,i #aahth ,,congress #b;d ,session ,h4 ,r4 #hcag ,,in ,,the ,,house ,,of ,,representatives ,may #h1 #bjbd,ms4 ,moore of ,wisconsin 7for herself1 ,ms4 ,underwood1 ,ms4 ,adams1 ,ms4 ,pressley1 and ,mrs4 ,dingell7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to provide coverage under the ,medicaid program for services provided by doulas and midwives1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,mamas ,first ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,according to the ,centers for ,disease ,control and ,prevention1 the maternal mortality rate varies drastically for women by race and ethnicity4 ,on average1 there are #bf4f deaths per #ajj1jjj live births for ,white women1 #fi4i deaths per #ajj1jjj live births for ,black women1 #di4b deaths for ,american ,indian and ,alaskan ,native women1 and #bh deaths per #ajj1jjj live births for ,hispanic women4 ,while maternal mortality disparately impacts ,black women and indigenous women1 this urgent public health crisis traverses race1 ethnicity1 socioeconomic status1 educational background1 and geography4 7#b7 ,united ,states maternal mortality rates are the highest in the developed world and are increasing rapidly4 7#c7 ,four out of five of these maternal deaths are likely preventable4 7#d7 ,according to the ,national ,institutes of ,health1 doula-assisted mothers are four times less likely to have a low-birth-weight baby1 two times less likely to experience a birth complication involving themselves or their baby1 and significantly more likely to initiate breastfeeding4 7#e7 ,midwife-led care is associated with cost savings1 decreased rates of intervention1 lower cesarean rates1 lower preterm birth rates1 and healthier outcomes for mothers and babies4 7#f7 ,midwives may practice in any setting1 including the home1 community1 hospitals1 birth centers1 clinics1 or health units4 #c4 ,medicaid coverage of services provided by doulas and midwives 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#cj71 by striking and at the end2 7,b7 by redesignating paragraph 7#ca7 as paragraph 7#cb72 and 7,c7 by inserting after paragraph 7#cj7 the following new paragraph3 7#ca7 services and care1 including prenatal1 delivery1 and postpartum care1 that is provided in a culturally congruent manner 7as defined in subsection 7kk77 by doulas1 midwives1 and tribal midwives 7as those terms are defined in subsection 7jj771 that is provided in the home1 community1 a hospital1 birth center1 clinic1 health unit1 or is furnished via telehealth to the extent authorized under ,state law2 and 2 and 7#b7 by adding at the end the following3 7jj7 ,doulas1 midwives1 and tribal midwife defined ,for purposes of subsection 7a77#ca73 7#a7 ,doulas defined ,the term doula means an individual who-- 7,a7 has completed #fj hours of foundational training2 7,b7 is certified by an organization1 which has been established for not less than five years and which requires the completion of continuing education to maintain such certification1 to provide non-medical advice1 information1 emotional support1 and physical comfort to an individual during such individual's pregnancy1 childbirth1 and postpartum period2 and 7,c7 maintains such certification by completing such required continuing education4 7#b7 ,midwives defined ,the term midwife means a midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives4 7#c7 ,tribal midwife defined ,the term tribal midwife means an individual who is recognized by an ,indian tribe 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 to practice midwifery for such tribe4 7kk7 ,culturally congruent care defined ,for purposes of subsection 7a77#ca71 the term culturally congruent care1 with respect to maternity care1 means care that is provided in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 4 7b7 ,requiring mandatory coverage under ,state plan ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended1 in the matter preceding clause 7i71 by striking and 7#cj7 and inserting 7#cj71 and 7#ca74 7c7 ,effective date 7#a7 ,in general ,subject to paragraph 7#b71 the amendments made by this section shall apply with respect to medical assistance furnished on or after ,january #a1 #bjbb4 7#b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this 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 the enactment of this ,act4 ,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