,i #aae? ,,congress #b;d ,session ,h4 ,r4 #eigg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #be1 #bjah,ms4 ,kelly ( ,ill9ois introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to improve ,f$]al ef=ts ) respect to ! prev5tion ( mat]nal mortality1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,mo!rs & ,(fspr+ ,mortality & ,morbidity ,aw>5ess ,act or ! ,,momma's ,act4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,e ye>1 across ! ,unit$ ,/ates1 f\r million wom5 give bir?1 ab\t #gjj wom5 suff] fatal complications dur+ pregnancy1 :ile giv+ bir?1 or dur+ ! po/p>tum p]iod1 & #fe1jjj wom5 suff] ne>-fatal1 p>tum-relat$ complications4 7#b7 ,! mat]nal mortality rate is (t5 us$ z a proxy to measure ! ov]all heal? ( a population4 ,:ile ! infant mortality rate 9 ! ,unit$ ,/ates has rea*$ its l[e/ po9t1 ! risk ( dea? = wom5 9 ! ,unit$ ,/ates dur+ pregnancy1 *ildbir?1 or ! po/p>tum p]iod is high] ?an su* risk 9 any all o!r develop$ nations4 ,! e/imat$ mat]nal mortality rate 7p] #ajj1jjj live bir?s7 = ! #dh contigu\s ,/ates & ,wa%+ton ,,dc increas$ f #ah4h p]c5t 9 #bjjj to #bc4h p]c5t 9 #bjad to #bf4f p]c5t 9 #bjah4 ,?is e/imat$ rate is on p> ) su* rate = und]develop$ nations su* z ,iraq & ,afghani/an4 7#c7 ,int]national /udies e/imate ! #bjae ,u4,s4 mat]nal mortality rate z #bf4d p] #ajj1jjj live bir?s1 :i* is almo/ twice ! #bjae ,_w ,heal? ,organization 7,,:o7 e/imation ( #ad p] #ajj1jjj live bir?s4 7#d7 ,x is e/imat$ t almo/ half ( all mat]nal mortalities 9 ! ,unit$ ,/ates are prev5table4 7#e7 ,african-,am]ican wom5 exp]i5ce mat]nal-relat$ dea?s at ?ree to f\r times ! rate ( non-,hispanic ,:ite wom54 7#f7 ,! f9d+s describ$ 9 p>agraphs 7#a7 ?r\gh 7#e7 are ( major conc]n to rese>*]s1 academicians1 & epidemiologi/s at ! ,c5t]s = ,disease ,control & ,prev5tion 7,,cdc72 provid]s across ! ob/etrical cont9uum repres5t$ by organizations su* z ! ,preeclampsia ,f\ndation2 ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s2 ! ,association ( ,wom5's ,heal?1 ,ob/etric1 & ,neonatal ,nurses2 ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative2 ,black ,wom5's ,heal? ,imp]ative2 ! ,national ,bir? ,equity ,collaborative2 ,black ,mamas ,matt] ,alliance2 ! ,national ,association ( ,c]tifi$ ,pr(essional ,midwives2 & ! ,am]ican ,college ( ,nurse ,midwives4 7#g7 ,accord+ to ! ,,cdc1 ! mat]nal mortality rate v>ies dra/ically = wom5 by race & e?nicity4 ,!re are #ab4g dea?s p] #ajj1jjj live bir?s = ,:ite wom51 #dc4e dea?s p] #ajj1jjj live bir?s = ,african-,am]ican wom51 & #ad4d dea?s p] #ajj1jjj live bir?s = wom5 ( o!r e?nicities4 ,:ile mat]nal mortality disp>ately impacts ,african-,am]ican wom51 ! ph5om5on trav]ses race1 e?nicity1 socioeconomic /atus1 educational backgr\nd1 & geography4 7#h7 ,hemorrhage1 c>diovascul> & coron>y conditions1 c>diomyopa?y1 infection1 embolism1 m5tal heal? conditions1 preeclampsia & eclampsia1 infection or sepsis1 & ane/hesia complications are ! pr$om9ant causes ( mat]nal-relat$ dea?s & complications4 ,su* conditions are l>gely prev5table or manageable4 7#i7 ,! ,unit$ ,/ates has n be5 able to submit a =mal mat]nal mortality rate to int]national data repositories s9ce #bjjg4 ,?us1 no (ficial mat]nal mortality rate exi/s = ! ,nation4 ,!re c be no mat]nal mortality rate )\t /reaml9+ mat]nal mortality-relat$ data f ! ,/ate level & extrapolat+ su* data to ! ,f$]al level4 7#aj7 ,9 ! ,unit$ ,/ates1 dea? report+ & analysis is a ,/ate function r ?an a ,f$]al process4 ,/ates report all dea?s--includ+ mat]nal dea?s--on a semi-volunt>y basis1 )\t /&>dization across ,/ates4 ,:ile ! ,,cdc has ! capacity & sy/em = collect+ dea?