,,ii #aadth ,,congress #ast ,session ,s4 #fgd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #d1 #bjae ,mrs4 ,murray 7for herself1 ,ms4 ,mikulski1 and ,mrs4 ,boxer7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to expand programs with respect to women's health4 #a4 ,short title ,this ,act may be cited as the #bast ,century ,women's ,health ,act of #bjae4 #b4 ,purpose ,it is the purpose of this ,act to provide women with affordable access to comprehensive health care1 including preventive services 7such as contraception and breast cancer screenings71 to improve maternal health1 and to ensure that a woman has the same benefits and services no matter what part of the ,united ,states she lives in1 all which is critical to improving the health and well-being of women1 children1 their families1 society as a whole1 and is an essential part of a woman's economic security and opportunity4 #c4 ,strengthening family planning 7a7 ,in general ,title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq47 is amended by inserting after section #ajjc the following3 #ajjc;,a4 ,grants for facilities improvements 7a7 ,in general ,the ,secretary is authorized to make grants to and enter into contracts with public or nonprofit private entities to plan1 develop1 or make improvements to facilities carrying out family planning service projects1 and expand preventive health services1 under section #ajja4 7b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #ej1jjj1jjj for each of fiscal years #bjaf through #bjai4 4 7b7 ,funding ,there is authorized to be appropriated to carry out programs under title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq471 #cbg1jjj1jjj for each of fiscal years #bjaf through #bjai4 #d4 ,ensuring parity in women's health coverage under ,medicaid 7a7 ,state plan requirement ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended by inserting after paragraph 7#gg7 the following3 7#gh7 provide that the ,state shall1 at a minimum and in addition to any other preventive care and screenings required under this title1 provide medical assistance for preventive care and screenings required under section #bgac7;a7 of the ,public ,health ,service ,act1 including evidence-based items or services required under section #bgac7;a77#a7 of such ,act1 evidence-informed preventive care and screenings required under section #bgac7;a77#c7 of such ,act1 and additional preventive care and screenings required for women under section #bgac7;a77#d7 of such ,act and as provided for in comprehensive guidelines supported by the ,health ,resources and ,services ,administration1 and shall not impose any copayment1 coinsurance1 deductible1 cost-sharing1 or similar charge for such preventive care and screenings2 4 7b7 ,application to managed care ,section #aicb7;b7 of such ,act 7#db ,u4,s4,c4 #acifu-#b7;b77 is amended by adding at the end the following3 7#i7 ,parity in women's health coverage ,each medicaid managed care organization shall at a minimum and in addition to any other preventive care and screenings required under a contract with the ,state under section #aijc7m71 provide medical assistance for preventive care and screenings required under section #bgac7;a7 of the ,public ,health ,service ,act1 including evidence-based items or services required under section #bgac7;a77#a7 of such ,act1 evidence-informed preventive care and screenings required under section #bgac7;a77#c7 of such ,act1 and additional preventive care and screenings required for women under section #bgac7;a77#d7 of such ,act and as provided for in comprehensive guidelines supported by the ,health ,resources and ,services ,administration1 and shall not impose any copayment1 coinsurance1 deductible1 cost-sharing1 or similar charge for such preventive care and screenings4 4 7c7 ,application to benchmark benefit plans ,section #aicg7;b77#e7 of such ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#e77 is amended by inserting and1 effective ,january #a1 #bjaf1 must provide1 at a minimum and in addition to any other preventive care and screenings required under this section1 preventive care and screenings1 required under section #bgac7;a7 of the ,public ,health ,service ,act1 including evidence-based items or services required under section #bgac7;a77#a7 of such ,act1 evidence-informed preventive care and screenings required under section #bgac7;a77#c7 of such ,act1 and additional preventive care and screenings required for women under section #bgac7;a77#d7 of such ,act and as provided for in comprehensive guidelines supported by the ,health ,resources and ,services ,administration1 and shall not impose any copayment1 coinsurance1 deductible1 cost-sharing or similar charge for such preventive care and screenings before the period4 7d7 ,parity in coverage of all ,,fda-,approved forms of contraception ,section #aije7;a77#d77;,c7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77#d77;,c77 is amended by inserting 1 including family planning services and supplies that are required under section #bgac7;a7 of the ,public ,health ,service ,act and as provided for in comprehensive guidelines supported by the ,health ,resources and ,services ,administration for purposes of section #bgac7;a77#d7 of such ,act1 before furnished4 7e7 ,conforming amendments prohibiting cost-,sharing 7#a7 ,in general ,subsections 7a77#b77;,d7 and 7b77#b77;,d7 of section #aiaf of such ,act 7#db ,u4,s4,c4 #acifo7 are each amended by inserting and items and services required under section #aijb7;a77#gh71 before or4 7#b7 ,alternative authority ,section #aiaf;,a7b77#c77;,b7 of such ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended by adding at the end the following3 7xi7 ,items and services required under section #aijb7;a77#gh74 4 7f7 ,application to waivers 7#a7 ,limitation of waiver authority ,notwithstanding section #aaae7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7;a771 subject to paragraph 7#b71 the ,secretary of ,health and ,human ,services may not grant a waiver under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7 or otherwise of the requirements imposed under the amendments made by this section4 7#b7 ,exception for current waivers ,the amendments made by this section shall not apply to any waiver granted to a ,state under section #aaae of the ,social ,security ,act 7#db ,u4,s4,c4 #acae7 or otherwise which relates to the provision of medical assistance under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 that is in effect as of the date of enactment of this ,act before the expiration 7determined without regard to any extensions7 of the waiver to the extent such amendments are inconsistent with the waiver4 7g7 ,effective date 7#a7 ,in general ,except as provided in paragraphs 7#b7 and 7#c71 the amendments made by this section shall be effective with respect to items or services furnished on or after the date of enactment of this ,act4 7#b7 ,benchmark and managed care plans ,the amendments made by subsections 7b7 and 7c7 shall apply to plan years beginning on or after ,january #a1 #bjaf4 7#c7 ,transition rule ,in the case of a ,state plan under title ,,xix or ,,xxi of the ,social ,security ,act1 which the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this