,,ii #aai? ,,congress #b;d ,session ,s4 #eeae ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,septemb] #bd1 #bjbf,mr4 ,durb9 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,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 ! ,community ,access1 ,res\rces1 & ,emp[]m5t = ,moms ,act or ! ,,c>e = ,moms ,act4 #b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,e ye>1 across ! ,unit$ ,/ates1 ne>ly #d1jjj1jjj wom5 give bir?1 m ?an #a1jjj wom5 suff] fatal complications dur+ pregnancy1 :ile giv+ bir? or dur+ ! po/p>tum p]iod1 & ab\t #gj1jjj 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 _m o!r high-income c\ntries4 ,! e/imat$ mat]nal mortality rate 7dea?s p] #ajj1jjj live bir?s7 = ! #dh contigu\s ,/ates & ! ,di/rict ( ,columbia1 increas$ f #ad4e p]c5t 9 #bjjj to #cb4j 9 #bjba4 ,! ,unit$ ,/ates is ! only indu/rializ$ nation ) a ris+ mat]nal mortality rate4 7#c7 ,! ,national ,vital ,/ati/ics ,sy/em ( ! ,c5t]s = ,disease ,control & ,prev5tion has f\nd t 9 #bjba1 !re 7 #cb4i mat]nal dea?s = e #ajj1jjj live bir?s 9 ! ,unit$ ,/ates4 ,t ratio cont9ues to exce$ ! rate 9 o!r high-income c\ntries4 7#d7 ,x is e/imat$ t m ?an #hj p]c5t ( mat]nal dea?s 9 ! ,unit$ ,/ates are prev5table4 7#e7 ,accord+ to ! ,c5t]s = ,disease ,control & ,prev5tion1 ! mat]nal mortality rate v>ies dra/ically = wom5 by race & e?nicity4 ,!re are ab\t #bf4f dea?s p] #ajj1jjj live bir?s = ,:ite wom51 #fi4i dea?s p] #ajj1jjj live bir?s = non-,hispanic ,black wom51 & #cb4j dea?s p] #ajj1jjj live bir?s = ,am]ican ,indian_/,alaska ,native wom54 ,:ile mat]nal mortality disp>ately impacts ,black wom51 ?is urg5t public heal? crisis trav]ses race1 e?nicity1 socioeconomic /atus1 educational backgr\nd1 & geography4 7#f7 ,9 ! ,unit$ ,/ates1 non-,hispanic ,black wom5 are ab\t #c times m likely to die f causes relat$ to pregnancy & *ildbir? comp>$ to non-,hispanic ,:ite wom51 :i* is "o ( ! mo/ disconc]t+ racial disp>ities 9 public heal?4 ,?is disp>ity wid5s 9 c]ta9 cities & ,/ates across ! c\ntry4 7#g7 ,accord+ to ! ,national ,c5t] = ,heal? ,/ati/ics ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! mat]nal mortality rate height5s ) age1 z wom5 #dj & old] die at a rate ( #ach4e p] #ajj1jjj bir?s comp>$ to #bj4d p] #ajj1jjj = wom5 "u #be4 ,?is translates to wom5 ov] #dj be+ #f4h times m likely to die comp>$ to _! c\nt]p>ts "u #be ye>s ( age4 7#h7 ,! ,,covid-#ai p&emic has exac]bat$ ! mat]nal heal? crisis4 ,a /udy ( ! ,c5t]s = ,disease ,control & ,prev5tion sugge/$ t pregnant wom5 are at a significantly high] risk = sev]e outcomes1 includ+ dea?1 f ,,covid-#ai z comp>$ to non-pregnant wom54 ,! ,,covid-#ai p&emic also decreas$ access to pr5atal & po/p>tum c>e4 ,a /udy by ! ,gov]nm5t ,acc\ntability ,(fice f\nd t ,,covid-#ai contribut$ to #be p]c5t ( mat]nal dea?s 9 #bjbj & #bjba4 7#i7 ,! f9d+s describ$ 9 p>agraphs 7#a7 ?r\gh 7#h7 are ( major conc]n to rese>*]s1 academics1 memb]s ( ! bus9ess community1 & provid]s across ! ob/etric cont9uum repres5t$ by organizations su* z-- 7,a7 ! ,am]ican ,college ( ,nurse-,midwives2 7,b7 ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s2 7,c7 ! ,am]ican ,m$ical ,association2 7,d7 ! ,association ( ,wom5's ,heal?1 ,ob/etric & ,neonatal ,nurses2 7,e7 ! ,black ,mamas ,matt] ,alliance2 7,f7 ! ,black ,wom5's ,heal? ,imp]ative2 7,g7 ! ,cali=nia ,mat]nal ,quality ,c>e ,collaborative2 7,h7 ,ever,thrive ,ill9ois2 7,i7 ! ,ill9ois ,p]9atal ,quality ,collaborative2 7,j7 ! ,m>* ( ,dimes2 7,k7 ! ,national ,association ( ,c]tifi$ ,pr(essional ,midwives2 7,l7 ,,rh ,impact3 ,! ,collaborative = ,equity & ,ju/ice2 7,m7 ! ,national ,p>tn]%ip = ,wom5 ,families2 7,n7 ! ,national ,polycy/ic ,ov>y ,syndrome ,association2 7,o7 ! ,preeclampsia ,f\ndation2 7,p7 ! ,society = ,mat]nal-,fetal ,m$ic9e2 7,q7 ! ,:at ,to ,expect ,project2 7,r7 ,tufts ,univ]sity ,s*ool ( ,m$ic9e ,c5t] = ,black ,mat]nal ,heal? & ,reproductive ,ju/ice2 7,s7 ! ,%ades ( ,blue ,project2 7,t7 ! ,mat]nal ,m5tal ,heal? ,lead]%ip ,alliance2 7,u7 ! ,tulane ,univ]sity ,m>y ,amelia ,c5t] = ,wom5's ,heal? ,equity ,rese>*2 7,v7 ,9 ,our ,own ,voice3 ,national ,black ,wom5's ,reproductive ,ju/ice ,ag5da2 & 7,w7 ,physicians = ,reproductive ,heal?4 7#aj7 ,hemorrhage1 c>diovascul> & coron>y conditions1 c>diomyopa?y1 infection or sepsis1 embolism1 m5tal heal? conditions 7includ+ sub/ance use disord]71 hyp]t5sive disord]s1 /roke & c]ebrovascul> accid5ts1 & ane/hesia complications are ! pr$om9ant m$ical causes ( mat]nal-relat$ dea?s & complications4 ,mo/ ( ^! conditions are l>gely prev5table or manageable4 ,ev5 :5 ^! conditions are n prev5table1 mortality & morbidity may be prev5t$ :5 conditions are diagnos$ & treat$ 9 a timely mann]4 7#aa7 ,accord+ to a /udy publi%$ by ! ,j\rnal ( ,p]9atal ,education1 d\la-assi/$ mo!rs 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$+ & human lactation4 ,d\la c>e has also be5 %[n to produce co/ sav+s result+ 9 "p f r$uc$ rates ( ces>ean & pre-t]m bir?s4 7#ab7 ,intimate p>tn] viol5ce is "o ( ! lead+ causes ( mat]nal dea?1 & wom5 are m likely to exp]i5ce intimate p>tn] viol5ce dur+ pregnancy ?an at any o!r "t 9 _! lives4 ,x is also m dang]\s ?an pregnancy4 ,intimate p>tn] viol5ce dur+ pregnancy & po/p>tum crosses e demographic & has be5 exac]bat$ by ! ,,covid-#ai p&emic4 7#ac7 ,oral heal? is an important "p ( p]9atal heal?4 ,r$uc+ bact]ia 9 a woman's m\? dur+ pregnancy c significantly r$uce h] risk ( develop+ oral diseases & spread+ decay-caus+ bact]ia to h] baby4 ,moreov]1 "s evid5ce sugge/s t wom5 ) p]iodontal disease dur+ pregnancy c\ld be at great] risk = poor bir? outcomes1 su* z preeclampsia1 pre-t]m bir?1 & l[-bir? weight4 ,fur!rmore1 a woman's oral heal? dur+ pregnancy is a good pr$ictor ( h] newborn's oral heal?1 & s9ce mo!rs c un9t5tionally spread oral bact]ia to _! babies1 putt+ _! *ildr5 at high] risk = too? decay1 prev5tion ef=ts %\ld happ5 ev5 be=e *ildr5 are born1 z a matt] ( pre-pregnancy heal? & pr5atal c>e dur+ pregnancy4 7#ad7 ,9 ! ,unit$ ,/ates1 dea? report+ & analysis is a ,/ate function r ?an a ,f$]al process4 ,/ates report all dea?s--includ+ mat]nal dea?s--on a semi-volunt>y basis1 )\t /&>dization across ,/ates4 ,:ile ! ,c5t]s = ,disease ,control & ,prev5tion has ! capacity & sy/em = collect+ dea?