-relat$ data bas$ on dea? c]tificates1 ^! data are n suffici5tly report$ by ,/ates 9 an organiz$ & /&>d =mat across ,/ates su* t ! ,,cdc is able to id5tify causes ( mat]nal dea? & be/ practices = ! prev5tion ( su* dea?4 7#aa7 ,vital regi/ration sy/ems (t5 und]e/imate mat]nal mortality & are insuffici5t data s\rces f :i* to d]ive a full scope ( m$ical & social det]m9ant factors contribut+ to mat]nal dea?s4 ,:ile ! addition ( pregnancy *eckboxes on dea? c]tificates s9ce #bjjc h likely improv$ ,/ates' abilities to id5tify pregnancy-relat$ dea?s1 !y are n g5]ally complet$ by ob/etrical provid]s or p]sons tra9$ to recognize pregnancy-relat$ mortality4 ,?us1 ^! vital =ms may be miss+ in=mation or may capture inconsi/5t data4 ,due to v>y+ mat]nal mortality-relat$ analyses1 lack ( reliability1 & granul>ity 9 data1 curr5t mat]nal mortality in=matics d n fully encapsulate ! myriad m$ical & socially det]m9ant factors t contribute to su* high mat]nal mortality rates )9 ! ,unit$ ,/ates comp>$ to o!r develop$ nations4 ,non-/&>dization ( data & lack ( data %>+ across ,/ates & betwe5 ,f$]al entities1 heal? networks1 & rese>* in/itutions keep ! ,nation 9 ! d>k ab\t ways to prev5t mat]nal dea?s4 7#ab7 ,hav+ reliable & valid ,/ate data aggregat$ at ! ,f$]al level are critical to ! ,nation's ability to quell surges 9 mat]nal dea? & imp]ative = rese>*]s to id5tify long-la/+ int]v5tions4 7#ac7 ,lead]s 9 mat]nal wellness highly recomm5d t mat]nal dea?s be inve/igat$ at ! ,/ate level fir/4 ,!n1 h data reg>d+ mat]nal dea?s be /&>diz$ across ,/ates1 /reaml9$1 de-id5tifi$1 & s5t once a ye> to a f$]ally sup]vis$ database1 manag$ by a ,f$]al ag5cy at ! discretion ( ! ,secret>y ( ,heal? & ,human ,s]vices4 ,su* data /&>dization & collection w\ld be simil> 9 op]ation & effect to ! ,national ,program ( ,canc] ,regi/ries h\s$ at ! ,,cdc & ak9 to ! ,confid5tial ,enquiry 9 ,mat]nal ,dea?s ,programme 9 ! ,unit$ ,k+dom4 ,su* a mat]nal mortality & morbidities regi/ry & surveillance w\ld help provid]s1 academicians1 lawmak]s1 & ! public to address que/ions conc]n+ ! types (1 causes (1 & be/ practices to ?w>t1 pregnancy-relat$ or pregnancy-associat$ mortalities & morbidities4 7#ad7 ,! ,unit$ ,nations' ,mill5nium ,developm5t ,goal #e;a aim$ to r$uce by ?ree qu>t]s1 betwe5 #aiij & #bjae1 ! mat]nal mortality rate1 yet ?is metric has n be5 a*iev$4 ,9 fact1 ! mat]nal mortality rate 9 ! ,unit$ ,/ates has be5 e/imat$ to h m ?an d\bl$ betwe5 #bjjj & #bjad4 ,yet1 because national data are n fully available1 ! ,unit$ ,/ates does n h an (ficial mat]nal mortality rate4 7#ae7 ,_m ,/ates h /ruggl$ to e/abli% or ma9ta9 ,mat]nal ,mortality ,review ,committees 7,,mmrc74 ,on ! ,/ate