,,ii #aaith ,,congress #b;d ,session ,s4 #dihf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ae1 #bjbf,ms4 ,warren introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to provide coverage under the ,medicaid program for services provided by doulas1 midwives1 and lactation support providers1 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 #ac4f deaths per #ajj1jjj live births for ,white women1 #de deaths per #ajj1jjj live births for ,black women1 and #ac4i deaths per #ajj1jjj live births for ,hispanic women4 ,for ,american ,indian and ,alaskan ,native women1 the ,national ,council of ,urban ,indian ,health estimates there are #ed4f deaths per #ajj1jjj live births4 ,while maternal mortality most 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 among similarly economically situated countries and continue to increase4 7#c7 ,four out of #e of these maternal deaths are likely preventable4 7#d7 ,according to the ,national ,institutes of ,health1 individuals who have doula support during their pregnancy are #d times less likely to have a low-birth-weight baby1 #b times less likely to experience a birth complication involving themselves or their baby1 and significantly more likely to initiate breastfeeding4 7#e7 ,midwifery-led care is associated with cost savings1 decreased rates of intervention1 lower rates of cesarean birth1 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 doulas1 midwives1 and lactation support providers 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#ca71 by striking and at the end2 7,b7 by redesignating paragraph 7#cb7 as paragraph 7#cc72 and 7,c7 by inserting after paragraph 7#ca7 the following new paragraph3 7#cb7 services and care1 including prenatal1 labor1 and postpartum care1 that is provided in a culturally congruent manner by doulas1 midwives1 tribal midwives1 and lactation support providers 7as those terms are defined in subsection 7ll771 that is provided in the home1 community1 a hospital1 birth center1 clinic1 or 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 7ll7 ,doulas1 midwives1 tribal midwives1 and lactation support providers defined ,for purposes of subsection 7a77#cb73 7#a7 ,doula defined ,the term doula means an individual who-- 7,a7 7i7 is certified by an organization 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 7ii7 maintains such certification by completing such required continuing education2 7,b7 can provide a recommendation from at least-- 7i7 three different former clients for whom the prospective doula provided doula services 7either paid or volunteer7 within the last #e years2 or 7ii7 two different licensed health care providers 7including physicians1 midwives1 social workers1 or nurses7 who observed the prospective doula providing doula services within the last #e years2 or 7,c7 is authorized to serve as a ,medicaid provider of doula services under the ,state plan under this title 7or a waiver of such plan7 of the individual's ,state4 7#b7 ,midwife defined ,the term midwife means a midwife who-- 7,a7 is authorized to serve as a ,medicaid provider of midwife services under the ,state plan under this title 7or a waiver of such plan7 of the individual's ,state2 or 7,b7 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-- 7,a7 is authorized to serve as a ,medicaid provider of tribal midwife services under the ,state plan under this title 7or a waiver of such plan7 of the individual's ,state2 or 7,b7 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 7#d7 ,lactation support provider defined ,the term lactation support provider means an individual who-- 7,a7 is authorized to serve as a ,medicaid provider of lactation support services under the ,state plan under this title 7or a waiver of such plan7 of the individual's ,state2 7,b7 has completed at least #bj hours of foundational training based on the ,world ,health ,organization_/,united ,nations ,children's ,fund lactation counseling training blueprint1 or an equivalent training2 or 7,c7 is recognized within any category on the ,lactation ,support ,provider ,descriptor chart published by the ,u4,s4 ,breastfeeding ,committee-affiliated ,lactation ,support ,provider ,constellation4 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#cb74 7c7 ,cost sharing prohibition ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended-- 7#a7 in subsections 7a77#b77;,b7 and 7b77#b77;,b7 of section #aiaf 7#db ,u4,s4,c4 #acifo7a77#b77;,b71 7b77#b77;,b771 by inserting after the comma at the end and services and care 7including prenatal1 labor1 and postpartum care7 provided by a doula1 midwife1 tribal midwife1 or lactation support provider 7as those terms are defined in section #aije7ll7712 and 7#b7 in section #aiaf;,a7b77#c77;,b77iii7 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77iii771 by inserting before the period at the end 1 and services and care 7including prenatal1 labor1 and postpartum care7 provided by a doula1 midwife1 tribal midwife1 or lactation support provider 7as those terms are defined in section #aije7ll774 7d7 ,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 #bjbg4 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