-relat$ data bas$ on dea? c]tificates1 ^! data are n suffici5tly report$ by ,/ates 9 an organiz$ & /&>d =mat across ,/ates su* t ! ,c5t]s = ,disease ,control & ,prev5tion is able to id5tify causes ( mat]nal dea? & be/ practices = ! prev5tion ( su* dea?4 7#ae7 ,vital /ati/ics sy/ems (t5 und]e/imate mat]nal mortality & are insuffici5t data s\rces f :i* to d]ive a full scope ( m$ical & social det]m9ant factors contribut+ to mat]nal dea?s1 su* z intimate p>tn] viol5ce4 ,:ile ! addition ( pregnancy *eckboxes on dea? c]tificates s9ce #bjjc h likely improv$ ,/ates' abilities to id5tify pregnancy-relat$ dea?s1 !y are n g5]ally complet$ by ob/etric 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 ,lack ( /&>dization ( data & data %>+ across ,/ates & betwe5 ,f$]al entities1 heal? networks1 & rese>* in/itutions keep ! ,unit$ ,/ates 9 ! d>k ab\t ways to prev5t mat]nal dea?s4 7#af7 ,hav+ reliable & valid ,/ate data aggregat$ at ! ,f$]al level are critical to ! ability ( ! ,unit$ ,/ates to quell surges 9 mat]nal dea? & imp]ative = rese>*]s to id5tify long-la/+ int]v5tions4 7#ag7 ,lead]s 9 mat]nal wellness highly recomm5d t mat]nal dea?s & cases ( mat]nal morbidity1 includ+ complications t result 9 *ronic illness & future increas$ risk ( dea?1 be inve/igat$ at ! ,/ate level fir/1 & t /&>diz$1 /reaml9$1 de-id5tifi$ data reg>d+ mat]nal dea?s be s5t annually to ! ,c5t]s = ,disease ,control & ,prev5tion4 ,su* data /&>dization & collection w\ld be simil> 9 op]ation & effect to ! ,national ,program ( ,canc] ,regi/ries ( ! ,c5t]s = ,disease ,control & ,prev5tion & ak9 to ! ,confid5tial ,enquiry 9 ,mat]nal ,dea?s ,programme 9 ! ,unit$ ,k+dom4 ,su* a mat]nal mortalities & morbidities regi/ry & surveillance sy/em w\ld help provid]s1 academicians1 lawmak]s1 & ! public to address que/ions conc]n+ ! types (1 causes (1 & be/ practices to ?w>t1 mat]nal mortality & morbidity4 7#ah7 ,! ,unit$ ,nations' ,mill5nium ,developm5t ,goal #e;a aim$ to r$uce by #ge p]c5t1 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 7#ai7 ,! ,unit$ ,/ates has no comp>able1 coord9at$ ,f$]al process by :i* to review cases ( mat]nal mortality1 sy/ems failures1 or be/ practices4 ,! majority ( ,/ates h active ,mat]nal ,mortality ,review ,committees 7ref]r$ to 9 ?is section z ,,mmrc71 :i* help lev]age "w to impact mat]nal wellness4 ,= example1 ! ,/ate ( ,cali=nia has work$ ext5sively ) ! ,cali=nia ,/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 su* ,/ate has 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 p]ip>tum c>diomyopa?y1 & ! 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 7#bj7 ,hospitals & heal? sy/ems across ! ,unit$ ,/ates lack /&>dization ( em]g5cy ob/etric 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/etric em]g5cy t does n consid] bo? cl9ical & public heal? approa*es falls woefully "u ! m>k ( excell5t c>e deliv]y4 ,/ate-bas$ p]9atal quality collaboratives1 or entities p>ticipat+ 9 ! ,alliance = ,innovation on ,mat]nal ,heal? 7,,aim71 h =m$ ob/etric 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 ,^! p]9atal quality collaboratives s]ve an important role 9 provid+ infra/ructure t supports quality improvem5t ef=ts address+ ob/etric c>e & outcomes4 ,/ate-bas$ p]9atal quality collaboratives p>tn] ) hospitals1 physicians1 nurses1 midwives1 pati5ts1 public heal?1 & o!r /akehold]s to provide opportunities = collaborative le>n+1 rapid response data1 & quality improvem5t sci5ce support to a*ieve sy/ems-level *ange4 7#ba7 ,! ,c5t]s = ,disease ,control & ,prev5tion reports t #bb p]c5t ( dea?s occurr$ dur+ pregnancy1 #be p]c5t occurr$ on ! day ( deliv]y or )9 #g days aft] ! day ( deliv]y1 & #ec p]c5t occurr$ betwe5 #g days & #a ye> aft] ! day ( deliv]y4 ,yet1 = wom5 eligible = ! ,m$icaid program on ! basis ( pregnancy 9 ,/ates )\t ,m$icaid po/p>tum ext5sion1 su* ,m$icaid cov]age lapses at ! end ( ! mon? on :i* ! #fj? po/p>tum day l&s4 7#bb7 ,! exp]i5ce ( s]i\s traumatic ev5ts1 su* z be+ expos$ to dome/ic viol5ce1 sub/ance use disord]1 or p]vasive & sy/ematic racism1 c ov]-activate ! body's /ress-response sy/em4 ,kn[n z toxic /ress1 ! repetition ( high-doses ( cortisol to ! bra91 c h>m heal?y neurological developm5t & o!r body sy/ems1 :i* c h cascad+ physical & m5tal heal? consequ5ces1 z docum5t$ 9 ! ,adv]se ,*ildhood ,exp]i5ces /udy ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7#bc7 ,a gr[+ body ( evid5ce-bas$ rese>* has %[n ! correlation betwe5 ! /ress associat$ ) sy/ematic racism & "o's bir?+ outcomes4 ,! undue /ress ( sex & race discrim9ation pair$ ) 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 educational level1 geographic region1 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 ,black wom5 rema9 ! mo/ at risk = pregnancy-associat$ or pregnancy-relat$ causes ( dea?4 ,:5 x comes to preeclampsia1 = example1 = :i* obesity is a risk factor1 ,black wom5 ( normal weight rema9 at a high] at risk ( dy+ dur+ ! p]9atal p]iod comp>$ to non-,black obese wom54 7#bd7 ,! ris+ mat]nal mortality rate 9 ! ,unit$ ,/ates is driv5 pr$om9antly by ! disproportionately high rates ( ,black mat]nal mortality4 7#be7 ,comp>$ to wom5 f o!r racial & e?nic demographics1 ,black wom5 across ! socioeconomic spectrum exp]i5ce prolong$1 unrel5t+ /ress relat$ to sy/ematic 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 /ress1 call$ wea!r+1 (t5 ext5ds across ! life c\rse & is situat$ 9 ev]yday spaces :]e ,black wom5 e/abli% livelihood4 ,sy/ematic racism1 /ructural b>ri]s1 lack ( access to quality mat]nal heal? c>e1 lack ( access to nutriti\s food1 & social det]m9ants ( heal? exac]bate ,black wom5's likelihood to exp]i5ce poor or fatal bir?