level1 ,m,m,r,cs h lagg$ because ,/ates h n _h ! res\rces to m\nt local reviews4 ,/ate-level reviews are necess>y z only ! ,/ate dep>tm5ts ( heal? h ! au?ority to reque/ m$ical records1 autopsy reports1 & police reports critical to ! function ( ! ,,mmrc4 7#af7 ,! ,unit$ ,k+dom reg>ds mat]nal dea?s z a heal? sy/ems failure & a national committee ( ob/etrics exp]ts review ea* mat]nal dea? or ne>-fatal *ildbir? complication4 ,su* committee also e/abli%es ! pr$om9ant c\rse ( mat]nal-relat$ dea?s f conditions su* z preeclampsia4 ,consequ5tly1 ! ,unit$ ,k+dom has be5 able to r$uce _! incid5ces ( preeclampsia to less ?an "o 9 #aj1jjj wom5--its l[e/ rate s9ce #aieb4 7#ag7 ,! ,unit$ ,/ates has no comp>able1 coord9at$ ,f$]al process by :i* to review cases ( mat]nal mortality1 sy/ems failures1 or be/ practices4 ,_m ,/ates h active ,m,m,r,cs & lev]age _! "w to impact mat]nal wellness4 ,= example1 ! ,/ate ( ,cali=nia has work$ ext5sively ) _! ,/ate heal? dep>tm5ts1 heal? & hospital sy/ems1 & rese>* collaborative organizations1 includ+ ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative & ! ,alliance = ,innovation on ,mat]nal ,heal?1 to e/abli% ,m,m,r,cs1 :]e9 !y h det]m9$ ! mo/ preval5t causes ( mat]nal mortality & record$ & %>$ data ) provid]s & rese>*]s1 :o h develop$ & implem5t$ safety bundles & c>e protocols relat$ to preeclampsia1 mat]nal hemorrhage1 & ! l4 ,9 ?is way1 ! ,/ate ( ,cali=nia has be5 able to lev]age its mat]nal mortality review bo>d sy/em1 g5]ate data1 & apply ^? data to effect *anges 9 mat]nal c>e-relat$ protocol4 ,to date1 ! ,/ate ( ,cali=nia has /ymi$ its mat]nal mortality rate1 :i* is n[ comp>able to ! l[ rates ( ! ,unit$ ,k+dom4 7#ah7 ,hospitals & heal? sy/ems across ! ,unit$ ,/ates lack /&>dization ( em]g5cy ob/etrical protocols be=e1 dur+1 & aft] deliv]y4 ,consequ5tly1 _m provid]s are delay$ 9 recogniz+ critical signs indicat+ mat]nal di/ress t quickly escalate into fatal or ne>-fatal incid5ces4 ,moreov]1 any attempt to address an ob/etrical em]g5cy t does n take into acc\nt bo? cl9ical & public heal? approa*es falls woefully "u ! m>k ( excell5t c>e deliv]y4 ,/ate-bas$ mat]nal quality collaborative organizations1 includ+ ! ,alliance = ,innovation on ,mat]nal ,heal? 7,a,i,ms7 & ,cali=nia ,mat]nal ,quality ,c>e ,collaborative1 h =m$ ob/etrical protocols1 tool kits1 & o!r res\rces to improve sy/em c>e & response z !y relate to mat]nal complications & w>n+ signs = su* conditions z mat]nal hemorrhage1 hyp]t5sion1 & preeclampsia4 ,/ate p]9atal quality collaboratives are work+ to id5tify heal? c>e processes t ne$ to be improv$ & use ! be/ available me?ods to make ^? *anges z quickly z possible1 :ile ! ,alliance = ,innovation on ,mat]nal ,heal? is work+ ) ,/ates & heal? sy/ems to align national1 ,/ate1 & hospital level quality improvem5t ef=ts ?r\gh ! creation & dissem9ation ( mat]nal safety bundles to improve ov]all mat]nal heal? outcomes4 7#ai7 ,! ,,cdc reports t m ?an half ( all mat]nal dea?s occur 9 ! imm$iate po/p>tum p]iod--betwe5 #db days up to a full ye>--:]eas m ?an "o-?ird ( pregnancy-relat$ or pregnancy-associat$ dea?s occur :ile a p]son is /ill pregnant4 ,yet1 = pregnant wom51 ,m$icaid cov]age lapses at ! end ( ! mon? on :i* ! #fj? po/p>tum day l&s4 7#bj7 ,a gr[+ body ( evid5ce-bas$ rese>* has %[n ! correlation betwe5 ! /ress associat$ ) "o's race--! /ress ( racism--& "o's bir?