,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #igab  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ae1 #bjbf,ms4  
,moore ( ,wiscons9 7= h]self1 ,mrs4     
,d+ell1 ,ms4 ,pressley1 ,ms4 ,adams1    
,ms4 ,und]wood1 ,ms4 ,norton1 ,mr4 ,gre5
 ( ,texas1 ,mrs4 ,grijalva1 ,mr4 ,lieu1 
& ,ms4 ,s*ak[sky7 introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce  ,a ,,bill  ,to am5d  
title ,,xix ( ! ,social ,security ,act  
to provide cov]age "u ! ,m$icaid program
 = s]vices provid$ by d\las1 midwives1 &
 lactation support provid]s1 & = o!r    
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,mamas ,fir/ ,act4  #b4    
,f9d+s ,congress f9ds ! foll[+3  7#a7   
,accord+ to ! ,c5t]s = ,disease ,control
 & ,prev5tion1 ! mat]nal mortality rate 
v>ies dra/ically = wom5 by race &       
e?nicity4 ,on av]age1 !re are #ac4f     
dea?s p] #ajj1jjj live bir?s = ,:ite    
wom51 #de dea?s p] #ajj1jjj live bir?s =
 ,black wom51 & #ac4i dea?s p] #ajj1jjj 
live bir?s = ,hispanic wom54 ,= ,am]ican

 ,indian & ,alaskan ,native wom51 !     
,national ,c\ncil ( ,urban ,indian      
,heal? e/imates !re are #ed4f dea?s p]  
#ajj1jjj live bir?s4 ,:ile mat]nal      
mortality mo/ disp>ately impacts ,black 
wom5 & ,indig5\s wom51 ?is urg5t public 
heal? crisis trav]ses race1 e?nicity1   
socioeconomic /atus1 educational        
backgr\nd1 & geography4  7#b7 ,unit$    
,/ates mat]nal mortality rates are !    
highe/ among simil>ly economically      
situat$ c\ntries & cont9ue to increase4 
7#c7 ,f\r out ( #e ( ^! mat]nal dea?s   
are likely prev5table4  7#d7 ,accord+ to
 ! ,national ,in/itutes ( ,heal?1       
individuals :o h d\la support dur+ _!   
pregnancy are #d times less likely to h 
a l[-bir?-weight baby1 #b times less    
likely to exp]i5ce a bir? complication  
involv+ !mselves or _! baby1 &          
significantly m likely to initiate      
brea/fe$+4  7#e7 ,midwif]y-l$ c>e is    
associat$ ) co/ sav+s1 decreas$ rates ( 
int]v5tion1 l[] rates ( ces>ean bir?1   
l[] pret]m bir? rates1 & heal?i]        

outcomes = mo!rs & babies4  7#f7        
,midwives may practice 9 any sett+1     
includ+ ! home1 community1 hospitals1   
bir? c5t]s1 cl9ics1 or heal? units4  #c4
 ,m$icaid cov]age ( s]vices provid$ by  
d\las1 midwives1 & lactation support    
provid]s  7a7 ,9 g5]al ,section #aije ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acif;d7 is am5d$-- 7#a7 9 subsection   
7a7--  7,a7 9 p>agraph 7#ca71 by /rik+ &
 at ! end2  7,b7 by r$esignat+ p>agraph 
7#cb7 z p>agraph 7#cc72 &  7,c7 by      
ins]t+ aft] p>agraph 7#ca7 ! foll[+ new 
p>agraph3  7#cb7 s]vices & c>e1 includ+ 
pr5atal1 labor1 & po/p>tum c>e1 t is    
provid$ 9 a culturally congru5t mann] by
 d\las1 midwives1 tribal midwives1 &    
lactation support provid]s 7z ^? t]ms   
are def9$ 9 subsection 7ll771 t is      
provid$ 9 ! home1 community1 a hospital1
 bir? c5t]1 cl9ic1 or heal? unit1 or is 
furni%$ via teleheal? to ! ext5t        
au?oriz$ "u ,/ate law2 &  2 &  7#b7 by  
add+ at ! end ! foll[+3  7ll7 ,d\las1   
midwives1 tribal midwives1 & lactation  