section1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this section4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 #e4 ,access to ,women's ,health ,care ,providers ,part ,b of title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bif;j et seq47 is amended by adding at the end the following3 #hab4 ,demonstration grants for nurse practitioner training program 7a7 ,establishment of program ,the ,secretary shall establish a demonstration program 7referred to in this section as the program7 to award grants to eligible entities for the training of nurse practitioners specializing in women's health care for careers as providers in health centers that receive assistance under title ,x 7referred to in this section as health centers74 7b7 ,purpose ,the purpose of the program is to enable each grant recipient to-- 7#a7 provide new nurse practitioners with clinical training to enable such practitioners to serve as providers in health centers2 7#b7 train new nurse practitioners to work under a model of care that is consistent with the principles set forth by the ,report ,providing ,quality ,family ,planning ,services of the ,centers for ,disease ,control and ,prevention2 and 7#c7 establish a model of training for nurse practitioners that specialize in women's health care that may be replicated nationwide4 7c7 ,grants ,under the program1 the ,secretary shall award #c-year grants to eligible entities that meet the requirements established by the ,secretary1 for the purpose of operating the nurse practitioner programs described in subsection 7a7 at such entities4 7d7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be-- 7#a7 a health center that receives funding under section #ajja2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7e7 ,eligibility of nurse practitioners 7#a7 ,in general ,to be eligible for acceptance into a training program carried out by an eligible entity under a grant under this section1 an individual shall-- 7,a7 be licensed1 or eligible for licensure1 in the ,state in which the program is being carried out as an advanced practice registered nurse or advanced practice nurse and be eligible or board-certified as a nurse practitioner2 and 7,b7 demonstrate commitment to a career as a provider in a health center4 7#b7 ,preference ,in accepting individuals into a training program under this section1 a grant recipient shall give preference to bilingual applicants that meet the requirements described in paragraph 7#a74 7f7 ,grant amount ,each grant awarded under this section shall be in an amount not to exceed #fjj1jjj per year4 ,a grant recipient may carry over funds from #a fiscal year to another without obtaining approval from the ,secretary4 7g7 ,technical assistance grants ,the ,secretary may award technical assistance grants to #a or more health centers that have demonstrated expertise in establishing a nurse practitioner residency training program4 ,such technical assistance grants shall be for the purpose of providing technical assistance to other recipients of grants under subsection 7c74 7h7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjaf through #bjai4 4 #f4 ,compassionate assistance and awareness for survivors of rape 7a7 ,definitions ,in this section3 7#a7 ,emergency contraception ,the term emergency contraception means a drug or device 7as such terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba771 or drug regimen that-- 7,a7 is used postcoitally2 7,b7 prevents pregnancy primarily by preventing or delaying ovulation1 and does not terminate an established pregnancy2 and 7,c7 is approved by the ,food and ,drug ,administration4 7#b7 ,health care provider ,the term health care provider means an individual who is licensed or certified under ,state law to provide health care services and who is operating within the scope of such license4 ,such term shall include a pharmacist4 7#c7 ,hospital ,the term hospital means-- 7,a7 a hospital as defined in section #ahfa7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7e772 7,b7 a critical access hospital as defined in section #ahfa7mm77#a7 of such ,act 7#db ,u4,s4,c4 #aciex7mm77#a772 and 7,c7 a health clinic located on the campus of an institution of higher education4 7#d7 ,institution of higher education ,the term institution of higher education has the meaning given such term in section #aja7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7;a774 7#e7 ,nonprofits ,the term nonprofits 7other than institutions of higher education7 means a community-based organization1 other than an institution of higher education1 with experience in providing evidence-based effective programs1 strategies1 and policies to prevent sexual violence1 intimate partner violence1 and other forms of violence on the campus of institutions of higher education4 7#f7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#g7 ,sexual assault 7,a7 ,in general ,the term sexual assault means a sexual act 7as defined in subparagraphs 7,a7 through 7,c7 of section #bbdf7b7 of title #ah1 ,united ,states ,code7 where the victim involved does not consent or lacks the capacity to consent4 7,b7 ,application of provisions ,the definition in subparagraph 7,a7 shall apply to all individuals4 7b7 ,survivors of sexual assault2 provision by hospitals of emergency contraception without charge 7#a7 ,in general ,federal funds may not be provided to a hospital unless such hospital complies with the conditions specified in paragraph 7#b7 in the case of-- 7,a7 any woman who arrives at the hospital and states that she is a victim of sexual assault1 or is accompanied by someone who states she is a victim of sexual assault2 and 7,b7 any woman who arrives at the hospital whom hospital personnel have reason to believe is a victim of sexual assault4 7#b7 ,assistance for victims ,the conditions specified in this subsection regarding a hospital and a woman described in paragraph 7#a7 are as follows3 7,a7 ,the hospital promptly provides the woman with medically and factually accurate and unbiased written and oral information about emergency contraception1 including information explaining that-- 7i7 some forms of emergency contraception have been approved by the ,food and ,drug ,administration as over-the-counter medications for all women without age restrictions and such contraception is a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner2 7ii7 emergency contraception is more effective the sooner it is taken2 and 7iii7 emergency contraception does not cause an abortion and cannot interrupt an established pregnancy4 7,b7 ,the hospital promptly offers emergency contraception to the woman1 and promptly provides such contraception to her at the hospital on her request4 7,c7 ,the information provided pursuant to subparagraph 7,a7 is in clear and concise language1 is readily comprehensible1 and meets such conditions regarding the provision of the information in languages other than ,english as the ,secretary may establish4 7,d7 ,the services described in subparagraphs 7,a7 through 7,c7 are not denied because of the inability of the woman or her family to pay for the services4 7#c7 ,effective date2 agency criteria ,this subsection shall take effect upon the expiration of the #ahj-;day period beginning on