+ outcomes4 ,! /ress ( sex & race discrim9ation & in/itutional racism has be5 demon/rat$ to contribute to a high] risk ( mat]nal mortality1 irrespective ( "o's ge/ational age1 mat]nal age1 socioeconomic /atus1 or individual-level heal? risk factors1 includ+ pov]ty1 limit$ access to pr5atal c>e1 & poor physical & m5tal heal? 7al?\gh ^! are n nom9al factors74 ,african-,am]ican wom5 rema9 ! mo/ at risk = pregnancy-associat$ or pregnancy-relat$ causes ( dea?4 ,:5 x comes to preeclampsia1 = example--:i* is relat$ to obesity--,african-,am]ican wom5 ( normal weight rema9 ! mo/ at risk ( dy+ dur+ ! p]9atal p]iod comp>$ to non-,african-,am]ican obese wom54 7#ba7 ,! ris+ ,u4,s4 mat]nal mortality rate is pr$om9antly driv5 by ! disproportionately high rates ( ,african-,am]ican mat]nal mortality4 7#bb7 ,african-,am]ican wom5 are ?ree to f\r times m likely to die f pregnancy or mat]nal-relat$ di/ress ?an are ,:ite wom51 yield+ "o ( ! greate/ & mo/ disconc]t+ racial disp>ities 9 public heal?4 7#bc7 ,comp>$ to wom5 f o!r racial & e?nic demographics1 ,african-,am]ican wom5 across ! socioeconomic spectrum exp]i5ce prolong$1 unrel5t+ /ress relat$ to racial & g5d] discrim9ation1 contribut+ to high] rates ( mat]nal mortality1 giv+ bir? to l[-weight babies1 & exp]i5c+ pre-t]m bir?4 ,racism is a risk-factor = ^! a=em5tion$ exp]i5ces4 ,?is cumulative /ress (t5 ext5ds across ! life c\rse & is situat$ 9 ev]yday spaces :]e ,african-,am]ican wom5 e/abli% livelihood4 ,/ructural b>ri]s1 lack ( access to c>e1 & g5etic pr$ispositions to heal? vuln]abilities exac]bate ,african-,am]ican wom5's likelihood to exp]i5ce poor or fatal bir?+ outcomes1 b d n fully acc\nt = ! great disp>ity4 7#bd7 ,african-,am]ican wom5 are twice z likely to exp]i5ce po/p>tum depression1 & disproportionately high] rates ( preeclampsia comp>$ to ,:ite wom54 7#be7 ,racism is deeply +ra9$ 9 ,unit$ ,/ates sy/ems1 includ+ 9 heal? c>e deliv]y sy/ems betwe5 pati5ts & provid]s1 (t5 result+ 9 disp>ate treatm5t = pa91 irrev]5ce = cultural norms ) respect to heal?1 & dismissiv5ess4 ,rese>* has demon/rat$ t pati5ts respond m w>mly & adh]e to m$ical treatm5t plans at a high] degree ) provid]s ( ! same race or e?nicity or ) provid]s ) great ability to ex]cise empa?y4 ,h[ev]1 ! provid] pool is n prim$ ) _m p ( color1 nor are provid]s 7:e!r /ud5t-doctors 9 tra9+ or lic5s$ practition]s7 consi/5tly requir$ to und]go implicit bias1 cultural compet5cy1 or empa?y tra9+ on a consi/5t1 on-go+ basis4 #c4 ,improv+ ,f$]al ef=ts ) respect to prev5tion ( mat]nal mortality 7a7 ,te*nical assi/ance = ,/ates ) respect to report+ mat]nal mortality ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is section z ! ,director7 %all provide te*nical assi/ance to ,/ates t elect to report on mat]nal mortality = ! purpose ( enc\rag+ uni=mity 9 ! report+ ( su* data & to enc\rage ! %>+ ( su* data among ! respective ,/ates4 7b7 ,be/ practices relat+ to prev5tion ( mat]nal