;
(9) consider how current funding of the Indian Health
Service affects the ability of the Service to deliver quality
maternity care;
(10) consider the extent to which the delivery of maternity
care services is culturally appropriate for American Indian and
Alaska Native pregnant and postpartum individuals;
(11) make recommendations to reduce misclassification of
American Indian and Alaska Native pregnant and postpartum
individuals, including consideration of best practices in
training for maternal mortality review committee members to be
able to correctly classify American Indian and Alaska Native
individuals; and
(12) make recommendations informed by the stories shared by
American Indian and Alaska Native pregnant and postpartum
individuals in paragraph (2) to improve maternal health
outcomes for such individuals.
(d) Report.--The agreement entered into under subsection (a) with
an independent research organization or Tribal Epidemiology Center
shall require that the organization or center transmit to Congress a
report on the results of the study conducted pursuant to that agreement
not later than 36 months after the date of the enactment of this Act.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2023 through 2025.
SEC. 1405. GRANTS TO MINORITY-SERVING INSTITUTIONS TO STUDY MATERNAL
MORTALITY, SEVERE MATERNAL MORBIDITY, AND OTHER ADVERSE
MATERNAL HEALTH OUTCOMES.
(a) In General.--The Secretary of Health and Human Services shall
establish a program under which the Secretary shall award grants to
research centers, health professions schools and programs, and other
entities at minority-serving institutions to study specific aspects of
the maternal health crisis among pregnant and postpartum individuals
from racial and ethnic minority groups. Such research may--
(1) include the development and implementation of
systematic processes of listening to the stories of pregnant
and postpartum individuals from racial and ethnic minority
groups, and perinatal health workers supporting such
individuals, to fully understand the causes of, and inform
potential solutions to, the maternal mortality and severe
maternal morbidity crisis within their respective communities;
(2) assess the potential causes of relatively low rates of
maternal mortality among Hispanic individuals, including
potential racial misclassification and other data collection
and reporting issues that might be misrepresenting maternal
mortality rates among Hispanic individuals in the United
States; and
(3) assess differences in rates of adverse maternal health
outcomes among subgroups identifying as Hispanic.
(b) Application.--To be eligible to receive a grant under
subsection (a), an entity described in such subsection shall submit to
the Secretary an application at such time, in such manner, and
containing such information as the Secretary may require.
(c) Technical Assistance.--The Secretary may use not more than 10
percent of the funds made available under subsection (f)--
(1) to conduct outreach to minority-serving institutions to
raise awareness of the availability of grants under this
subsection (a);
(2) to provide technical assistance in the application
process for such a grant; and
(3) to promote capacity building as needed to enable
entities described in such subsection to submit such an
application.
(d) Reporting Requirement.--Each entity awarded a grant under this
section shall periodically submit to the Secretary a report on the
status of activities conducted using the grant.
(e) Evaluation.--Beginning one year after the date on which the
first grant is awarded under this section, the Secretary shall submit
to Congress an annual report summarizing the findings of research
conducted using funds made available under this section.
(f) Minority-Serving Institutions Defined.--In this section, the
term ``minority-serving institution'' has the meaning given the term in
section 371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)).
(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2023 through 2027.
Subtitle F--Moms Matter
SEC. 1501. MATERNAL MENTAL HEALTH EQUITY GRANT PROGRAM.
(a) In General.--The Secretary of Health and Human Services, acting
through the Assistant Secretary for Mental Health and Substance Use,
shall establish a program to award grants to eligible entities to
address maternal mental health conditions and substance use disorders
with respect to pregnant and postpartum individuals, with a focus on
racial and ethnic minority groups.
(b) Application.--To be eligible to receive a grant under this
section an eligible entity shall submit to the Secretary an application
at such time, in such manner, and containing such information as the
Secretary may provide, including how such entity will use funds for
activities described in subsection (d) that are culturally congruent.
(c) Priority.--In awarding grants under this section, the Secretary
shall give priority to an eligible entity that--
(1) is, or will partner with, a community-based
organization to address maternal mental health conditions and
substance use disorders described in subsection (a);
(2) is operating in an area with high rates of--
(A) adverse maternal health outcomes; or
(B) significant racial or ethnic disparities in
maternal health outcomes; and
(3) is operating in a health professional shortage area
designated under section 332 of the Public Health Service Act
(42 U.S.C. 254e).
(d) Use of Funds.--An eligible entity that receives a grant under
this section shall use funds for the following:
(1) Establishing or expanding maternity care programs to
improve the integration of maternal health and behavioral
health care services into primary care settings where pregnant
individuals regularly receive health care services.
(2) Establishing or expanding group prenatal care programs
or postpartum care programs.
(3) Expanding existing programs that improve maternal
mental and behavioral health during the prenatal and postpartum
periods, with a focus on individuals from racial and ethnic
minority groups.
(4) Providing services and support for pregnant and
postpartum individuals with maternal mental health conditions
and substance use disorders, including referrals to addiction
treatment centers that offer evidence-based treatment options.
(5) Addressing stigma associated with maternal mental
health conditions and substance use disorders, with a focus on
racial and ethnic minority groups.
(6) Raising awareness of warning signs of maternal mental
health conditions and substance use disorders, with a focus on
pregnant and postpartum individuals from racial and ethnic
minority groups.
(7) Establishing or expanding programs to prevent suicide
or self-harm among pregnant and postpartum individuals.
(8) Offering evidence-aligned programs at freestanding
birth centers that provide maternal mental and behavioral
health care education, treatments, and services, and other
services for individuals throughout the prenatal and postpartum
period.
(9) Establishing or expanding programs to provide education
and training to maternity care providers with respect to--
(A) identifying potential warning signs for
maternal mental health conditions or substance use
disorders in pregnant and postpartum individuals, with
a focus on individuals from racial and ethnic minority
groups; and
(B) in the case where such providers identify such
warning signs, offering referrals to mental and
behavioral health care professionals.
(10) Developing a website, or other source, that includes
information on health care providers who treat maternal mental
health conditions and substance use disorders.
(11) Establishing or expanding programs in communities to
improve coordination between maternity care providers and
mental and behavioral health care providers who treat maternal
mental health conditions and substance use disorders, including
through the use of toll-free hotlines.
(12) Carrying out other programs aligned with evidence-
based practices for addressing maternal mental health
conditions and substance use disorders for pregnant and
postpartum individuals from racial and ethnic minority groups.
(e) Reporting.--
(1) Eligible entities.--An eligible entity that receives a
grant under subsection (a) shall submit annually to the
Secretary, and make publicly available, a report on the
activities conducted using funds received through a grant under
this section. Such reports shall include quantitative and
qualitative evaluations of such activities, including the
experience of individuals who received health care through such
grant.
(2) Secretary.--Not later than the end of fiscal year 2025,
the Secretary shall submit to Congress a report that includes--
(A) a summary of the reports received under
paragraph (1);
(B) an evaluation of the effectiveness of grants
awarded under this section;
(C) recommendations with respect to expanding
coverage of evidence-based screenings and treatments
for maternal mental health conditions and substance use
disorders; and
(D) recommendations with respect to ensuring
activities described under subsection (d) continue
after the end of a grant period.
(f) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) a community-based organization serving pregnant
and postpartum individuals, including such
organizations serving individuals from racial and
ethnic minority groups and other underserved
populations;
(B) a nonprofit or patient advocacy organization
with expertise in maternal mental and behavioral
health;
(C) a maternity care provider;
(D) a mental or behavioral health care provider who
treats maternal mental health conditions or substance
use disorders;
(E) a State or local governmental entity, including
a State or local public health department;
(F) an Indian Tribe or Tribal organization (as such
terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
5304)); and
(G) an Urban Indian organization (as such term is
defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)).
(2) Freestanding birth center.--The term ``freestanding
birth center'' has the meaning given that term under section
1905(l) of the Social Security Act (42 U.S.C. 1396d(1)).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $25,000,000 for each of fiscal
years 2023 through 2026.
SEC. 1502. GRANTS TO GROW AND DIVERSIFY THE MATERNAL MENTAL AND
BEHAVIORAL HEALTH CARE WORKFORCE.
Title VII of the Public Health Service Act (42 U.S.C. 292 et seq.)
is amended by inserting after section 758 of such Act, as added by
section 1302 of this title, the following new section:
``SEC. 758A. MATERNAL MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE
GRANTS.
``(a) In General.--The Secretary may award grants to entities to
establish or expand programs described in subsection (b) to grow and
diversify the maternal mental and behavioral health care workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the maternal mental and behavioral
health care workforce by--
``(1) establishing schools or programs that provide
education and training to individuals seeking appropriate
licensing or certification as mental or behavioral health care
providers who will specialize in maternal mental health
conditions or substance use disorders; or
``(2) expanding the capacity of existing schools or
programs described in paragraph (1), for the purposes of
increasing the number of students enrolled in such schools or
programs, including by awarding scholarships for students.
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to any entity that--
``(1) has demonstrated a commitment to recruiting and
retaining students and faculty from racial and ethnic minority
groups;
``(2) has developed a strategy to recruit and retain a
diverse pool of students into the maternal mental or behavioral
health care workforce program or school supported by funds
received through the grant, particularly from racial and ethnic
minority groups and other underserved populations;
``(3) has developed a strategy to recruit and retain
students who plan to practice in a health professional shortage
area designated under section 332;
``(4) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(5) includes in the standard curriculum for all students
within the maternal mental or behavioral health care workforce
program or school a bias, racism, or discrimination training
program that includes training on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section for a maternal mental or behavioral health care workforce
program or school, an entity shall agree to submit to the Secretary an
annual report on the activities conducted through the grant,
including--
``(1) the number and demographics of students participating
in the program or school;
``(2) the extent to which students in the program or school
are entering careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with significant racial and ethnic
disparities in maternal health outcomes, to the extent
such data are available; and
``(3) whether the program or school has included in the
standard curriculum for all students a bias, racism, or
discrimination training program that includes training on
implicit bias and racism, and if so the effectiveness of such
training program.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to entities seeking or receiving a
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the maternal mental or behavioral health
care workforce programs or schools proposed to be, or being,
established or expanded through the grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups and other underserved populations;
``(2) increasing the number of mental or behavioral health
care providers specializing in maternal mental health
conditions or substance use disorders from racial and ethnic
minority groups and other underserved populations;
``(3) increasing the number of mental or behavioral health
care providers specializing in maternal mental health
conditions or substance use disorders working in health
professional shortage areas designated under section 332; and
``(4) increasing the number of mental or behavioral health
care providers specializing in maternal mental health
conditions or substance use disorders working in areas with
significant racial and ethnic disparities in maternal health
outcomes, to the extent such data are available.
``(i) Definitions.--In this section:
``(1) Racial and ethnic minority group.--The term `racial
and ethnic minority group' has the meaning given such term in
section 1707(g)(1).
``(2) Mental or behavioral health care provider.--The term
`mental or behavioral health care provider' refers to a health
care provider in the field of mental and behavioral health,
including substance use disorders, acting in accordance with
State law.
``(j) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2023 through 2027.''.
Subtitle G--Justice for Incarcerated Moms
SEC. 1601. ENDING THE SHACKLING OF PREGNANT INDIVIDUALS.
(a) In General.--Beginning on the date that is 6 months after the
date of enactment of this Act, and annually thereafter, in each State
that receives a grant under subpart 1 of part E of title I of the
Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et
seq.) (commonly referred to as the ``Edward Byrne Memorial Justice
Grant Program'') and that does not have in effect throughout the State
for such fiscal year laws restricting the use of restraints on pregnant
individuals in prison that are substantially similar to the rights,
procedures, requirements, effects, and penalties set forth in section
4322 of title 18, United States Code, the amount of such grant that
would otherwise be allocated to such State under such subpart for the
fiscal year shall be decreased by 25 percent.
(b) Reallocation.--Amounts not allocated to a State for failure to
comply with subsection (a) shall be reallocated in accordance with
subpart 1 of part E of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (34 U.S.C. 10151 et seq.) to States that have
complied with such subsection.
SEC. 1602. CREATING MODEL PROGRAMS FOR THE CARE OF INCARCERATED
INDIVIDUALS IN THE PRENATAL AND POSTPARTUM PERIODS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Attorney General, acting through the Director of the
Bureau of Prisons, shall establish, in not fewer than 6 Bureau of
Prisons facilities, programs to optimize maternal health outcomes for
pregnant and postpartum individuals incarcerated in such facilities.
The Attorney General shall establish such programs in consultation with
stakeholders such as--
(1) relevant community-based organizations, particularly
organizations that represent incarcerated and formerly
incarcerated individuals and organizations that seek to improve
maternal health outcomes for pregnant and postpartum
individuals from racial and ethnic minority groups;
(2) relevant organizations representing patients, with a
particular focus on patients from racial and ethnic minority
groups;
(3) organizations representing maternity care providers and
maternal health care education programs;
(4) perinatal health workers; and
(5) researchers and policy experts in fields related to
maternal health care for incarcerated individuals.
(b) Start Date.--Each selected facility shall begin facility
programs not later than 18 months after the date of enactment of this
Act.
(c) Facility Priority.--In carrying out subsection (a), the
Director shall give priority to a facility based on--
(1) the number of pregnant and postpartum individuals
incarcerated in such facility and, among such individuals, the
number of pregnant and postpartum individuals from racial and
ethnic minority groups; and
(2) the extent to which the leaders of such facility have
demonstrated a commitment to developing exemplary programs for
pregnant and postpartum individuals incarcerated in such
facility.
(d) Program Duration.--The programs established under this section
shall be for a 5-year period.
(e) Programs.--Bureau of Prisons facilities selected by the
Director shall establish programs for pregnant and postpartum
incarcerated individuals, and such programs may--
(1) provide access to perinatal health workers from
pregnancy through the postpartum period;
(2) provide access to healthy foods and counseling on
nutrition, recommended activity levels, and safety measures
throughout pregnancy;
(3) train correctional officers to ensure that pregnant
incarcerated individuals receive safe and respectful treatment;
(4) train medical personnel to ensure that pregnant
incarcerated individuals receive trauma-informed, culturally
congruent care that promotes the health and safety of the
pregnant individuals;
(5) provide counseling and treatment for individuals who
have suffered from--
(A) diagnosed mental or behavioral health
conditions, including trauma and substance use
disorders;
(B) trauma or violence, including domestic
violence;
(C) human immunodeficiency virus;
(D) sexual abuse;
(E) pregnancy or infant loss; or
(F) chronic conditions;
(6) provide evidence-based pregnancy and childbirth
education, parenting support, and other relevant forms of
health literacy;
(7) provide clinical education opportunities to maternity
care providers in training to expand pathways into maternal
health care careers serving incarcerated individuals;
(8) offer opportunities for postpartum individuals to
maintain contact with the individual's newborn child to promote
bonding, including enhanced visitation policies, access to
prison nursery programs, or breastfeeding support;
(9) provide reentry assistance, particularly to--
(A) ensure access to health insurance coverage and
transfer of health records to community providers if an
incarcerated individual exits the criminal justice
system during such individual's pregnancy or in the
postpartum period; and
(B) connect individuals exiting the criminal
justice system during pregnancy or in the postpartum
period to community-based resources, such as referrals
to health care providers, substance use disorder
treatments, and social services that address social
determinants maternal of health; or
(10) establish partnerships with local public entities,
private community entities, community-based organizations,
Indian Tribes and tribal organizations (as such terms are
defined in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304)), and urban Indian
organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)) to
establish or expand pretrial diversion programs as an
alternative to incarceration for pregnant and postpartum
individuals. Such programs may include--
(A) evidence-based childbirth education or
parenting classes;
(B) prenatal health coordination;
(C) family and individual counseling;
(D) evidence-based screenings, education, and, as
needed, treatment for mental and behavioral health
conditions, including drug and alcohol treatments;
(E) family case management services;
(F) domestic violence education and prevention;
(G) physical and sexual abuse counseling; and
(H) programs to address social determinants of
health such as employment, housing, education,
transportation, and nutrition.
(f) Implementation and Reporting.--A selected facility shall be
responsible for--
(1) implementing programs, which may include the programs
described in subsection (e); and
(2) not later than 3 years after the date of enactment of
this Act, and 6 years after the date of enactment of this Act,
reporting results of the programs to the Director, including
information describing--
(A) relevant quantitative indicators of success in
improving the standard of care and health outcomes for
pregnant and postpartum incarcerated individuals in the
facility, including data stratified by race, ethnicity,
sex, gender, age, geography, disability status, the
category of the criminal charge against such
individual, rates of pregnancy-related deaths,
pregnancy-associated deaths, cases of infant mortality
and morbidity, rates of preterm births and low-
birthweight births, cases of severe maternal morbidity,
cases of violence against pregnant or postpartum
individuals, diagnoses of maternal mental or behavioral
health conditions, and other such information as
appropriate;
(B) relevant qualitative and quantitative
evaluations from pregnant and postpartum incarcerated
individuals who participated in such programs,
including measures of patient-reported experience of
care; and
(C) strategies to sustain such programs after
fiscal year 2027 and expand such programs to other
facilities.
(g) Report.--Not later than 6 years after the date of enactment of
this Act, the Director shall submit to the Attorney General and to the
Congress a report describing the results of the programs funded under
this section.
(h) Oversight.--Not later than 1 year after the date of enactment
of this Act, the Attorney General shall award a contract to an
independent organization or independent organizations to conduct
oversight of the programs described in subsection (e).
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2023 through 2027.
SEC. 1603. GRANT PROGRAM TO IMPROVE MATERNAL HEALTH OUTCOMES FOR
INDIVIDUALS IN STATE AND LOCAL PRISONS AND JAILS.
(a) Establishment.--Not later than 1 year after the date of
enactment of this Act, the Attorney General, acting through the
Director of the Bureau of Justice Assistance, shall award Justice for
Incarcerated Moms grants to States to establish or expand programs in
State and local prisons and jails for pregnant and postpartum
incarcerated individuals. The Attorney General shall award such grants
in consultation with stakeholders such as--
(1) relevant community-based organizations, particularly
organizations that represent incarcerated and formerly
incarcerated individuals and organizations that seek to improve
maternal health outcomes for pregnant and postpartum
individuals from racial and ethnic minority groups;
(2) relevant organizations representing patients, with a
particular focus on patients from racial and ethnic minority
groups;
(3) organizations representing maternity care providers and
maternal health care education programs;
(4) perinatal health workers; and
(5) researchers and policy experts in fields related to
maternal health care for incarcerated individuals.
(b) Applications.--Each applicant for a grant under this section
shall submit to the Director of the Bureau of Justice Assistance an
application at such time, in such manner, and containing such
information as the Director may require.
(c) Use of Funds.--A State that is awarded a grant under this
section shall use such grant to establish or expand programs for
pregnant and postpartum incarcerated individuals, and such programs
may--
(1) provide access to perinatal health workers from
pregnancy through the postpartum period;
(2) provide access to healthy foods and counseling on
nutrition, recommended activity levels, and safety measures
throughout pregnancy;
(3) train correctional officers to ensure that pregnant
incarcerated individuals receive safe and respectful treatment;
(4) train medical personnel to ensure that pregnant
incarcerated individuals receive trauma-informed, culturally
congruent care that promotes the health and safety of the
pregnant individuals;
(5) provide counseling and treatment for individuals who
have suffered from--
(A) diagnosed mental or behavioral health
conditions, including trauma and substance use
disorders;
(B) trauma or violence, including domestic
violence;
(C) human immunodeficiency virus;
(D) sexual abuse;
(E) pregnancy or infant loss; or
(F) chronic conditions;
(6) provide evidence-based pregnancy and childbirth
education, parenting support, and other relevant forms of
health literacy;
(7) provide clinical education opportunities to maternity
care providers in training to expand pathways into maternal
health care careers serving incarcerated individuals;
(8) offer opportunities for postpartum individuals to
maintain contact with the individual's newborn child to promote
bonding, including enhanced visitation policies, access to
prison nursery programs, or breastfeeding support;
(9) provide reentry assistance, particularly to--
(A) ensure access to health insurance coverage and
transfer of health records to community providers if an
incarcerated individual exits the criminal justice
system during such individual's pregnancy or in the
postpartum period; and
(B) connect individuals exiting the criminal
justice system during pregnancy or in the postpartum
period to community-based resources, such as referrals
to health care providers, substance use disorder
treatments, and social services that address social
determinants of maternal health; or
(10) establish partnerships with local public entities,
private community entities, community-based organizations,
Indian Tribes and tribal organizations (as such terms are
defined in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304)), and urban Indian
organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)) to
establish or expand pretrial diversion programs as an
alternative to incarceration for pregnant and postpartum
individuals. Such programs may include--
(A) evidence-based childbirth education or
parenting classes;
(B) prenatal health coordination;
(C) family and individual counseling;
(D) evidence-based screenings, education, and, as
needed, treatment for mental and behavioral health
conditions, including drug and alcohol treatments;
(E) family case management services;
(F) domestic violence education and prevention;
(G) physical and sexual abuse counseling; and
(H) programs to address social determinants of
health such as employment, housing, education,
transportation, and nutrition.
(d) Priority.--In awarding grants under this section, the Director
of the Bureau of Justice Assistance shall give priority to applicants
based on--
(1) the number of pregnant and postpartum individuals
incarcerated in the State and, among such individuals, the
number of pregnant and postpartum individuals from racial and
ethnic minority groups; and
(2) the extent to which the State has demonstrated a
commitment to developing exemplary programs for pregnant and
postpartum individuals incarcerated in the prisons and jails in
the State.
(e) Grant Duration.--A grant awarded under this section shall be
for a 5-year period.
(f) Implementing and Reporting.--A State that receives a grant
under this section shall be responsible for--
(1) implementing the program funded by the grant; and
(2) not later than 3 years after the date of enactment of
this Act, and 6 years after the date of enactment of this Act,
reporting results of such program to the Attorney General,
including information describing--
(A) relevant quantitative indicators of the
program's success in improving the standard of care and
health outcomes for pregnant and postpartum
incarcerated individuals in the facility, including
data stratified by race, ethnicity, sex, gender, age,
geography, disability status, category of the criminal
charge against such individual, incidence rates of
pregnancy-related deaths, pregnancy-associated deaths,
cases of infant mortality and morbidity, rates of
preterm births and low-birthweight births, cases of
severe maternal morbidity, cases of violence against
pregnant or postpartum individuals, diagnoses of
maternal mental or behavioral health conditions, and
other such information as appropriate;
(B) relevant qualitative and quantitative
evaluations from pregnant and postpartum incarcerated
individuals who participated in such programs,
including measures of patient-reported experience of
care; and
(C) strategies to sustain such programs beyond the
duration of the grant and expand such programs to other
facilities.
(g) Report.--Not later than 6 years after the date of enactment of
this Act, the Attorney General shall submit to the Congress a report
describing the results of such grant programs.
(h) Oversight.--Not later than 1 year after the date of enactment
of this Act, the Attorney General shall award a contract to an
independent organization or independent organizations to conduct
oversight of the programs described in subsection (c).
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2023 through 2027.
SEC. 1604. GAO REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Comptroller General of the United States shall submit
to Congress a report on adverse maternal and infant health outcomes
among incarcerated individuals and infants born to such individuals,
with a particular focus on racial and ethnic disparities in maternal
and infant health outcomes for incarcerated individuals.