the date of the enactment of this ,act4 ,not later than #cj days prior to the expiration of such period1 the ,secretary shall publish in the ,federal ,register criteria for carrying out this section4 7c7 ,survivors of campus sexual assault2 provision by community-,based organizations and nonprofits 7,other than institutions of higher education7 of emergency contraception and sexual assault prevention programs ,nonprofits 7other than institutions of higher education7 shall provide for campus programs focused on effective prevention strategies that include-- 7#a7 the implementation of a comprehensive prevention strategy based on evidence-based research that identifies strategies to prevent sexually violent behavior2 7#b7 the use of risk and protective factors through the provision of training to students on sexual violence and prevention and the provision of campus outreach on preventing sexual violence and information about emergency contraception2 and 7#c7 the coordination of activities with campus-based health facilities to ensure prompt access to medically and factually accurate and unbiased written and oral information about emergency contraception and assistance as determined under subsection 7b77#b74 7d7 ,emergency contraception education and information programs 7#a7 ,emergency contraception public education program 7,a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop and disseminate to the public information on emergency contraception4 7,b7 ,dissemination ,the ,secretary may disseminate information on emergency contraception under subparagraph 7,a7 directly or through arrangements with health agencies1 professional and nonprofit organizations1 consumer groups1 institutions of higher education1 clinics1 the media1 and ,federal1 ,state1 and local agencies4 7,c7 ,information ,the information on emergency contraception disseminated under subparagraph 7,a7 shall include1 at a minimum1 the most current evidence-based and evidence-informed standards of care with respect to emergency contraception and an explanation of the proper1 use1 safety1 efficacy1 and availability of such contraception1 and the availability of counseling with respect to such contraception4 7#b7 ,emergency contraception information program for health care providers 7,a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with major medical and public health organizations1 shall develop and disseminate to health care providers information on emergency contraception4 7,b7 ,information ,the information disseminated under subparagraph 7,a7 shall include1 at a minimum-- 7i7 information describing the most current evidence-based and evidence-informed standards of care1 proper use1 safety1 efficacy1 and availability of emergency contraception1 and the availability of counseling with respect to such contraception2 7ii7 recommendations regarding the use of such contraception in appropriate cases2 7iii7 recommendations for health care providers working in emergency rooms to consult with survivors of sexual assault1 once such survivors are clinically stable1 regarding options for emergency contraception and to provide any necessary follow-up care and referral services2 and 7iv7 information explaining how to obtain copies of the information developed under paragraph 7#a7 for distribution to the patients of the providers4 7#c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 such sums as may be necessary for each of the fiscal years #bjaf through #bjbj4 7#d7 ,study ,the ,agency for ,healthcare ,research and ,quality shall conduct a study of access of survivors of sexual assault to emergency contraception in each ,state and nationally1 to make access and care safer1 of higher quality1 and more accessible1 equitable1 and affordable4 #g4 ,improved customer service and protections for women ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended by adding at the end the following3 ,w ,women's health #cii,,oo4 ,office of the ,ombudsperson on ,women's ,health 7a7 ,establishment ,there is established within the ,office of ,secretary of the ,department of ,health and ,human ,services an ,office of the ,ombudsperson on ,women's ,health 7in this section referred to as the ,office74 ,the ,office shall be headed by an ,ombudsperson who is appointed by the ,secretary and reports directly to the ,secretary4 7b7 ,deadline for designation of ombudsperson ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall designate an individual to serve as the ,ombudsperson of the ,office on ,women's ,health 7referred to in this part as the ,ombudsperson74 7c7 ,duties of office 7#a7 ,in general ,the ,ombudsperson1 in coordination 7as defined in paragraph 7#d77 with major medical1 public health1 and legal organizations1 agencies within the ,department of ,health and ,human ,services1 the ,department of ,labor1 and consumer organizations shall develop recommendations to identify and better assist women in accessing health and human services4 7#b7 ,additional duties ,the ,office shall-- 7,a7 serve as the coordinator for the ,department of ,health and ,human ,services for complaints and issues with respect to the provision of health services to women that involve any administrative body within the ,department of ,health and ,human ,services1 including the ,office on ,women's ,health1 the ,office of ,population ,affairs1 the ,centers for ,disease ,control and ,prevention1 the ,national ,institutes of ,health1 the ,food and ,drug ,administration1 the ,office of ,adolescent ,health1 the ,health ,resources and ,services ,administration1 the ,office of ,civil ,rights1 and the ,center for ,consumer ,information and ,insurance ,oversight1 and shall consult with the ,department of ,labor regarding such complaints and issues1 in order to refer women to the appropriate agency for her complaint and issue2 7,b7 collect data and information about the complaints concerning health services for women that are received across the ,department by the ,ombudsperson and other agencies2 7,c7 help to coordinate assistance for women among the various administrative bodies of the ,department of ,health and ,human ,services2 7,d7 maintain and publicize a toll-free telephone number for women seeking assistance regarding issues related to a health service1 and to report complaints2 7,e7 provide assistance within the ,department of ,health and ,human ,services1 and in consultation with the ,secretary of ,labor1 when there are barriers to getting information about a complaint1 or accessing services or benefits2 7,f7 issue reports on how women's health care issues are addressed and handled within the ,department of ,health and ,human ,services and track what agencies are being responsive to complaints in order to improve customer service and improve women's access to health services2 7,g7 work with other administrative bodies of the ,department of ,health and ,human ,services to address issues identified through fact-finding and inquiries2 7,h7 ,work with external stakeholders1 such as pharmacies1 providers1 community-based organizations1 clinics1 and hospitals1 to ensure that there is information regarding the cost-sharing and preventive services1 including access to all ,food and ,drug ,administration approved forms of