+ outcomes1 b d n fully acc\nt = ! great disp>ity4 7#bf7 ,black wom5 are twice z likely to exp]i5ce po/p>tum depression1 & disproportionately high] rates ( preeclampsia comp>$ to ,:ite wom54 7#bg7 ,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 ,h[ev]1 ! provid] pool is n prim$ ) _m p ( color1 nor are provid]s 7:e!r mat]nity c>e cl9icians or mat]nity c>e support p]sonnel7 consi/5tly requir$ to und]go implicit bias1 cultural compet5cy1 respectful c>e practices1 or empa?y tra9+ on a consi/5t1 on-go+ basis4 7#bh7 ,wom5 are n ! only p :o c become pregnant or give bir?4 ,nonb9>y1 transg5d]1 & g5d]-expansive p c also become pregnant4 ,! t]ms bir?+ p or bir?+ p]sons are also us$ to describe pregnant or po/p>tum p 9 a way t is inclusive ( individuals :o exp]i5ce g5d] beyond ! b9>y4 7#bi7 ,sub/ance misuse among pregnant wom51 includ+ ! use ( sub/ances t are illegal or crim9aliz$1 misuse ( prescrib$ m$ications1 & b+e dr9k+1 has increas$ ye> aft] ye> = ! pa/ decade4 ,pregnant p ) ,sub/ance ,use ,disord]1 p>ticul>ly ^? ) opioids1 amphetam9es1 & coca9e use disord]s1 are at great] risk ( sev]e mat]nal morbidity1 includ+ conditions su* z eclampsia1 he>t attack or failure1 & sepsis4 #c4 ,improv+ ,f$]al ef=ts ) respect to prev5tion ( mat]nal mortality 7a7 ,fund+ = ,/ate-,bas$ p]9atal quality collaboratives developm5t & su/a9ability 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is ,act 7o!r ?an section #h7 z ! ,secret>y71 act+ ?r\gh ! ,division ( ,reproductive ,heal? ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all e/abli% a grant program1 to be kn[n z ! ,/ate-,bas$ ,p]9atal ,quality ,collaborative ,grant ,program1 "u :i* ! ,secret>y %all aw>d grants to eligible entities = ! purpose ( developm5t & su/a9ability ( p]9atal quality collaboratives 9 ea* ,/ate1 ! ,di/rict ( ,columbia1 & eligible t]ritories1 9 ord] to measurably improve p]9atal c>e & p]9atal heal? outcomes = pregnant & po/p>tum wom5 & _! infants4 7#b7 ,grant am\nts ,grants aw>d$ "u ?is subsection %all be 9 am\nts n to exce$ #bej1jjj p] ye>1 = ! duration ( ! grant p]iod4 7#c7 ,def9ition ( p]9atal quality collaborative ,9 ?is subsection1 ! t]m p]9atal quality collaborative means a network ( teams t-- 7,a7 is multidiscipl9>y 9 nature & includes ! full range ( p]9atal & mat]nity c>e provid]s2 7,b7 works to improve measurable outcomes = mat]nal & infant heal? by advanc+ evid5ce-in=m$ cl9ical practices us+ quality improvem5t pr9ciples2 7,c7 works ) hospital-bas$ or outpati5t facility-bas$ cl9ical teams1 exp]ts1 & /akehold]s1 includ+ pati5ts & families1 to spread be/ practices & optimize res\rces to improve p]9atal c>e & outcomes2 7,d7 employs /rategies t include ! use ( ! collaborative le>n+ model to provide opportunities = hospitals & cl9ical teams to collaborate on improvem5t /rategies1 rapid-response data to provide timely fe$back to hospital & o!r cl9ical teams to track progress1 & quality improvem5t sci5ce to provide support & coa*+ to hospital & cl9ical teams2 7,e7 has ! goal ( improv+ population-level outcomes 9 mat]nal & infant heal?2 & 7,f7 has ! goal ( improv+ outcomes ( all bir?+ p1 ?r\gh ! coord9ation1 integration1 & collaboration across bir? sett+s4 7#d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #ce1jjj1jjj = ea* ( fiscal ye>s #bjbg ?r\gh #bjca4 7b7 ,expansion ( ,m$icaid & ,,*ip cov]age = pregnant & po/p>tum wom5 7#a7 ,requir+ cov]age ( oral heal? s]vices = pregnant & po/p>tum wom5 7,a7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7i7 9 subsection 7a77#d7-- 7,i7 by /rik+ 2 & 7,d7 & ins]t+ 2 7,d72 7,,ii7 by /rik+ 2 & 7,e7 & ins]t+ 2 7,e72 7,,iii7 by /rik+ 2 & 7,f7 & ins]t+ 2 7,f72 & 7,,iv7 by /rik+ ! semicolon at ! end & ins]t+ 2 & 7,g7 oral heal? s]vices = pregnant & po/p>tum wom5 7z def9$ 9 subsection 7ll7722 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7ll7 ,oral heal? s]vices = pregnant & po/p>tum wom5 7#a7 ,9 g5]al ,= purposes ( ?is title1 ! t]m oral heal? s]vices = pregnant & po/p>tum wom5 means d5tal s]vices necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 & treat em]g5cy conditions t are furni%$ to a woman dur+ pregnancy 7or dur+ ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy74 7#b7 ,cov]age requirem5ts ,to satisfy ! requirem5t to provide oral heal? s]vices = pregnant & po/p>tum wom51 a ,/ate %all1 at a m9imum1 provide cov]age = prev5tive1 diagno/ic1 p]iodontal1 & re/orative c>e consi/5t ) recomm5dations = p]9atal oral heal? c>e & d5tal c>e dur+ pregnancy f ! ,am]ican ,academy ( ,p$iatric ,d5ti/ry & ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s4 4 7,b7 ,,*ip ,section #bajc7;c77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#f77 is am5d$-- 7i7 9 subp>agraph 7,a7-- 7,i7 by ins]t+ or a t>get$ l[-income pregnant woman aft] t>get$ l[-income *ild2 & 7,,ii7 by ins]t+ 1 &1 9 ! case ( a t>get$ l[-income *ild :o is pregnant or a t>get$ l[-income pregnant woman1 satisfy ! cov]age requirem5ts specifi$ 9 section #aije7ll7 aft] em]g5cy conditions2 & 7ii7 9 subp>agraph 7,b71 by ins]t+ 7b only if1 9 ! case ( a t>get$ l[-income *ild :o is pregnant or a t>get$ l[-income pregnant woman1 ! b5*m>k d5tal b5efit package satisfies ! cov]age