support provid]s def9$ ,= purposes (    
subsection 7a77#cb73  7#a7 ,d\la def9$  
,! t]m d\la means an individual :o--    
7,a7 7i7 is c]tifi$ by an organization  
:i* requires ! completion ( cont9u+     
education to ma9ta9 su* c]tification1 to
 provide non-m$ical advice1 in=mation1  
emotional support1 & physical com=t to  
an individual dur+ su* individual's     
pregnancy1 *ildbir?1 & po/p>tum p]iod2 &
  7ii7 ma9ta9s su* c]tification by      
complet+ su* requir$ cont9u+ education2 
7,b7 c provide a recomm5dation f at     
lea/--  7i7 ?ree diff]5t =m] cli5ts =   
:om ! prospective d\la provid$ d\la     
s]vices 7ei!r paid or volunte]7 )9 ! la/
 #e ye>s2 or  7ii7 two diff]5t lic5s$   
heal? c>e provid]s 7includ+ physicians1 
midwives1 social work]s1 or nurses7 :o  
obs]v$ ! prospective d\la provid+ d\la  
s]vices )9 ! la/ #e ye>s2 or  7,c7 is   
au?oriz$ to s]ve z a ,m$icaid provid] ( 
d\la s]vices "u ! ,/ate plan "u ?is     
title 7or a waiv] ( su* plan7 ( !       
individual's ,/ate4  7#b7 ,midwife def9$

 ,! t]m midwife means a midwife :o--    
7,a7 is au?oriz$ to s]ve z a ,m$icaid   
provid] ( midwife s]vices "u ! ,/ate    
plan "u ?is title 7or a waiv] ( su*     
plan7 ( ! individual's ,/ate2 or  7,b7  
meets at a m9imum ! int]national        
def9ition ( ! midwife & global /&>ds =  
midwif]y education z e/abli%$ by !      
,int]national ,conf$]ation ( ,midwives4 
7#c7 ,tribal midwife def9$ ,! t]m tribal
 midwife means an individual :o-- 7,a7  
is au?oriz$ to s]ve z a ,m$icaid provid]
 ( tribal midwife s]vices "u ! ,/ate    
plan "u ?is title 7or a waiv] ( su*     
plan7 ( ! individual's ,/ate2 or  7,b7  
is recogniz$ by an ,indian tribe 7z     
def9$ 9 section #d ( ! ,indian ,heal?   
,c>e ,improvem5t ,act 7#be ,u4,s4,c4    
#afjc77 to practice midwif]y = su*      
tribe4  7#d7 ,lactation support provid] 
def9$ ,! t]m lactation support provid]  
means an individual :o--  7,a7 is       
au?oriz$ to s]ve z a ,m$icaid provid] ( 
lactation support s]vices "u ! ,/ate    
plan "u ?is title 7or a waiv] ( su*     

plan7 ( ! individual's ,/ate2  7,b7 has 
complet$ at lea/ #bj h\rs ( f\ndational 
tra9+ bas$ on ! ,_w ,heal?              
,organization_/,unit$ ,nations ,*ildr5's
 ,fund lactation c\nsel+ tra9+ bluepr9t1
 or an equival5t tra9+2 or  7,c7 is     
recogniz$ )9 any category on !          
,lactation ,support ,provid] ,descriptor
 *>t publi%$ by ! ,u4,s4 ,brea/fe$+     
,committee-affiliat$ ,lactation ,support
 ,provid] ,con/ellation4  4  7b7        
,requir+ m&atory cov]age "u ,/ate plan  
,section #aijb7;a77#aj77;,a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77#aj77;,a77 is am5d$1 9 !     
matt] prec$+ clause 7i71 by /rik+ &     
7#cj7 & ins]t+ 7#cj71 & 7#cb74  7c7 ,co/
 %>+ prohibition ,title ,,xix ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 is am5d$-- 7#a7 9        
subsections 7a77#b77;,b7 & 7b77#b77;,b7 
( section #aiaf 7#db ,u4,s4,c4          
#acifo7a77#b77;,b71 7b77#b77;,b771 by   
ins]t+ aft] ! comma at ! end & s]vices &
 c>e 7includ+ pr5atal1 labor1 & po/p>tum

 c>e7 provid$ by a d\la1 midwife1 tribal
 midwife1 or lactation support provid]  
7z ^? t]ms are def9$ 9 section          
#aije7ll7712 &  7#b7 9 section          
#aiaf;,a7b77#c77;,b77iii7 7#db ,u4,s4,c4
 #acifo-#a7;b77#c77;,b77iii771 by ins]t+
 be=e ! p]iod at ! end 1 & s]vices & c>e
 7includ+ pr5atal1 labor1 & po/p>tum    
c>e7 provid$ by a d\la1 midwife1 tribal 
midwife1 or lactation support provid] 7z
 ^? t]ms are def9$ 9 section #aije7ll774
  7d7 ,effective date  7#a7 ,9 g5]al    
,subject to p>agraph 7#b71 ! am5dm5ts   
made by ?is section %all apply ) respect
 to m$ical assi/ance furni%$ on or aft] 
,janu>y #a1 #bjbg4  7#b7 ,exception =   
,/ate legislation ,9 ! case ( a ,/ate   
plan "u title ,,xix ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 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 section1 !         
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