contraception made available under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh72 and 7,i7 submit an annual report to ,congress in accordance with subsection 7e74 7#c7 ,responsibilities of the ,ombudsperson ,in carrying out the duties of the ,office1 the ,ombudsperson shall-- 7,a7 evaluate each complaint received by the ,office objectively2 7,b7 maintain confidentiality of any matter related to complaints1 including the identities of the complainants and witnesses2 and 7,c7 ensure that any action taken by the ,ombudsperson1 and other offices of the ,department of ,health and ,human ,services1 with respect to such a matter does not negatively affect the ability of any woman to receive health care or benefits under a law administered by the ,secretary4 7#d7 ,coordination ,to better identify and address issues related to health care for women1 the ,ombudsperson shall coordinate efforts with respect to such issues among-- 7,a7 all entities within the ,department of ,health and ,human ,services2 7,b7 the ,department of ,labor2 and 7,c7 any other ,federal agency with jurisdiction over matters related to access to health care services for women4 7#e7 ,public meetings ,the ,ombudsperson shall convene a public meeting quarterly to ensure communication and coordination of services for women4 7d7 ,consultation ,in carrying out the duties of the ,office1 the ,ombudsperson1 as appropriate1 shall consult with ,state offices of health insurance consumer assistance and health insurance ombudsman programs for which a ,state has received a grant under section #bgic4 7e7 ,annual reports 7#a7 ,in general ,not later than ,september #cj of each year1 the ,office shall submit a report to ,congress on the actions taken by the ,office over the preceding year and the objectives of those actions4 ,such report shall be provided by the ,ombudsperson directly to ,congress without any prior comment or amendment by the ,secretary4 7#b7 ,contents ,each report submitted under paragraph 7#a7 shall include1 with respect to the preceding year-- 7,a7 statistical information1 by region1 on the volume of complaints received by the ,office1 the general nature of complaints1 general information on complainants1 and the percentage of complaints that resulted in a fact-finding inquiry2 7,b7 a summary of problems encountered by complainants1 including information on the most pervasive or serious types of problems encountered by complainants1 including an enumeration of actions that the ,office has taken in response to such problems2 7,c7 policy recommendations that the ,office made to the ,department of ,health and ,human ,services and the ,department of ,labor to remedy continual problems or address areas of concerns that are reported to the ,office to better inform policymaking1 including an enumeration of actions that the ,office has taken in response to such problems or concerns2 and 7,d7 such other information as the ,office considers relevant4 7#c7 ,report from the ,secretary ,the ,ombudsperson shall seek comment from the ,secretary on the report prepared for submission under paragraph 7#a71 and the ,ombudsperson shall submit to ,congress the comments of the ,secretary together with the annual report under paragraph 7#a74 7#d7 ,other reports ,nothing in this subsection shall be construed to preclude the ,office from issuing additional reports on the activities of the ,office4 7f7 ,network adequacy study 7#a7 ,study ,the ,ombudsperson shall conduct a study on the network adequacy for women's health services4 ,such study shall include-- 7,a7 an analysis of the number of in-network providers for women's health services across the ,united ,states1 including ,state-by-,state information on waiting times and distance traveled2 7,b7 an analysis of the availability of women's health services1 including contraception counseling and reproductive health services2 7,c7 the identification of geographic areas in which there may be a shortage of providers1 clinics1 and hospitals that are able to provide women with the full reproductive services2 7,d7 a comparison of information provided to women concerning in-network and out-of-network providers2 7,e7 an analysis of factors related to women's health care access that identifies geographic gaps1 health center availability1 and barriers to providing such care in training1 expertise1 and stocking of drugs2 7,f7 information on a ,state's balance billing policies as related to consumers and providers2 and 7,g7 a ,state-by-,state comparison of accessibility1 essential community providers1 and transparency of information4 7#b7 ,report ,not later than ,january #a1 #bjag1 the ,ombudsperson shall submit a report to ,congress on the study conducted under paragraph 7#a74 ,the report shall include the recommendations of the ,ombudsperson with respect to network adequacy for women4 4 #h4 ,national women's health awareness campaign ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda;g et seq471 as amended by section #g1 is further amended by adding at the end the following3 #cii,,oo-#a4 ,women's preventive health awareness campaign 7a7 ,in general ,the ,secretary1 in cooperation with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 the ,director of the ,center for ,consumer ,information and ,insurance ,oversight1 the ,director of the ,office of ,women's ,health1 the ,director of the ,national ,institutes of ,health1 the ,commissioner of ,food and ,drugs1 and the ,ombudsperson of the ,office of ,women's ,health1 shall coordinate and provide for a national public outreach and education campaign to raise public awareness1 including among providers1 of preventive health services for women and families1 including contraception coverage made available under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh74 7b7 ,dissemination of information ,the outreach and awareness campaign shall include the media campaign under subsection 7c7 and the ,internet website under subsection 7d71 and shall provide for the dissemination of information that-- 7#a7 describes the guidelines for preventive services for women1 including the most up-to-date recommendations on domestic violence screenings and counseling1 breast cancer1 cervical cancer1 and other diseases that disproportionately impact women1 available from the ,united ,states ,preventive ,services ,task ,force and major medical and public health organizations2 7#b7 promotes well-woman visits for health assessments which include screenings1 evaluations1 counseling1 immunizations1 breastfeeding services and supplies1 and prenatal visits1 as appropriate2 7#c7 increases awareness of domestic violence screenings and counseling made available1 and ensure that women are able to access and utilize such screenings and counseling2 7#d7 explains the preventive services for women that are required under section #bgac to be covered without cost-sharing by a group health plan or a health insurance issuer offering group or individual health insurance coverage that is not a grandfathered plan 7as defined in section #abea7;e7 of the ,patient ,protection and ,affordable ,care ,act72 7#e7 provides broad information for women1 pharmacists1 pharmacies1 and providers to ensure full access to all ,food and ,drug ,administration-approved forms of contraception and preventive services that are covered in accordance with section #bgac without cost-sharing2 7#f7 addresses health disparities in preventive care for women2 7#g7 informs women about what to do if they are denied entitled benefits and services by making them aware of the ,office of the ,ombudsperson of the ,office on ,women's ,health under section #cii,,oo2 and 7#h7 provides robust information about access to health care providers through both private and public health insurance programs1 including information regarding an employer's contraceptive coverage policy4 7c7 ,media campaign 7#a7 ,in general ,not later than #ahj days after the date of enactment of the #bast ,century ,women's ,health ,act of #bjae1 the ,secretary shall establish and implement a national media campaign to disseminate the information described in subsection 7b74 7#b7 ,requirements ,the campaign described in paragraph 7#a7-- 7,a7 shall provide information about the updated guidelines for women's preventive services described in subsection 7b77#a71 promote well-woman visits described in subsection 7b77#b71 and provide information on the preventive services for women described in subsection 7b77#c72 and 7,b7 may include the use of television1 radio1 ,internet1 and other commercial marketing venues4 7d7 ,internet website 7#a7 ,in general ,the ,secretary1 in consultation with private sector experts1 or through a contract with a private entity such as a medical association or non-profit organization1 shall establish an ,internet website to-- 7,a7 disseminate information on preventive health services for women and families directly or through health agencies1 professional and nonprofit organizations1 consumer groups1 institutions of higher education1 clinics1 the media1 or ,federal1 ,state1 and local agencies2 and 7,b7 provide information and resources about the updated guidelines for women's preventive services1 promote well-woman visits1 and provide information on women's preventive services4 7#b7 ,reporting tool ,the ,secretary1 acting through the ,ombudsperson on ,women's ,health appointed under section #cii,,oo1 shall develop and operate a consumer-focused reporting tool on the ,internet website established under paragraph 7#a7 that enables women and families to report instances of being inappropriately charged for1 or not being provided1 benefits under section #bgac4 7#c7 ,guidance and policy ,the ,ombudsperson shall use information obtained through the website to develop recommendations on policy and implementation with respect to the benefits and services under section #bgac1 to ensure that women and families receive such benefits and services as afforded by the law4 7e7 ,funding ,from any funds otherwise made available to the ,department of ,health and ,human ,services1 the ,secretary may allocate such sums as may be necessary to carry out this section4 4 #i4 ,reproductive health services access ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda;g et seq471 as amended by section #h1 is further amended by adding at the end the following3 #cii,,oo-#b4 ,study and ,report on ,women's ,health ,care ,access to the ,full ,range of ,reproductive ,health ,care ,services 7a7 ,in general ,the ,secretary shall conduct a study on women's access to the full range of reproductive health care services across the ,united ,states1 and1 not later than ,january #a1 #bjag1 and every #e years thereafter1 the ,secretary shall submit a report to ,congress on such study4 7b7 ,contents ,the study and report under subsection 7a7 shall include-- 7#a7 identification and analysis of how ,state laws regarding abortion access1 including facility requirements including admitting privileges1 insurance coverage limitations1 mandatory delays1 gestational limits1 medication restrictions1 and parental notification and consent impact a women's access to reproductive family planning services2 7#b7 identification of geographic areas in which such ,state laws and practices have a strong impact on access to family planning services for women and their families2 7#c7 analysis of factors related to reproductive health services that impact women1 children1 and families1 such as the ability to work1 children's access to health insurance1 access to health coverage1 and the ,state's role in making these services available to women and families2 7#d7 analysis of how women's access to family planning services in such geographic areas correlate with maternity-related health outcomes1 including the rates of infant mortality1 premature births1 birth weight1 burden of sexually transmitted infections1 and other measures deemed appropriate2 and 7#e7 the recommendations of the ,secretary with respect to the necessary coverage of services to ensure full access to reproductive services and best practices for ,states4 4 #aj4 ,maternal health accountability 7a7 ,purposes ,the purposes of this section are the following3 7#a7 ,to establish governmental accountability and a shared responsibility between ,states and the ,federal ,government to identify opportunities for improvement in quality of care and system changes1 and to educate and inform health institutions and professionals1 women1 and families about preventing pregnancy-related deaths and complications and reducing disparities4 7#b7 ,to develop a model for ,states to operate maternal mortality reviews and assess the various factors that may have contributed to maternal mortality1 including quality of care1 racial disparities1 and systemic problems in the delivery of health care1 and to develop appropriate interventions to reduce and prevent such deaths4 7b7 ,uniform ,state maternal mortality review committees on pregnancy-,related deaths 7#a7 ,condition of receipt of payments from allotment under ,maternal and ,child ,health ,service ,block ,grant ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda;g et seq471 as amended by section #i1 is further amended by adding at the end the following3 #cii,,oo-#c4 ,uniform ,state maternal mortality review committees on pregnancy-related deaths 7a7 ,grants 7#a7 ,in general ,for each of fiscal years #bjaf through #bjbb1 the ,secretary shall1 subject to paragraph 7#c7 and in accordance with the criteria established under paragraph 7#b71 award grants to ,states to-- 7,a7 carry out the activities described in subsection 7b77#a72 7,b7 establish a ,state maternal mortality review committee1 in accordance with subsection 7b77#b71 to carry out the activities described in subsection 7b77#b77;,a71 and to establish the processes described in subsection 7b77#a72 7,c7 ensure the ,state department of health carries out the applicable activities described in subsection 7b77#c71 with respect to pregnancy-related deaths occurring within the ,state during such fiscal year2 7,d7 provide for public disclosure of information1 in accordance with subsection 7c72 and 7,e7 collect1 analyze1 and report to the ,secretary cases of maternal morbidity1 including reports of maternal morbidity data on admissions to an intensive care unit or the transfusion of more than three units of blood products4 7#b7 ,criteria ,the ,secretary shall establish criteria for determining eligibility for and the amount