requirem5ts specifi$ 9 section #aije7ll77 aft] subp>agraph 7,c74 7#b7 ,requir+ #ab-mon? cont9u\s cov]age ( full b5efits = pregnant & po/p>tum individuals "u ,m$icaid & ,,*ip 7,a7 ,m$icaid ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7i7 9 subsection 7a7-- 7,i7 9 p>agraph 7#hi71 by /rik+ & at ! end2 7,,ii7 9 p>agraph 7#ij77;,c71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,,iii7 by ins]t+ aft] p>agraph 7#ij77;,c7 ! foll[+ new p>agraph3 7#ia7 provide t ! ,/ate plan is 9 compliance ) subsection 7e77#af74 2 & 7ii7 9 subsection 7e77#af7-- 7,i7 9 subp>agraph 7,a71 by /rik+ ,at ! option ( ! ,/ate1 ! ,/ate plan 7or waiv] ( su* ,/ate plan7 may provide & ins]t+ ,a ,/ate plan 7or waiv] ( su* ,/ate plan7 %all provide2 7,,ii7 9 subp>agraph 7,b71 9 ! matt] prec$+ clause 7i71 by /rik+ by a ,/ate mak+ an election "u ?is p>agraph & ins]t+ "u a ,/ate plan 7or a waiv] ( su* ,/ate plan72 & 7,,iii7 by /rik+ subp>agraph 7,c74 7,b7 ,,*ip 7i7 ,9 g5]al ,section #bajg7;e77#a77,k7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77,k77 is am5d$ to read z foll[s3 7,k7 ,p>agraphs 7#e7 & 7#af7 ( section #aijb7;e7 7relat+ to ! requirem5t to provide m$ical assi/ance "u ! ,/ate plan or waiv] consi/+ ( full b5efits dur+ pregnancy & ?r\gh\t ! #ab-mon? po/p>tum p]iod "u title ,,xix74 4 7ii7 ,con=m+ am5dm5t ,section #baab7;d77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is am5d$ by /rik+ ! mon? 9 :i* ! #fj-;day p]iod & all t foll[s ?r\gh pursuant to section #bajg7;e77#a714 7#c7 ,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 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is #e ye>s aft] su* date ( enactm5t1 z a condition = receiv+ any ,f$]al paym5ts "u section #aijc7;a7 = cal5d> qu>t]s occurr+ dur+ su* p]iod1 a ,/ate %all n h 9 effect1 ) respect to wom5 :o are eligible = m$ical assi/ance "u ! ,/ate plan or "u a waiv] ( su* plan on ! basis ( be+ pregnant or hav+ be5 pregnant1 eligibility /&>ds1 me?odologies1 or proc$ures "u ! ,/ate plan or waiv] t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan or waiv] t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 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 ,eligibility /&>ds = t>get$ l[-income pregnant wom5 ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is #e ye>s aft] su* date ( enactm5t1 z a condition ( receiv+ paym5ts "u subsection 7a7 & section #aijc7;a71 a ,/ate t elects to provide assi/ance to wom5 on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to t>get$ l[-income pregnant wom5 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to wom5 :o are eligible = su* assi/ance ?r\gh application ( section #aijc7v77#d77;,a77i7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 :i* is provid$ to wom5 on ! basis ( be+ pregnant7 %all n h 9 effect1 ) respect to su* wom51 eligibility /&>ds1 me?odologies1 or proc$ures "u su* plan 7or waiv]7 t are m re/rictive ?an ! eligibility /&>ds1 me?odologies1 or proc$ures1 respectively1 "u su* plan 7or waiv]7 t are 9 effect on ! date ( enactm5t ( ?is p>agraph4 4 7#d7 ,in=mation on b5efits ,! ,secret>y %all make publicly available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices in=mation reg>d+ b5efits available to pregnant & po/p>tum wom5 & "u ! ,m$icaid program & ! ,*ildr5's ,heal? ,insurance ,program1 includ+ in=mation on-- 7,a7 b5efits t ,/ates are requir$ to provide to pregnant & po/p>tum wom5 "u su* programs2 7,b7 optional b5efits t ,/ates may provide to pregnant & po/p>tum wom5 "u su* programs2 & 7,c7 ! availability ( diff]5t k9ds ( b5efits = pregnant & po/p>tum wom51 includ+ oral heal? & m5tal heal? b5efits & brea/fe$+ s]vices & supplies1 "u su* programs4 7#e7 ,f$]al fund+ = co/ ( ext5d$ ,m$icaid & ,,*ip cov]age = po/p>tum wom5 7,a7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by p>agraph 7#a71 is fur!r am5d$ by add+ at ! end ! foll[+3 7mm7 ,increas$ ,,fmap = ext5d$ m$ical assi/ance = po/p>tum individuals 7#a7 ,9 g5]al ,not)/&+ subsection 7b71 ! ,f$]al m$ical assi/ance p]c5tage = a ,/ate1 ) respect to am\nts exp5d$ by su* ,/ate = m$ical assi/ance = an individual :o is eligible = su* assi/ance on ! basis ( be+ pregnant or hav+ be5 pregnant t is provid$ dur+ ! #cje-;day p]iod t beg9s on ! #fj? day aft] ! la/ day ( ! individual's pregnancy 7includ+ any su* assi/ance provid$ dur+ ! mon? 9 :i* su* p]iod ends71 %all be equal to-- 7,a7 dur+ ! fir/ #bj-qu>t] p]iod = :i* ?is subsection is 9 effect ) respect to a ,/ate1 #ajj p]c5t2 & 7,b7 ) respect to a ,/ate1 dur+ ea* qu>t] !reaft]1 #ij p]c5t4 7#b7 ,exclusion f t]ritorial caps ,any paym5t made to a t]ritory = exp5ditures = m$ical assi/ance = an individual describ$ 9 p>agraph 7#a7 t is subject to ! ,f$]al m$ical assi/ance p]c5tage specifi$ "u p>agraph 7#a7 %all n be tak5 into acc\nt = purposes ( apply+ paym5t limits "u subsections 7f7 & 7g7 ( section #aajh4 4 7,b7 ,,*ip ,section #baje7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ac7 ,enhanc$ paym5t = ext5d$ assi/ance provid$ to pregnant wom5 ,not)/&+ subsection 7b71 ! enhanc$ ,,fmap1 ) respect to paym5ts "u subsection 7a7 = exp5ditures "u ! ,/ate *ild heal? plan 7or a waiv] ( su* plan7 = assi/ance provid$ "u ! plan 7or waiv]7 to a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to a t>get$ l[-income pregnant woman 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to a woman :o is eligible = su* assi/ance ?r\gh application ( section #aijc7v77#d77;,a77i7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! plan 7or waiv]7 provid$ to a woman :o is eligible = su* assi/ance on ! basis ( be+ pregnant7 dur+ ! #cje-;day p]iod t beg9s on ! #fj? day aft] ! la/ day ( h] pregnancy 7includ+ any su* assi/ance provid$ dur+ ! mon? 9 :i* su* p]iod ends71 %all be equal to-- 7,a7 dur+ ! fir/ #bj-qu>t] p]iod = :i* ?is subsection is 9 effect ) respect to a ,/ate1 #ajj p]c5t2 & 7,b7 ) respect to a ,/ate1 dur+ ea* qu>t] !reaft]1 #ij p]c5t4 4 7#f7 ,guidance on ,/ate options = ,m$icaid cov]age ( d\la s]vices ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all issue guidance = ! ,/ates conc]n+ options = ,m$icaid cov]age & paym5t = support s]vices provid$ by d\las4 7#g7 ,enhanc$ ,,fmap = rural ob/etric & gynecological s]vices ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by p>agraphs 7#a7 & 7#e71 is fur!r am5d$-- 7,a7 9 subsection 7b71 by /rik+ & 7ii7 & ins]t+ 7ii71 7mm71 & 7nn72 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7nn7 ,increas$ ,,fmap = m$ical assi/ance = ob/etric & gynecological s]vices furni%$ at rural hospitals 7#a7 ,9 g5]al ,not)/&+ subsection 7b71 ! ,f$]al m$ical assi/ance p]c5tage = a ,/ate1 ) respect to am\nts exp5d$ by su* ,/ate = m$ical assi/ance = ob/etric or gynecological s]vices t are furni%$ 9 a hospital t is locat$ 9 a rural area 7z def9$ = purposes ( section #ahhf7 %all be equal to #ij p]c5t = ea* cal5d> qu>t] beg9n+ ) ! fir/ cal5d> qu>t] dur+ :i* ?is subsection is 9 effect4 7#b7 ,exclusion f t]ritorial caps ,any paym5t made to a t]ritory = exp5ditures = m$ical assi/ance describ$ 9 p>agraph 7#a7 t is subject to ! ,f$]al m$ical assi/ance p]c5tage specifi$ "u p>agraph 7#a7 %all n be tak5 into acc\nt = purposes ( apply+ paym5t limits "u subsections 7f7 & 7g7 ( section #aajh4 4 7#h7 ,effective dates 7,a7 ,9 g5]al ,subject to subp>agraphs 7,b7 & 7,c7-- 7i7 ! am5dm5ts made by p>agraphs 7#a71 7#b71 & 7#e7 %all take effect on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or aft] ! date t is #a ye> aft] ! date ( enactm5t ( ?is ,act2 7ii7 ! am5dm5ts made by p>agraph 7#c7 %all take effect on ! date ( enactm5t ( ?is ,act2 & 7iii7 ! am5dm5ts made by p>agraph 7#g7 %all take effect on ! fir/ day ( ! fir/ cal5d> qu>t] t beg9s on or 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 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 7,c7 ,/ate option = e>li] effective date ,a ,/ate may elect to h subsection 7e77#af7 ( section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 & subp>agraph 7,k7 ( section #bajg7;e77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a771 z am5d$ by p>agraph 7#b71 & subsection 7mm7 ( section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 & p>agraph 7#ac7 ( section #baje7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c771 z add$ by p>agraph 7#e71 take effect ) respect to ! ,/ate on ! fir/ day ( any fiscal qu>t] t beg9s be=e ! date describ$ 9 subp>agraph 7,a7 & apply to am\nts payable to ! ,/ate = exp5ditures = m$ical assi/ance1 *ild heal? assi/ance1 or pregnancy-relat$ assi/ance to pregnant or po/p>tum individuals furni%$ on or aft] su* day4 7c7 ,regional c5t]s ( excell5ce ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ by add+ at ! end ! foll[+3 #cii,v-#h4 ,regional c5t]s ( excell5ce address+ implicit bias & cultural compet5cy 9 pati5t-provid] int]actions education 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y1 9 consultation ) su* o!r ag5cy heads z ! ,secret>y det]m9es appropriate1 %all ent] into coop]ative agreem5ts ) eligible entities = ! e/abli%m5t or support ( regional c5t]s ( excell5ce t address implicit bias1 cultural compet5cy1 & respectful c>e practices 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 ent] into a coop]ative agreem5t "u subsection 7a71 an entity %all-- 7#a7 be a public or o!r 7z specifi$ by ! ,secret>y7 nonpr(it entity t provides educational & tra9+ opportunities = /ud5ts & heal? c>e pr(essionals1 includ+ a heal? sy/em1 tea*+ hospital1 community heal? c5t]1 m$ical s*ool1 s*ool ( public heal?1 s*ool ( nurs+1 d5tal s*ool1 social "w s*ool1 s*ool ( pr(essional psy*ology1 or any o!r heal? pr(essional s*ool or program at an in/itution ( high] education 7z def9$ 9 section #aja ( ! ,high] ,education ,act ( #aife7 focus$ on ! prev5tion1 treatm5t1 or recov]y ( heal? conditions t contribute to mat]nal mortality & ! prev5tion ( mat]nal mortality & sev]e mat]nal morbidity2 7#b7 demon/rate community engagem5t & p>ticipation1 su* z ?r\gh p>tn]%ips ) home visit+ & case managem5t programs or community-bas$ organizations s]v+ m9ority populations2 7#c7 demon/rate engagem5t ) gr\ps engag$ 9 ! implem5tation ( heal? c>e pr(essional tra9+ 9 implicit bias & deliv]+ culturally compet5t c>e1 su* z dep>tm5ts ( public heal?1 p]9atal quality collaboratives1 hospital sy/ems1 & heal? c>e pr(essional gr\ps1 9 ord] to obta9 input on res\rces ne$$ = effective implem5tation /rategies2 & 7#d7 provide to ! ,secret>y su* in=mation1 at su* "t & 9 su* mann]1 z ! ,secret>y may require4 7c7 ,div]sity ,9 select+ eligible entities ) :i* to ent] into 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#d74 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 7#c7 ,di/ribution ,! ,secret>y %all %>e ! evaluations & ov]all f9d+s describ$ 9 p>agraph 7#b7 ) ,/ate dep>tm5ts ( heal? & o!r relevant ,/ate level (fices to in=m ,/ate & local be/ practices4 7e7 ,def9ition ( mat]nal mortality ,9 ?is section1 ! t]m mat]nal mortality means dea? ( a woman t occurs dur+ pregnancy or )9 ! #a-ye> p]iod foll[+ ! end ( su* pregnancy4 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #e1jjj1jjj = ea* ( fiscal ye>s #bjbg ?r\gh #bjca4 4 7d7 ,special supplem5tal nutrition program = wom51 infants1 & *ildr5 ,section #ag7;d77#c77;,a77ii7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is am5d$-- 7#a7 by /rik+ ! clause designation & head+ & all t foll[s ?r\gh ,a ,/ate & ins]t+ ! foll[+3 7ii7 ,wom5 7,i7 ,brea/fe$+ wom5 ,a ,/ate 2 7#b7 