(b) Contents of Report.--The report described in this section shall
include--
(1) to the extent practicable--
(A) the number of pregnant individuals who are
incarcerated in Bureau of Prisons facilities;
(B) the number of incarcerated individuals,
including those incarcerated in Federal, State, and
local correctional facilities, who have experienced a
pregnancy-related death, pregnancy-associated death, or
the death of an infant in the most recent 10 years of
available data;
(C) the number of cases of severe maternal
morbidity among incarcerated individuals, including
those incarcerated in Federal, State, and local
detention facilities, in the most recent 10 years of
available data;
(D) the number of preterm and low-birthweight
births of infants born to incarcerated individuals,
including those incarcerated in Federal, State, and
local correctional facilities, in the most recent 10
years of available data; and
(E) statistics on the racial and ethnic disparities
in maternal and infant health outcomes and severe
maternal morbidity rates among incarcerated
individuals, including those incarcerated in Federal,
State, and local detention facilities;
(2) in the case that the Comptroller General of the United
States is unable determine the information required in
subparagraphs (A) through (C) of paragraph (1), an assessment
of the barriers to determining such information and
recommendations for improvements in tracking maternal health
outcomes among incarcerated individuals, including those
incarcerated in Federal, State, and local detention facilities;
(3) causes of adverse maternal health outcomes that are
unique to incarcerated individuals, including those
incarcerated in Federal, State, and local detention facilities;
(4) causes of adverse maternal health outcomes and severe
maternal morbidity that are unique to incarcerated individuals
from racial and ethnic minority groups;
(5) recommendations to reduce maternal mortality and severe
maternal morbidity among incarcerated individuals and to
address racial and ethnic disparities in maternal health
outcomes for incarcerated individuals in Bureau of Prisons
facilities and State and local prisons and jails; and
(6) such other information as may be appropriate to reduce
the occurrence of adverse maternal health outcomes among
incarcerated individuals and to address racial and ethnic
disparities in maternal health outcomes for such individuals.
SEC. 1605. MACPAC REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Medicaid and CHIP Payment and Access Commission
(referred to in this section as ``MACPAC'') shall publish a report on
the implications of pregnant and postpartum incarcerated individuals
being ineligible for medical assistance under a State plan under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) that contains
the information described in subsection.
(b) Information Described.--For purposes of subsection (a), the
information described in this subsection includes--
(1) information on the effect of ineligibility for medical
assistance under a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) on maternal health
outcomes for pregnant and postpartum incarcerated individuals,
concentrating on the effects of such ineligibility for pregnant
and postpartum individuals from racial and ethnic minority
groups; and
(2) the potential implications on maternal health outcomes
resulting from suspending eligibility for medical assistance
under a State plan under such title of such Act when a pregnant
or postpartum individual is incarcerated.
Subtitle H--Tech to Save Moms
SEC. 1701. INTEGRATED TELEHEALTH MODELS IN MATERNITY CARE SERVICES.
(a) In General.--Section 1115A(b)(2)(B) of the Social Security Act
(42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the
following:
``(xxviii) Focusing on title XIX, providing
for the adoption of and use of telehealth tools
that allow for screening, monitoring, and
management of common health complications with
respect to an individual receiving medical
assistance during such individual's pregnancy
and for not more than a 1-year period beginning
on the last day of the pregnancy.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect 1 year after the date of the enactment of this Act.
SEC. 1702. GRANTS TO EXPAND THE USE OF TECHNOLOGY-ENABLED COLLABORATIVE
LEARNING AND CAPACITY MODELS FOR PREGNANT AND POSTPARTUM
INDIVIDUALS.
Title III of the Public Health Service Act is amended by inserting
after section 330P (42 U.S.C. 254c-22) the following:
``SEC. 330Q. EXPANDING CAPACITY FOR MATERNAL HEALTH OUTCOMES.
``(a) Establishment.--Beginning not later than 1 year after the
date of enactment of this section, the Secretary shall award grants to
eligible entities to evaluate, develop, and expand the use of
technology-enabled collaborative learning and capacity building models
and improve maternal health outcomes--
``(1) in health professional shortage areas;
``(2) in areas with high rates of maternal mortality and
severe maternal morbidity;
``(3) in areas with significant racial and ethnic
disparities in maternal health outcomes; and
``(4) for medically underserved populations and American
Indians and Alaska Natives, including Indian Tribes, Tribal
organizations, and Urban Indian organizations.
``(b) Use of Funds.--
``(1) Required uses.--Recipients of grants under this
section shall use the grants to--
``(A) train maternal health care providers,
students, and other similar professionals through
models that include--
``(i) methods to increase safety and health
care quality;
``(ii) implicit bias, racism, and
discrimination;
``(iii) best practices in screening for
and, as needed, evaluating and treating
maternal mental health conditions and substance
use disorders;
``(iv) training on best practices in
maternity care for pregnant and postpartum
individuals during the COVID-19 public health
emergency or future public health emergencies;
``(v) methods to screen for social
determinants of maternal health risks in the
prenatal and postpartum; and
``(vi) the use of remote patient monitoring
tools for pregnancy-related complications
described in section 1115A(b)(2)(B)(xxviii);
``(B) evaluate and collect information on the
effect of such models on--
``(i) access to and quality of care;
``(ii) outcomes with respect to the health
of an individual; and
``(iii) the experience of individuals who
receive pregnancy-related health care;
``(C) develop qualitative and quantitative measures
to identify best practices for the expansion and use of
such models;
``(D) study the effect of such models on patient
outcomes and maternity care providers; and
``(E) conduct any other activity determined by the
Secretary.
``(2) Permissible uses.--Recipients of grants under this
section may use grants to support--
``(A) the use and expansion of technology-enabled
collaborative learning and capacity building models,
including hardware and software that--
``(i) enables distance learning and
technical support; and
``(ii) supports the secure exchange of
electronic health information; and
``(B) maternity care providers, students, and other
similar professionals in the provision of maternity
care through such models.
``(c) Application.--
``(1) In general.--An eligible entity seeking a grant under
subsection (a) shall submit to the Secretary an application, at
such time, in such manner, and containing such information as
the Secretary may require.
``(2) Assurance.--An application under paragraph (1) shall
include an assurance that such entity shall collect information
on and assess the effect of the use of technology-enabled
collaborative learning and capacity building models, including
with respect to--
``(A) maternal health outcomes;
``(B) access to maternal health care services;
``(C) quality of maternal health care; and
``(D) retention of maternity care providers serving
areas and populations described in subsection (a).
``(d) Limitations.--
``(1) Number.--The Secretary may not award more than 1
grant under this section.
``(2) Duration.--A grant awarded under this section shall
be for a 5-year period.
``(e) Access to Broadband.--In administering grants under this
section, the Secretary may coordinate with other agencies to ensure
that funding opportunities are available to support access to reliable,
high-speed internet for grantees.
``(f) Technical Assistance.--The Secretary shall provide (either
directly or by contract) technical assistance to eligible entities,
including recipients of grants under subsection (a), on the
development, use, and sustainability of technology-enabled
collaborative learning and capacity building models to expand access to
maternal health care services provided by such entities, including--
``(1) in health professional shortage areas;
``(2) in areas with high rates of maternal mortality and
severe maternal morbidity or significant racial and ethnic
disparities in maternal health outcomes; and
``(3) for medically underserved populations or American
Indians and Alaska Natives.
``(g) Research and Evaluation.--The Secretary, in consultation with
experts, shall develop a strategic plan to research and evaluate the
evidence for such models.
``(h) Reporting.--
``(1) Eligible entities.--An eligible entity that receives
a grant under subsection (a) shall submit to the Secretary a
report, at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Secretary.--Not later than 4 years after the date of
enactment of this section, the Secretary shall submit to the
Congress, and make available on the website of the Department
of Health and Human Services, a report that includes--
``(A) a description of grants awarded under
subsection (a) and the purpose and amounts of such
grants;
``(B) a summary of--
``(i) the evaluations conducted under
subsection (b)(B);
``(ii) any technical assistance provided
under subsection (g); and
``(iii) the activities conducted under
subsection (a); and
``(C) a description of any significant findings
with respect to--
``(i) patient outcomes; and
``(ii) best practices for expanding, using,
or evaluating technology-enabled collaborative
learning and capacity building models.
``(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $6,000,000 for each of fiscal
years 2023 through 2027.
``(j) Definitions.--In this section:
``(1) Eligible entity.--
``(A) In general.--The term `eligible entity' means
an entity that provides, or supports the provision of,
maternal health care services or other evidence-based
services for pregnant and postpartum individuals--
``(i) in health professional shortage
areas;
``(ii) in areas with high rates of adverse
maternal health outcomes or significant racial
and ethnic disparities in maternal health
outcomes; and
``(iii) who are--
``(I) members of medically
underserved populations; or
``(II) American Indians and Alaska
Natives, including Indian Tribes,
Tribal organizations, and urban Indian
organizations.
``(B) Inclusions.--An eligible entity may include
entities that lead, or are capable of leading a
technology-enabled collaborative learning and capacity
building model.
``(2) Health professional shortage area.--The term `health
professional shortage area' means a health professional
shortage area designated under section 332.
``(3) Indian tribe.--The term `Indian Tribe' has the
meaning given such term in section 4 of the Indian Self-
Determination and Education Assistance Act.
``(4) Maternal mortality.--The term `maternal mortality'
means a death occurring during or within 1-year period after
pregnancy caused by pregnancy-related or childbirth
complications, including a suicide, overdose, or other death
resulting from a mental health or substance use disorder
attributed to or aggravated by pregnancy or childbirth
complications.
``(5) Medically underserved population.--The term
`medically underserved population' has the meaning given such
term in section 330(b)(3).
``(6) Postpartum.--The term `postpartum' means the 1-year
period beginning on the last date of an individual's pregnancy.
``(7) Severe maternal morbidity.--The term `severe maternal
morbidity' means a health condition, including a mental health
or substance use disorder, attributed to or aggravated by
pregnancy or childbirth that results in significant short-term
or long-term consequences to the health of the individual who
was pregnant.
``(8) Technology-enabled collaborative learning and
capacity building model.--The term `technology-enabled
collaborative learning and capacity building model' means a
distance health education model that connects health care
professionals, and other specialists, through simultaneous
interactive videoconferencing for the purpose of facilitating
case-based learning, disseminating best practices, and
evaluating outcomes in the context of maternal health care.
``(9) Tribal organization.--The term `Tribal organization'
has the meaning given such term in section 4 of the Indian
Self-Determination and Education Assistance Act.
``(10) Urban indian organization.--The term `urban Indian
organization' has the meaning given such term in section 4 of
the Indian Health Care Improvement Act.''.
SEC. 1703. GRANTS TO PROMOTE EQUITY IN MATERNAL HEALTH OUTCOMES THROUGH
DIGITAL TOOLS.
(a) In General.--Beginning not later than 1 year after the date of
the enactment of this Act, the Secretary of Health and Human Services
shall make grants to eligible entities to reduce racial and ethnic
disparities in maternal health outcomes by increasing access to digital
tools related to maternal health care.
(b) Applications.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
(c) Prioritization.--In awarding grants under this section, the
Secretary shall prioritize an eligible entity--
(1) in an area with high rates of adverse maternal health
outcomes or significant racial and ethnic disparities in
maternal health outcomes;
(2) in a health professional shortage area designated under
section 332 of the Public Health Service Act (42 U.S.C. 254e);
and
(3) that promotes technology that addresses racial and
ethnic disparities in maternal health outcomes.
(d) Limitations.--
(1) Number.--The Secretary may award not more than 1 grant
under this section.
(2) Duration.--A grant awarded under this section shall be
for a 5-year period.
(e) Technical Assistance.--The Secretary shall provide technical
assistance to an eligible entity on the development, use, evaluation,
and post-grant sustainability of digital tools for purposes of
promoting equity in maternal health outcomes.
(f) Reporting.--
(1) Eligible entities.--An eligible entity that receives a
grant under subsection (a) shall submit to the Secretary a
report, at such time, in such manner, and containing such
information as the Secretary may require.
(2) Secretary.--Not later than 4 years after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report that includes--
(A) an evaluation on the effectiveness of grants
awarded under this section to improve health outcomes
for pregnant and postpartum individuals from racial and
ethnic minority groups;
(B) recommendations on new grant programs that
promote the use of technology to improve such maternal
health outcomes; and
(C) recommendations with respect to--
(i) technology-based privacy and security
safeguards in maternal health care;
(ii) reimbursement rates for maternal
telehealth services;
(iii) the use of digital tools to analyze
large data sets to identify potential
pregnancy-related complications;
(iv) barriers that prevent maternity care
providers from providing telehealth services
across States;
(v) the use of consumer digital tools such
as mobile phone applications, patient portals,
and wearable technologies to improve maternal
health outcomes;
(vi) barriers that prevent access to
telehealth services, including a lack of access
to reliable, high-speed internet or electronic
devices;
(vii) barriers to data sharing between the
Special Supplemental Nutrition Program for
Women, Infants, and Children program and
maternity care providers, and recommendations
for addressing such barriers; and
(viii) lessons learned from expanded access
to telehealth related to maternity care during
the COVID-19 public health emergency.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $6,000,000 for each of fiscal
years 2023 through 2027.
SEC. 1704. REPORT ON THE USE OF TECHNOLOGY IN MATERNITY CARE.
(a) In General.--Not later than 60 days after the date of enactment
of this Act, the Secretary of Health and Human Services shall seek to
enter an agreement with the National Academies of Sciences,
Engineering, and Medicine (referred to in this title as the ``National
Academies'') under which the National Academies shall conduct a study
on the use of technology and patient monitoring devices in maternity
care.
(b) Content.--The agreement entered into pursuant to subsection (a)
shall provide for the study of the following:
(1) The use of innovative technology (including artificial
intelligence) in maternal health care, including the extent to
which such technology has affected racial or ethnic biases in
maternal health care.
(2) The use of patient monitoring devices (including pulse
oximeter devices) in maternal health care, including the extent
to which such devices have affected racial or ethnic biases in
maternal health care.
(3) Best practices for reducing and preventing racial or
ethnic biases in the use of innovative technology and patient
monitoring devices in maternity care.
(4) Best practices in the use of innovative technology and
patient monitoring devices for pregnant and postpartum
individuals from racial and ethnic minority groups.
(5) Best practices with respect to privacy and security
safeguards in such use.
(c) Report.--The agreement under subsection (a) shall direct the
National Academies to complete the study under this section, and
transmit to Congress a report on the results of the study, not later
than 24 months after the date of enactment of this Act.
Subtitle I--Impact to Save Moms
SEC. 1801. PERINATAL CARE ALTERNATIVE PAYMENT MODEL DEMONSTRATION
PROJECT.
(a) In General.--For the period of fiscal years 2023 through 2027,
the Secretary of Health and Human Services (referred to in this section
as the ``Secretary''), acting through the Administrator of the Centers
for Medicare & Medicaid Services, shall establish and implement, in
accordance with the requirements of this section, a demonstration
project, to be known as the Perinatal Care Alternative Payment Model
Demonstration Project (referred to in this section as the
``Demonstration Project''), for purposes of allowing States to test
payment models under their State plans under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) and State child health plans
under title XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to
maternity care provided to pregnant and postpartum individuals enrolled
in such State plans and State child health plans.
(b) Coordination.--In establishing the Demonstration Project, the
Secretary shall coordinate with stakeholders such as--
(1) State Medicaid programs;
(2) maternity care providers and organizations representing
maternity care providers;
(3) relevant organizations representing patients, with a
particular focus on patients from racial and ethnic minority
groups;
(4) relevant community-based organizations, particularly
organizations that seek to improve maternal health outcomes for
pregnant and postpartum individuals from racial and ethnic
minority groups;
(5) perinatal health workers;
(6) relevant health insurance issuers;
(7) hospitals, health systems, midwifery practices,
freestanding birth centers (as such term is defined in
paragraph (3)(B) of section 1905(l) of the Social Security Act
(42 U.S.C. 1396d(l))), Federally-qualified health centers (as
such term is defined in paragraph (2)(B) of such section), and
rural health clinics (as such term is defined in section
1861(aa) of such Act (42 U.S.C. 1395x(aa)));
(8) researchers and policy experts in fields related to
maternity care payment models; and
(9) any other stakeholders as the Secretary determines
appropriate, with a particular focus on stakeholders from
racial and ethnic minority groups.
(c) Considerations.--In establishing the Demonstration Project, the
Secretary shall consider any alternative payment model that--
(1) is designed to improve maternal health outcomes for
racial and ethnic groups with disproportionate rates of adverse
maternal health outcomes;
(2) includes methods for stratifying patients by pregnancy
risk level and, as appropriate, adjusting payments under such
model to take into account pregnancy risk level;
(3) establishes evidence-based quality metrics for such
payments;
(4) includes consideration of non-hospital birth settings
such as freestanding birth centers (as so defined);
(5) includes consideration of social determinants of
maternal health; or
(6) includes diverse maternity care teams that include--
(A) maternity care providers, mental and behavioral
health care providers acting in accordance with State
law, registered dietitians or nutrition professionals
(as such term is defined in 42 U.S.C. 1395x(vv)(2)),
and International Board Certified Lactation
Consultants--
(i) from racially, ethnically, and
professionally diverse backgrounds;
(ii) with experience practicing in racially
and ethnically diverse communities; or
(iii) who have undergone training on
implicit bias and racism; and
(B) perinatal health workers.
(d) Eligibility.--To be eligible to participate in the
Demonstration Project, a State shall submit an application to the
Secretary at such time, in such manner, and containing such information
as the Secretary may require.
(e) Evaluation.--The Secretary shall conduct an evaluation of the
Demonstration Project to determine the impact of the Demonstration
Project on--
(1) maternal health outcomes, with data stratified by race,
ethnicity, socioeconomic indicators, and any other factors as
the Secretary determines appropriate;
(2) spending on maternity care by States participating in
the Demonstration Project;
(3) to the extent practicable, qualitative and quantitative
measures of patient experience; and
(4) any other areas of assessment that the Secretary
determines relevant.
(f) Report.--Not later than one year after the completion or
termination date of the Demonstration Project, the Secretary shall
submit to the Congress, and make publicly available, a report
containing--
(1) the results of any evaluation conducted under
subsection (e); and
(2) a recommendation regarding whether the Demonstration
Project should be continued after fiscal year 2027 and expanded
on a national basis.
(g) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.
(h) Definitions.--In this section:
(1) Alternative payment model.--The term ``alternative
payment model'' has the meaning given such term in section
1833(z)(3)(C) of the Social Security Act (42 U.S.C.
1395l(z)(3)(C)).
(2) Perinatal.--The term ``perinatal'' means the period
beginning on the day an individual becomes pregnant and ending
on the last day of the 1-year period beginning on the last day
of such individual's pregnancy.
(3) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term in
section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
300u-6(g)(1)).
SEC. 1802. MACPAC REPORT.
Not later than two years after the date of the enactment of this
Act, the Medicaid and CHIP Payment and Access Commission shall publish
a report on issues relating to the continuity of coverage under State
plans under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) and State child health plans under title XXI of such Act (42
U.S.C. 1397aa et seq.) for pregnant and postpartum individuals. Such
report shall, at a minimum, include the following:
(1) An assessment of any existing policies under such State
plans and such State child health plans regarding presumptive
eligibility for pregnant individuals while their application
for enrollment in such a State plan or such a State child
health plan is being processed.
(2) An assessment of any existing policies under such State
plans and such State child health plans regarding measures to
ensure continuity of coverage under such a State plan or such a
State child health plan for pregnant and postpartum
individuals, including such individuals who need to change
their health insurance coverage during their pregnancy or the
postpartum period following their pregnancy.
(3) An assessment of any existing policies under such State
plans and such State child health plans regarding measures to
automatically reenroll individuals who are eligible to enroll
under such a State plan or such a State child health plan as a
parent.
(4) If determined appropriate by the Commission, any
recommendations for the Department of Health and Human
Services, or such State plans and such State child health
plans, to ensure continuity of coverage under such a State plan
or such a State child health plan for pregnant and postpartum
individuals.
Subtitle J--Maternal Health Pandemic Response
SEC. 1901. DEFINITIONS.
In this subtitle:
(1) COVID-19 public health emergency.--The term ``COVID-19
public health emergency'' means the period--
(A) beginning on the date that the Secretary of
Health and Human Services declared a public health
emergency under section 319 of the Public Health
Service Act (42 U.S.C. 247d), with respect to COVID-19;
and
(B) ending on the later of the end of such public
health emergency, or January 1, 2023.
(2) Respectful maternity care.--The term ``respectful
maternity care'' refers to care organized for, and provided to,
pregnant and postpartum individuals in a manner that--
(A) is culturally congruent;
(B) maintains their dignity, privacy, and
confidentiality;
(C) ensures freedom from harm and mistreatment; and
(D) enables informed choice and continuous support.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 1902. FUNDING FOR DATA COLLECTION, SURVEILLANCE, AND RESEARCH ON
MATERNAL HEALTH OUTCOMES DURING THE COVID-19 PUBLIC
HEALTH EMERGENCY.
To conduct or support data collection, surveillance, and research
on maternal health as a result of the COVID-19 public health emergency,
including support to assist in the capacity building for State, Tribal,
territorial, and local public health departments to collect and
transmit racial, ethnic, and other demographic data related to maternal
health, there are authorized to be appropriated--
(1) $100,000,000 for the Surveillance for Emerging Threats
to Mothers and Babies program of the Centers for Disease
Control and Prevention, to support the Centers for Disease
Control and Prevention in its efforts to--
(A) work with public health, clinical, and
community-based organizations to provide timely,
continually updated guidance to families and health
care providers on ways to reduce risk to pregnant and
postpartum individuals and their newborns and tailor
interventions to improve their long-term health;
(B) partner with more State, Tribal, territorial,
and local public health programs in the collection and
analysis of clinical data on the impact of COVID-19 on
pregnant and postpartum patients and their newborns,
particularly among patients from racial and ethnic
minority groups; and
(C) establish regionally based centers of
excellence to offer medical, public health, and other
knowledge to ensure communities, especially communities
with large populations of individuals from racial and
ethnic minority groups, can help pregnant and
postpartum individuals and newborns get the care and
support they need;
(2) $30,000,000 for the Enhancing Reviews and Surveillance
to Eliminate Maternal Mortality program (commonly known as the
``ERASE MM program'') of the Centers for Disease Control and
Prevention, to support the Centers for Disease Control and
Prevention in expanding its partnerships with States and Indian
Tribes and provide technical assistance to existing Maternal
Mortality Review Committees;
(3) $45,000,000 for the Pregnancy Risk Assessment
Monitoring System (commonly known as the ``PRAMS'') of the
Centers for Disease Control and Prevention, to support the
Centers for Disease Control and Prevention in its efforts to--
(A) create a COVID-19 supplement to its PRAMS
questionnaire;
(B) add questions around experiences of respectful
maternity care in prenatal, intrapartum, and postpartum
care;
(C) conduct a rapid assessment of COVID-19
awareness, impact on care and experiences, and use of
preventive measures among pregnant, laboring and
birthing, and postpartum individuals during the COVID-
19 public health emergency; and
(D) work to transition the survey to an electronic
platform and expand the survey to a larger population,
with a special focus on reaching underrepresented
communities; and
(4) $15,000,000 for the National Institute of Child Health
and Human Development, to conduct or support research for
interventions to mitigate the effects of the COVID-19 public
health emergency on pregnant and postpartum individuals, with a
particular focus on individuals from racial and ethnic minority
groups.