mortality ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director %all issue be/ practices to ,/ate mat]nal mortality review committees on h[ be/ to id5tify1 review1 & prev5t mat]nal mortality4 ,9 issu+ su* be/ practices1 ! ,director %all take into acc\nt any data made available by ,/ates relat+ to mat]nal mortality4 7c7 ,alliance = ,innovation on ,mat]nal ,heal? ,grant ,program 7#a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,associate ,adm9i/rator ( ! ,mat]nal & ,*ild ,heal? ,bureau ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all e/abli% a grant program to be kn[n z ! ,alliance = ,innovation on ,mat]nal ,heal? ,grant ,program 7ref]r$ to 9 ?is subsection z ,,aim7 "u :i* ! ,secret>y %all aw>d grants to eligible entities = ! purpose ( direct+ widespread adoption & implem5tation ( mat]nal safety bundles ?r\gh collaborative ,/ate-bas$ teams & collect+ & analyz+ process1 /ructure1 & outcome data to drive cont9u\s improvem5t 9 ! implem5tation ( su* safety bundles by su* ,/ate-bas$ teams ) ! ultimate goal ( elim9at+ prev5table mat]nal mortality & sev]e mat]nal morbidity 9 ! ,unit$ ,/ates4 7#b7 ,eligible entities ,9 ord] to be eligible = a grant "u p>agraph 7#a71 an entity %all-- 7,a7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require2 & 7,b7 demon/rate 9 su* application t ! entity is an int]discipl9>y1 multi-/akehold] national organization ) a national data-driv5 mat]nal safety & quality improvem5t initiative bas$ on implem5tation approa*es t h be5 prov5 to improve mat]nal safety & outcomes 9 ! ,unit$ ,/ates4 7#c7 ,use ( funds ,an eligible entity t receives a grant "u p>agraph 7#a7 %all use su* grant funds-- 7,a7 to develop & implem5t1 ?r\gh a robu/1 multi-/akehold] process1 mat]nal safety bundles to assi/ ,/ates & heal? c>e sy/ems 9 align+ national1 ,/ate1 & hospital-level quality improvem5t ef=ts to improve mat]nal heal? outcomes1 specifically ! r$uction ( mat]nal mortality & sev]e mat]nal morbidity2 7,b7 to ensure1 9 develop+ & implem5t+ mat]nal safety bundles "u subp>agraph 7,a71 t su* mat]nal safety bundles-- 7i7 satisfy ! quality improvem5t ne$s ( a ,/ate or heal? c>e sy/em by factor+ 9 ! results & f9d+s ( relevant data reviews1 su* z reviews conduct$ by a ,/ate mat]nal mortality review committee2 & 7ii7 address topics su* z-- 7,i7 ob/etric hemorrhage2 7,,ii7 mat]nal m5tal heal?2 7,,iii7 ! mat]nal v5\s sy/em2 7,,iv7 ob/etric c>e = wom5 ) opioid use disord]2 7,v7 po/p>tum c>e basics = mat]nal safety2 7,,vi7 r$uction ( p]ip>tum racial & e?nic disp>ities2 7,,vii7 r$uction ( prim>y caes>ean bir?2 7,,viii7 sev]e hyp]t5sion 9 pregnancy2 7,,ix7 sev]e mat]nal morbidity reviews2 7,x7 support aft] a sev]al mat]nal morbidity ev5t2 & 7,,xi7 ?romboembolism2 & 7,c7 to provide ongo+ te*nical assi/ance at ! national & ,/ate levels to support implem5tation ( mat]nal safety bundles "u subp>agraph 7,a74 7#d7 ,mat]nal safety bundle def9$ ,= purposes ( ?is subsection1 ! t]m mat]nal safety bundle means /&>diz$1 evid5ce-in=m$ processes to improve v>iation 9 response to mat]nal c>e4 7#e7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is