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 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 teams that— is multidisciplinary in nature and includes the full range of perinatal and maternity care providers; works to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles; 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; 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; has the goal of improving population-level outcomes in maternal and infant health; and has the goal of improving outcomes of all birthing people, through the coordination, integration, and collaboration across birth settings.

For purposes of carrying out this subsection, there is authorized to be appropriated $35,000,000 per year for each of fiscal years 2024 through 2028. 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); by striking ; and

(E)and inserting ;

(E); by striking ; and

(F)and inserting ;

(F); and by striking the semicolon at the end and inserting ; and

(G)oral health services for pregnant and postpartum women (as defined in subsection (jj)); ; 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)(6) of the Social Security Act ( 42 U.S.C. 1397cc(c)(6) ) is amended— in subparagraph (A)— by inserting or a targeted low-income pregnant woman after targeted low-income child ; and by inserting , and, in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman, satisfy the coverage requirements specified in section 1905(jj) after emergency conditions ; and in subparagraph (B), by inserting (but only if, in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman, the benchmark dental benefit package satisfies the coverage requirements specified in section 1905(jj)) after subparagraph

(C). Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) is amended— in subsection (a)— in paragraph (86), by striking and at the end; in paragraph (87), by striking the period at the end and inserting ; and ; and by inserting after paragraph

(87)the following new paragraph: provide that the State plan is in compliance with subsection (e)(16). ; and in subsection (e)(16)— in subparagraph (A), by striking At the option of the State, the State plan (or waiver of such State plan) may provide and inserting A State plan (or waiver of such State plan) shall provide ; in subparagraph (B), in the matter preceding clause (i), by striking by a State making an election under this paragraph and inserting under a State plan (or a waiver of such State plan) ; and by striking subparagraph (C). Section 2107(e)(1)(J) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1)(J) ), as inserted by section 9822 of the American Rescue Plan Act of 2021 ( Public Law 117–2 ), is amended to read as follows: Paragraphs

(5)and

(16)of section 1902(e) (relating to the requirement to provide medical assistance under the State plan or waiver consisting of full benefits during pregnancy and throughout the 12-month postpartum period under title XIX). . Section 2112(d)(2)(A) of the Social Security Act ( 42 U.S.C. 1397ll(d)(2)(A) ) is amended by striking the month in which the 60-day period and all that follows through pursuant to section 2107(e)(1), . 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 5 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 5 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 and breastfeeding services and supplies, under such programs. Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as amended by paragraph (1), is further amended 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 an individual 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 the individual's pregnancy (including any such assistance provided during the month in which such period ends), shall be equal to— during the first 20-quarter period for which this subsection is in effect with respect to a State, 100 percent; and with respect to a State, during each quarter thereafter, 90 percent. Any payment made to a territory for expenditures for medical assistance for an individual described in paragraph

(1)that is subject to the Federal medical assistance percentage specified under paragraph

(1)shall not be taken into account for purposes of applying payment limits under subsections

(f)and

(g)of section 1108. . 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— during the first 20-quarter period for which this subsection is in effect with respect to a State, 100 percent; and with respect to a State, during each quarter thereafter, 90 percent. . Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidance for the States concerning options for Medicaid coverage and payment for support services provided by doulas. Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as amended by paragraphs

(1)and (5), is further amended— in subsection (b), by striking and

(ii)and inserting (ii), (jj), (kk), and

(ll); and by adding at the end the following new subsection: Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for obstetric or gynecological services that are furnished in a hospital that is located in a rural area (as defined for purposes of section 1886) shall be equal to 90 percent for each calendar quarter beginning with the first calendar quarter during which this subsection is in effect. Any payment made to a territory for expenditures for medical assistance described in paragraph

(1)that is subject to the Federal medical assistance percentage specified under paragraph

(1)shall not be taken into account for purposes of applying payment limits under subsections

(f)and

(g)of section 1108. . Subject to subparagraphs

(B)and (C)— the amendments made by paragraphs (1), (2), and

(5)shall take effect on the first day of the first calendar quarter that begins on or after the date that is 1 year after the date of enactment of this Act; the amendments made by paragraph

(3)shall take effect on the date of enactment of this Act; and the amendments made by paragraph

(7)shall take effect on the first day of the first calendar quarter that begins on or 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. A State may elect to have subsection (e)(16) of section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) and subparagraph

(J)of section 2107(e)(1) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1) ), as amended by paragraph (2), and subsection

(kk)of section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) and paragraph

(13)of section 2105(c) of the Social Security Act ( 42 U.S.C. 1397ee(c) ), as added by paragraph (5), take effect with respect to the State on the first day of any fiscal quarter that begins before the date described in subparagraph

(A)and apply to amounts payable to the State for expenditures for medical assistance, child health assistance, or pregnancy-related assistance to pregnant or postpartum individuals furnished on or after such day. 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: 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. 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, 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; demonstrate community engagement and participation, such as through partnerships with home visiting and case management programs or community-based organizations serving minority populations; 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 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 2024 through 2028. . 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.

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