SEC. 1903. COVID-19 MATERNAL HEALTH DATA COLLECTION AND DISCLOSURE.
(a) Availability of Collected Data.--The Secretary, acting through
the Director of the Centers for Disease Control and Prevention and the
Administrator of the Centers for Medicare & Medicaid Services, shall
make publicly available on the website of the Centers for Disease
Control and Prevention data described in subsection (b).
(b) Data Described.--The data under subsection (a) means data
collected through Federal surveillance systems under the Centers for
Disease Control and Prevention with respect to COVID-19 and individuals
who are pregnant or in a postpartum period. Such data shall include the
following:
(1) Diagnostic testing, including the number of pregnant
and postpartum individuals who are tested for COVID-19 and the
number of positive cases.
(2) Suspected cases of COVID-19 in pregnant and birthing
individuals and individuals in a postpartum period.
(3) Serologic testing, including the number of pregnant and
postpartum individuals tested and the number of such serologic
tests that were positive.
(4) Health care treatment for individuals who were infected
with the virus, including hospitalizations, emergency room
visits, and intensive care unit admissions.
(5) Health outcomes for pregnant individuals and infants
confirmed or suspected of being infected with the virus,
including--
(A) the number of fatalities and case fatalities
(expressed as the proportion of individuals who were
infected with the virus to individuals who died from
the virus); and
(B) the number of stillbirths, infant mortality,
pre-term births, infants born with a low-birth weight,
and cesarean section births.
(c) Indian Health Service.--In carrying out subsection (a), the
Secretary shall consult with Indian Tribes and confer with urban Indian
organizations.
(d) Disaggregated Information.--In carrying out subsection (a), the
Secretary shall disaggregate data by race, ethnicity, and location.
(e) Update.--During the COVID-19 public health emergency, the
Secretary shall update the data made available under this section--
(1) at least on a monthly basis; and
(2) not less than one month after the end of such public
health emergency.
(f) Privacy.--In carrying out subsection (a), the Secretary shall
take steps to protect the privacy of individuals pursuant to
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note).
(g) Guidance.--
(1) In general.--Not later than 30 days after the date of
enactment of this Act, the Secretary shall issue guidance to
States and local public health departments to ensure that--
(A) laboratories that test specimens for COVID-19
receive all relevant demographic data on race,
ethnicity, pregnancy status, and other demographic data
as determined by the Secretary; and
(B) data described in subsection (b) is
disaggregated by race, ethnicity, and location.
(2) Consultation.--In carrying out paragraph (1), the
Secretary shall consult with Indian Tribes--
(A) to ensure that such guidance includes Tribally
developed best practices; and
(B) to reduce misclassification of American Indians
and Alaska Natives.
SEC. 1904. INCLUSION OF PREGNANT INDIVIDUALS AND LACTATING INDIVIDUALS
IN VACCINE AND THERAPEUTIC DEVELOPMENT FOR COVID-19.
The Director of the National Institutes of Health shall when safe
and appropriate, support and advance the inclusion of pregnant and
lactating individuals in therapeutic and vaccine clinical trials with
respect to the treatment or prevention of COVID-19, including
prioritizing recommendations made by the Task Force on Research
Specific to Pregnant Women and Lactating Women established under
section 2041 of the 21st Century Cures Act (42 U.S.C. 289a-2 note) with
respect to including such individuals in such clinical trials.
SEC. 1905. PUBLIC HEALTH COMMUNICATION REGARDING MATERNAL CARE DURING
COVID-19.
The Director of the Centers for Disease Control and Prevention
shall conduct a public health education campaign to increase access by
pregnant individuals, their employers, and their health care providers
to accurate, evidence-based information on COVID-19 and pregnancy
risks, with a particular focus pregnant individuals in underserved
communities.
SEC. 1906. TASK FORCE ON BIRTHING EXPERIENCE AND SAFE MATERNITY CARE
DURING A PUBLIC HEALTH EMERGENCY.
(a) Establishment.--The Secretary, in consultation with the
Director of the Centers for Disease Control and Prevention and the
Administrator of the Health Resources and Services Administration,
shall convene a task force (in this subsection referred to as the
``Task Force'') to develop recommendations, and make such
recommendations publicly available in multiple languages, on respectful
maternity care during the COVID-19 public health emergency and other
public health emergencies, with a particular focus on outcomes for
individuals from racial and ethnic minority groups and other
underserved communities.
(b) Content.--In developing recommendations under paragraph (1),
the Task Force shall address the following:
(1) Measures to facilitate respectful maternity care.
(2) Strategies to increase access to specialized care for
individuals with high-risk pregnancies.
(3) COVID-19 diagnostic testing for pregnant individuals
and individuals in labor.
(4) The designation of a companion during birthing.
(5) The ability to communicate using an electronic mobile
device during birthing.
(6) With respect to an individual who has the virus that
causes COVID-19--
(A) separation from a newborn after birth; and
(B) ensuring safety while breastfeeding.
(7) Licensing, training, and reimbursement for midwives
from racial and ethnic minority groups and underserved
communities.
(8) Financial support for perinatal health workers who
provide nonclinical support to pregnant individuals and
postpartum individuals from underserved communities.
(9) The identification and treatment of prenatal and
postpartum mental and behavioral health conditions may have
developed during or worsened because of the COVID-19 public
health emergency or future public health emergencies, including
anxiety, substance use disorder, and depression.
(10) Strategies to address hospital capacity issues in
communities with an increase in COVID-19 cases, or cases of
other infectious diseases.
(11) Options for maternal care that reduce cross-
contamination and maintain safety and quality of care,
including auxiliary maternity units and freestanding birth
centers.
(12) Methods to identify and address racism, bias, and
discrimination in treatment and support to pregnant and
postpartum individuals, including--
(A) evaluating the training of hospital staff on
implicit bias and racism and respectful maternity care;
and
(B) the collection of demographic data.
(13) Other matters the Task Force determines appropriate.
(c) Membership.--
(1) Chair.--The Secretary shall select the chair of the
Task Force from among the members of the Task Force.
(2) Composition.--The Task Force shall be composed of--
(A) representatives of Federal agencies, including
the agencies listed in paragraph (3);
(B) three or more representatives of State, local,
or territorial public health departments from different
areas in the United States that have a large
historically marginalized population;
(C) one or more representatives of Tribal public
health departments;
(D) one or more obstetrician-gynecologists or other
physicians who provide obstetric care, with
consideration for physicians who are from, or work in,
communities experiencing a high rate of mortality and
morbidity from COVID-19;
(E) one or more nurses who provide obstetric care,
with consideration for physicians who are from, or work
in, communities experiencing a high rate of mortality
and morbidity from COVID-19;
(F) one or more perinatal health workers;
(G) one or more individuals who were pregnant or
gave birth during the COVID-19 public health emergency;
(H) one or more individuals who had the virus that
causes COVID-19 and later gave birth;
(I) one or more individuals who have received
support from a perinatal health; and
(J) three or more independent experts who are
racially and ethnically diverse with knowledge on
racial and ethnic disparities in--
(i) public health;
(ii) maternal health; or
(iii) maternal mortality and severe
maternal morbidity.
(3) Federal agencies.--The agencies represented under
paragraph (2)(A) shall include the following:
(A) The Department of Health and Human Services.
(B) The Centers for Disease Control and Prevention.
(C) The Centers for Medicare & Medicaid Services.
(D) The Health Resources and Services
Administration.
(E) The Indian Health Service.
(F) The National Institutes of Health.
SEC. 1907. GAO REPORT ON MATERNAL HEALTH AND PUBLIC HEALTH EMERGENCY
PREPAREDNESS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to Congress a report on maternal health and public health
emergency preparedness. Such report shall include the information and
recommendations described in subsection (b).
(b) Content of Report.--The report under subsection (b) shall
include the following:
(1) A review of prenatal, labor and delivery, and
postpartum experiences of individuals during such public health
emergency, including--
(A) barriers to accessing pregnancy, birth, and
postpartum care during a pandemic;
(B) public and private insurance coverage with
respect to maternal health care, including telehealth
services;
(C) to the extent practicable, maternal and infant
health outcomes by race and ethnicity (including
quality of care, mortality, morbidity, cesarean section
rates, preterm birth, prevalence of prenatal and
postpartum mental health conditions and substance use
disorders);
(D) with respect to such health outcomes, the
impact of Federal and State policy changes during such
public health emergency;
(E) contributing factors to population-based
disparities in health outcomes, including bias and
discrimination toward individuals from racial and
ethnic minority groups; and
(F) the effect of increased unemployment, paid
family leave, changes in health care coverage, and
other social determinants of health for pregnant and
postpartum individuals during the public health
emergency.
(2) Recommendations on improving the public health
emergency response and preparedness efforts of the Federal
Government with respect to maternal health, with a focus on
outcomes for pregnant and postpartum individuals from racial
and ethnic minority groups, including--
(A) improving research, surveillance, and data
collection with respect to maternal health;
(B) factoring maternal health outcomes and
disparities into decisions regarding distribution of
resources;
(C) improving the distribution of public health
funds, data, and information to Indian Tribes and
Tribal organizations with regard to maternal health
during a public health emergency; and
(D) improving communications during a public health
emergency with--
(i) maternity care providers;
(ii) maternal mental and behavioral health
care providers;
(iii) researchers who specialize in
maternal health, maternal mortality, or severe
maternal morbidity;
(iv) individuals who experienced pregnancy
or childbirth during the COVID-19 public health
emergency;
(v) representatives from community-based
organizations that address maternal health; and
(vi) perinatal health workers.
Subtitle K--Protecting Moms and Babies Against Climate Change
SEC. 1911. DEFINITIONS.
In this subtitle, the following definitions apply:
(1) Adverse maternal and infant health outcomes.--The term
``adverse maternal and infant health outcomes'' includes the
outcomes of preterm birth, low birth weight, stillbirth, infant
or maternal mortality, and severe maternal morbidity.
(2) Institution of higher education.--The term
``institution of higher education'' has the meaning given such
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(3) Minority-serving institution.--The term ``minority-
serving institution'' means an entity specified in any of
paragraphs (1) through (7) of section 371(a) of the Higher
Education Act of 1965 (20 U.S.C. 1067q(a)).
(4) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term in
section 1707(g) of the Public Health Service Act (42 U.S.C.
300u-6(g)).
(5) Risks associated with climate change.--The term ``risks
associated with climate change'' includes risks associated with
extreme heat, air pollution, extreme weather events, and other
environmental issues associated with climate change that can
result in adverse maternal and infant health outcomes.
(6) Stakeholder organization.--The term ``stakeholder
organization'' means--
(A) a community-based organization with expertise
in providing assistance to vulnerable individuals;
(B) a nonprofit organization with expertise in
maternal or infant health or environmental justice; and
(C) a patient advocacy organization representing
vulnerable individuals.
(7) Vulnerable individual.--The term ``vulnerable
individual'' means--
(A) an individual who is pregnant;
(B) an individual who was pregnant during any
portion of the preceding 1-year period; and
(C) an individual under 3 years of age.
SEC. 1912. GRANT PROGRAM TO PROTECT VULNERABLE MOTHERS AND BABIES FROM
CLIMATE CHANGE RISKS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
establish a grant program (in this section referred to as the
``Program'') to protect vulnerable individuals from risks associated
with climate change.
(b) Grant Authority.--In carrying out the Program, the Secretary
may award, on a competitive basis, grants to 10 covered entities.
(c) Applications.--To be eligible for a grant under the Program, a
covered entity shall submit to the Secretary an application at such
time, in such form, and containing such information as the Secretary
may require, which shall include, at a minimum, a description of the
following:
(1) Plans for the use of grant funds awarded under the
Program and how patients and stakeholder organizations were
involved in the development of such plans.
(2) How such grant funds will be targeted to geographic
areas that have disproportionately high levels of risks
associated with climate change for vulnerable individuals.
(3) How such grant funds will be used to address racial and
ethnic disparities in--
(A) adverse maternal and infant health outcomes;
and
(B) exposure to risks associated with climate
change for vulnerable individuals.
(4) Strategies to prevent an initiative assisted with such
grant funds from causing--
(A) adverse environmental impacts;
(B) displacement of residents and businesses;
(C) rent and housing price increases; or
(D) disproportionate adverse impacts on racial and
ethnic minority groups and other underserved
populations.
(d) Selection of Grant Recipients.--
(1) Timing.--Not later than 270 days after the date of the
enactment of this Act, the Secretary shall select the
recipients of grants under the Program.
(2) Consultation.--In selecting covered entities for grants
under the Program, the Secretary shall consult with--
(A) representatives of stakeholder organizations;
(B) the Administrator of the Environmental
Protection Agency;
(C) the Administrator of the National Oceanic and
Atmospheric Administration; and
(D) from the Department of Health and Human
Services--
(i) the Deputy Assistant Secretary for
Minority Health;
(ii) the Administrator of the Centers for
Medicare & Medicaid Services;
(iii) the Administrator of the Health
Resources and Services Administration;
(iv) the Director of the National
Institutes of Health; and
(v) the Director of the Centers for Disease
Control and Prevention.
(3) Priority.--In selecting a covered entity to be awarded
a grant under the Program, the Secretary shall give priority to
covered entities that serve a county--
(A) designated, or located in an area designated,
as a nonattainment area pursuant to section 107 of the
Clean Air Act (42 U.S.C. 7407) for any air pollutant
for which air quality criteria have been issued under
section 108(a) of such Act (42 U.S.C. 7408(a));
(B) with a level of vulnerability of moderate-to-
high or higher, according to the Social Vulnerability
Index of the Centers for Disease Control and
Prevention; or
(C) with temperatures that pose a risk to human
health, as determined by the Secretary, in consultation
with the Administrator of the National Oceanic and
Atmospheric Administration and the Chair of the United
States Global Change Research Program, based on the
best available science.
(4) Limitation.--A recipient of grant funds under the
Program may not use such grant funds to serve a county that is
served by any other recipient of a grant under the Program.
(e) Use of Funds.--A covered entity awarded grant funds under the
Program may only use such grant funds for the following:
(1) Initiatives to identify risks associated with climate
change for vulnerable individuals and to provide services and
support to such individuals that address such risks, which may
include--
(A) training for health care providers, doulas, and
other employees in hospitals, birth centers, midwifery
practices, and other health care practices that provide
prenatal or labor and delivery services to vulnerable
individuals on the identification of, and patient
counseling relating to, risks associated with climate
change for vulnerable individuals;
(B) hiring, training, or providing resources to
community health workers and perinatal health workers
who can help identify risks associated with climate
change for vulnerable individuals, provide patient
counseling about such risks, and carry out the
distribution of relevant services and support;
(C) enhancing the monitoring of risks associated
with climate change for vulnerable individuals,
including by--
(i) collecting data on such risks in
specific census tracts, neighborhoods, or other
geographic areas; and
(ii) sharing such data with local health
care providers, doulas, and other employees in
hospitals, birth centers, midwifery practices,
and other health care practices that provide
prenatal or labor and delivery services to
local vulnerable individuals; and
(D) providing vulnerable individuals--
(i) air conditioning units, residential
weatherization support, filtration systems,
household appliances, or related items;
(ii) direct financial assistance; and
(iii) services and support, including
housing and transportation assistance, to
prepare for or recover from extreme weather
events, which may include floods, hurricanes,
wildfires, droughts, and related events.
(2) Initiatives to mitigate levels of and exposure to risks
associated with climate change for vulnerable individuals,
which shall be based on the best available science and which
may include initiatives to--
(A) develop, maintain, or expand urban or community
forestry initiatives and tree canopy coverage
initiatives;
(B) improve infrastructure, including buildings and
paved surfaces;
(C) develop or improve community outreach networks
to provide culturally and linguistically appropriate
information and notifications about risks associated
with climate change for vulnerable individuals; and
(D) provide enhanced services to racial and ethnic
minority groups and other underserved populations.
(f) Length of Award.--A grant under this section shall be disbursed
over 4 fiscal years.
(g) Technical Assistance.--The Secretary shall provide technical
assistance to a covered entity awarded a grant under the Program to
support the development, implementation, and evaluation of activities
funded with such grant.
(h) Reports to Secretary.--
(1) Annual report.--For each fiscal year during which a
covered entity is disbursed grant funds under the Program, such
covered entity shall submit to the Secretary a report that
summarizes the activities carried out by such covered entity
with such grant funds during such fiscal year, which shall
include a description of the following:
(A) The involvement of stakeholder organizations in
the implementation of initiatives assisted with such
grant funds.
(B) Relevant health and environmental data,
disaggregated, to the extent practicable, by race,
ethnicity, gender, and pregnancy status.
(C) Qualitative feedback received from vulnerable
individuals with respect to initiatives assisted with
such grant funds.
(D) Criteria used in selecting the geographic areas
assisted with such grant funds.
(E) Efforts to address racial and ethnic
disparities in adverse maternal and infant health
outcomes and in exposure to risks associated with
climate change for vulnerable individuals.
(F) Any negative and unintended impacts of
initiatives assisted with such grant funds, including--
(i) adverse environmental impacts;
(ii) displacement of residents and
businesses;
(iii) rent and housing price increases; and
(iv) disproportionate adverse impacts on
racial and ethnic minority groups and other
underserved populations.
(G) How the covered entity will address and prevent
any impacts described in subparagraph (F).
(2) Publication.--Not later than 30 days after the date on
which a report is submitted under paragraph (1), the Secretary
shall publish such report on a public website of the Department
of Health and Human Services.
(i) Report to Congress.--Not later than the date that is 5 years
after the date on which the Program is established, the Secretary shall
submit to Congress and publish on a public website of the Department of
Health and Human Services a report on the results of the Program,
including the following:
(1) Summaries of the annual reports submitted under
subsection (h).
(2) Evaluations of the initiatives assisted with grant
funds under the Program.
(3) An assessment of the effectiveness of the Program in--
(A) identifying risks associated with climate
change for vulnerable individuals;
(B) providing services and support to such
individuals;
(C) mitigating levels of and exposure to such
risks; and
(D) addressing racial and ethnic disparities in
adverse maternal and infant health outcomes and in
exposure to such risks.
(4) A description of how the Program could be expanded,
including--
(A) monitoring efforts or data collection that
would be required to identify areas with high levels of
risks associated with climate change for vulnerable
individuals;
(B) how such areas could be identified using the
strategy developed under section 1915; and
(C) recommendations for additional funding.
(j) Covered Entity Defined.--In this section, the term ``covered
entity'' means a consortium of organizations serving a county that--
(1) shall include a community-based organization; and
(2) may include--
(A) another stakeholder organization;
(B) the government of such county;
(C) the governments of one or more municipalities
within such county;
(D) a State or local public health department or
emergency management agency;
(E) a local health care practice, which may include
a licensed and accredited hospital, birth center,
midwifery practice, or other health care practice that
provides prenatal or labor and delivery services to
vulnerable individuals;
(F) an Indian tribe or tribal organization (as such
terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
5304));
(G) an Urban Indian organization (as defined in
section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603)); and
(H) an institution of higher education.
(k) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $100,000,000 for the period of
fiscal years 2023 through 2026.
SEC. 1913. GRANT PROGRAM FOR EDUCATION AND TRAINING AT HEALTH
PROFESSION SCHOOLS.
(a) In General.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
establish a grant program (in this section referred to as the
``Program'') to provide funds to health profession schools to support
the development and integration of education and training programs for
identifying and addressing risks associated with climate change for
vulnerable individuals.
(b) Grant Authority.--In carrying out the Program, the Secretary
may award, on a competitive basis, grants to health profession schools.
(c) Application.--To be eligible for a grant under the Program, a
health profession school shall submit to the Secretary an application
at such time, in such form, and containing such information as the
Secretary may require, which shall include, at a minimum, a description
of the following:
(1) How such health profession school will engage with
vulnerable individuals, and stakeholder organizations
representing such individuals, in developing and implementing
the education and training programs supported by grant funds
awarded under the Program.
(2) How such health profession school will ensure that such
education and training programs will address racial and ethnic
disparities in exposure to, and the effects of, risks
associated with climate change for vulnerable individuals.
(d) Use of Funds.--A health profession school awarded a grant under
the Program shall use the grant funds to develop, and integrate into
the curriculum and continuing education of such health profession
school, education and training on each of the following:
(1) Identifying risks associated with climate change for
vulnerable individuals and individuals with the intent to
become pregnant.
(2) How risks associated with climate change affect
vulnerable individuals and individuals with the intent to
become pregnant.
(3) Racial and ethnic disparities in exposure to, and the
effects of, risks associated with climate change for vulnerable
individuals and individuals with the intent to become pregnant.
(4) Patient counseling and mitigation strategies relating
to risks associated with climate change for vulnerable
individuals.
(5) Relevant services and support for vulnerable
individuals relating to risks associated with climate change
and strategies for ensuring vulnerable individuals have access
to such services and support.
(6) Implicit and explicit bias, racism, and discrimination.
(7) Related topics identified by such health profession
school based on the engagement of such health profession school
with vulnerable individuals and stakeholder organizations
representing such individuals.
(e) Partnerships.--In carrying out activities with grant funds, a
health profession school awarded a grant under the Program may partner
with one or more of the following:
(1) A State or local public health department.
(2) A health care professional membership organization.
(3) A stakeholder organization.
(4) A health profession school.
(5) An institution of higher education.
(f) Reports to Secretary.--
(1) Annual report.--For each fiscal year during which a
health profession school is disbursed grant funds under the
Program, such health profession school shall submit to the
Secretary a report that describes the activities carried out
with such grant funds during such fiscal year.
(2) Final report.--Not later than the date that is 1 year
after the end of the last fiscal year during which a health
profession school is disbursed grant funds under the Program,
the health profession school shall submit to the Secretary a
final report that summarizes the activities carried out with
such grant funds.
(g) Report to Congress.--Not later than the date that is 6 years
after the date on which the Program is established, the Secretary shall
submit to Congress and publish on a public website of the Department of
Health and Human Services a report that includes the following:
(1) A summary of the reports submitted under subsection
(f).
(2) Recommendations to improve education and training
programs at health profession schools with respect to
identifying and addressing risks associated with climate change
for vulnerable individuals.
(h) Health Profession School Defined.--In this section, the term
``health profession school'' means an accredited--
(1) medical school;
(2) school of nursing;
(3) midwifery program;
(4) physician assistant education program;
(5) teaching hospital;
(6) residency or fellowship program; or
(7) other school or program determined appropriate by the
Secretary.
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $5,000,000 for the period of
fiscal years 2023 through 2026.
SEC. 1914. NIH CONSORTIUM ON BIRTH AND CLIMATE CHANGE RESEARCH.
(a) Establishment.--Not later than one year after the date of the
enactment of this Act, the Director of the National Institutes of
Health shall establish the Consortium on Birth and Climate Change
Research (in this section referred to as the ``Consortium'').
(b) Duties.--
(1) In general.--The Consortium shall coordinate, across
the institutes, centers, and offices of the National Institutes
of Health, research on the risks associated with climate change
for vulnerable individuals.