subsection1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjai ?r\gh #bjbc4 7d7 ,expansion ( ,m$icaid & ,,*ip cov]age = pregnant & po/p>tum wom5 7#a7 ,ext5d+ ,m$icaid cov]age = pregnant & po/p>tum wom5 ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7,a7 9 subsection 7e7-- 7i7 9 p>agraph 7#e71 by /rik+ #fj-;day & ins]t+ "o-ye>2 & 7ii7 9 p>agraph 7#f71 by /rik+ #fj-;day & ins]t+ "o-ye>2 & 7,b7 9 subsection 7l77#a77;,a71 by /rik+ #fj-;day & ins]t+ "o-ye>4 7#b7 ,ext5d+ ,m$icaid cov]age = lawful resid5ts ,section #aijc7v77#d77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d77;,a77 is am5d$ by /rik+ #fj-;day & ins]t+ "o-ye>4 7#c7 ,ext5d+ ,,*ip cov]age = pregnant & po/p>tum wom5 ,section #baab7;d77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is am5d$ by /rik+ #fj-;day & ins]t+ "o-ye>4 7#d7 ,ma9t5ance ( ef=t 7,a7 ,m$icaid ,section #aijb7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 7,a7 ,subject to subp>agraph 7,b71 dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is five ye>s aft] su* date ( enactm5t1 z a condition = receiv+ any ,f$]al paym5ts "u section #aijc7;a7 = cal5d> qu>t]s occurr+ dur+ su* p]iod1 a ,/ate1 includ+ a ,/ate describ$ 9 p>agraph 7#d77;,b7 t elects to meet ! requirem5t ( subsection 7a77#aj77;,a77i77,,iv71 %all n h 9 effect1 ) respect to wom5 :o are eligible = m$ical assi/ance because ( su* subsection 7a77#aj77;,a77i77,,iv7 or section #aijc7v77#d77;,a77i71 eligibility /&>ds1 me?odologies1 or proc$ures "u ! ,/ate plan 7or a waiv] ( su* plan7 t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan 7or waiv]7 t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 7,b7 ,a ,/ate's det]m9ation ( income 9 accordance ) subsection 7e77#ad7 %all n be consid]$ to be eligibility /&>ds1 me?odologies1 or proc$ures t are m re/rictive ?an ! /&>ds1 me?odologies1 or proc$ures 9 effect "u ! ,/ate plan 7or a waiv] ( su* plan7 on ! date ( enactm5t ( ?is p>agraph = purposes ( det]m9+ compliance ) ! requirem5t ( subp>agraph 7,a74 4 7,b7 ,,*ip ,section #baje7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,9 eligibility /&>ds = t>get$ l[-income pregnant wom5 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is five ye>s aft] su* date ( enactm5t1 z a condition ( receiv+ paym5ts "u subsection 7a7 & section #aijc7;a71 a ,/ate t elects to provide pregnancy-relat$ assi/ance to t>get$ l[-income pregnant wom5 7z def9$ 9 section #baab7;d771 or wom5 :o are eligible = su* assi/ance ?r\gh ! application ( section #aijc7v77#d77;,a77i7 "u section #bajg7;e77#a71 %all n h 9 effect1 ) respect to su* wom51 eligibility /&>ds1 me?odologies1 or proc$ures "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan 7or waiv]7 t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 4 7#e7 ,effective date 7,a7 ,9 g5]al ,except z o!rwise provid$ & subject to subp>agraph 7,b71 ! am5dm5ts made by ?is subsection %all take effect ) respect to eligibility det]m9ations made ) respect to a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act on or aft] ! date t is "o ye> aft] ! date ( enactm5t ( ?is ,act4 7,b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act or a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 9 ord] = ! respective plan to meet any requirem5t impos$ by am5dm5ts made by ?is subsection1 ! respective plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( its failure to meet su* an additional requirem5t be=e ! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ aft] ! close ( ! fir/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session %all be consid]$ to be a sep>ate regul> session ( ! ,/ate legislature4 7e7 ,regional c5t]s ( excell5ce ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act is am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#g4 ,regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education 7a7 ,9 g5]al ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) su* o!r ag5cy heads z ! ,secret>y det]m9es appropriate1 %all1 subject to ! availability ( appropriations1 aw>d coop]ative agreem5ts = ! e/abli%m5t or support ( regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education = ! purpose ( enhanc+ & improv+ h[ heal? c>e pr(essionals are educat$ 9 implicit bias & deliv]+ culturally compet5t heal? c>e4 7b7 ,eligibility ,to be eligible to receive a coop]ative agreem5t "u subsection 7a71 an entity %all-- 7#a7 be an entity specifi$ by ! ,secret>y t provides educational opportunities = /ud5ts 9 a heal? c>e pr(ession1 :i* may include a heal? sy/em1 tea*+ hospital1 bir?+ c5t]1 community heal? c5t]1 physician's (fice1 m$ical s*ool1 s*ool ( public heal?1 or any o!r heal? pr(essional s*ool or a program at an in/itution ( high] education focus$ on ! prev5tion1 treatm5t1 or recov]y ( heal? conditions t contribute to mat]nal mortality & ! prev5tion ( mat]nal mortality2 7#b7 demon/rate community engagem5t & p>ticipation ?r\gh community p>tn]s su* z m5tal heal? c\nselors & social work]s2 & 7#c7 provide to ! ,secret>y su* in=mation1 at su* "t & 9 su* mann]1 z ! ,secret>y may require4 7c7 ,div]sity ,9 aw>d+ a coop]ative agreem5t "u subsection 7a71 ! ,secret>y %all take into acc\nt any regional diff]5ces among eligible entities & make an ef=t to ensure geographic div]sity among aw>d recipi5ts4 7d7 ,dissem9ation ( in=mation 7#a7 ,public availability ,! ,secret>y %all make publicly available on ! ,int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices in=mation submitt$ to ! ,secret>y "u subsection 7b77#c74 7#b7 ,evaluation ,! ,secret>y %all evaluate ea* regional c5t] ( excell5ce e/abli%$ or support$ pursuant to subsection 7a7 & dissem9ate ! f9d+s result+ f ea* su* evaluation to ! appropriate public & private entities4 7e7 ,mat]nal mortality def9$ ,9 ?is section1 ! t]m mat]nal mortality means dea? t occurs to a woman dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7f7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is section1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjai ?r\gh #bjbc4 4 7f7 ,def9itions ,9 ?is section3 7#a7 ,mat]nal mortality ,! t]m mat]nal mortality means dea? t occurs to a woman dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7#b7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity includes unexpect$ outcomes ( labor & deliv]y t result 9 significant %ort-t]m or long-t]m consequ5ces to a woman's heal?4