(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.

(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.

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:

(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.

(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.

(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.

(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.

(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.

(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.

Title VII of the Public Health Service Act is amended by inserting after section 757 (42 U.S.C. 294f) the following new section:

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:

(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.

(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))”.

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;”.

(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.

(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.

(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.

(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.

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:

(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.

(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.

(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.

(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.

(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.

(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.

Title III of the Public Health Service Act is amended by inserting after section 330P (42 U.S.C. 254c–22) the following:

(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.

(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.

(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)).

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.

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.

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.

(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.

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.

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.

(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.

(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.

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.

(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.

(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.

(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.

(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.

(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.

(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.

(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”.

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”.

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.

(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).

(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.

(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.

(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.”.