(2) Required activities.--In carrying out paragraph (1),
the Consortium shall--
(A) establish research priorities, including by
prioritizing research that--
(i) identifies the risks associated with
climate change for vulnerable individuals with
a particular focus on disparities in such risks
among racial and ethnic minority groups and
other underserved populations; and
(ii) identifies strategies to reduce levels
of, and exposure to, such risks, with a
particular focus on risks among racial and
ethnic minority groups and other underserved
populations;
(B) identify gaps in available data related to such
risks;
(C) identify gaps in, and opportunities for,
research collaborations;
(D) identify funding opportunities for community-
based organizations and researchers from racially,
ethnically, and geographically diverse backgrounds; and
(E) publish annual reports on the work and findings
of the Consortium on a public website of the National
Institutes of Health.
(c) Membership.--The Director shall appoint to the Consortium
representatives of such institutes, centers, and offices of the
National Institutes of Health as the Director considers appropriate,
including, at a minimum, representatives of--
(1) the National Institute of Environmental Health
Sciences;
(2) the National Institute on Minority Health and Health
Disparities;
(3) the Eunice Kennedy Shriver National Institute of Child
Health and Human Development;
(4) the National Institute of Nursing Research; and
(5) the Office of Research on Women's Health.
(d) Chairperson.--The Chairperson of the Consortium shall be
designated by the Director and selected from among the representatives
appointed under subsection (c).
(e) Consultation.--In carrying out the duties described in
subsection (b), the Consortium shall consult with--
(1) the heads of relevant Federal agencies, including--
(A) the Environmental Protection Agency;
(B) the National Oceanic and Atmospheric
Administration;
(C) the Occupational Safety and Health
Administration; and
(D) from the Department of Health and Human
Services--
(i) the Office of Minority Health in the
Office of the Secretary;
(ii) the Centers for Medicare & Medicaid
Services;
(iii) the Health Resources and Services
Administration;
(iv) the Centers for Disease Control and
Prevention;
(v) the Indian Health Service; and
(vi) the Administration for Children and
Families; and
(2) representatives of--
(A) stakeholder organizations;
(B) health care providers and professional
membership organizations with expertise in maternal
health or environmental justice;
(C) State and local public health departments;
(D) licensed and accredited hospitals, birth
centers, midwifery practices, or other health care
practices that provide prenatal or labor and delivery
services to vulnerable individuals; and
(E) institutions of higher education, including
such institutions that are minority-serving
institutions or have expertise in maternal health or
environmental justice.
SEC. 1915. STRATEGY FOR IDENTIFYING CLIMATE CHANGE RISK ZONES FOR
VULNERABLE MOTHERS AND BABIES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
shall develop a strategy (in this section referred to as the
``Strategy'') for designating areas that the Secretary determines to
have a high risk of adverse maternal and infant health outcomes among
vulnerable individuals as a result of risks associated with climate
change.
(b) Strategy Requirements.--
(1) In general.--In developing the Strategy, the Secretary
shall establish a process to identify areas where vulnerable
individuals are exposed to a high risk of adverse maternal and
infant health outcomes as a result of risks associated with
climate change in conjunction with other factors that can
impact such health outcomes, including--
(A) the incidence of diseases associated with air
pollution, extreme heat, and other environmental
factors;
(B) the availability and accessibility of maternal
and infant health care providers;
(C) English-language proficiency among women of
reproductive age;
(D) the health insurance status of women of
reproductive age;
(E) the number of women of reproductive age who are
members of racial or ethnic groups with
disproportionately high rates of adverse maternal and
infant health outcomes;
(F) the socioeconomic status of women of
reproductive age, including with respect to--
(i) poverty;
(ii) unemployment;
(iii) household income; and
(iv) educational attainment; and
(G) access to quality housing, transportation, and
nutrition.
(2) Resources.--In developing the Strategy, the Secretary
shall identify, and incorporate a description of, the
following:
(A) Existing mapping tools or Federal programs that
identify--
(i) risks associated with climate change
for vulnerable individuals; and
(ii) other factors that can influence
maternal and infant health outcomes, including
the factors described in paragraph (1).
(B) Environmental, health, socioeconomic, and
demographic data relevant to identifying risks
associated with climate change for vulnerable
individuals.
(C) Existing monitoring networks that collect data
described in subparagraph (B), and any gaps in such
networks.
(D) Federal, State, and local stakeholders involved
in maintaining monitoring networks identified under
subparagraph (C), and how such stakeholders are
coordinating their monitoring efforts.
(E) Additional monitoring networks, and
enhancements to existing monitoring networks, that
would be required to address gaps identified under
subparagraph (C), including at the subcounty and census
tract level.
(F) Funding amounts required to establish the
monitoring networks identified under subparagraph (E)
and recommendations for Federal, State, and local
coordination with respect to such networks.
(G) Potential uses for data collected and generated
as a result of the Strategy, including how such data
may be used in determining recipients of grants under
the program established by section 1912 or other
similar programs.
(H) Other information the Secretary considers
relevant for the development of the Strategy.
(c) Coordination and Consultation.--In developing the Strategy, the
Secretary shall--
(1) coordinate with the Administrator of the Environmental
Protection Agency and the Administrator of the National Oceanic
and Atmospheric Administration; and
(2) consult with--
(A) stakeholder organizations;
(B) health care providers and professional
membership organizations with expertise in maternal
health or environmental justice;
(C) State and local public health departments;
(D) licensed and accredited hospitals, birth
centers, midwifery practices, or other health care
providers that provide prenatal or labor and delivery
services to vulnerable individuals; and
(E) institutions of higher education, including
such institutions that are minority-serving
institutions or have expertise in maternal health or
environmental justice.
(d) Notice and Comment.--At least 240 days before the date on which
the Strategy is published in accordance with subsection (e), the
Secretary shall provide--
(1) notice of the Strategy on a public website of the
Department of Health and Human Services; and
(2) an opportunity for public comment of at least 90 days.
(e) Publication.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall publish on a public website
of the Department of Health and Human Services--
(1) the Strategy;
(2) the public comments received under subsection (d); and
(3) the responses of the Secretary to such public comments.
Subtitle L--Maternal Vaccinations
SEC. 1921. MATERNAL VACCINATION AWARENESS AND EQUITY CAMPAIGN.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary''), acting through the
Director of the Centers for Disease Control and Prevention, shall carry
out a national campaign to--
(1) increase awareness of the importance of maternal
vaccinations for the health of pregnant and postpartum
individuals and their children; and
(2) increase maternal vaccination rates, with a focus on
communities with historically high rates of unvaccinated
individuals.
(b) Consultation.--In carrying out the campaign under this
subtitle, the Secretary shall consult with relevant community-based
organizations, health care professional associations and public health
associations, State public health departments and local public health
departments, Tribal-serving organizations, nonprofit organizations, and
nationally recognized private entities.
(c) Activities.--The campaign under this section shall--
(1) focus on increasing maternal vaccination rates in
communities with historically high rates of unvaccinated
individuals, including for pregnant and postpartum individuals
from racial and ethnic minority groups;
(2) include efforts to engage with pregnant and postpartum
individuals in communities with historically high rates of
unvaccinated individuals to seek input on the development and
effectiveness of the campaign;
(3) provide evidence-based, culturally congruent resources
and communications efforts; and
(4) be carried out in partnership with trusted individuals
and entities in communities with historically high rates of
unvaccinated individuals, including community-based
organizations, community health centers, perinatal health
workers, and maternity care providers.
(d) Collaboration.--The Secretary shall ensure that the information
and resources developed for the campaign under this section are made
publicly available and shared with relevant Federal, State, and local
entities.
(e) Evaluation.--Not later than the end of fiscal year 2026, the
Secretary shall--
(1) establish quantitative and qualitative metrics to
evaluate the campaign under this section; and
(2) submit a report detailing the campaign's impact to the
Congress.
(f) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $2,000,000 for each of fiscal
years 2023 through 2027.
TITLE II--CHILDREN'S HEALTH INSURANCE PROGRAM PERMANENCY
SEC. 2001. PERMANENT EXTENSION OF CHILDREN'S HEALTH INSURANCE PROGRAM.
(a) In General.--Section 2104(a)(28) of the Social Security Act (42
U.S.C. 1397dd(a)(28)) is amended to read as follows:
``(28) for fiscal year 2027 and each subsequent year, such
sums as are necessary to fund allotments to States under
subsections (c) and (m).''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
(A) in paragraph (2)(B)(i), by striking ``,, 2023,
and 2027'' and inserting ``and 2023'';
(B) in paragraph (5)--
(i) by striking ``for a fiscal year'' and
inserting ``for a fiscal year before 2027'';
and
(ii) by striking ``2023, or 2027'' and
inserting ``or 2023'';
(C) in paragraph (7)--
(i) in subparagraph (A), by striking ``and
ending with fiscal year 2027,''; and
(ii) in the flush left matter at the end,
by striking ``or fiscal year 2026'' and
inserting ``fiscal year 2026, or a subsequent
even-numbered fiscal year'';
(D) in paragraph (9)--
(i) by striking ``(10), or (11)'' and
inserting ``or (10)''; and
(ii) by striking ``2023, or 2027,'' and
inserting ``or 2023''; and
(E) by striking paragraph (11).
(2) Conforming amendment.--Section 50101(b)(2) of the
Bipartisan Budget Act of 2018 (Public Law 115-123) is repealed.
SEC. 2002. PERMANENT EXTENSIONS OF OTHER PROGRAMS AND DEMONSTRATION
PROJECTS.
(a) Pediatric Quality Measures Program.--Section 1139A(i)(1) of the
Social Security Act (42 U.S.C. 1320b-9a(i)(1)) is amended--
(1) in subparagraph (C), by striking at the end ``and'';
(2) in subparagraph (D), by striking the period at the end
and insert a semicolon; and
(3) by adding at the end the following new subparagraphs:
``(E) for fiscal year 2028, $15,000,000 for the
purpose of carrying out this section (other than
subsections (e), (f), and (g)); and
``(F) for a subsequent fiscal year, the amount
appropriated under this paragraph for the previous
fiscal year, increased by the percentage increase in
the consumer price index for all urban consumers (all
items; United States city average) over such previous
fiscal year, for the purpose of carrying out this
section (other than subsections (e), (f), and (g)).''.
(b) Express Lane Eligibility Option.--Section 1902(e)(13) of the
Social Security Act (42 U.S.C. 1396a(e)(13)) is amended by striking
subparagraph (I).
(c) Assurance of Affordability Standard for Children and
Families.--
(1) In general.--Section 2105(d)(3) of the Social Security
Act (42 U.S.C. 1397ee(d)(3)) is amended--
(A) in the paragraph heading, by striking ``through
september 30, 2027''; and
(B) in subparagraph (A), in the matter preceding
clause (i)--
(i) by striking ``During the period that
begins on the date of enactment of the Patient
Protection and Affordable Care Act and ends on
September 30, 2027'' and inserting ``Beginning
on the date of the enactment of the Patient
Protection and Affordable Care Act'';
(ii) by striking ``During the period that
begins on October 1, 2019, and ends on
September 30, 2027'' and inserting ``Beginning
on October 1, 2019''; and
(iii) by striking ``The preceding sentences
shall not be construed as preventing a State
during any such periods from'' and inserting
``The preceding sentences shall not be
construed as preventing a State from''.
(2) Conforming amendments.--Section 1902(gg)(2) of the
Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
(A) in the paragraph heading, by striking ``through
september 30, 2027''; and
(B) by striking ``through September 30'' and all
that follows through ``ends on September 30, 2027'' and
inserting ``(but beginning on October 1, 2019,''.
(d) Qualifying States Option.--Section 2105(g)(4) of the Social
Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
(1) in the paragraph heading, by striking ``for fiscal
years 2009 through 2027'' and inserting ``after fiscal year
2008''; and
(2) in subparagraph (A), by striking ``for any of fiscal
years 2009 through 2027'' and inserting ``for any fiscal year
after fiscal year 2008''.
(e) Outreach and Enrollment Program.--Section 2113 of the Social
Security Act (42 U.S.C. 1397mm) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``during the
period of fiscal years 2009 through 2027'' and
inserting ``, beginning with fiscal year 2009,'';
(B) in paragraph (2)--
(i) by striking ``10 percent of such
amounts'' and inserting ``10 percent of such
amounts for the period or the fiscal year for
which such amounts are appropriated''; and
(ii) by striking ``during such period'' and
inserting ``, during such period or such fiscal
year,''; and
(C) in paragraph (3), by striking ``For the period
of fiscal years 2024 through 2027, an amount equal to
10 percent of such amounts'' and inserting ``Beginning
with fiscal year 2024, an amount equal to 10 percent of
such amounts for the period or the fiscal year for
which such amounts are appropriated''; and
(2) in subsection (g)--
(A) by striking ``2017,,'' and inserting ``2017,'';
(B) by striking ``and $48,000,000'' and inserting
``$48,000,000''; and
(C) by inserting after ``through 2027'' the
following: ``, $12,000,000 for fiscal year 2028, and,
for each fiscal year after fiscal year 2028, the amount
appropriated under this subsection for the previous
fiscal year, increased by the percentage increase in
the consumer price index for all urban consumers (all
items; United States city average) over such previous
fiscal year''.
(f) Child Enrollment Contingency Fund.--Section 2104(n) of the
Social Security Act (42 U.S.C. 1397dd(n)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A)(ii)--
(i) by striking ``and 2024 through 2026''
and inserting ``beginning with fiscal year
2024''; and
(ii) by striking ``2023, and 2027'' and
inserting ``, and 2023''; and
(B) in subparagraph (B)--
(i) by striking ``2024 through 2026'' and
inserting ``beginning with fiscal year 2024'';
and
(ii) by striking ``2023, and 2027'' and
inserting ``, and 2023''; and
(2) in paragraph (3)(A)--
(A) by striking ``fiscal years 2024 through 2026''
and inserting ``fiscal year 2024 or any subsequent
fiscal year''; and
(B) by striking ``2023, or 2027'' and inserting ``,
or 2023''.
SEC. 2003. STATE OPTION TO INCREASE CHILDREN'S ELIGIBILITY FOR MEDICAID
AND CHIP.
Section 2110(b)(1)(B)(ii) of the Social Security Act (42 U.S.C.
1397jj(b)(1)(B)(ii)) is amended--
(1) in subclause (II), by striking ``or'' at the end;
(2) in subclause (III), by striking ``and'' at the end and
inserting ``or''; and
(3) by inserting after subclause (III) the following new
subclause:
``(IV) at the option of the State, whose
family income exceeds the maximum income level
otherwise established for children under the
State child health plan as of the date of the
enactment of this subclause; and''.
TITLE III--FAMILY AND MEDICAL LEAVE
SEC. 3001. DEFINITIONS.
In this title, the following definitions apply:
(1) Caregiving day.--The term ``caregiving day'' means,
with respect to an individual, a calendar day in which the
individual engaged in qualified caregiving.
(2) Commissioner.--The term ``Commissioner'' means the
Commissioner of Social Security.
(3) Deputy commissioner.--The term ``Deputy Commissioner''
means the Deputy Commissioner who heads the Office of Paid
Family and Medical Leave established under section 3002(a).
(4) Eligible individual.--The term ``eligible individual''
means an individual who is entitled to a benefit under section
3003 for a particular month, upon filing an application for
such benefit for such month.
(5) Initial waiting period.--The term ``initial waiting
period'' means a period beginning with the first caregiving day
of an individual occurring during the individual's benefit
period and ending after the earlier of--
(A) the fifth caregiving day of the individual
occurring during the benefit period; or
(B) the month preceding the first month in the
benefit period during which occur not less than 15
caregiving days of the individual.
(6) Qualified caregiving.--The term ``qualified
caregiving'' means any activity engaged in by an individual,
other than regular employment, for a reason for which an
eligible employee would be entitled to leave under
subparagraphs (A) through (E) of paragraph (1) of section
102(a) of the Family and Medical Leave Act of 1993 (29 U.S.C.
2612(a)).
(7) Self-employment income.--The term ``self-employment
income'' has the same meaning as such term in section 211(b) of
the Social Security Act (42 U.S.C. 411(b)).
(8) State.--The term ``State'' means any State of the
United States or the District of Columbia or any territory or
possession of the United States.
(9) Wages.--The term ``wages'', except as such term is used
in subsection (h)(2) of section 3003, has the same meaning as
such term in section 209 of the Social Security Act (42 U.S.C.
409).
(10) 60-day limitation period.--The term ``60-day
limitation period'' means a period--
(A) beginning with the first caregiving day of an
individual occurring during the individual's benefit
period and after the expiration of the individual's 5-
day waiting period, if applicable; and
(B) ending with the 60th caregiving day of the
individual occurring during the benefit period and
after the expiration of the 5-day waiting period,
disregarding any caregiving day of the individual occurring
during any month in the benefit period after the first 20
caregiving days of the individual occurring during such month.
SEC. 3002. OFFICE OF PAID FAMILY AND MEDICAL LEAVE.
(a) Establishment of Office.--There is established within the
Social Security Administration an office to be known as the Office of
Paid Family and Medical Leave. The Office shall be headed by a Deputy
Commissioner who shall be appointed by the Commissioner.
(b) Responsibilities of Deputy Commissioner.--The Commissioner,
acting through the Deputy Commissioner, shall be responsible for--
(1) hiring personnel and making employment decisions with
regard to such personnel;
(2) issuing such regulations as may be necessary to carry
out the purposes of this title;
(3) entering into cooperative agreements with other
agencies and departments to ensure the efficiency of the
administration of the program;
(4) determining eligibility for family and medical leave
insurance benefits under section 3003;
(5) determining benefit amounts for each month of such
eligibility and making timely payments of such benefits to
entitled individuals in accordance with such section;
(6) establishing and maintaining a system of records
relating to the administration of such section;
(7) preventing fraud and abuse relating to such benefits;
(8) providing information on request regarding eligibility
requirements, the claims process, benefit amounts, maximum
benefits payable, notice requirements, nondiscrimination
rights, confidentiality, coordination of leave under this title
and other laws, collective bargaining agreements, and employer
policies;
(9) annually providing employers a notice informing
employees of the availability of such benefits;
(10) annually making available to the public a report that
includes the number of individuals who received such benefits,
the purposes for which such benefits were received, and an
analysis of utilization rates of such benefits by gender, race,
ethnicity, and income levels; and
(11) tailoring culturally and linguistically competent
education and outreach toward increasing utilization rates of
benefits under such section.
(c) Availability of Data.--The Commissioner shall make available to
the Deputy Commissioner such data as the Commissioner determines
necessary to enable the Deputy Commissioner to effectively carry out
the responsibilities described in subsection (b).
SEC. 3003. FAMILY AND MEDICAL LEAVE INSURANCE BENEFIT PAYMENTS.
(a) In General.--Every individual who--
(1) is insured for disability insurance benefits (as
determined under section 223(c) of the Social Security Act (42
U.S.C. 423(c))) at the time such individual's application is
filed;
(2) has earned income from employment during the 12 months
prior to the month in which the application is filed;
(3) has filed an application for a family and medical leave
insurance benefit in accordance with subsection (d); and
(4) was engaged in qualified caregiving, or anticipates
being so engaged, during the period that begins 90 days before
the date on which such application is filed or within 30 days
after such date,
shall be entitled to such a benefit for each month in the benefit
period specified in subsection (c), not to exceed 60 caregiving days
per benefit period.
(b) Benefit Amount.--
(1) In general.--Except as otherwise provided in this
subsection, the benefit amount to which an individual is
entitled under this section for a month shall be an amount
equal to the greater of--
(A) the lesser of \1/18\ of the wages and self-
employment income of the individual for the calendar
year in which such wages and self-employment income are
the highest among the most recent three calendar years,
or the maximum benefit amount determined under
paragraph (2); or
(B) the minimum benefit amount determined under
paragraph (2),
multiplied by the quotient (not greater than 1) obtained by
dividing the number of caregiving days of the individual in
such month by 20.
(2) Annual increase of maximum and minimum benefit
amounts.--
(A) For individuals who initially become eligible
for family and medical leave insurance benefits in the
first full calendar year after the date of enactment of
this Act, the maximum monthly benefit amount and the
minimum monthly benefit amount shall be $4,000 and
$580, respectively.
(B) For individuals who initially become eligible
for family and medical leave insurance benefits in any
calendar year after such first full calendar year the
maximum benefit amount and the minimum benefit amount
shall be, respectively, the product of the
corresponding amount determined with respect to the
first calendar year under subparagraph (A) and the
quotient obtained by dividing--
(i) the national average wage index (as
defined in section 209(k)(1) of the Social
Security Act (42 U.S.C. 409(k)(1))) for the
second calendar year preceding the calendar
year for which the determination is made, by
(ii) the national average wage index (as so
defined) for the calendar year immediately
preceding the calendar year in which occurs the
date of enactment of this Act.
(3) Limitations on benefits paid.--
(A) Nonpayable waiting period.--Any calendar day
during an individual's benefit period which occurs
before the expiration of an initial waiting period
shall not be taken into account under this subsection
as a caregiving day of the individual.
(B) Limitation on total benefits paid.--Any
calendar day during an individual's benefit period
which occurs after the expiration of a 60-day
limitation period shall not be taken into account under
this subsection as a caregiving day of the individual.
(4) Reduction in benefit amount on account of receipt of
certain benefits.--A benefit under this section for a month
shall be reduced by the amount, if any, in certain benefits (as
determined under regulations issued by the Commissioner) as may
be otherwise received by an individual. For purposes of the
preceding sentence, certain benefits include--
(A) periodic benefits on account of such
individual's total or partial disability under a
workmen's compensation law or plan of the United States
or a State; and
(B) periodic benefits on account of an individual's
employment status under an unemployment law or plan of
the United States or a State.
(5) Coordination of benefit amount with certain state
benefits.--A benefit received under this section shall be
coordinated, in a manner determined by regulations issued by
the Commissioner, with the periodic benefits received from
temporary disability insurance or family leave insurance
programs under any law or plan of a State, a political
subdivision (as that term is used in section 218(b)(2) of the
Social Security Act (42 U.S.C. 418(b)(2))), or an
instrumentality of two or more States (as that term is used in
section 218(g) of such Act of the Social Security Act (42
U.S.C. 418(g))).
(c) Benefit Period.--
(1) In general.--Except as provided in paragraph (2), the
benefit period specified in this subsection shall begin on the
1st day of the 1st month in which the individual meets the
criteria specified in paragraphs (1), (2), and (3) of
subsection (a), and shall end on the date that is 365 days
after the 1st day of the benefit period.
(2) Retroactive benefits.--In the case of an application
for benefits under this section for qualified caregiving in
which the individual was engaged at any time during the 90-day
period preceding the date on which such application is
submitted, the benefit period specified in this subsection
shall begin on the later of--
(A) the 1st day of the 1st month in which the
individual engaged in such qualified caregiving; or
(B) the 1st day of the 1st month that begins during
such 90-day period,
and shall end on the date that is 365 days after the 1st day of
the benefit period.