of a grant awarded to a ,state under paragraph 7#a74 ,such criteria shall provide that in the case of a ,state that receives such a grant for a fiscal year and is determined by the ,secretary to have not used such grant in accordance with this section1 such ,state shall not be eligible for such a grant for any subsequent fiscal year4 7#c7 ,authorization of appropriations ,for purposes of carrying out the grant program under this section1 including for administrative purposes1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjaf through #bjbb4 7b7 ,pregnancy-,related death review 7#a7 ,review of pregnancy-related death and pregnancy-associated death cases ,for purposes of subsection 7a71 with respect to a ,state that receives a grant under subsection 7a71 the following shall apply3 7,a7 ,mandatory reporting of pregnancy-related deaths 7i7 ,in general ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process1 separate from any reporting process established by the ,state department of health prior to the date of the enactment of this section1 that provides for mandatory and confidential case reporting by individuals and entities described in clause 7ii7 of pregnancy-related deaths to the ,state department of health4 7ii7 ,individuals and ,entities described ,individuals and entities described in this clause include each of the following3 7,i7 ,health care providers4 7,,ii7 ,medical examiners4 7,,iii7 ,medical coroners4 7,,iv7 ,hospitals4 7,v7 ,free-standing birth centers4 7,,vi7 ,other health care facilities4 7,,vii7 ,any other individuals responsible for completing death certificates4 7,,viii7 ,any other appropriate individuals or entities specified by the ,secretary4 7,b7 ,voluntary reporting of pregnancy-related and pregnancy-associated deaths 7i7 ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process for and encourage1 separate from any reporting process established by the ,state department of health prior to the date of the enactment of this section1 voluntary and confidential case reporting by individuals described in clause 7ii7 of pregnancy-associated deaths to the ,state department of health4 7ii7 ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process for voluntary and confidential reporting by family members of the deceased and by other individuals on possible pregnancy-related and pregnancy-associated deaths to the ,state department of health4 ,such process shall include-- 7,i7 making publicly available on the ,internet website of the ,state department of health a telephone number1 ,internet ,web link1 and email address for such reporting2 and 7,,ii7 publicizing to local professional organizations1 community organizations1 and social services agencies the availability of the telephone number1 ,internet ,web link1 and email address made available under subclause 7,i74 7,c7 ,development of case-finding ,the ,state1 through the vital statistics unit of the ,state1 shall annually identify pregnancy-related and pregnancy-associated deaths occurring in such ,state during the year involved by-- 7i7 matching all death records1 with respect to such year1 for women of childbearing age to live birth certificates and infant death certificates to identify deaths of women that occurred during pregnancy and within one year after the end of a pregnancy2 7ii7 identifying deaths reported during such year as having an underlying or contributing cause of death related to pregnancy1 regardless of the time that has passed between the end of the pregnancy and the death2 7iii7 collecting data from medical examiner and coroner reports2 and 7iv7 any other methods the ,states may devise to identify maternal deaths1 such as through review of a random sample of reported deaths of women of childbearing age to ascertain cases of pregnancy-related and pregnancy-associated deaths that are not discernable from a review of death certificates alone4 ,when feasible and for purposes of effectively collecting and obtaining data on pregnancy-related and pregnancy-associated deaths1 the ,state shall adopt the most recent standardized birth and death certificates1 as issued by the ,national ,center for ,vital ,health ,statistics1 including the recommended checkbox section for pregnancy on the death certificates4 7,d7 ,case investigation and development of case summaries ,following receipt of reports by the ,state department of health pursuant to subparagraph 7,a7 or 7,b7 and collection by the vital statistics unit of the ,state of possible cases of pregnancy-related and pregnancy-associated deaths pursuant to subparagraph 7,c71 the ,state1 through the ,state maternal mortality review committee established under subsection 7a71 shall investigate each case1 utilizing the case abstraction form described in subsection 7c71 and prepare de-identified case summaries1 which shall be reviewed by the committee and included in applicable reports4 ,for purposes of subsection 7a71 under the processes established under subparagraphs 7,a71 7,b71 and 7,c71 a ,state department of health or vital statistics unit of a ,state shall provide to the ,state maternal mortality review committee access to information collected pursuant to such subparagraphs as necessary to carry out this subparagraph4 ,data and information collected for the case summary and review are for purposes of public health activities1 in accordance with ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b774 ,such case investigations shall include data and information obtained through-- 7i7 medical examiner and autopsy reports of the woman involved2 7ii7 medical records of the woman1 including such records related to health care prior to pregnancy1 prenatal and postnatal care1 labor and delivery care1 emergency room care1 hospital discharge records1 and any care delivered up until the time of death of the woman for purposes of public health activities1 in accordance with ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b772 7iii7 oral and written interviews of individuals directly involved in the maternal care of the woman during and immediately following the pregnancy of the woman1 including health care1 mental health1 and social service providers1 as applicable2 7iv7 optional oral or written interviews of the family of the woman2 7v7 socioeconomic and other relevant background information about the woman2 7vi7 information collected in subparagraph 7,c77i72 and 7vii7 other information on the cause of death of the woman1 such as social services and child welfare reports4 7#b7 ,state maternal mortality review committees 7,a7 ,duties 7i7 ,required committee activities ,for purposes of subsection 7a71 a maternal mortality review committee established by a ,state pursuant to a grant under such subsection shall carry out the following pregnancy-related death and pregnancy-associated death review activities3 7,i7 ,with respect to a case of pregnancy-related or pregnancy-associated death of a woman1 review the case summaries prepared under subparagraphs 7,a71 7,b71 7,c71 and 7,d7 of paragraph 7#a74 7,,ii7 ,review aggregate statistical reports developed by the vital statistics unit of the ,state under paragraph 7#a77;,c7 regarding pregnancy-related and pregnancy-associated deaths to identify trends1 