9 subclause 7,i7 7z s designat$71 by /rik+ #a ye> & all t foll[s ?r\gh e>li] & ins]t+ #b ye>s po/p>tum2 & 7#c7 by add+ at ! end ! foll[+3 7,,ii7 ,po/p>tum wom5 ,a ,/ate may elect to c]tify a po/p>tum woman = a p]iod ( #b ye>s4 4 #d4 ,full-spectrum d\la work=ce 7a7 ,9 g5]al ,! ,secret>y %all e/abli% & implem5t a program to aw>d grants to1 or ent] into contracts )1 eligible entities to e/abli% or exp& programs to gr[ & div]sify ! d\la work=ce1 includ+ ?r\gh improv+ ! capacity & supply ( heal? c>e provid]s4 7b7 ,eligibility ,to be eligible to receive a grant or ent] into a contract "u subsection 7a71 an entity %all be-- 7#a7 a heal? pr(essions s*ool2 7#b7 a s*ool ( public heal?2 7#c7 an academic heal? c5t]2 7#d7 a ,/ate or local gov]nm5t2 7#e7 a t]ritory2 7#f7 an ,indian ,tribe1 ,tribal organization1 urban ,indian organization1 or ,native ,hawaiian organization2 7#g7 a community-bas$ organization2 or 7#h7 ano!r appropriate public or private nonpr(it entity or a consortium ( public or private nonpr(it entities1 includ+ entities t promote multidiscipl9>y approa*es4 7c7 ,use ( funds ,an eligible entity t receives a grant or ent]s into a contract "u subsection 7a7 %all use ! funds receiv$ pursuant to su* grant or contract = #a or m ( ! foll[+ activities3 7#a7 ,e/abli%+ programs t provide education & tra9+ to individuals seek+ appropriate tra9+ or c]tification z a full-spectrum d\la4 7#b7 ,exp&+ ! capacity ( exi/+ programs t provide education & tra9+ to individuals seek+ appropriate tra9+ or c]tification z a full-spectrum d\la = ! purpose ( increas+ ! numb] ( /ud5ts enroll$ 9 su* programs1 includ+ by aw>d+ s*ol>%ips = /ud5ts :o agree to "w 9 und]s]v$ communities aft] receiv+ su* education & tra9+4 7#c7 ,develop+ & implem5t+ /rategies to recruit & reta9 /ud5ts f und]s]v$ communities1 p>ticul>ly f demographic gr\ps exp]i5c+ high rates ( mat]nal mortality & sev]e mat]nal morbidity1 includ+ racial & e?nic m9ority gr\ps1 into programs describ$ 9 p>agraphs 7#a7 & 7#b74 7d7 ,fund+ ,9 addition to am\nts o!rwise available1 !re is au?oriz$ to be appropriat$ to ! ,secret>y to c>ry out ?is section1 & !re is appropriat$1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #ej1jjj1jjj = fiscal ye> #bjbg1 to rema9 available until exp5d$4 #e4 ,grants = rural ob/etric mobile heal? units ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq47 is am5d$ by add+ at ! end ! foll[+3 #cbj;,c4 ,grants = rural ob/etric mobile heal? units 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration 7ref]r$ to 9 ?is section z ! ,secret>y71 %all e/abli% a #e-ye> pilot program "u :i* ! ,secret>y %all make grants to ,/ates-- 7#a7 to pur*ase & equip rural mobile heal? units = ! purpose ( provid+ pre-conception1 pregnancy1 po/p>tum1 & ob/etric em]g5cy s]vices 9 rural & und]s]v$ communities2 7#b7 to tra9 provid]s1 includ+ ob/etrician-gynecologi/s1 c]tifi$ nurse-midwives1 nurse practition]s1 nurses1 & midwives1 to op]ate & provide ob/etric s]vices1 includ+ tra9+ & plann+ = ob/etric em]g5cies1 9 su* mobile heal? units2 & 7#c7 to address access issues1 includ+ social det]m9ants ( heal? & wrap-ar\nd cl9ical & community s]vices1 includ+ nutrition1 h\s+1 lactation s]vices1 & transportation support & ref]rals4 7b7 ,no %>+ ( data ) law en=cem5t ,z a condition ( receiv+ a grant "u ?is section1 a ,/ate %all submit to ! ,secret>y an assurance t ! ,/ate w n make available to ,f$]al or ,/ate law en=cem5t any p]sonally id5tifiable in=mation reg>d+ any pregnant or po/p>tum individual collect$ pursuant to su* grant4 7c7 ,grant duration ,! p]iod ( a grant "u ?is section %all n exce$ #e ye>s4 7d7 ,report+ requirem5ts 7#a7 ,9 g5]al ,n lat] ?an #c ye>s aft] ! date on :i* a ,/ate receives a grant "u ?is section1 & n lat] ?an #f ye>s aft] su* date1 su* ,/ate %all submit to ! ,secret>y a report t describes ! results ( ! activities c>ri$ out pursuant to ! grant1 includ+-- 7,a7 relevant in=mation & relevant quantitative indicators ( ! success ( su* activities 9 improv+ ! /&>d ( c>e & mat]nal heal? outcomes = individuals 9 rural & und]s]v$ communities :o are se5 = pre-conception1 pregnancy1 or po/p>tum visits 9 ! rural mobile heal? units1 /ratifi$ by ! categories ( data describ$ 9 p>agraph 7#b72 7,b7 relevant qualitative evaluations f individuals receiv+ pre-conception1 pregnant1 or po/p>tum c>e f rural mobile heal? units provid$ ?r\gh ! grant1 includ+ measures ( pati5t-report$ exp]i5ce ( c>e & measures ( pati5t-report$ issues ) access to c>e )\t su* rural mobile heal? unit2 & 7,c7 /rategies to su/a9 su* activities beyond ! duration ( ! grant & exp& su* activities to o!r rural & und]s]v$ communities4 7#b7 ,categories ( data ,! categories ( data describ$ 9 ?is p>agraph are ! foll[+3 7,a7 ,race1 e?nicity1 sex1 g5d]1 g5d] id5tity1 prim>y language1 age1 geography1 disability /atus1 & insurance /atus4 7,b7 ,numb] ( visits provid$ = preconception1 pr5atal1 or po/p>tum c>e4 7,c7 ,numb] ( repeat visits provid$ = preconception1 pr5atal1 or po/p>tum c>e4 7,d7 ,numb] ( scre5+s or te/s provid$ = smok+1 sub/ance use1 hyp]t5sion1 sexually transmitt$ diseases1 diabetes1 ,,hiv1 depression1 intimate p>tn] viol5ce1 ,pap sme>s1 & pregnancy4 7#c7 ,data privacy protection ,! reports requir$ "u p>agraph 7#a7 %all n conta9 any p]sonally id5tifiable in=mation reg>d+ any pregnant or po/p>tum individual4 7e7 ,evaluation ,n lat] ?an ,decemb] #ca1 #bjcb1 ! ,secret>y %all conduct an evaluation ( ! pilot program "u ?is section to det]m9e ! impact ( ! pilot program ) respect to-- 7#a7 ! effectiv5ess ( ! grants aw>d$ "u ?is section to improve mat]nal heal? outcomes 9 rural & und]s]v$ communities1 ) data /ratifi$ by race1 e?nicity1 prim>y language1 