(d) Application.--An application for a family and medical leave
insurance benefit shall include--
(1) a statement that the individual was engaged in
qualified caregiving, or anticipates being so engaged, during
the period that begins 90 days before the date on which the
application is submitted or within 30 days after such date;
(2) if the qualified caregiving described in the statement
in paragraph (1) is engaged in by the individual because of a
serious health condition of the individual or a relative of the
individual, a certification, issued by the health care provider
treating such serious health condition, that affirms the
information specified in paragraph (1) and contains such
information as the Commissioner shall specify in regulations,
which shall be no more than the information that is required to
be stated under section 103(b) of the Family and Medical Leave
Act of 1993 (29 U.S.C. 2613(b));
(3) if such qualified caregiving is engaged in by the
individual for any other authorized reason, a certification,
issued by a relevant authority determined under regulations
issued by the Commissioner, that affirms the circumstances
giving rise to such reason; and
(4) an attestation from the applicant that his or her
employer has been provided with written notice of the
individual's intention to take family or medical leave, if the
individual has an employer, or to the Commissioner in all other
cases.
(e) Ineligibility; Disqualification.--
(1) Ineligibility for benefit.--An individual shall be
ineligible for a benefit under this section for any month for
which the individual is entitled to--
(A) disability insurance benefits under section 223
of the Social Security Act (42 U.S.C. 423) or a similar
permanent disability program under any law or plan of a
State or political subdivision or instrumentality of a
State (as such terms are used in section 218 of the
Social Security Act (42 U.S.C. 418));
(B) monthly insurance benefits under section 202 of
such Act (42 U.S.C. 402) based on such individual's
disability (as defined in section 223(d) of such Act
(42 U.S.C. 423(d))); or
(C) benefits under title XVI of such Act (42 U.S.C.
1381 et seq.) based on such individual's status as a
disabled individual (as determined under section 1614
of such Act (42 U.S.C. 1382c)).
(2) Disqualification.--An individual who has been convicted
of a violation under section 208 of the Social Security Act (42
U.S.C. 408) or who has been found to have used false statements
to secure benefits under this section, shall be ineligible for
benefits under this section for a 1-year period following the
date of such conviction.
(f) Review of Eligibility and Benefit Payment Determinations.--
(1) Eligibility determinations.--
(A) In general.--The Commissioner shall provide
notice to an individual applying for benefits under
this section of the initial determination of
eligibility for such benefits, and the estimated
benefit amount for a month in which one caregiving day
of the individual occurs, as soon as practicable after
the application is received.
(B) Review.--An individual may request review of an
initial adverse determination with respect to such
application at any time before the end of the 20-day
period that begins on the date notice of such
determination is received, except that such 20-day
period may be extended for good cause. As soon as
practicable after the individual requests review of the
determination, the Commissioner shall provide notice to
the individual of a final determination of eligibility
for benefits under this section.
(2) Benefit payment determinations.--
(A) In general.--The Commissioner shall make any
monthly benefit payment to an individual claiming
benefits for a month under this section, or provide
notice of the reason such payment will not be made if
the Commissioner determines that the individual is not
entitled to payment for such month, not later than 20
days after the individual's monthly benefit claim
report for such month is received. Such monthly report
shall be filed with the Commissioner not later than 15
days after the end of each month.
(B) Review.--If the Commissioner determines that
payment will not be made to an individual for a month,
or if the Commissioner determines that payment shall be
made based on a number of caregiving days in the month
inconsistent with the number of caregiving days in the
monthly benefit claim report of the individual for such
month, the individual may request review of such
determination at any time before the end of the 20-day
period that begins on the date notice of such
determination is received, except that such 20-day
period may be extended for good cause. Not later than
20 days after the individual requests review of the
determination, the Commissioner shall provide notice to
the individual of a final determination of payment for
such month, and shall make payment to the individual of
any additional amount not included in the initial
payment to the individual for such month to which the
Commissioner determines the individual is entitled.
(3) Burden of proof.--An application for benefits under
this section and a monthly benefit claim report of an
individual shall each be presumed to be true and accurate,
unless the Commissioner demonstrates by a preponderance of the
evidence that information contained in the application is
false.
(4) Definition of monthly benefit claim report.--For
purposes of this subsection, the term ``monthly benefit claim
report'' means, with respect to an individual for a month, the
individual's report to the Commissioner of the number of
caregiving days of the individual in such month, which shall be
filed no later than 15 days after the end of each month.
(5) Review.--All final determinations of the Commissioner
under this subsection shall be reviewable according to the
procedures set out in section 205 of the Social Security Act
(42 U.S.C. 405).
(g) Relationship With State Law; Employer Benefits.--
(1) In general.--This section does not preempt or supercede
any provision of State or local law that authorizes a State or
local municipality to provide paid family and medical leave
benefits similar to the benefits provided under this section.
(2) Greater benefits allowed.--Nothing in this title shall
be construed to diminish the obligation of an employer to
comply with any contract, collective bargaining agreement, or
any employment benefit program or plan that provides greater
paid leave or other leave rights to employees than the rights
established under this title.
(h) Prohibited Acts; Enforcement.--
(1) In general.--It shall be unlawful for any person to
discharge or in any other manner discriminate against an
individual because the individual has applied for, indicated an
intent to apply for, or received family and medical leave
insurance benefits.
(2) Civil action by an individual.--
(A) Liability.--Any person who violates paragraph
(1) shall be liable to any individual employed by such
person who is affected by the violation--
(i) for damages equal to the sum of--
(I) the amount of--
(aa) any wages, salary,
employment benefits, or other
compensation denied or lost to
such individual by reason of
the violation; or
(bb) in a case in which
wages, salary, employment
benefits, or other compensation
have not been denied or lost to
the individual, any actual
monetary losses sustained by
the individual as a direct
result of the violation, such
as the cost of providing care,
up to a sum equal to 60
calendar days of wages or
salary for the individual;
(II) the interest on the amount
described in subclause (I) calculated
at the prevailing rate; and
(III) an additional amount as
liquidated damages equal to the sum of
the amount described in subclause (I)
and the interest described in subclause
(II), except that if a person who has
violated paragraph (1) proves to the
satisfaction of the court that the act
or omission which violated paragraph
(1) was in good faith and that the
person had reasonable grounds for
believing that the act or omission was
not a violation of paragraph (1), such
court may, in the discretion of the
court, reduce the amount of the
liability to the amount and interest
determined under subclauses (I) and
(II), respectively; and
(ii) for such equitable relief as may be
appropriate, including employment,
reinstatement, and promotion.
(B) Right of action.--An action to recover the
damages or equitable relief prescribed in subparagraph
(A) may be maintained against any person in any Federal
or State court of competent jurisdiction by any
individual for and on behalf of--
(i) the individual; or
(ii) the individual and other individuals
similarly situated.
(C) Fees and costs.--The court in such an action
shall, in addition to any judgment awarded to the
plaintiff, allow a reasonable attorney's fee,
reasonable expert witness fees, and other costs of the
action to be paid by the defendant.
(D) Limitations.--The right provided by
subparagraph (B) to bring an action by or on behalf of
any individual shall terminate--
(i) on the filing of a complaint by the
Commissioner in an action under paragraph (5)
in which restraint is sought of any further
delay in the payment of the amount described in
subparagraph (A)(I) to such individual by the
person responsible under subparagraph (A) for
the payment; or
(ii) on the filing of a complaint by the
Commissioner in an action under paragraph (3)
in which a recovery is sought of the damages
described in subparagraph (A)(I) owing to an
individual by a person liable under
subparagraph (A),
unless the action described in clause (i) or (ii) is
dismissed without prejudice on motion of the
Commissioner.
(3) Action by the commissioner.--
(A) Civil action.--The Commissioner may bring an
action in any court of competent jurisdiction to
recover the damages described in paragraph (2)(A)(I).
(B) Sums recovered.--Any sums recovered by the
Commissioner pursuant to subparagraph (A) shall be held
in a special deposit account and shall be paid, on
order of the Commissioner, directly to each individual
affected. Any such sums not paid to an individual
because of inability to do so within a period of 3
years shall be deposited into the Federal Family and
Medical Leave Insurance Trust Fund.
(4) Limitation.--
(A) In general.--An action may be brought under
this subsection not later than 3 years after the date
of the last event constituting the alleged violation
for which the action is brought.
(B) Commencement.--An action brought by the
Commissioner under this subsection shall be considered
to be commenced on the date when the complaint is
filed.
(5) Action for injunction by commissioner.--The district
courts of the United States shall have jurisdiction, for cause
shown, in an action brought by the Commissioner--
(A) to restrain violations of paragraph (1),
including the restraint of any withholding of payment
of wages, salary, employment benefits, or other
compensation, plus interest, found by the court to be
due to an individual; or
(B) to award such other equitable relief as may be
appropriate, including employment, reinstatement, and
promotion.
(i) Special Rule for Railroad Employees.--For purposes of
subsection (a)(1), an individual shall be deemed to be insured for
disability insurance benefits if the individual would be so insured if
the individual's service as an employee (as defined in the section 1(b)
of the Railroad Retirement Act of 1974) after December 31, 1936, were
included within the meaning of the term ``employment'' for purposes of
title II of the Social Security Act (42 U.S.C. 401 et seq.).
(j) Determination of Whether an Activity Constitutes Qualified
Caregiving.--
(1) In general.--For purposes of determining whether an
activity engaged in by an individual constitutes qualified
caregiving under this section--
(A) the term ``spouse'' (as used in section 102(a)
of the Family and Medical Leave Act (29 U.S.C.
2612(a))) includes the individual's domestic partner;
and
(B) the term ``son or daughter'' (as used in such
section) includes a son or daughter (as defined in
section 101 of such Act) of the individual's domestic
partner.
(2) Domestic partner.--
(A) In general.--For purposes of paragraph (1), the
term ``domestic partner'', with respect to an
individual, means another individual with whom the
individual is in a committed relationship.
(B) Committed relationship defined.--The term
``committed relationship'' means a relationship between
two individuals (each at least 18 years of age) in
which each individual is the other individual's sole
domestic partner and both individuals share
responsibility for a significant measure of each
other's common welfare. The term includes any such
relationship between two individuals, including
individuals of the same sex, that is granted legal
recognition by a State or political subdivision of a
State as a marriage or analogous relationship,
including a civil union or domestic partnership.
(k) Applicability of Certain Social Security Act Provisions.--The
provisions of sections 204, 205, 206, and 208 of the Social Security
Act shall apply to benefit payments authorized by and paid out pursuant
to this section in the same way that such provisions apply to benefit
payments authorized by and paid out pursuant to title II of such Act.
(l) Effective Date for Applications.--Applications described in
this section may be filed beginning 18 months after the date of
enactment of this Act.
SEC. 3004. ESTABLISHMENT OF FAMILY AND MEDICAL LEAVE INSURANCE TRUST
FUND.
(a) In General.--There is hereby created on the books of the
Treasury of the United States a trust fund to be known as the ``Federal
Family and Medical Leave Insurance Trust Fund''. The Federal Family and
Medical Leave Insurance Trust Fund shall consist of such gifts and
bequests as may be made as provided in section 201(i)(1) of the Social
Security Act (42 U.S.C. 401(i)(1)) and such amounts as may be
appropriated to, or deposited in, the Federal Family and Medical Leave
Insurance Trust Fund as provided in this section.
(b) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
the Federal Family and Medical Leave Insurance Trust Fund out
of moneys in the Treasury not otherwise appropriated--
(A) for the first three fiscal years beginning
after the date of enactment of this Act, such sums as
may be necessary for the Commissioner to administer the
office established under section 3002 and pay the
benefits under section 3003;
(B) 100 percent of the taxes imposed by sections
3101(c) and 3111(c) of the Internal Revenue Code of
1986 with respect to wages (as defined in section 3121
of such Code) reported to the Secretary of the Treasury
pursuant to subtitle F of such Code, as determined by
the Secretary of the Treasury by applying the
applicable rate of tax under such sections to such
wages;
(C) 100 percent of the taxes imposed by section
1401(c) of such Code with respect to self-employment
income (as defined in section 1402 of such Code)
reported to the Secretary of the Treasury on tax
returns under subtitle F of such Code, as determined by
the Secretary of the Treasury by applying the
applicable rate of tax under such section to such self-
employment income; and
(D) 100 percent of the taxes imposed by sections
3201(c), 3211(c), and 3221(c) of such Code with respect
to compensation (as defined in section 3231 of such
Code) reported to the Secretary of the Treasury on tax
returns under subtitle F of such Code, as determined by
the Secretary of the Treasury by applying the
applicable rate of tax under such sections to such
compensation.
(2) Repayment of initial appropriation.--Amounts
appropriated pursuant to subparagraph (A) of paragraph (1)
shall be repaid to the Treasury of the United States not later
than 10 years after the first appropriation is made pursuant to
such subparagraph.
(3) Transfer to trust fund.--The amounts described in
paragraph (2) shall be transferred from time to time from the
general fund in the Treasury to the Federal Family and Medical
Leave Insurance Trust Fund, such amounts to be determined on
the basis of estimates by the Secretary of the Treasury of the
taxes, specified in such paragraph, paid to or deposited into
the Treasury. Proper adjustments shall be made in amounts
subsequently transferred to the extent prior estimates were
inconsistent with the taxes specified in such paragraph.
(c) Management of Trust Fund.--The provisions of subsections (c),
(d), (e), (f), (i), and (m) of section 201 of the Social Security Act
(42 U.S.C. 401) shall apply with respect to the Federal Family and
Medical Leave Insurance Trust Fund in the same manner as such
provisions apply to the Federal Old-Age and Survivors Insurance Trust
Fund and the Disability Insurance Trust Fund.
(d) Benefits Paid From Trust Fund.--Benefit payments required to be
made under section 3003 shall be made only from the Federal Family and
Medical Leave Insurance Trust Fund.
(e) Administration.--There are authorized to be made available for
expenditure, out of the Federal Family and Medical Leave Insurance
Trust Fund, such sums as may be necessary to pay the costs of the
administration of section 3003, including start-up costs, technical
assistance, outreach, education, evaluation, and reporting.
(f) Prohibition.--No funds from the Social Security Trust Fund or
appropriated to the Social Security Administration to administer Social
Security programs may be used for Federal Family and Medical Leave
Insurance benefits or administration set forth under this title.
SEC. 3005. INTERNAL REVENUE CODE PROVISIONS.
(a) In General.--
(1) Employee contribution.--Section 3101 of the Internal
Revenue Code of 1986 is amended--
(A) by redesignating subsection (c) as subsection
(d); and
(B) by inserting after subsection (b) the
following:
``(c) Family and Medical Leave Insurance.--
``(1) In general.--In addition to other taxes, there is
hereby imposed on the income of every individual a tax equal to
the applicable percentage of the wages (as defined in section
3121(a)) received by the individual with respect to employment
(as defined in section 3121(b)).
``(2) Applicable percentage.--For purposes of paragraph
(1), the term `applicable percentage' means 0.2 percent in the
case of wages received in any calendar year.''.
(2) Employer contribution.--Section 3111 of such Code is
amended--
(A) by redesignating subsection (c) as subsection
(d); and
(B) by inserting after subsection (b) the
following:
``(c) Family and Medical Leave Insurance.--
``(1) In general.--In addition to other taxes, there is
hereby imposed on every employer an excise tax, with respect to
having individuals in his employ, equal to the applicable
percentage of the wages (as defined in section 3121(a)) paid by
the employer with respect to employment (as defined in section
3121(b)).
``(2) Applicable percentage.--For purposes of paragraph
(1), the term `applicable percentage' means 0.2 percent in the
case of wages paid in any calendar year.''.
(3) Self-employment income contribution.--
(A) In general.--Section 1401 of such Code is
amended--
(i) by redesignating subsection (c) as
subsection (d); and
(ii) by inserting after subsection (b) the
following:
``(c) Family and Medical Leave Insurance.--
``(1) In general.--In addition to other taxes, there is
hereby imposed for each taxable year, on the self-employment
income of every individual, a tax equal to the applicable
percentage of the amount of the self-employment income for such
taxable year.
``(2) Applicable percentage.--For purposes of paragraph
(1), the term `applicable percentage' means 0.4 percent in the
case of self-employment income in any taxable year.''.
(B) Exclusion of certain net earnings from self-
employment.--Section 1402(b)(1) of such Code is amended
by striking ``tax imposed by section 1401(a)'' and
inserting ``taxes imposed by subsections (a) and (c) of
section 1401''.
(b) Railroad Retirement Tax Act.--
(1) Employee contribution.--Section 3201 of such Code is
amended--
(A) by redesignating subsection (c) as subsection
(d); and
(B) by inserting after subsection (b) the
following:
``(c) Family and Medical Leave Insurance.--
``(1) In general.--In addition to other taxes, there is
hereby imposed on the income of each employee a tax equal to
the applicable percentage of the compensation received during
any calendar year by such employee for services rendered by
such employee.
``(2) Applicable percentage.--For purposes of paragraph
(1), the term `applicable percentage' means 0.2 percent in the
case of compensation received in any calendar year.''.
(2) Employee representative contribution.--Section 3211 of
such Code is amended--
(A) by redesignating subsection (c) as subsection
(d); and
(B) by inserting after subsection (b) the
following:
``(c) Family and Medical Leave Insurance.--
``(1) In general.--In addition to other taxes, there is
hereby imposed on the income of each employee representative a
tax equal to the applicable percentage of the compensation
received during any calendar year by such employee
representative for services rendered by such employee
representative.
``(2) Applicable percentage.--For purposes of paragraph
(1), the term `applicable percentage' means 0.2 percent in the
case of compensation received in any calendar year.''.
(3) Employer contribution.--Section 3221 of such Code is
amended--
(A) by redesignating subsection (c) as subsection
(d); and
(B) by inserting after subsection (b) the
following:
``(c) Family and Medical Leave Insurance.--
``(1) In general.--In addition to other taxes, there is
hereby imposed on every employer an excise tax, with respect to
having individuals in his employ, equal to the applicable
percentage of the compensation paid during any calendar year by
such employer for services rendered to such employer.
``(2) Applicable percentage.--For purposes of paragraph
(1), the term `applicable percentage' means 0.2 percent in the
case of compensation paid in any calendar year.''.
(c) Conforming Amendments.--
(1) Section 6413(c) of the Internal Revenue Code of 1986 is
amended--
(A) in paragraph (1)--
(i) by inserting ``, section 3101(c),''
after ``by section 3101(a)''; and
(ii) by striking ``both'' and inserting
``each''; and
(B) in paragraph (2), by inserting ``or 3101(c)''
after ``3101(a)'' each place it appears.
(2) Section 15(a) of the Railroad Retirement Act of 1974
(45 U.S.C. 231n(a)) is amended by inserting ``(other than
sections 3201(c), 3211(c), and 3221(c))'' before the period at
the end.
(d) Effective Date.--The amendments made by this section shall take
effect 120 days after the date of the enactment of this Act.
SEC. 3006. REGULATIONS.
The Commissioner, in consultation with the Secretary of Labor,
shall prescribe regulations necessary to carry out this title. In
developing such regulations, the Commissioner shall consider the input
from a volunteer advisory body comprised of not more than 15
individuals, including experts in the relevant subject matter and
officials charged with implementing State paid family and medical leave
insurance programs. The Commissioner shall take such programs into
account when proposing regulations. Such individuals shall be appointed
as follows:
(1) Five individuals to be appointed by the President.
(2) Three individuals to be appointed by the majority
leader of the Senate.
(3) Two individuals to be appointed by the minority leader
of the Senate.
(4) Three individuals to be appointed by the Speaker of the
House of Representatives.
(5) Two individuals to be appointed by the minority leader
of the House of Representatives.
SEC. 3007. GAO STUDY.
As soon as practicable after calendar year 2025, the Comptroller
General shall submit to Congress a report on family and medical leave
insurance benefits paid under section 3003 for any month during the 1-
year period beginning on January 1, 2025. The report shall include the
following:
(1) An identification of the total number of applications
for such benefits filed for any month during such 1-year
period, and the average number of days occurring in the period
beginning on the date on which such an application is received
and ending on the date on which the initial determination of
eligibility with respect to the application is made.
(2) An identification of the total number of requests for
review of an initial adverse determination of eligibility for
such benefits made during such 1-year period, and the average
number of days occurring in the period beginning on the date on
which such review is requested and ending on the date on which
the final determination of eligibility with respect to such
review is made.
(3) An identification of the total number of monthly
benefit claim reports for such benefits filed during such 1-
year period, and the average number of days occurring in the
period beginning on the date on which such a claim report is
received and ending on the date on which the initial
determination of eligibility with respect to the claim report
is made.
(4) An identification of the total number of requests for
review of an initial adverse determination relating to a
monthly benefit claim report for such benefits made during such
1-year period, and the average number of days occurring in the
period beginning on the date on which such review is requested
and ending on the date on which the final determination of
eligibility with respect to such review is made.
(5) An identification of any excessive delay in any of the
periods described in paragraphs (1) through (4), and a
description of the causes for such delay.
TITLE IV--FULLY REFUNDABLE CHILD TAX CREDIT
SEC. 4001. ESTABLISHMENT OF FULLY REFUNDABLE CHILD TAX CREDIT.
(a) Elimination of Existing Child Tax Credit.--Subpart A of part IV
of subchapter A of chapter 1 of subtitle A of the Internal Revenue Code
of 1986 is amended by striking section 24.
(b) Establishment of Fully Refundable Child Tax Credit.--Subpart C
of part IV of subchapter A of chapter 1 of subtitle A of such Code is
amended by inserting after section 36B the following new section:
``SEC. 36C. CHILD TAX CREDIT.
``(a) Allowance of Credit.--In the case of an eligible individual,
there shall be allowed as a credit against the tax imposed by this
chapter for the taxable year an amount equal to the sum of--
``(1) with respect to each qualifying child of the taxpayer
who has attained 6 years of age before the close of such
taxable year and for which the taxpayer is allowed a deduction
under section 151, an amount equal to $3,000, and
``(2) with respect to each qualifying child of the taxpayer
who has not attained 6 years of age before the close of such
taxable year and for which the taxpayer is allowed a deduction
under section 151, an amount equal to 120 percent of the dollar
amount in paragraph (1).
``(b) Limitation.--
``(1) In general.--The amount of the credit allowable under
subsection (a) shall be reduced (but not below zero) by the
applicable amount for each $1,000 (or fraction thereof) by
which the taxpayer's modified adjusted gross income exceeds the
threshold amount. For purposes of the preceding sentence, the
term `modified adjusted gross income' means adjusted gross
income increased by any amount excluded from gross income under
section 911, 931, or 933.
``(2) Threshold amount.--
``(A) In general.--For purposes of paragraph (1),
the term `threshold amount' means--
``(i) $180,000 in the case of a joint
return,
``(ii) $130,000 in the case of an
individual who is not married, and
``(iii) $90,000 in the case of a married
individual filing a separate return.
``(B) Marital status.--For purposes of this
paragraph, marital status shall be determined under
section 7703.
``(3) Applicable amount.--For purposes of paragraph (1),
the term `applicable amount' means an amount equal to the
quotient of--
``(A) the amount of the credit allowable under
subsection (a), as determined without regard to this
subsection, divided by
``(B) an amount equal to the product of--
``(i) $20, multiplied by
``(ii) the total number of qualifying
children of the taxpayer.
``(c) Qualifying Child.--For purposes of this section--
``(1) In general.--The term `qualifying child' means a
qualifying child of the taxpayer (as defined in section 152(c))
who has not attained 18 years of age.
``(2) Exception for certain non-citizens.--The term
`qualifying child' shall not include any individual who would
not be a dependent if subparagraph (A) of section 152(b)(3)
were applied without regard to all that follows `resident of
the United States'.