patterns1 and disparities in adverse outcomes and address medical1 non-medical1 and system-related factors that may have contributed to such pregnancy-related and pregnancy-associated deaths and disparities4 7,,iii7 ,develop recommendations1 based on the review of the case summaries under paragraph 7#a77;,d7 and aggregate statistical reports under subclause 7,,ii71 to improve maternal care1 social and health services1 and public health policy and institutions1 including with respect to improving access to maternal care1 improving the availability of social services1 and eliminating disparities in maternal care and outcomes4 7ii7 ,optional committee activities ,for purposes of subsection 7a71 a maternal mortality review committee established by a ,state under such subsection may present findings and recommendations regarding a specific case or set of circumstances directly to a health care facility or its local or ,state professional organization for the purpose of instituting policy changes1 educational activities1 or otherwise improving the quality of care provided by the facilities4 7,b7 ,composition of maternal mortality review committees 7i7 ,in ,general ,each ,state maternal mortality review committee established pursuant to a grant under subsection 7a7 shall be multi-disciplinary1 consisting of health care and social service providers1 public health officials1 other persons with professional expertise on maternal health and mortality1 and patient and community advocates who represent those communities within such ,state that are the most affected by maternal mortality4 ,membership on such a committee of a ,state shall be reviewed annually by the ,state department of health to ensure that membership representation requirements are being fulfilled in accordance with this paragraph4 7ii7 ,required membership ,each such review committee shall include-- 7,i7 representatives from medical specialties providing care to pregnant and postpartum patients1 including obstetricians 7including generalists and maternal fetal medicine specialists71 and family practice physicians2 7,,ii7 certified nurse midwives1 certified midwives1 and advanced practice nurses2 7,,iii7 hospital-based registered nurses2 7,,iv7 representatives of the ,state department of health maternal and child health department2 7,v7 social service providers or social workers2 7,,vi7 the chief medical examiners or designees2 7,,vii7 facility representatives1 such as from hospitals or free-standing birth centers2 and 7,,viii7 community or patient advocates who represent those communities within the ,state that are the most affected by maternal mortality4 7iii7 ,additional members ,each such review committee may also include representatives from other relevant academic1 health1 social service1 or policy professions1 or community organizations1 on an ongoing basis1 or as needed1 as determined beneficial by the review committee1 including-- 7,i7 anesthesiologists2 7,,ii7 emergency physicians2 7,,iii7 pathologists2 7,,iv7 epidemiologists or biostatisticians2 7,v7 intensivists2 7,,vi7 vital statistics officers2 7,,vii7 nutritionists2 7,,viii7 mental health professionals2 7,,ix7 substance abuse treatment specialists2 7,x7 representatives of relevant advocacy groups2 7,,xi7 academics2 7,,xii7 representatives of beneficiaries of the ,state plan under the ,medicaid program under title ,,xix2 7,,xiii7 paramedics2 7,,xiv7 lawyers2 7,,xv7 risk management specialists2 7,,xvi7 representatives of the departments of health or public health of major cities in the ,state involved2 and 7,,xvii7 policymakers4 7iv7 ,diverse community membership ,the composition of such a committee1 with respect to a ,state1 shall include-- 7,i7 representatives from diverse communities1 particularly those communities within such ,state most severely affected by pregnancy-related deaths or pregnancy-associated deaths and by a lack of access to relevant maternal care services1 from community maternal child health organizations1 and from minority advocacy groups2 7,,ii7 members1 including health care providers1 from different geographic regions in the ,state1 including any rural1 urban1 and tribal areas2 and 7,,iii7 health care and social service providers who work in communities that are diverse with regard to race1 ethnicity1 immigration status1 ,indigenous status1 and ,english proficiency4 7v7 ,maternal mortality review staff ,staff of each such review committee shall include-- 7,i7 vital health statisticians1 maternal child health statisticians1 or epidemiologists2 7,,ii7 a coordinator of the ,state maternal mortality review committee1 to be designated by the ,state2 and 7,,iii7 administrative staff4 7,c7 ,option for ,states to form regional maternal mortality reviews ,states with a low rate of occurrence of pregnancy-associated or pregnancy-related deaths may choose to partner with one or more neighboring ,states to fulfill the activities described in paragraph 7#a77;,c74 ,in such a case1 with respect to ,states in such a partnership1 any requirement under this section relating to the reporting of information related to such activities shall be deemed to be fulfilled by each such ,state if a single such report is submitted for the partnership4 7#c7 ,state ,department of ,health ,activities ,for purposes of subsection 7a71 a ,state department of health of a ,state receiving a grant under such subsection shall-- 7,a7 in consultation with the maternal mortality review committee of the ,state and in conjunction with relevant professional organizations1 develop a plan for ongoing health care provider education1 based on the findings and recommendations of the committee1 in order to improve the quality of maternal care2 and 7,b7 take steps to widely disseminate the findings and recommendations of the ,state maternal mortality review committees of the ,state and to implement the recommendations of such committee4 7c7 ,public disclosure of information 7#a7 ,in general ,for fiscal year #bjaf or a subsequent fiscal year1 each ,state receiving a grant under this section for such year shall1 subject to paragraph 7#c71 provide for the public disclosure1 and submission to the information clearinghouse established under paragraph 7#b71 of the information relating to the findings for such year of the ,state maternal mortality review committee established by the ,state under this section4 7#b7 ,information clearinghouse ,the ,secretary shall establish an information clearinghouse1 that shall be administered by the ,director of the ,centers for ,disease ,control and ,prevention1 that will maintain findings and recommendations submitted pursuant to paragraph 7#a7 and provide such findings and recommendations for public review and research purposes by ,state health departments1 maternal mortality review committees1 and health providers and institutions4 7#c7 ,confidentiality of information ,in no case shall any individually identifiable health information be provided to the public1 or submitted to the information clearinghouse1 under paragraph 7#a74 7d7 ,confidentiality of review committee proceedings 7#a7 ,in general ,all proceedings and activities of a ,state maternal mortality review committee under this section1 opinions