socioeconomic /atus1 geography1 insurance type1 & su* o!r factors z ! ,secret>y det]m9es appropriate2 7#b7 sp5d+ on mat]nity c>e by ,/ates p>ticipat+ 9 ! pilot program2 7#c7 to ! maximum ext5t practicable1 qualitative & quantitative measures ( pati5t exp]i5ce2 & 7#d7 any o!r areas ( assessm5t t ! ,secret>y det]m9es relevant4 7f7 ,report ,n lat] ?an #a ye> aft] ! completion ( ! pilot program "u ?is section1 ! ,secret>y %all submit to ,congress1 & make publicly available1 a report t conta9s-- 7#a7 ! results ( ! evaluation conduct$ "u subsection 7e72 & 7#b7 recomm5dations reg>d+ :e!r ! pilot program %\ld be cont9u$ & exp&$ on a national basis4 7g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to ! ,secret>y to c>ry out ?is section #aj1jjj1jjj = ea* ( fiscal ye>s #bjbg ?r\gh #bjca4 4 #f4 ,requir+ notification ( imp5d+ hospital ob/etric unit closure ,section #ahff7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is am5d$-- 7#a7 9 subp>agraph 7,x71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,y77ii77,v71 by /rik+ ! p]iod & ins]t+ 1 &2 & 7#c7 by ins]t+ aft] subp>agraph 7,y7 ! foll[+ new subp>agraph3 7,z7 beg9n+ #ahj days aft] ! date ( ! enactm5t ( ?is subp>agraph1 9 ! case ( a hospital1 n less ?an #ij days prior to ! closure ( any ob/etric unit ( ! hospital1 to submit to ! ,secret>y a notification :i* %all include-- 7i7 a report analyz+ ! impact ! closure w h on ! community2 7ii7 /eps ! hospital w take to id5tify o!r heal? c>e provid]s t c alleviate any s]vice gaps z a result ( ! closure2 & 7iii7 any additional in=mation z may be requir$ by ! ,secret>y4 4 #g4 ,report on mat]nal heal? ne$s 7a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all prep>e1 & submit to ,congress1 a report on-- 7#a7 :]e ! mat]nal heal? ne$s are greate/ 9 ! ,unit$ ,/ates2 & 7#b7 ! ,f$]al exp5ditures made to address su* ne$s4 7b7 ,p]iod cov]$ ,! report "u subsection 7a7 %all cov] ! p]iod ( #bjjj ?r\gh #bjbd4 7c7 ,cont5ts ,! report "u subsection 7a7 %all include an analysis ( ea* ( ! foll[+3 7#a7 ,h[ ,f$]al funds provid$ to ,/ates = mat]nal heal? 7 di/ribut$ across regions1 ,/ates1 & localities or c\nties4 7#b7 ,b>ri]s to apply+ = & receiv+ ,f$]al funds = mat]nal heal?1 includ+ ) respect to initial applications-- 7,a7 requirem5ts = submission 9 p>tn]%ip ) o!r entities2 & 7,b7 /r+5t network requirem5ts4 7#c7 ,:y applicants did n receive fund+1 includ+ limit$ availability ( funds1 ! /r5g? ( ! respective applications1 & failure to adh]e to requirem5ts4 7d7 ,disaggregation ( data ,! report "u subsection 7a7 %all disaggregate data on mo!rs s]v$ by race1 e?nicity1 insurance /atus1 & language spok54 #h4 ,increas+ excise taxes on cig>ettes & e/abli%+ excise tax equity among all tobacco product tax rates 7a7 ,tax p>ity = ,roll-,y\r-,own tobacco ,section #egja7;g7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #bd4gh & ins]t+ #di4ef4 7b7 ,tax p>ity = pipe tobacco ,section #egja7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #b4hcaa c5ts & ins]t+ #di4ef4 7c7 ,tax p>ity = smokeless tobacco 7#a7 ,section #egja7;e7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 9 p>agraph 7#a71 by /rik+ #a4ea & ins]t+ #bf4hd2 7,b7 9 p>agraph 7#b71 by /rik+ #ej4cc c5ts & ins]t+ #aj4gd2 & 7,c7 by add+ at ! end ! foll[+3 7#c7 ,smokeless tobacco sold 9 discrete s+le-use units ,on discrete s+le-use units1 #ajj4ff p] ?\s&4 4 7#b7 ,section #egjb7m7 ( su* ,code is am5d$-- 7,a7 9 p>agraph 7#a71 by /rik+ or *ew+ tobacco & ins]t+ 1 *ew+ tobacco1 or discrete s+le-use unit2 7,b7 9 p>agraphs 7#b7 & 7#c71 by ins]t+ t is n a discrete s+le-use unit be=e ! p]iod 9 ea* su* p>agraph2 & 7,c7 by add+ at ! end ! foll[+3 7#d7 ,discrete s+le-use unit ,! t]m discrete s+le-use unit means any product conta9+1 made f1 or d]iv$ f tobacco or nicot9e t-- 7,a7 is n int5d$ to be smok$2 & 7,b7 is 9 ! =m ( a loz5ge1 tablet1 pill1 p\*1 dissolvable /rip1 or o!r discrete s+le-use or s+le-dose unit4 4 7d7 ,tax p>ity = small cig>s ,p>agraph 7#a7 ( section #egja7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7e7 ,tax p>ity = l>ge cig>s 7#a7 ,9 g5]al ,p>agraph 7#b7 ( section #egja7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ #eb4ge p]c5t & all t foll[s ?r\gh ! p]iod & ins]t+ ! foll[+3 #di4ef p] p\nd & a proportionate tax at ! l rate on all fractional p>ts ( a p\nd b n less ?an #aj4jff c5ts p] cig>44 7#b7 ,guidance ,! ,secret>y ( ! ,treasury1 or ! ,secret>y's delegate1 may issue guidance reg>d+ ! appropriate me?od = det]m9+ ! weight ( l>ge cig>s = purposes ( calculat+ ! applicable tax "u section #egja7;a77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 7#c7 ,con=m+ am5dm5t ,section #egjb ( su* ,code is am5d$ by /rik+ subsection 7l74 7f7 ,tax p>ity = ,roll-,y\r-,own tobacco & c]ta9 process$ tobacco ,subsection 7o7 ( section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 1 & includes process$ tobacco t is remov$ = deliv]y or deliv]$ to a p]son o!r ?an a p]son ) a p]mit provid$ "u section #egac1 b does n include removals ( process$ tobacco = exportation aft] wrapp]s !re(4 7g7 ,cl>ify+ tax rate = o!r tobacco products 7#a7 ,9 g5]al ,section #egja ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,o!r tobacco products ,any product n o!rwise describ$ "u ?is section t has be5 det]m9$ to be a tobacco product by ! ,food & ,drug ,adm9i/ration ?r\gh its au?orities "u ! ,family ,smok+ ,prev5tion & ,tobacco ,control ,act %all be tax$ at a level ( tax equival5t to ! tax rate = cig>ettes on an e/imat$ p] use basis z det]m9$ by ! ,secret>y4 4 7#b7 ,e/abli%+ p] use basis ,= purposes ( section #egja7;i7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 n lat] ?an #ab mon?s aft] ! lat] ( ! date ( ! enactm5t ( ?is ,act or ! date t a product has be5 det]m9$ to be a tobacco product by ! ,food & ,drug ,adm9i/ration1 ! ,secret>y ( ! ,treasury 7or ! ,secret>y ( ! ,treasury's delegate7 %all issue f9al regulations e/abli%+ ! level ( tax = su* product t is equival5t to ! tax rate = cig>ettes on an e/imat$ p] use basis4 7h7 ,cl>ify+ def9ition ( tobacco products 7#a7 ,9 g5]al ,subsection 7c7 ( section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7c7 ,tobacco products ,! t]m tobacco products means-- 7#a7 cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 & roll-y\r-own tobacco1 & 7#b7 any o!r product subject to tax pursuant to section #egja7;i74 4 7#b7 ,con=m+ am5dm5ts ,subsection 7d7 ( section #egjb ( su* ,code is am5d$ by /rik+ cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 or roll-y\r-own tobacco ea* place x appe>s & ins]t+ tobacco products4 7i7 ,increas+ tax on cig>ettes 7#a7 ,small cig>ettes ,section #egja7;b77#a7 ( su* ,code is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7#b7 ,l>ge cig>ettes ,section #egja7;b77#b7 ( su* ,code is am5d$ by /rik+ #aje4fi & ins]t+ #baa4ch4 7j7 ,tax rates adju/$ = inflation ,section #egja ( su* ,code1 z am5d$ by subsection 7g71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,inflation adju/m5t 7#a7 ,9 g5]al ,9 ! case ( any cal5d> ye> beg9n+ aft] #bjbf1 ! doll> am\nts provid$ "u ?is *apt] %all ea* be increas$ by an am\nt equal to-- 7,a7 su* doll> am\nt1 multipli$ by 7,b7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye>1 det]m9$ by sub/itut+ #8cal5d> ye> #bjbe' = #8cal5d> ye> #bjaf' 9 subp>agraph 7,a77ii7 !re(4 7#b7 ,r\nd+ ,if any am\nt z adju/$ "u p>agraph 7#a7 is n a multiple ( #j4ja1 su* am\nt %all be r\nd$ to ! next highe/ multiple ( #j4ja4 4 7k7 ,floor ,/ocks ,taxes 7#a7 ,imposition ( tax ,on tobacco products manufactur$ 9 or import$ into ! ,unit$ ,/ates :i* are remov$ be=e any tax increase date & held on su* date = sale by any p]son1 !re is h]eby impos$ a tax 9 an am\nt equal to ! excess (-- 7,a7 ! tax :i* w\ld be impos$ "u section #egja ( ! ,int]nal ,rev5ue ,code ( #aihf on ! article if ! article _h be5 remov$ on su* date1 ov] 7,b7 ! prior tax 7if any7 impos$ "u section #egja ( su* ,code on su* article4 7#b7 ,cr$it aga9/ tax ,ea* p]son %all be all[$ z a cr$it aga9/ ! taxes impos$ by p>agraph 7#a7 an am\nt equal to ! less] ( #a1jjj or ! am\nt ( su* taxes4 ,= purposes ( ! prec$+ s5t5ce1 all p]sons treat$ z a s+le employ] "u subsection 7b71 7c71 7m71 or 7o7 ( section #dad ( ! ,int]nal ,rev5ue ,code ( #aihf %all be treat$ z #a p]son = purposes ( ?is p>agraph4 7#c7 ,liability = tax & me?od ( paym5t 7,a7 ,liability = tax ,a p]son hold+ tobacco products on any tax increase date to :i* any tax impos$ by p>agraph 7#a7 applies %all be liable = su* tax4 7,b7 ,me?od ( paym5t ,! tax impos$ by p>agraph 7#a7 %all be paid 9 su* mann] z ! ,secret>y %all prescribe by regulations4 7,c7 ,"t = paym5t ,! tax impos$ by p>agraph 7#a7 %all be paid on or be=e ! date t is #abj days aft] ! effective date ( ! tax rate increase4 7#d7 ,articles 9 =eign trade zones ,not)/&+ ! ,act ( ,june #ah1 #aicd 7commonly kn[n z ! ,=eign ,trade ,zone ,act1 #dh ,/at4 #iih1 #ai ,u4,s4,c4 #ha;a et seq471 or any o!r provision ( law1 any article :i* is locat$ 9 a =eign trade zone on any tax increase date %all be subject to ! tax impos$ by p>agraph 7#a7 if-- 7,a7 int]nal rev5ue taxes h be5 det]m9$1 or cu/oms duties liquidat$1 ) respect to su* article be=e su* date pursuant to a reque/ made "u ! fir/ proviso ( section #c7;a7 ( su* ,act1 or 7,b7 su* article is held on su* date "u ! sup]vision ( an (fic] ( ! ,unit$ ,/ates ,cu/oms & ,bord] ,protection ( ! ,dep>tm5t ( ,homel& ,security pursuant to ! second proviso ( su* section #c7;a74 7#e7 ,def9itions ,= purposes ( ?is subsection-- 7,a7 ,9 g5]al ,any t]m us$ 9 ?is subsection :i* is also us$ 9 section #egjb ( su* ,code %all h ! same mean+ z su* t]m has 9 su* section4 7,b7 ,tax increase date ,! t]m tax increase date means ! effective date ( any increase 9 any tobacco product excise tax rate pursuant to ! am5dm5ts made by ?is section 7o!r ?an subsection 7j7 !re(74 7,c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ! ,treasury or ! ,secret>y's delegate4 7#f7 ,controll$ gr\ps ,rules simil> to ! rules ( section #ejfa7;e77#c7 ( su* ,code %all apply = purposes ( ?is subsection4 7#g7 ,o!r laws applicable ,all provisions ( law1 includ+ p5alties1 applicable ) respect to ! taxes impos$ by section #egja ( su* ,code %all1 ins(> z applicable & n inconsi/5t ) ! provisions ( ?is subsection1 apply to ! floor /ocks taxes impos$ by p>agraph 7#a71 to ! same ext5t z if su* taxes 7 impos$ by su* section #egja4 ,! ,secret>y may treat any p]son :o bore ! ultimate burd5 ( ! tax impos$ by p>agraph 7#a7 z ! p]son to :om a cr$it or refund "u su* provisions may be all[$ or made4 7l7 ,effective dates 7#a7 ,9 g5]al ,except z provid$ 9 p>agraphs 7#b7 & 7#c71 ! am5dm5ts made by ?is section %all apply to articles remov$ 7z def9$ 9 section #egjb7;j7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 aft] ! la/ day ( ! mon? :i* includes ! date ( ! enactm5t ( ?is ,act4 7#b7 ,discrete s+le-use units1 l>ge cig>s1 & process$ tobacco ,! am5dm5ts made by subsections 7c77#a77;,c71 7c77#b71 7e71 & 7f7 %all apply to articles remov$ 7z def9$ 9 section #egjb7;j7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 aft] ! date t is #f mon?s aft] ! date ( ! enactm5t ( ?is ,act4 7#c7 ,o!r tobacco products ,! am5dm5ts made by subsection 7g77#a7 %all apply to products remov$ aft] ! la/ day ( ! mon? :i* includes ! date t ! ,secret>y ( ! ,treasury 7or ! ,secret>y ( ! ,treasury's delegate7 issues f9al regulations e/abli%+ ! level ( tax = su* product4