``(d) Eligible Individual.--For purposes of this section, the term
`eligible individual' means, with respect to any taxable year, any
individual if such individual's principal place of abode is in the
United States (as determined under section 32(c)(4)) for more than one-
half of such taxable year.
``(e) Inflation Adjustment.--
``(1) In general.--In the case of any taxable year
beginning after 2022, the $3,000 amount in subsection (a)(1)
shall be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under paragraph (2) for the calendar year in which the
taxable year begins.
``(2) Cost-of-living adjustment.--For purposes of paragraph
(1), the cost-of-living adjustment for any calendar year is the
percentage (if any) by which--
``(A) the CPI for the preceding calendar year (as
determined pursuant to section 1(f)(4)), exceeds
``(B) the CPI for calendar year 2021.
``(3) Rounding.--If any increase determined under paragraph
(1) is not a multiple of $50, such increase shall be rounded to
the nearest multiple of $50.
``(f) Partial Non-Refundable Credit Allowed for Certain Other
Dependents.--
``(1) In general.--In the case of a taxable year beginning
after December 31, 2021, and before January 1, 2026, the
aggregate credits allowed to a taxpayer under subpart A shall
be increased by $500 for each dependent of the taxpayer (as
defined in section 152) other than a qualifying child described
in subsection (c). The amount of the credit allowed under this
subsection shall not be treated as a credit allowed under this
subpart.
``(2) Exception for certain noncitizens.--Paragraph (1)
shall not apply with respect to any individual who would not be
a dependent if subparagraph (A) of section 152(b)(3) were
applied without regard to all that follows `resident of the
United States'.
``(3) Limitation.--
``(A) In general.--The amount of the credit
allowable under paragraph (1) shall be reduced (but not
below zero) by $50 for each $1,000 (or fraction
thereof) by which the taxpayer's modified adjusted
gross income exceeds the threshold amount.
``(B) Modified adjusted gross income.--For purposes
of subparagraph (A), the term `modified adjusted gross
income' means adjusted gross income increased by any
amount excluded from gross income under section 911,
931, or 933.
``(C) Threshold amount.--
``(i) In general.--For purposes of
subparagraph (A), the term `threshold amount'
means--
``(I) $200,000 in the case of a
joint return,
``(II) $150,000 in the case of an
individual who is not married, and
``(III) $100,000 in the case of a
married individual filing a separate
return.
``(ii) Marital status.--For purposes of
this subparagraph, marital status shall be
determined under section 7703.
``(g) Identification Requirements.--
``(1) Qualifying child and dependent identification
requirement.--No credit shall be allowed under this section to
a taxpayer with respect to any qualifying child or dependent
unless the taxpayer includes the name and taxpayer
identification number of such qualifying child or dependent on
the return of tax for the taxable year and such taxpayer
identification number was issued on or before the due date for
filing such return.
``(2) Taxpayer identification requirement.--No credit shall
be allowed under this section if the taxpayer identification
number of the taxpayer was issued after the due date for filing
the return for the taxable year.
``(h) Taxable Year Must Be Full Taxable Year.--Except in the case
of a taxable year closed by reason of the death of the taxpayer, no
credit shall be allowable under this section in the case of a taxable
year covering a period of less than 12 months.
``(i) Restrictions on Taxpayers Who Improperly Claimed Credit in
Prior Year.--
``(1) Taxpayers making prior fraudulent or reckless
claims.--
``(A) In general.--No credit shall be allowed under
this section for any taxable year in the disallowance
period.
``(B) Disallowance period.--For purposes of
subparagraph (A), the disallowance period is--
``(i) the period of 10 taxable years after
the most recent taxable year for which there
was a final determination that the taxpayer's
claim of credit under this section was due to
fraud, and
``(ii) the period of 2 taxable years after
the most recent taxable year for which there
was a final determination that the taxpayer's
claim of credit under this section was due to
reckless or intentional disregard of rules and
regulations (but not due to fraud).
``(2) Taxpayers making improper prior claims.--In the case
of a taxpayer who is denied credit under this section for any
taxable year as a result of the deficiency procedures under
subchapter B of chapter 63, no credit shall be allowed under
this section for any subsequent taxable year unless the
taxpayer provides such information as the Secretary may require
to demonstrate eligibility for such credit.
``(j) Reconciliation of Credit and Advance Credit.--
``(1) In general.--The amount of the credit allowed under
this section to any taxpayer for any taxable year shall be
reduced (but not below zero) by the aggregate amount of
payments made under section 7527A to such taxpayer during such
taxable year.
``(2) Excess advance payments.--If the aggregate amount of
payments under section 7527A to the taxpayer during the taxable
year exceeds the amount of the credit allowed under this
section to such taxpayer for such taxable year (determined
without regard to paragraph (1)), the tax imposed by this
chapter for such taxable year shall be increased by the amount
of such excess.''.
(c) Advance Payment of Credit.--Section 7527A of such Code is
amended to read as follows:
``SEC. 7527A. ADVANCE PAYMENT OF CHILD TAX CREDIT.
``(a) In General.--As soon as practicable after the date of the
enactment of this section, the Secretary shall establish a program for
making monthly payments to taxpayers which, in the aggregate during any
calendar year, equal the annual advance amount determined with respect
to such taxpayer for such calendar year.
``(b) Annual Advance Amount.--For purposes of this section--
``(1) In general.--Except as otherwise provided in this
subsection, the term `annual advance amount' means, with
respect to any taxpayer for any calendar year, the amount of
the credit which would be allowed to such taxpayer under
section 36C(a) (determined without regard to subsection (j)
thereof) for the taxpayer's taxable year beginning in such
calendar year if--
``(A) the taxpayer's modified adjusted gross income
for such taxable year were equal to the taxpayer's
modified adjusted gross income for the reference
taxable year,
``(B) the only qualifying children of such taxpayer
are qualifying children properly claimed on the
taxpayer's return of tax for the reference taxable
year, and
``(C) the age of such qualifying children is
determined for such taxable year by taking into account
the passage of time since the reference taxable year.
``(2) Reference taxable year.--Except as provided in
paragraph (3)(A), the term `reference taxable year' means, with
respect to any taxpayer for any calendar year, the taxpayer's
taxable year beginning in the preceding calendar year or, in
the case of taxpayer who did not file a return of tax for such
taxable year, the taxpayer's taxable year beginning in the
second preceding calendar year.
``(3) Modifications during calendar year.--The Secretary
may modify, during any calendar year, the annual advance amount
with respect to any taxpayer for such calendar year to take
into account--
``(A) a return of tax filed by such taxpayer during
such calendar year (and the taxable year to which such
return relates may be taken into account as the
reference taxable year), and
``(B) any other information provided by the
taxpayer to the Secretary which allows the Secretary to
determine payments under subsection (a) which, in the
aggregate during any taxable year of the taxpayer, more
closely total the Secretary's best estimate of the
credit allowed to the taxpayer under section 36C(a)
(determined without regard to subsection (i) thereof)
for such taxable year.
``(c) On-Line Information Portal.--The Secretary shall establish an
on-line portal which allows taxpayers to--
``(1) elect not to receive payments under this section, and
``(2) provide information to the Secretary which would be
relevant to a modification under subsection (b)(3)(B) of the
annual advance amount, including information regarding--
``(A) a change in the number of the taxpayer's
qualifying children, including by reason of the birth
of a child,
``(B) a change in the taxpayer's marital status,
``(C) a significant change in the taxpayer's
modified adjusted gross income, and
``(D) any other factor which the Secretary may
provide.
``(d) Notice of Payments.--Not later than January 31 of the
calendar year following any calendar year during which the Secretary
makes one or more payments to any taxpayer under this section, the
Secretary shall provide such taxpayer with a written notice which
includes the taxpayer's taxpayer identity (as defined in section
6103(b)(6)), the aggregate amount of such payments made to such
taxpayer during such calendar year, and such other information as the
Secretary determines appropriate.
``(e) Authority To Adjust Interval of Payments.--If the Secretary
determines that it is not administratively feasible to make monthly
payments under this section, such payments shall be made on the basis
of the shortest interval which the Secretary determines is
administratively feasible.''.
(d) Conforming Amendments.--
(1) The table of sections for subpart A of part IV of
subchapter A of chapter 1 of subtitle A of the Internal Revenue
Code of 1986 is amended by striking the item relating to
section 24.
(2) The table of sections for subpart C of part IV of
subchapter A of chapter 1 of subtitle A of such Code is amended
by inserting after the item relating to section 36B the
following:
``Sec. 36C. Child tax credit.''.
(3) Subparagraph (B) of section 45R(f)(3) of such Code is
amended to read as follows:
``(B) Special rule.--Any amounts paid pursuant to
an agreement under section 3121(l) (relating to
agreements entered into by American employers with
respect to foreign affiliates) which are equivalent to
the taxes referred to in subparagraph (A) shall be
treated as taxes referred to in such subparagraph.''.
(4) Section 152(f)(6)(B)(ii) of such Code is amended by
striking ``section 24'' and inserting ``section 36C''.
(5) Paragraph (26) of section 501(c) of such Code is
amended in the flush matter at the end by striking ``section
24(c))'' and inserting ``section 36C(c))''.
(6) Section 6211(b)(4)(A) of such Code is amended--
(A) by striking ``24(d),''; and
(B) by inserting ``36C(a),'' after ``36B,''.
(7) Section 6213(g)(2) of such Code is amended--
(A) in subparagraph (I), by striking ``section
24(e)'' and inserting ``section 36C(g)''; and
(B) in subparagraph (L), by striking ``24, or 32''
and inserting ``32, or 36C''.
(8) Paragraph (2) of section 1324(b) of title 31, United
States Code, is amended by inserting ``36C,'' after ``36B,''.
(e) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2021.
SEC. 4002. PAYMENTS TO POSSESSIONS.
(a) Mirror Code Possession.--The Secretary of the Treasury shall
pay to each possession of the United States with a mirror code tax
system amounts equal to the loss to that possession by reason of the
application of section 36C of the Internal Revenue Code of 1986 (as
added by section 4001) with respect to taxable years beginning after
2020. Such amounts shall be determined by the Secretary of the Treasury
based on information provided by the government of the respective
possession.
(b) Other Possessions.--The Secretary of the Treasury shall pay to
each possession of the United States which does not have a mirror code
tax system amounts estimated by the Secretary of the Treasury as being
equal to the aggregate benefits that would have been provided to
residents of such possession by reason of the application of section
36C of such Code (as so added) for taxable years beginning after 2021
if a mirror code tax system had been in effect in such possession. The
preceding sentence shall not apply with respect to any possession of
the United States unless such possession has a plan, which has been
approved by the Secretary of the Treasury, under which such possession
will promptly distribute such payments to the residents of such
possession.
(c) Coordination With Credit Allowed Against United States Income
Taxes.--No credit shall be allowed against United States income taxes
for any taxable year under section 36C of the Internal Revenue Code of
1986 (as so added) to any person--
(1) to whom a credit is allowed against taxes imposed by
the possession by reason of the amendments made by this section
for such taxable year; or
(2) who is eligible for a payment under a plan described in
subsection (b) with respect to such taxable year.
(d) Definitions and Special Rules.--
(1) Possession of the united states.--For purposes of this
section, the term ``possession of the United States'' includes
the Commonwealth of Puerto Rico and the Commonwealth of the
Northern Mariana Islands.
(2) Mirror code tax system.--For purposes of this section,
the term ``mirror code tax system'' means, with respect to any
possession of the United States, the income tax system of such
possession if the income tax liability of the residents of such
possession under such system is determined by reference to the
income tax laws of the United States as if such possession were
the United States.
(3) Treatment of payments.--For purposes of section
1324(b)(2) of title 31, United States Code, the payments under
this section shall be treated in the same manner as a refund
due from the credit allowed under section 36C of the Internal
Revenue Code of 1986.
TITLE V--CHILD CARE IS INFRASTRUCTURE
SEC. 5001. INFRASTRUCTURE GRANTS TO IMPROVE CHILD CARE SAFETY.
(a) In General.--Part A of title IV of the Social Security Act (42
U.S.C. 601 et seq.) is amended by inserting after section 418 the
following:
``SEC. 418A. INFRASTRUCTURE GRANTS TO IMPROVE CHILD CARE SAFETY.
``(a) Short Title.--This section may be cited as the
`Infrastructure Grants To Improve Child Care Safety Act'.
``(b) Needs Assessments.--
``(1) Immediate needs assessment.--
``(A) In general.--The Secretary shall conduct an
immediate needs assessment of the condition of child
care facilities throughout the United States (with
priority given to child care facilities that receive
Federal funds), that--
``(i) determines the extent to which the
COVID-19 pandemic has created immediate
infrastructure needs, including infrastructure-
related health and safety needs, which must be
addressed for child care facilities to operate
in compliance with public health guidelines;
``(ii) considers the effects of the
pandemic on a variety of child care centers,
including home-based centers; and
``(iii) considers how the pandemic has
impacted specific metrics, such as--
``(I) capacity;
``(II) investments in
infrastructure changes;
``(III) the types of infrastructure
changes centers need to implement and
their associated costs;
``(IV) the price of tuition; and
``(V) any changes or anticipated
changes in the number and demographic
of children attending.
``(B) Timing.--The immediate needs assessment
should occur simultaneously with the first grant-making
cycle under subsection (c).
``(C) Report.--Not later than 1 year after the date
of the enactment of this section, the Secretary shall
submit to the Congress a report containing the result
of the needs assessment conducted under subparagraph
(A), and make the assessment publicly available.
``(2) Long-term needs assessment.--
``(A) In general.--The Secretary shall conduct a
long-term assessment of the condition of child care
facilities throughout the United States (with priority
given to child care facilities that receive Federal
funds). The assessment may be conducted through
representative random sampling.
``(B) Report.--Not later than 4 years after the
date of the enactment of this section, the Secretary
shall submit to the Congress a report containing the
results of the needs assessment conducted under
subparagraph (A), and make the assessment publicly
available.
``(c) Child Care Facilities Grants.--
``(1) Grants to states.--
``(A) In general.--The Secretary may award grants
to States for the purpose of acquiring, constructing,
renovating, or improving child care facilities,
including adapting, reconfiguring, or expanding
facilities to respond to the COVID-19 pandemic.
``(B) Prioritized facilities.--The Secretary may
not award a grant to a State under subparagraph (A)
unless the State involved agrees, with respect to the
use of grant funds, to prioritize--
``(i) child care facilities primarily
serving low-income populations;
``(ii) child care facilities primarily
serving children who have not attained the age
of 5 years;
``(iii) child care facilities that made
maximum health and safety modifications to
account for the impact of the COVID-19
pandemic;
``(iv) child care facilities that operate
under nontraditional hours; and
``(v) child care facilities located in
rural or underserved communities.
``(C) Duration of grants.--A grant under this
subsection shall be awarded for a period of not more
than 5 years.
``(D) Application.--To seek a grant under this
subsection, a State shall submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require, which information shall--
``(i) be disaggregated as the Secretary may
require; and
``(ii) include a plan to use a portion of
the grant funds to report back to the Secretary
on the impact of using the grant funds to
improve child care facilities.
``(E) Priority.--In selecting States for grants
under this subsection, the Secretary shall prioritize
States that--
``(i) plan to improve center-based and
home-based child care programs, which may
include a combination of child care and early
Head Start or Head Start programs;
``(ii) aim to meet specific needs across
urban, suburban, or rural areas as determined
by the State; and
``(iii) show evidence of collaboration
with--
``(I) local government officials;
``(II) other State agencies;
``(III) nongovernmental
organizations, such as--
``(aa) organizations within
the philanthropic community;
``(bb) certified community
development financial
institutions, as defined in
section 103 of the Community
Development Banking and
Financial Institutions Act of
1994 (12 U.S.C. 4702); and
``(cc) organizations that
have demonstrated experience
in--
``(AA) providing
technical or financial
assistance for the
acquisition,
construction,
renovation, or
improvement of child
care facilities;
``(BB) providing
technical, financial,
or managerial
assistance to child
care providers; and
``(CC) securing
private sources of
capital financing for
child care facilities
or other low-income
community development
projects; and
``(IV) local community
organizations, such as--
``(aa) child care
providers;
``(bb) community care
agencies;
``(cc) resource and
referral agencies; and
``(dd) unions.
``(F) Consideration.--In selecting States for
grants under this subsection, the Secretary shall
consider--
``(i) whether the applicant--
``(I) has or is developing a plan
to address child care facility needs;
and
``(II) demonstrates the capacity to
execute such a plan; and
``(ii) after the date the report required
by subsection (b)(1)(C) is submitted to the
Congress, the needs of the applicants based on
the results of the assessment.
``(G) Diversity of awards.--In awarding grants
under this section, the Secretary shall give equal
consideration to States with varying capacities under
subparagraph (F).
``(H) Matching requirement.--
``(i) In general.--As a condition for the
receipt of a grant under subparagraph (A), a
State that is not an Indian tribe shall agree
to make available (directly or through
donations from public or private entities)
contributions with respect to the cost of the
activities to be carried out pursuant to
subparagraph (A), which may be provided in cash
or in kind, in an amount equal to 10 percent of
the funds provided through the grant.
``(ii) Determination of amount
contributed.--Contributions required by clause
(i) may include--
``(I) amounts provided by the
Federal Government, or services
assisted or subsidized to any
significant extent by the Federal
Government; or
``(II) philanthropic or private-
sector funds.
``(I) Report.--Not later than 6 months after the
last day of the grant period, a State receiving a grant
under this paragraph shall submit a report to the
Secretary as described in subparagraph (D)--
``(i) to determine the effects of the grant
in constructing, renovating, or improving child
care facilities, including any changes in
response to the COVID-19 pandemic and any
effects on access to and quality of child care;
and
``(ii) to provide such other information as
the Secretary may require.
``(J) Amount limit.--The annual amount of a grant
under this paragraph may not exceed $35,000,000.
``(2) Grants to intermediary organizations.--
``(A) In general.--The Secretary may award grants
to intermediary organizations, such as certified
community development financial institutions, tribal
organizations, or other organizations with demonstrated
experience in child care facilities financing, for the
purpose of providing technical assistance, capacity
building, and financial products to develop or finance
child care facilities.
``(B) Application.--A grant under this paragraph
may be made only to intermediary organizations that
submit to the Secretary an application at such time, in
such manner, and containing such information as the
Secretary may require.
``(C) Priority.--In selecting intermediary
organizations for grants under this subsection, the
Secretary shall prioritize intermediary organizations
that--
``(i) demonstrate experience in child care
facility financing or related community
facility financing;
``(ii) demonstrate the capacity to assist
States and local governments in developing
child care facilities and programs;
``(iii) demonstrate the ability to leverage
grant funding to support financing tools to
build the capacity of child care providers,
such as through credit enhancements;
``(iv) propose to focus on child care
facilities that operate under nontraditional
hours;
``(v) propose to meet a diversity of needs
across States and across urban, suburban, and
rural areas at varying types of center-based,
home-based, and other child care settings,
including early care programs located in
freestanding buildings or in mixed-use
properties; and
``(vi) propose to focus on child care
facilities primarily serving low-income
populations and children who have not attained
the age of 5 years.
``(D) Amount limit.--The amount of a grant under
this paragraph may not exceed $10,000,000.
``(3) Report.--Not later than the end of fiscal year 2027,
the Secretary shall submit to the Congress a report on the
effects of the grants provided under this subsection, and make
the report publically accessible.
``(d) Labor Standards for All Grants.--The Secretary shall require
that each entity, including grantees and subgrantees, that applies for
an infrastructure grant for constructing, renovating, or improving
child care facilities, including adapting, reconfiguring, or expanding
such facilities, which is funded in whole or in part under this
section, shall include in its application written assurance that all
laborers and mechanics employed by contractors or subcontractors in the
performance of construction, alternation or repair, as part of such
project, shall be paid wages at rates not less than those prevailing on
similar work in the locality as determined by the Secretary of Labor in
accordance with subchapter IV of chapter 31 of title 40, United States
Code (commonly referred to as the `Davis-Bacon Act'), and with respect
to the labor standards specified in this subsection, the Secretary of
Labor shall have the authority and functions set forth in
Reorganization Plan Numbered 14 of 1950 (15 Fed. Reg. 3176; 5 U.S.C.
App.).
``(e) Limitations on Authorization of Appropriations.--
``(1) In general.--To carry out this section, there is
authorized to be appropriated $10,000,000,000 for fiscal year
2023, which shall remain available through fiscal year 2027.
``(2) Reservations of funds.--
``(A) Indian tribes.--The Secretary shall reserve 3
percent of the total amount made available to carry out
this section, for payments to Indian tribes.
``(B) Territories.--The Secretary shall reserve 3
percent of the total amount made available to carry out
this section, for payments to territories.
``(3) Grants for intermediary organizations.--Not less than
10 percent and not more than 15 percent of the total amount
made available to carry out this section may be used to carry
out subsection (c)(2).
``(4) Limitation on use of funds for needs assessments.--
Not more than $5,000,000 of the amounts made available to carry
out this section may be used to carry out subsection (b).
``(f) Definition of State.--In this section, the term `State' has
the meaning provided in section 419, except that it includes the
Commonwealth of the Northern Mariana Islands and any Indian tribe.''.
(b) Exemption of Territory Grants From Limitation on Total Payments
to the Territories.--Section 1108(a)(2) of such Act (42 U.S.C.
1308(a)(2)) is amended by inserting ``418A(c),'' after ``413(f),''.
SEC. 5002. EARLY CHILDHOOD EDUCATOR LOAN ASSISTANCE PROGRAM.
Part Q of title III of the Public Health Service Act (42 U.S.C.
280h) is amended by adding at the end the following:
``SEC. 399Z-3. EARLY CHILDHOOD EDUCATOR LOAN ASSISTANCE PROGRAM.
``(a) Authority.--The Secretary may carry out a program of entering
into contracts with eligible early childhood educators under which such
educators agree to serve for a period of 5 years as early childhood
educators with a qualified employer, in consideration of the Federal
Government agreeing to repay, for each year of such service, not more
than $6,000 of the principal and interest of the educational loans of
such educators.
``(b) Recertification.--An eligible early childhood educator
seeking to continue to receive payments under this section shall submit
on an annual basis to the Secretary such information as the Secretary
may require to certify that the educator is continuing to meet the
criteria to be considered an eligible educator.
``(c) Maximum Amount of Loan.--The total amount of payments
received by an eligible early childhood educator under this section may
not exceed the total amount of the principal and interest of the
educational loans of such educator.
``(d) Applicability of Certain Provisions.--The following
provisions of the National Health Service Corps Loan Assistance Program
established in subpart III of part D shall apply to the program
established under this section in the same manner and to the same
extent as such provisions apply to the National Health Service Corps
Loan Assistance Program:
``(1) Paragraphs (1) through (3) of section 338B(c)
(relating to application information, understandability, and
availability).
``(2) Section 338B(c)(4) (relating to recruitment and
retention).
``(3) Section 338B(d) (relating to factors considered in
providing contracts).
``(4) Section 338(e) (relating to the approval required for
participation).
``(5) Section 338B(f) (relating to contents of contracts).
``(6) Section 338B(g) (relating to payments, including
repayment schedule and tax liability).
``(e) Report to Congress.--Not later than 5 years after the date of
the enactment of this section, the Secretary shall submit to Congress a
report on the implementation of this section.