of members of such a committee formed as a result of such proceedings and activities1 and records obtained1 created1 or maintained pursuant to this section1 including records of interviews1 written reports1 and statements procured by the ,department of ,health and ,human ,services or by any other person1 agency1 or organization acting jointly with the ,department1 in connection with morbidity and mortality reviews under this section1 shall be confidential1 and not subject to discovery1 subpoena1 or introduction into evidence in any civil1 criminal1 legislative1 or other proceeding4 ,such records shall not be open to public inspection4 7#b7 ,testimony of members of committee 7,a7 ,in general ,members of a ,state maternal mortality review committee under this section may not be questioned in any civil1 criminal1 legislative1 or other proceeding regarding information presented in1 or opinions formed as a result of1 a meeting or communication of the committee4 7,b7 ,clarification ,nothing in this subsection shall be construed to prevent a member of such a committee from testifying regarding information that was obtained independent of such member's participation on the committee1 or that is public information4 7#c7 ,availability of information for research purposes ,nothing in this subsection shall prohibit the publishing by such a committee or the ,department of ,health and ,human ,services of statistical compilations and research reports that-- 7,a7 are based on confidential information1 relating to morbidity and mortality review2 and 7,b7 do not contain identifying information or any other information that could be used to ultimately identify the individuals concerned4 7e7 ,definitions ,for purposes of this section3 7#a7 ,pregnancy-associated death ,the term pregnancy-associated death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy1 irrespective of the cause of such death4 7#b7 ,pregnancy-related death ,the term pregnancy-related death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy1 irrespective of the duration or site of the pregnancy1 from any cause related to or aggravated by the pregnancy or its management1 but not from any accidental or incidental cause4 7#c7 ,woman of childbearing age ,the term woman of childbearing age means a woman who is at least #aj years of age and not more than #ed years of age4 4 7c7 ,,nih workshop and research plan development on severe maternal morbidity 7#a7 ,workshop ,the ,secretary of ,health and ,human ,services1 acting through the ,director of ,,nih and in consultation with the ,administrator of the ,health ,resources and ,services ,administration1 the ,director of the ,centers for ,disease ,control and ,prevention1 the heads of other ,federal agencies that administer ,federal health programs1 and relevant national professional organizations dealing with maternal morbidity1 shall organize a national workshop to identify definitions for severe maternal morbidity and make recommendations for a research plan to identify and monitor severe maternal morbidity in the ,united ,states4 7#b7 ,research plan and data collection protocols ,the ,secretary1 taking into account the findings of the workshop under paragraph 7#a71 shall develop uniform definitions of severe maternal morbidity1 a research plan on severe maternal morbidity1 and possible data collection protocols to assist ,states in identifying and monitoring cases of severe maternal morbidity and to develop recommendations on addressing such cases4 7#c7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report concerning the definitions and research plan developed under this section4 7#d7 ,authorization of appropriations ,there is authorized to be appropriated for fiscal year #bjaf-- 7,a7 #ej1jjj to carry out paragraph 7#a72 and 7,b7 #ajj1jjj to carry out paragraph 7#b74 7d7 ,eliminating disparities in maternity health outcomes ,part ,b of title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #cag,t of such ,act 7#db ,u4,s4,c4 #bdg;b-#bb7 the following new section3 #cag,u4 ,eliminating disparities in maternity health outcomes 7a7 ,in general ,the ,secretary shall1 in consultation with relevant national stakeholder organizations1 such as national medical specialty organizations1 national maternal child health organizations1 and national health disparity organizations1 carry out the following activities to eliminate disparities in maternal health outcomes3 7#a7 ,conduct research into the determinants and the distribution of disparities in maternal care1 health risks1 and health outcomes1 and improve the capacity of the performance measurement infrastructure to measure such disparities4 7#b7 ,expand access to services that have been demonstrated to improve the quality and outcomes of maternity care for vulnerable populations4 7#c7 ,establish a demonstration project to compare the effectiveness of interventions to reduce disparities in maternity services and outcomes1 and implement and assessing effective interventions4 7b7 ,scope and selection of ,states for demonstration project ,the demonstration project under subsection 7a77#c7 shall be conducted in no more than #h ,states1 which shall be selected by the ,secretary based on-- 7#a7 applications submitted by ,states1 which specify which regions and populations the ,state involved will serve under the demonstration project2 7#b7 criteria designed by the ,secretary to ensure that1 as a whole1 the demonstration project is1 to the greatest extent possible1 representative of the demographic and geographic composition of communities most affected by disparities2 7#c7 criteria designed by the ,secretary to ensure that a variety of type of models are tested through the demonstration project and that such models include interventions that have an existing evidence base for effectiveness2 and 7#d7 criteria designed by the ,secretary to assure that the demonstration projects and models will be carried out in consultation with local and regional provider organizations1 such as community health centers1 hospital systems1 and medical societies representing providers of maternity services4 7c7 ,duration of demonstration project ,the demonstration project under subsection 7a77#c7 shall begin on ,january #a1 #bjae1 and end on ,december #ca1 #bjai4 7d7 ,grants for evaluation and monitoring ,the ,secretary may make grants to ,states and health care providers participating in the demonstration project under subsection 7a77#c7 for the purpose of collecting data necessary for the evaluation and monitoring of such project4 7e7 ,reports 7#a7 ,state reports ,each ,state that participates in the demonstration project under subsection 7a77#c7 shall report to the ,secretary1 in a time1 form1 and manner specified by the ,secretary1 the data necessary to-- 7,a7 monitor the-- 7i7 outcomes of the project2 7ii7 costs of the project2 and 7iii7 quality of maternity care provided under the project2 and 7,b7 evaluate the rationale for the selection of the items and services included in any bundled payment made by the ,state under the project4 7#b7 ,final report ,not later than ,december #ca1 #bjbj1 the ,secretary shall submit to ,congress a report on the results of the demonstration project under subsection 7a77#c74 4