Sec. 3. Improving Federal efforts with respect to prevention of maternal mortality

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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, including oral, mental, 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.

Not later than one year after the date of enactment of this Act— 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 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.

For purposes of carrying out this subsection, there is authorized to be appropriated $5,000,000 for each of fiscal years 2019 through 2023. 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— directing widespread adoption and implementation of maternal safety bundles through collaborative State-based teams; and 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.

In order to be eligible for a grant under paragraph (1), an entity shall— submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and 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.

An eligible entity that receives a grant under paragraph

(1)shall use such grant funds— to develop and implement, through a robust, multi-stakeholder process, maternal safety bundles to assist States 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; to ensure, in developing and implementing maternal safety bundles under subparagraph (A), that such maternal safety bundles— satisfy the quality improvement needs of a State 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 address topics such as— obstetric hemorrhage; maternal mental health; the maternal venous system; obstetric care for women with substance use disorders, including opioid use disorder; postpartum care basics for maternal safety; reduction of peripartum racial and ethnic disparities; reduction of primary caesarean birth; severe hypertension in pregnancy; severe maternal morbidity reviews; support after a severe maternal morbidity event; thromboembolism; optimization of support for breastfeeding; and maternal oral health; and to provide ongoing technical assistance at the national and State levels to support implementation of maternal safety bundles under subparagraph (A). For purposes of this subsection, the term maternal safety bundle means standardized, evidence-informed processes for maternal health care. For purposes of carrying out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2019 through 2023. 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. Grants awarded under this subsection shall be in amounts not to exceed $250,000 per year, for the duration of the grant period. For purposes of this subsection, the term State-based perinatal quality collaborative means a network of multidisciplinary teams that— work to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles; work 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; employ 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; and have the goal of improving population-level outcomes in maternal and infant health. For purposes of carrying out this subsection, there is authorized to be appropriated $14,000,000 per year for each of fiscal years 2020 through 2024. Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— in subsection (a)(4)— by striking ; and

(D)and inserting ;

(D); and by inserting ; and

(E)oral health services for pregnant and postpartum women (as defined in subsection (ee)) after subsection (bb)) ; and by adding at the end the following new subsection: 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). 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. . Section 2103(c)(5)(A) of the Social Security Act ( 42 U.S.C. 1397cc(c)(5)(A) ) is amended by inserting or a targeted low-income pregnant woman after targeted low-income child . Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (e)— in paragraph (5)— by inserting (including oral health services for pregnant and postpartum women (as defined in section 1905(ee)) after postpartum medical assistance under the plan ; and by striking 60-day and inserting 1-year ; and in paragraph (6), by striking 60-day and inserting 1-year ; and in subsection (l)(1)(A), by striking 60-day and inserting 1-year . Section 1903(v)(4)(A) of the Social Security Act ( 42 U.S.C. 1396b(v)(4)(A) ) is amended by striking 60-day and inserting 1-year . Section 2112(d)(2)(A) of the Social Security Act ( 42 U.S.C. 1397ll(d)(2)(A) ) is amended by striking 60-day and inserting 1-year . 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: 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. . 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: 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. . 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— benefits that States are required to provide to pregnant and postpartum women under such programs; optional benefits that States may provide to pregnant and postpartum women under such programs; and the availability of different kinds of benefits for pregnant and postpartum women, including oral health and mental health benefits, under such programs. Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as amended by paragraph (1), is further amended— in subsection (b), by striking and

(aa)and inserting (aa), and

(ff); and by adding at the end the following: 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— 100 percent for the first 20 calendar quarters during which this subsection is in effect; and 90 percent for calendar quarters thereafter. . 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: 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— 100 percent for the first 20 calendar quarters during which this paragraph is in effect; and 90 percent for calendar quarters thereafter. . 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. 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. Part P of title III of the Public Health Service Act is amended by adding at the end the following new section: 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 and cultural competency 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. To be eligible to receive a cooperative agreement under subsection (a), an entity shall— 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, 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; demonstrate community engagement and participation, such as through partnerships with home visiting and case management programs; and provide to the Secretary such information, at such time and in such manner, as the Secretary may require. 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. 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). 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. 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. 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. For purposes of carrying out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2019 through 2023. . Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 ( 42 U.S.C. 1786(d)(3)(A)(ii) ) is amended— by striking the clause designation and heading and all that follows through A State and inserting the following: A State ; in subclause

(I)(as so designated), by striking 1 year and all that follows through earlier and inserting 2 years postpartum ; and by adding at the end the following: A State may elect to certify a postpartum woman for a period of 2 years. . 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. 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.

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Sec. 3

Improving Federal efforts with respect to prevention of maternal mortality

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