``(f) Definitions.--In this section:
``(1) The term `eligible early childhood educator' means an
individual that--
``(A) as of the date on which the agreement
referred to in subsection (a)(1) is entered into--
``(i) has outstanding Federal direct loans
obtained for purposes of pursuing an
associate's degree, a 4-year bachelor's degree,
a graduate degree, or a combined bachelor and
master's degree, in early childhood education
or a related field from an accredited
institution (including any such loan for which
the individual is enrolled in an income-based
repayment plan); and
``(ii) is in good standing with respect to
the loans referred to in clause (i); and
``(B) agrees to--
``(i) serve as an early childhood educator
with a qualified employer for a period of not
less than 5 years; and
``(ii) make timely payments with respect to
the loans described in subparagraph (A)(i).
``(2) The term `qualified employer' means a childcare
provider that receives or is eligible to receive vouchers or
assistance under the Child Care and Development Block Grant Act
of 1990.
``(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $25,000,000 for each of fiscal
years 2023 through 2028.''.
SEC. 5003. GRANTS FOR EARLY CHILDHOOD EDUCATORS.
(a) In General.--Beginning not later than 180 days after the date
of the enactment of this Act, the Secretary of Education (referred to
in this section as the ``Secretary'') shall carry out a program under
which the Secretary makes payments to institutions of higher education
with a qualified early childhood educator program to enable such
institutions to make grants, on a competitive basis, to eligible
individuals who file an application and agreement in accordance with
subsections (b) and (c).
(b) Applications.--
(1) In general.--The Secretary shall periodically set dates
by which eligible individuals shall file applications for a
grant under this section. Each eligible individual desiring a
grant under this section shall file an application containing
such information and assurances as the Secretary may determine
necessary to enable the Secretary to carry out the functions
and responsibilities of this section.
(2) Renewal.--A grant awarded under this section may be
renewed for additional one-year periods if--
(A) the recipient submits a renewal application
containing such information and assurances as the
Secretary may determine necessary; and
(B) the grant is renewed not more than three times,
for a total of not more than four academic years for
each eligible recipient.
(c) Service Obligation.--
(1) Agreements to serve.--Each application under subsection
(b) shall include, or be accompanied by--
(A) an agreement by the applicant that--
(i) in the event that the applicant
receives a grant under this section, the
applicant shall--
(I) serve as a full-time or part-
time educator in a licensed early
learning program for a total of not
less than one academic year, and four
additional months for each subsequent
grant renewal, within two years after
the date on which the period of time
covered by the grant is completed; and
(II) submit a certification of
employment by the employing early
learning program in such form as the
Secretary may determine necessary; and
(ii) in the event that the applicant is
determined to have failed or refused to carry
out such service obligation, the sum of the
amounts of any grants received by such
applicant under this section will be treated as
a loan and collected from the applicant in
accordance with paragraph (3) and the
regulations thereunder; and
(B) a plain-language disclosure form developed by
the Secretary that clearly describes the nature of the
grant award, the service obligation, and the loan
repayment requirements that are the consequence of the
failure to complete the service obligation.
(2) Treatment of concurrent service.--An individual who
serves as a full or part-time educator in a licensed early
childhood education program concurrently while enrolled in a
qualified early childhood educator program may count such
service toward the fulfillment of the service obligation in the
agreement under paragraph (1).
(3) Repayment for failure to complete service.--Except as
provided in paragraph (4), in the event that any recipient of a
grant under this section fails or refuses to comply with the
service obligation in the agreement under paragraph (1), the
sum of the amounts of any grants received by such recipient
shall, upon a determination of such a failure or refusal in
such service obligation, be treated as a Federal Direct
Unsubsidized Stafford Loan under part D of title IV of the
Higher Education Act of 1965 (20 U.S.C. 1087a et seq.) except
that--
(A) no interest shall accrue on such amounts; and
(B) such amounts shall be subject to repayment in
accordance with--
(i) an income-contingent or income-based
repayment plan, if the individual meets the
eligibility requirements for such a repayment
plan; and
(ii) such other terms and conditions as are
specified by the Secretary in regulations
promulgated under this section.
(4) Hardship extension.--In the case of a recipient who has
made a good faith effort to find employment in a licensed early
learning program and has been unable to acquire such
employment, the Secretary is authorized to provide a hardship
extension for a period of not more than one year to grant
recipients who fail to complete their service requirement
within a 2-year period.
(d) Grant Amount.--An eligible individual selected to receive a
grant or a grant renewal under this section shall receive a grant in an
amount not to exceed $3,000 for each academic year during which the
individual is enrolled on a full-time or part-time basis in the
qualified early childhood educator program for which the grant was
awarded.
(e) Grant Disbursement.--Payments under this section shall be made
in accordance with regulations promulgated by the Secretary for such
purpose and in such manner as will best accomplish the purposes of this
section, provided--
(1) any disbursement made by crediting a grant recipient's
account shall be limited to tuition and fees and other
materials necessary for the completion of coursework as
determined by the Secretary; and
(2) not less than 85 percent of any funds provided to an
eligible institution under subsection (a) shall be advanced to
the eligible institution prior to the start of each payment
period and shall be based upon an amount requested by the
institution as needed to cover the total cost of grants awarded
to eligible recipients until such time as the Secretary
determines and publishes in the Federal Register with an
opportunity for comment, an alternative payment system that
provides payments to institutions in an accurate and timely
manner, except that this sentence shall not be construed to
limit the authority of the Secretary to place an institution on
a reimbursement system of payment.
(f) Direct Payment.--Nothing in this section shall be construed to
prohibit the Secretary from making a grant directly to an eligible
individual in a case in which an institution of higher education with a
qualified early childhood educator program does not participate in the
program under subsection (a).
(g) Definitions.--In this section:
(1) Eligible individual.--The term ``eligible individual''
means an individual who is enrolled on a full-time or part-time
basis in a qualified early childhood educator program.
(2) Institution of higher education.--The term
``institution of higher education'' has the meaning given that
term in section 102 of the Higher Education Act of 1965 (20
U.S.C. 1002).
(3) Qualified early childhood educator program.--The term
``qualified early childhood educator program'' means a course
of study leading to an associate's degree or a certificate in
early childhood education or a related field from an
institution of higher education.
(4) Licensed early learning program.--The term ``licensed
early learning program'' means any State-licensed or State-
regulated program or provider, regardless of setting or funding
source, that provides early care and education for children
from birth to kindergarten entry, including, but not limited
to, programs operated by child care centers and in family child
care homes.
(h) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated to
carry out this section $10,000,000 for each of fiscal years
2023 through 2027.
(2) Limitation.--Of the amount made available under
paragraph (1) in any fiscal year, not more than 3 percent may
be used for evaluation, monitoring, salaries, and
administrative expenses.
SEC. 5004. CCAMPIS REAUTHORIZATION.
Section 419N of the Higher Education Act of 1965 (20 U.S.C. 1070e)
is amended--
(1) in subsection (b)--
(A) in paragraph (2)--
(i) in subparagraph (A)--
(I) by striking ``The amount'' and
inserting ``Except as provided in
subparagraph (C), the amount''; and
(II) by striking ``1 percent'' and
inserting ``2 percent'';
(ii) in subparagraph (B)(ii), by striking
``subsection (g)'' and inserting ``subsection
(h)''; and
(iii) by adding at the end the following:
``(C) Performance bonus.--
``(i) In general.--Notwithstanding
subparagraph (A), for any fiscal year for which
the amount appropriated under subsection (h) is
not less than $140,000,000, the Secretary may
pay a performance bonus to an eligible
institution of higher education.
``(ii) Maximum amount.--A bonus paid to an
eligible institution of higher education under
clause (i) for a fiscal year shall not exceed
an amount equal to 20 percent of the amount of
the annual grant payment received by the
institution under paragraph (3)(B) for the
fiscal year preceding the fiscal year for which
the bonus is paid.
``(iii) Use of bonus.--A bonus received by
an institution under clause (i) shall be used
by the institution in the same manner as a
grant under this section and shall be treated
as grant funds for purposes of the application
of paragraph (5), except that the Secretary may
extend the grant period as necessary for the
institution to use such bonus.
``(iv) Eligible institution of higher
education.--In this subparagraph, the term
`eligible institution of higher education'
means an institution of higher education that--
``(I) has received a grant under
this section for not less than the
period of three consecutive fiscal
years preceding the fiscal year in
which the bonus is paid under clause
(i);
``(II) for each such preceding
fiscal year, has met or exceeded the
performance levels established by the
institution for such year under
subsection (e)(1)(B)(v); and
``(III) has demonstrated the need
for such bonus.''; and
(B) in paragraph (3)--
(i) in subparagraph (A), by striking ``4
years'' and inserting ``5 years''; and
(ii) in subparagraph (B), by striking
``subsection (e)(2)'' and inserting
``subsection (e)(3)'';
(2) by amending subsection (c) to read as follows:
``(c) Applications.--
``(1) In general.--An institution of higher education
desiring a grant under this section shall submit an application
to the Secretary at such time, in such manner, and accompanied
by such information as the Secretary may require. Such
application shall--
``(A) demonstrate that the institution is an
eligible institution described in subsection (b)(4);
``(B) specify the amount of funds requested;
``(C) demonstrate the need of low-income students
at the institution for campus-based child care services
by including in the application--
``(i) information regarding student
demographics, including whether the student is
a full-time or part-time student;
``(ii) an assessment of child care capacity
on or near campus;
``(iii) information regarding the waiting
lists for child care services on or near
campus;
``(iv) information regarding additional
needs created by concentrations of poverty or
by geographic isolation;
``(v) information about the number of low-
income student parents being served through
campus-based child care services; and
``(vi) other relevant data;
``(D) specify the estimated percentage of the
institution's grant that will be used directly to
subsidize the fee charged for on-campus and off-campus
childcare, respectively, for low-income students;
``(E) contain a description of the activities to be
assisted, including whether the grant funds will
support an existing child care program or a new child
care program;
``(F) identify the resources, including technical
expertise and financial support, that the institution
will draw upon to support the child care program and
the participation of low-income students in the program
(such as accessing social services funding, using
student activity fees to help pay the costs of child
care, using resources obtained by meeting the needs of
parents who are not low-income students, and accessing
foundation, corporate, or other institutional support)
and demonstrate that the use of the resources will not
result in increases in student tuition;
``(G) contain an assurance that the institution
will meet the child care needs of low-income students
through the provision of services, or through a
contract for the provision of services;
``(H) describe the extent to which the child care
program will coordinate with the institution's early
childhood education curriculum, to the extent the
curriculum is available, to meet the needs of the
students in the early childhood education program at
the institution, and the needs of the parents and
children participating in the child care program
assisted under this section;
``(I) in the case of an institution seeking
assistance for a new child care program--
``(i) provide a timeline, covering the
period from receipt of the grant through the
provision of the child care services,
delineating the specific steps the institution
will take to achieve the goal of providing low-
income students with child care services;
``(ii) specify any measures the institution
will take to assist low-income students with
child care during the period before the
institution provides child care services; and
``(iii) include a plan for identifying
resources needed for the child care services,
including space in which to provide child care
services, and technical assistance if
necessary;
``(J) contain an assurance that any child care
facility assisted under this section will meet the
applicable State and local government licensing,
certification, approval, or registration requirements;
``(K) in the case of an institution that is awarded
a grant under this section after the date of the
enactment of the PRO-LIFE Act of 2022, provide an
assurance that, not later than three years after the
date on which such grant is awarded, any child care
facility assisted with such grant will--
``(i) meet Head Start performance standards
under subchapter B of chapter 13 of title 45,
Code of Federal Regulations (as in effect on
the date of enactment of the PRO-LIFE Act of
2022) and any successor regulations;
``(ii) be in the top tier of the quality
rating improvement system for such facilities
used by the State in which the facility is
located;
``(iii) meet the licensing requirements of
the State in which the facility is located and
the quality requirements under the Child Care
and Development Block Grant Act of 1990 (42
U.S.C. 9858 et seq.); or
``(iv) be accredited by a national early
childhood accrediting body with demonstrated
valid and reliable program quality standards;
``(L) contain an assurance that the institution,
when applicable, will make information available to
students receiving child care services provided under
this section about the eligibility of such students and
their dependents for assistance under the supplemental
nutrition assistance program under the Food and
Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), the
special supplemental nutrition program for women,
infants, and children under the Child Nutrition Act of
1966 (42 U.S.C. 1786), and the program of block grants
for States for temporary assistance for needy families
established under part A of title IV of the Social
Security Act (42 U.S.C. 601 et seq.); and
``(M) contain an abstract summarizing the contents
of such application and how the institution intends to
achieve the purpose under subsection (a).
``(2) Technical assistance.--The Secretary may provide
technical assistance to eligible institutions to help such
institutions qualify, apply for, and maintain a grant under
this section.'';
(3) in subsection (d)--
(A) in the matter preceding paragraph (1), by
striking ``to institutions of higher education that
submit applications describing programs that'';
(B) by amending paragraph (1) to read as follows:
``(1) based on the extent to which institutions of higher
education that submit applications for such a grant leverage
local or institutional resources, including in-kind
contributions, to support the activities assisted under this
section;'';
(C) by redesignating paragraph (2) as paragraph
(3);
(D) by inserting after paragraph (1), the
following:
``(2) to institutions of higher education that, compared to
other institutions of higher education that submit applications
for such a grant, demonstrate a high likelihood of need for
campus-based child care based on student demographics (such as
a high proportion of low-income students or independent
students); and''; and
(E) in paragraph (3) (as redesignated by
subparagraph (C)), by inserting ``to institutions of
higher education that submit applications describing
programs that'' before ``utilize''; and
(4) in subsection (e)--
(A) in paragraph (1)(B)--
(i) by redesignating clauses (ii), (iii),
and (iv) as clauses (vi), (vii), and (viii),
respectively; and
(ii) by striking the semicolon at the end
of clause (i) and inserting the following: ``,
which shall include--
``(I) the number of full- and part-
time students, respectively, receiving
child care services under this section
at least once per week during the
academic year;
``(II) the number of credits
accumulated by students receiving such
child care services; and
``(III) the number of students
receiving child care services under
this section at least once per week
during the academic year who--
``(aa) remain enrolled at
the institution during the
academic year for which they
received such services;
``(bb) enroll at the
institution for the following
academic year; and
``(cc) graduate or transfer
within--
``(AA) 150 percent
of the normal time for
completion of a
student's four-year
degree granting
program; or
``(BB) 200 percent
of the normal time for
completion of a
student's two-year
degree-granting
program;
``(ii) with respect to the total student
enrollment at the institution and the total
enrollment of low-income students at the
institution, respectively--
``(I) the rate at which students
who complete an academic year at the
institution re-enroll in the
institution for the following academic
year; and
``(II) the percentage of students
graduating or transferring within--
``(aa) 150 percent of the
normal time for completion of a
student's four-year degree
granting program; or
``(bb) 200 percent of the
normal time for completion of a
student's two-year degree
granting program;
``(iii) the percentage of the institution's
grant that was used directly to subsidize the
fee charged for on-campus and off-campus
childcare, respectively, for low-income
students;
``(iv) whether the institution restricts
eligibility for child care services to only
full-time students;
``(v) the sufficiently ambitious levels of
performance established for such year by the
institution that demonstrate meaningful
progress and allow for meaningful evaluation of
program quality based on the information in
clauses (i)(III) and (iii);'';
(B) by redesignating paragraph (2) as paragraph
(3);
(C) by inserting after paragraph (1) the following:
``(2) Report.--
``(A) Report required.--On an annual basis, the
Secretary shall submit to the authorizing committees a
report that includes--
``(i) a summary of the information
described in paragraph (1); and
``(ii) each abstract submitted under
subsection (c)(1)(M) by an institution of
higher education that receives a grant under
this section.
``(B) Public availability.--The Secretary shall
make each report submitted under subparagraph (A)
publicly available.'';
(D) in paragraph (3), as so redesignated, by
inserting ``(other than the information provided under
subparagraph (B)(v) of such paragraph)'' after
``paragraph (1)''; and
(E) by adding at the end the following:
``(4) Technical assistance.--The Secretary shall provide
technical assistance to institutions of higher education
receiving grants under this section to help such institutions
meet the reporting requirements under this subsection.'';
(5) by redesignating subsection (g) as subsection (h);
(6) by inserting after subsection (f) the following:
``(g) Nondiscrimination.--No person in the United States shall, on
the basis of actual or perceived race, color, religion, national
origin, sex (including sexual orientation, gender identity, pregnancy,
childbirth, a medical condition related to pregnancy or childbirth, and
sex stereotype), or disability, be excluded from participation in, be
denied the benefits of, or be subjected to discrimination by any
program funded, in whole or in part, with funds made available under
this section or with amounts appropriated for grants, contracts, or
certificates administered with such funds.''; and
(7) in subsection (h), as so redesignated, by striking
``such sums as may be necessary for fiscal year 2009'' and
inserting ``$200,000,000 for fiscal year 2023''.
SEC. 5005. EVALUATION OF APPLICATIONS FOR ASSISTANCE UNDER CHOICE
NEIGHBORHOODS INITIATIVE.
In providing assistance for fiscal year 2023 and any fiscal year
thereafter under the Choice Neighborhoods Initiative of the Secretary
of Housing and Urban Development (pursuant to section 24 of the United
States Housing Act of 1937 (42 U.S.C. 1437v)), the Secretary shall
consider early care and learning facilities for children as a
neighborhood asset for purposes of evaluating applications for planning
and implementation grants, shall ensure that any metric for evaluating
such applications gives credit for the provision of early care and
learning facilities under a neighborhood plan, and shall include early
care and learning facilities as such an asset in any Notice of Funding
Availability for any such fiscal year.
TITLE VI--HONORING FAMILY-FRIENDLY WORKPLACES
SEC. 6001. DEFINITIONS.
In this title:
(1) Employee; employer.--The terms ``employee'' and
``employer'' have the meanings given such terms in section 3 of
the Fair Labor Standards Act of 1938 (29 U.S.C. 203).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Labor.
(3) Serious health condition.--The term ``serious health
condition'' has the meaning given such term in section 101 of
the Family and Medical Leave Act of 1993 (29 U.S.C. 2611).
SEC. 6002. CERTIFICATION PROGRAM ESTABLISHED.
(a) In General.--The Secretary shall establish a national
certification program to award certifications to recognize employers
that have a commitment to helping employees balance employment
responsibilities and family obligations (referred to in this section as
``family-friendly certifications'').
(b) Criteria for Certification.--In order to be eligible to receive
a family-friendly certification, an employer shall carry out each of
the following family-friendly employment policies and benefits:
(1) Assistance paying for, or referring employees to,
fertility or adoption services.
(2) Paid family leave of not less than 12 weeks per year,
including the option to use leave for any of the following
reasons:
(A) The birth of a child of the employee and in
order to care for such child.
(B) The placement of a child with the employee for
adoption or foster care.
(C) To address the serious health condition,
including pregnancy, childbirth, or pregnancy loss, of
the employee.
(D) To address the serious health condition of a
family member.
(E) For specific military caregiving and leave.
(3) Paid sick days for employees that are separate from
time accrued as part of a paid time off policy.
(4) A subsidy for child care or policies that allow parents
to work alongside their infants in safe settings.
(5) Policies that allow for flexible hours once a parent
returns to work after a birth, adoption, or foster care
placement.
(6) If feasible, policies that allow employees to work
remotely as needed for reasons related to the care of a child.
(7) Lactation support, such as reimbursement of expressed
breastmilk delivery while on travel, access to pumps, kits, and
other lactation supplies and amenities, and access to lactation
consultants and support.
(c) Application.--An employer who desires to receive a family-
friendly certification from the Secretary under this section shall
submit an application to the Secretary at such time, containing such
information, and in such manner as the Secretary may require.
(d) Award of Certification.--The Secretary shall review
applications submitted under subsection (c) and award a family-friendly
certification to an employer whose application demonstrates that the
employer has met the requirements established under subsection (b)
regarding family-friendly policies and benefits.
TITLE VII--MOTHERS AND OFFSPRING MORTALITY AND MORBIDITY AWARENESS
SEC. 7001. IMPROVING FEDERAL EFFORTS WITH RESPECT TO PREVENTION OF
MATERNAL MORTALITY.
(a) Technical Assistance for States With Respect to Reporting
Maternal Mortality.--Not later than one year after the date of
enactment of this Act, the Director of the Centers for Disease Control
and Prevention (referred to in this section as the ``Director''), in
consultation with the Administrator of the Health Resources and
Services Administration, shall provide technical assistance to States
that elect to report comprehensive data on maternal mortality and
factors relating to such mortality (including oral and mental health),
intimate partner violence, and breastfeeding health information, for
the purpose of encouraging uniformity in the reporting of such data and
to encourage the sharing of such data among the respective States.
(b) Best Practices Relating to Prevention of Maternal Mortality.--
(1) In general.--Not later than one year after the date of
enactment of this Act--
(A) the Director, in consultation with relevant
patient and provider groups, shall issue best practices
to State maternal mortality review committees on how
best to identify and review maternal mortality cases,
taking into account any data made available by States
relating to maternal mortality, including data on oral,
mental, and breastfeeding health, and utilization of
any emergency services; and
(B) the Director, working in collaboration with the
Health Resources and Services Administration, shall
issue best practices to hospitals, State professional
society groups, and perinatal quality collaboratives on
how best to prevent maternal mortality.
(2) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $5,000,000 for each of fiscal years 2023 through
2027.
(c) Alliance for Innovation on Maternal Health Grant Program.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the ``Secretary''),
acting through the Associate Administrator of the Maternal and
Child Health Bureau of the Health Resources and Services
Administration, shall establish a grant program to be known as
the Alliance for Innovation on Maternal Health Grant Program
(referred to in this subsection as ``AIM'') under which the
Secretary shall award grants to eligible entities for the
purpose of--
(A) directing widespread adoption and
implementation of maternal safety bundles through
collaborative State-based teams; and
(B) collecting and analyzing process, structure,
and outcome data to drive continuous improvement in the
implementation of such safety bundles by such State-
based teams with the ultimate goal of eliminating
preventable maternal mortality and severe maternal
morbidity in the United States.
(2) Eligible entities.--In order to be eligible for a grant
under paragraph (1), an entity shall--
(A) submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require; and
(B) demonstrate in such application that the entity
is an interdisciplinary, multi-stakeholder, national
organization with a national data-driven maternal
safety and quality improvement initiative based on
implementation approaches that have been proven to
improve maternal safety and outcomes in the United
States.
(3) Use of funds.--An eligible entity that receives a grant
under paragraph (1) shall use such grant funds--
(A) to develop and implement, through a robust,
multi-stakeholder process, maternal safety bundles to
assist States, perinatal quality collaboratives, and
health care systems in aligning national, State, and
hospital-level quality improvement efforts to improve
maternal health outcomes, specifically the reduction of
maternal mortality and severe maternal morbidity;
(B) to ensure, in developing and implementing
maternal safety bundles under subparagraph (A), that
such maternal safety bundles--
(i) satisfy the quality improvement needs
of a State, perinatal quality collaborative, or
health care system by factoring in the results
and findings of relevant data reviews, such as
reviews conducted by a State maternal mortality
review committee; and
(ii) address topics which may include--
(I) information on evidence-based
practices to improve the quality and
safety of maternal health care in
hospitals and other health care
settings of a State or health care
system, including by addressing topics
commonly associated with health
complications or risks related to
prenatal care, labor care, birthing,
and postpartum care;
(II) best practices for improving
maternal health care based on data
findings and reviews conducted by a
State maternal mortality review
committee that address topics of
relevance to common complications or
health risks related to prenatal care,
labor care, birthing, and postpartum
care;
(III) information on addressing
determinants of health that impact
maternal health outcomes for women
before, during, and after pregnancy;
(IV) obstetric hemorrhage;
(V) obstetric and postpartum care
for women with substance use disorders,
including opioid use disorder;
(VI) maternal cardiovascular
system;
(VII) maternal mental health;
(VIII) postpartum care basics for
maternal safety;
(IX) reduction of peripartum racial
and ethnic disparities;
(X) reduction of primary caesarean
birth;
(XI) severe hypertension in
pregnancy;
(XII) severe maternal morbidity
reviews;
(XIII) support after a severe
maternal morbidity event;
(XIV) thromboembolism;
(XV) optimization of support for
breastfeeding;
(XVI) maternal oral health; and
(XVII) intimate partner violence;
and
(C) to provide ongoing technical assistance at the
national and State levels to support implementation of
maternal safety bundles under subparagraph (A).
(4) Maternal safety bundle defined.--For purposes of this
subsection, the term ``maternal safety bundle'' means
standardized, evidence-informed processes for maternal health
care.
(5) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $10,000,000 for each of fiscal years 2023 through
2027.
(d) Funding for State-Based Perinatal Quality Collaboratives
Development and Sustainability.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the ``Secretary''),
acting through the Division of Reproductive Health of the
Centers for Disease Control and Prevention, shall establish a
grant program to be known as the State-Based Perinatal Quality
Collaborative grant program under which the Secretary awards
grants to eligible entities for the purpose of development and
sustainability of perinatal quality collaboratives in every
State, the District of Columbia, and eligible territories, in
order to measurably improve perinatal care and perinatal health
outcomes for pregnant and postpartum women and their infants.
(2) Grant amounts.--Grants awarded under this subsection
shall be in amounts not to exceed $250,000 per year, for the
duration of the grant period.
(3) State-based perinatal quality collaborative defined.--
For purposes of this subsection, the term ``State-based
perinatal quality collaborative'' means a network of teams
that--
(A) is multidisciplinary in nature and includes the
full range of perinatal and maternity care providers;
(B) works to improve measurable outcomes for
maternal and infant health by advancing evidence-
informed clinical practices using quality improvement
principles;
(C) works with hospital-based or outpatient
facility-based clinical teams, experts, and
stakeholders, including patients and families, to
spread best practices and optimize resources to improve
perinatal care and outcomes;
(D) employs strategies that include the use of the
collaborative learning model to provide opportunities
for hospitals and clinical teams to collaborate on
improvement strategies, rapid-response data to provide
timely feedback to hospital and other clinical teams to
track progress, and quality improvement science to
provide support and coaching to hospital and clinical
teams;
(E) has the goal of improving population-level
outcomes in maternal and infant health; and
(F) has the goal of improving outcomes of all
birthing people, through the coordination, integration,
and collaboration across birth settings.
(4) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $14,000,000 per year for each of fiscal years 2023
through 2027.
(e) Expansion of Medicaid and CHIP Coverage for Pregnant and
Postpartum Women.--
(1) Requiring coverage of oral health services for pregnant
and postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d) is amended--
(i) in subsection (a)(4)--
(I) by striking ``; and (F)'' and
inserting ``; (F)''; and
(II) by inserting ``; and (G) oral
health services for pregnant and
postpartum women (as defined in
subsection (jj))'' after ``if otherwise
covered under the State plan (or waiver
of such plan)''; and
(ii) by adding at the end the following new
subsection:
``(jj) Oral Health Services for Pregnant and Postpartum Women.--
``(1) In general.--For purposes of this title, the term
`oral health services for pregnant and postpartum women' means
dental services necessary to prevent disease and promote oral
health, restore oral structures to health and function, and
treat emergency conditions that are furnished to a woman during
pregnancy (or during the 1-year period beginning on the last
day of the pregnancy).
``(2) Coverage requirements.--To satisfy the requirement to
provide oral health services for pregnant and postpartum women,
a State shall, at a minimum, provide coverage for preventive,
diagnostic, periodontal, and restorative care consistent with
recommendations for perinatal oral health care and dental care
during pregnancy from the American Academy of Pediatric
Dentistry and the American College of Obstetricians and
Gynecologists.''.
(B) CHIP.--Section 2103(c)(6)(A) of the Social
Security Act (42 U.S.C. 1397cc(c)(6)(A)) is amended by
inserting ``or a targeted low-income pregnant woman''
after ``targeted low-income child''.
(2) Extending medicaid coverage for pregnant and postpartum
women.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(A) in subsection (e)--
(i) in paragraph (5)--
(I) by inserting ``(including oral
health services for pregnant and
postpartum women (as defined in section
1905(hh)))'' after ``postpartum medical
assistance under the plan''; and
(II) by striking ``60-day'' and
inserting ``1-year''; and
(ii) in paragraph (6), by striking ``60-
day'' and inserting ``1-year''; and
(B) in subsection (l)(1)(A), by striking ``60-day''
and inserting ``1-year''.
(3) Extending medicaid coverage for lawful residents.--
Section 1903(v)(4)(A)(i) of the Social Security Act (42 U.S.C.
1396b(v)(4)(A)(i)) is amended by striking ``60-day'' and
inserting ``1-year''.
(4) Extending chip coverage for pregnant and postpartum
women.--Section 2112(d)(2)(A) of the Social Security Act (42
U.S.C. 1397ll(d)(2)(A)) is amended to read as follows:
``(A) during pregnancy and through the end of the
month in which the 1-year period (including in the case
that subparagraph (A) of section 1902(e)(16) applies to
the State child health plan (or waiver of such plan),
pursuant to section 2107(e)(1)), beginning on the last
day of her pregnancy ends;''.
(5) Maintenance of effort.--
(A) Medicaid.--Section 1902(l) of the Social
Security Act (42 U.S.C. 1396a(l)) is amended by adding
at the end the following new paragraph:
``(5) During the period that begins on the date of enactment of
this paragraph and ends on the date that is five years after such date
of enactment, as a condition for receiving any Federal payments under
section 1903(a) for calendar quarters occurring during such period, a
State shall not have in effect, with respect to women who are eligible
for medical assistance under the State plan or under a waiver of such
plan on the basis of being pregnant or having been pregnant,
eligibility standards, methodologies, or procedures under the State
plan or waiver that are more restrictive than the eligibility
standards, methodologies, or procedures, respectively, under such plan
or waiver that are in effect on the date of enactment of this
paragraph.''.
(B) CHIP.--Section 2105(d) of the Social Security
Act (42 U.S.C. 1397ee(d)) is amended by adding at the
end the following new paragraph:
``(4) In eligibility standards for targeted low-income
pregnant women.--During the period that begins on the date of
enactment of this paragraph and ends on the date that is five
years after such date of enactment, as a condition of receiving
payments under subsection (a) and section 1903(a), a State that
elects to provide assistance to women on the basis of being
pregnant (including pregnancy-related assistance provided to
targeted low-income pregnant women (as defined in section
2112(d)), pregnancy-related assistance provided to women who
are eligible for such assistance through application of section
1902(v)(4)(A)(i) under section 2107(e)(1), or any other
assistance under the State child health plan (or a waiver of
such plan) which is provided to women on the basis of being
pregnant) shall not have in effect, with respect to such women,
eligibility standards, methodologies, or procedures under such
plan (or waiver) that are more restrictive than the eligibility
standards, methodologies, or procedures, respectively, under
such plan (or waiver) that are in effect on the date of
enactment of this paragraph.''.
(6) Information on benefits.--The Secretary of Health and
Human Services shall make publicly available on the internet
website of the Department of Health and Human Services,
information regarding benefits available to pregnant and
postpartum women and under the Medicaid program and the
Children's Health Insurance Program, including information on--
(A) benefits that States are required to provide to
pregnant and postpartum women under such programs;
(B) optional benefits that States may provide to
pregnant and postpartum women under such programs; and
(C) the availability of different kinds of benefits
for pregnant and postpartum women, including oral
health and mental health benefits, under such programs.
(7) Federal funding for cost of extended medicaid and chip
coverage for postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security
Act (42 U.S.C. 1396d), as amended by paragraph (1), is
further amended--
(i) in subsection (b), by striking ``and
(ii)'' and inserting ``(ii), and (kk)''; and
(ii) by adding at the end the following:
``(kk) Increased FMAP for Extended Medical Assistance for
Postpartum Women.--Notwithstanding subsection (b), the Federal medical
assistance percentage for a State, with respect to amounts expended by
such State for medical assistance for a woman who is eligible for such
assistance on the basis of being pregnant or having been pregnant that
is provided during the 305-day period that begins on the 60th day after
the last day of her pregnancy (including any such assistance provided
during the month in which such period ends), shall be equal to--
``(1) 100 percent for the first 20 calendar quarters during
which this subsection is in effect; and
``(2) 90 percent for calendar quarters thereafter.''.
(B) CHIP.--Section 2105(c) of the Social Security
Act (42 U.S.C. 1397ee(c)) is amended by adding at the
end the following new paragraph:
``(13) Enhanced payment for extended assistance provided to
pregnant women.--Notwithstanding subsection (b), the enhanced
FMAP, with respect to payments under subsection (a) for
expenditures under the State child health plan (or a waiver of
such plan) for assistance provided under the plan (or waiver)
to a woman who is eligible for such assistance on the basis of
being pregnant (including pregnancy-related assistance provided
to a targeted low-income pregnant woman (as defined in section
2112(d)), pregnancy-related assistance provided to a woman who
is eligible for such assistance through application of section
1902(v)(4)(A)(i) under section 2107(e)(1), or any other
assistance under the plan (or waiver) provided to a woman who
is eligible for such assistance on the basis of being pregnant)
during the 305-day period that begins on the 60th day after the
last day of her pregnancy (including any such assistance
provided during the month in which such period ends), shall be
equal to--
``(A) 100 percent for the first 20 calendar
quarters during which this paragraph is in effect; and
``(B) 90 percent for calendar quarters
thereafter.''.
(8) Guidance on state options for medicaid coverage of
doula services.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human
Services, acting through the Administrator of the Centers for
Medicare & Medicaid Services, shall issue guidance for the
States concerning options for Medicaid coverage and payment for
support services provided by doulas.
(9) Effective date.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this subsection shall take effect on
the first day of the first calendar quarter that begins
on or after the date that is one year after the date of
enactment of this Act.
(B) Exception for state legislation.--In the case
of a State plan under title XIX of the Social Security
Act or a State child health plan under title XXI of
such Act that the Secretary of Health and Human
Services determines requires State legislation in order
for the respective plan to meet any requirement imposed
by amendments made by this subsection, the respective
plan shall not be regarded as failing to comply with
the requirements of such title solely on the basis of
its failure to meet such an additional requirement
before the first day of the first calendar quarter
beginning after the close of the first regular session
of the State legislature that begins after the date of
enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the
State legislature.
(f) Regional Centers of Excellence.--Part P of title III of the
Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding
at the end the following new section:
``SEC. 399V-7. REGIONAL CENTERS OF EXCELLENCE ADDRESSING IMPLICIT BIAS
AND CULTURAL COMPETENCY IN PATIENT-PROVIDER INTERACTIONS
EDUCATION.
``(a) In General.--Not later than one year after the date of
enactment of this section, the Secretary, in consultation with such
other agency heads as the Secretary determines appropriate, shall award
cooperative agreements for the establishment or support of regional
centers of excellence addressing implicit bias, cultural competency,
and respectful care practices in patient-provider interactions
education for the purpose of enhancing and improving how health care
professionals are educated in implicit bias and delivering culturally
competent health care.
``(b) Eligibility.--To be eligible to receive a cooperative
agreement under subsection (a), an entity shall--
``(1) be a public or other nonprofit entity specified by
the Secretary that provides educational and training
opportunities for students and health care professionals, which
may be a health system, teaching hospital, community health
center, medical school, school of public health, school of
nursing, dental school, social work school, school of
professional psychology, or any other health professional
school or program at an institution of higher education (as
defined in section 101 of the Higher Education Act of 1965)
focused on the prevention, treatment, or recovery of health
conditions that contribute to maternal mortality and the
prevention of maternal mortality and severe maternal morbidity;
``(2) demonstrate community engagement and participation,
such as through partnerships with home visiting and case
management programs;
``(3) demonstrate engagement with groups engaged in the
implementation of health care professional training in implicit
bias and delivering culturally competent care, such as
departments of public health, perinatal quality collaboratives,
hospital systems, and health care professional groups, in order
to obtain input on resources needed for effective
implementation strategies; and
``(4) provide to the Secretary such information, at such
time and in such manner, as the Secretary may require.
``(c) Diversity.--In awarding a cooperative agreement under
subsection (a), the Secretary shall take into account any regional
differences among eligible entities and make an effort to ensure
geographic diversity among award recipients.
``(d) Dissemination of Information.--
``(1) Public availability.--The Secretary shall make
publicly available on the internet website of the Department of
Health and Human Services information submitted to the
Secretary under subsection (b)(3).
``(2) Evaluation.--The Secretary shall evaluate each
regional center of excellence established or supported pursuant
to subsection (a) and disseminate the findings resulting from
each such evaluation to the appropriate public and private
entities.
``(3) Distribution.--The Secretary shall share evaluations
and overall findings with State departments of health and other
relevant State level offices to inform State and local best
practices.
``(e) Maternal Mortality Defined.--In this section, the term
`maternal mortality' means death of a woman that occurs during
pregnancy or within the one-year period following the end of such
pregnancy.
``(f) Authorization of Appropriations.--For purposes of carrying
out this section, there is authorized to be appropriated $5,000,000 for
each of fiscal years 2023 through 2027.''.
(g) Special Supplemental Nutrition Program for Women, Infants, and
Children.--Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966
(42 U.S.C. 1786(d)(3)(A)(ii)) is amended--
(1) by striking the clause designation and heading and all
that follows through ``A State'' and inserting the following:
``(ii) Women.--
``(I) Breastfeeding women.--A
State'';
(2) in subclause (I) (as so designated), by striking ``1
year'' and all that follows through ``earlier'' and inserting
``2 years postpartum''; and
(3) by adding at the end the following:
``(II) Postpartum women.--A State
may elect to certify a postpartum woman
for a period of 2 years.''.
(h) Definitions.--In this section:
(1) Maternal mortality.--The term ``maternal mortality''
means death of a woman that occurs during pregnancy or within
the one-year period following the end of such pregnancy.
(2) Pregnancy related death.--The term ``pregnancy related
death'' includes the death of a woman during pregnancy or
within one year of the end of pregnancy from a pregnancy
complication, a chain of events initiated by pregnancy, or the
aggravation of an unrelated condition by the physiologic
effects of pregnancy.
(3) Severe maternal morbidity.--The term ``severe maternal
morbidity'' includes unexpected outcomes of labor and delivery
that result in significant short-term or long-term consequences
to a woman's health.
SEC. 7002. INCREASING EXCISE TAXES ON CIGARETTES AND ESTABLISHING
EXCISE TAX EQUITY AMONG ALL TOBACCO PRODUCT TAX RATES.
(a) Tax Parity for Roll-Your-Own Tobacco.--Section 5701(g) of the
Internal Revenue Code of 1986 is amended by striking ``$24.78'' and
inserting ``$49.56''.
(b) Tax Parity for Pipe Tobacco.--Section 5701(f) of the Internal
Revenue Code of 1986 is amended by striking ``$2.8311 cents'' and
inserting ``$49.56''.
(c) Tax Parity for Smokeless Tobacco.--
(1) Section 5701(e) of the Internal Revenue Code of 1986 is
amended--
(A) in paragraph (1), by striking ``$1.51'' and
inserting ``$26.84'';
(B) in paragraph (2), by striking ``50.33 cents''
and inserting ``$10.74''; and
(C) by adding at the end the following:
``(3) Smokeless tobacco sold in discrete single-use
units.--On discrete single-use units, $100.66 per thousand.''.
(2) Section 5702(m) of such Code is amended--
(A) in paragraph (1), by striking ``or chewing
tobacco'' and inserting ``, chewing tobacco, or
discrete single-use unit'';
(B) in paragraphs (2) and (3), by inserting ``that
is not a discrete single-use unit'' before the period
in each such paragraph; and
(C) by adding at the end the following:
``(4) Discrete single-use unit.--The term `discrete single-
use unit' means any product containing, made from, or derived
from tobacco or nicotine that--
``(A) is not intended to be smoked; and
``(B) is in the form of a lozenge, tablet, pill,
pouch, dissolvable strip, or other discrete single-use
or single-dose unit.''.
(d) Tax Parity for Small Cigars.--Paragraph (1) of section 5701(a)
of the Internal Revenue Code of 1986 is amended by striking ``$50.33''
and inserting ``$100.66''.
(e) Tax Parity for Large Cigars.--
(1) In general.--Paragraph (2) of section 5701(a) of the
Internal Revenue Code of 1986 is amended by striking ``52.75
percent'' and all that follows through the period and inserting
the following: ``$49.56 per pound and a proportionate tax at
the like rate on all fractional parts of a pound but not less
than 10.066 cents per cigar.''.
(2) Guidance.--The Secretary of the Treasury, or the
Secretary's delegate, may issue guidance regarding the
appropriate method for determining the weight of large cigars
for purposes of calculating the applicable tax under section
5701(a)(2) of the Internal Revenue Code of 1986.
(f) Tax Parity for Roll-Your-Own Tobacco and Certain Processed
Tobacco.--Subsection (o) of section 5702 of the Internal Revenue Code
of 1986 is amended by inserting ``, and includes processed tobacco that
is removed for delivery or delivered to a person other than a person
with a permit provided under section 5713, but does not include
removals of processed tobacco for exportation'' after ``wrappers
thereof''.
(g) Clarifying Tax Rate for Other Tobacco Products.--
(1) In general.--Section 5701 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(i) Other Tobacco Products.--Any product not otherwise described
under this section that has been determined to be a tobacco product by
the Food and Drug Administration through its authorities under the
Family Smoking Prevention and Tobacco Control Act shall be taxed at a
level of tax equivalent to the tax rate for cigarettes on an estimated
per use basis as determined by the Secretary.''.
(2) Establishing per use basis.--For purposes of section
5701(i) of the Internal Revenue Code of 1986, not later than 12
months after the later of the date of the enactment of this Act
or the date that a product has been determined to be a tobacco
product by the Food and Drug Administration, the Secretary of
the Treasury (or the Secretary of the Treasury's delegate)
shall issue final regulations establishing the level of tax for
such product that is equivalent to the tax rate for cigarettes
on an estimated per use basis.
(h) Clarifying Definition of Tobacco Products.--
(1) In general.--Subsection (c) of section 5702 of the
Internal Revenue Code of 1986 is amended to read as follows:
``(c) Tobacco Products.--The term `tobacco products' means--
``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco,
and roll-your-own tobacco, and
``(2) any other product subject to tax pursuant to section
5701(i).''.
(2) Conforming amendments.--Subsection (d) of section 5702
of such Code is amended by striking ``cigars, cigarettes,
smokeless tobacco, pipe tobacco, or roll-your-own tobacco''
each place it appears and inserting ``tobacco products''.
(i) Increasing Tax on Cigarettes.--
(1) Small cigarettes.--Section 5701(b)(1) of such Code is
amended by striking ``$50.33'' and inserting ``$100.66''.
(2) Large cigarettes.--Section 5701(b)(2) of such Code is
amended by striking ``$105.69'' and inserting ``$211.38''.
(j) Tax Rates Adjusted for Inflation.--Section 5701 of such Code,
as amended by subsection (g), is amended by adding at the end the
following new subsection:
``(j) Inflation Adjustment.--
``(1) In general.--In the case of any calendar year
beginning after 2022, the dollar amounts provided under this
chapter shall each be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined
under section 1(f)(3) for the calendar year, determined
by substituting `calendar year 2021' for `calendar year
2016' in subparagraph (A)(ii) thereof.
``(2) Rounding.--If any amount as adjusted under paragraph
(1) is not a multiple of $0.01, such amount shall be rounded to
the next highest multiple of $0.01.''.
(k) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products manufactured in
or imported into the United States which are removed before any
tax increase date and held on such date for sale by any person,
there is hereby imposed a tax in an amount equal to the excess
of--
(A) the tax which would be imposed under section
5701 of the Internal Revenue Code of 1986 on the
article if the article had been removed on such date,
over
(B) the prior tax (if any) imposed under section
5701 of such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of taxes
imposed by paragraph (1) on such date for which such person is
liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco
products on any tax increase date to which any tax
imposed by paragraph (1) applies shall be liable for
such tax.
(B) Method of payment.--The tax imposed by
paragraph (1) shall be paid in such manner as the
Secretary shall prescribe by regulations.
(C) Time for payment.--The tax imposed by paragraph
(1) shall be paid on or before the date that is 120
days after the effective date of the tax rate increase.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade Zone
Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other
provision of law, any article which is located in a foreign
trade zone on any tax increase date shall be subject to the tax
imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or
customs duties liquidated, with respect to such article
before such date pursuant to a request made under the
first proviso of section 3(a) of such Act, or
(B) such article is held on such date under the
supervision of an officer of the United States Customs
and Border Protection of the Department of Homeland
Security pursuant to the second proviso of such section
3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection
which is also used in section 5702 of such Code shall
have the same meaning as such term has in such section.
(B) Tax increase date.--The term ``tax increase
date'' means the effective date of any increase in any
tobacco product excise tax rate pursuant to the
amendments made by this section (other than subsection
(j) thereof).
(C) Secretary.--The term ``Secretary'' means the
Secretary of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were imposed
by such section 5701. The Secretary may treat any person who
bore the ultimate burden of the tax imposed by paragraph (1) as
the person to whom a credit or refund under such provisions may
be allowed or made.
(l) Effective Dates.--
(1) In general.--Except as provided in paragraphs (2)
through (4), the amendments made by this section shall apply to
articles removed (as defined in section 5702(j) of the Internal
Revenue Code of 1986) after the last day of the month which
includes the date of the enactment of this Act.
(2) Discrete single-use units and processed tobacco.--The
amendments made by subsections (c)(1)(C), (c)(2), and (f) shall
apply to articles removed (as defined in section 5702(j) of the
Internal Revenue Code of 1986) after the date that is 6 months
after the date of the enactment of this Act.
(3) Large cigars.--The amendments made by subsection (e)
shall apply to articles removed after December 31, 2022.
(4) Other tobacco products.--The amendments made by
subsection (g)(1) shall apply to products removed after the
last day of the month which includes the date that the
Secretary of the Treasury (or the Secretary of the Treasury's
delegate) issues final regulations establishing the level of
tax for such product.
<all>
Introduced in House
Introduced in House
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.
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.
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.
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.
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.
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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.
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.
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.
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.
Referred to the Subcommittee on Highways and Transit.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Nutrition, Oversight, and Department Operations.
Referred to the Subcommittee on Crime, Terrorism, and Homeland Security.