Health Equity and Accountability Act of 2026

Part Q of title III of the Public Health Service Act (42 U.S.C. 280h et seq.) is amended by adding at the end the following:

“399Z–3. Grants to promote health for underserved communities.—

(a) Grants Authorized.— The Secretary, in collaboration with the Administrator of the Health Resources and Services Administration and other Federal officials determined appropriate by the Secretary, may award grants to eligible entities—

(1) to promote health for medically underserved communities, such as racial and ethnic minority women, racial and ethnic minority children, adolescents, and lesbian, gay, bisexual, transgender, queer, nonbinary, gender-nonconforming, or questioning communities; and

(2) to strengthen health outreach initiatives in medically underserved communities, including linguistically isolated populations.

(b) Use of Funds.— Grants awarded pursuant to subsection (a) may be used to support the activities of community health workers, including such activities—

(1) to provide education and outreach regarding enrollment in health insurance including the State Children’s Health Insurance Program under title XXI of the Social Security Act, Medicare under title XVIII of such Act, and Medicaid under title XIX of such Act;

(2) to provide education and outreach in a community setting regarding health problems prevalent among medically underserved communities, and especially among racial and ethnic minority women, racial and ethnic minority children, adolescents, and lesbian, gay, bisexual, transgender, queer, nonbinary, gender-nonconforming, or questioning communities;

(3) to provide education and experiential learning opportunities and target risk factors and healthy behaviors that impede or contribute to achieving positive health outcomes, including—

(A) healthy nutrition;

(B) physical activity;

(C) overweight or obesity;

(D) tobacco use, including the use of e-cigarettes and vaping;

(E) alcohol and substance use;

(F) injury and violence;

(G) sexual health;

(H) mental health;

(I) musculoskeletal health and arthritis;

(J) prenatal and postnatal care;

(K) dental and oral health;

(L) understanding informed consent;

(M) stigma; and

(N) environmental hazards;

(4) to promote community wellness and awareness; and

(5) to provide education and refer target populations to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health care services, including preventive health services.

(c) Application.—

(1) In general.— Each eligible entity that desires to receive a grant under subsection (a) shall submit an application to the Secretary at such time, in such manner, and accompanied by such additional information as the Secretary may require.

(2) Contents.— Each application submitted pursuant to paragraph (1) shall—

(A) describe the activities for which assistance under this section is sought;

(B) contain an assurance that, with respect to each community health worker program receiving funds under the grant awarded, such program provides in-language training and supervision to community health workers to enable such workers to provide authorized program activities in (at least) the most commonly used languages within a particular geographic region;

(C) contain an assurance that the applicant will evaluate the effectiveness of community health worker programs receiving funds under the grant;

(D) contain an assurance that each community health worker program receiving funds under the grant will provide culturally competent services in the linguistic context most appropriate for the individuals served by the program;

(E) contain a plan to document and disseminate project descriptions and results to other States and organizations as identified by the Secretary; and

(F) describe plans to enhance the capacity of individuals to utilize health services and health-related social services under Federal, State, and local programs by—

(i) assisting individuals in establishing eligibility under the programs and in receiving the services or other benefits of the programs; and

(ii) providing other services, as the Secretary determines to be appropriate, which may include transportation and translation services.

(d) Priority.— In awarding grants under subsection (a), the Secretary shall give priority to those applicants—

(1) who propose to target geographic areas that—

(A)

(i) have a high percentage of residents who are uninsured or underinsured (if the targeted geographic area is located in a State that has elected to make medical assistance available under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act to individuals described in such section);

(ii) have a high percentage of underinsured residents in a particular geographic area (if the targeted geographic area is located in a State that has not so elected); or

(iii) have a high number of households experiencing extreme poverty; and

(B) have a high percentage of families for whom English is not their primary language or including smaller limited English-proficient communities within the region that are not otherwise reached by linguistically appropriate health services;

(2) with experience in providing health or health-related social services to individuals who are underserved with respect to such services; and

(3) with documented community activity and experience with community health workers.

(e) Collaboration with academic institutions.— The Secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions, including minority-serving institutions. Nothing in this section shall be construed to require such collaboration.

(f) Quality assurance and cost-Effectiveness.— The Secretary shall establish guidelines for ensuring the quality of the training and supervision of community health workers under the programs funded under this section and for ensuring the cost-effectiveness of such programs.

(g) Monitoring.— The Secretary shall monitor community health worker programs identified in approved applications and shall determine whether such programs are in compliance with the guidelines established under subsection (f).

(h) Technical assistance.— The Secretary may provide technical assistance to community health worker programs identified in approved applications with respect to planning, developing, and operating programs under the grant.

(i) Report to Congress.—

(1) In general.— Not later than 4 years after the date on which the Secretary first awards grants under subsection (a), the Secretary shall submit to Congress a report regarding the grant project.

(2) Contents.— The report required under paragraph (1) shall include the following:

(A) A description of the programs for which grant funds were used.

(B) The number of individuals served.

(C) An evaluation of—

(i) the effectiveness of these programs;

(ii) the cost of these programs; and

(iii) the impact of these programs on the health outcomes of the community residents.

(D) Recommendations for sustaining the community health worker programs developed or assisted under this section.

(E) Recommendations regarding training to enhance career opportunities for community health workers.

(j) Definitions.— In this section:

(1) Community health worker.— The term community health worker means an individual who promotes health or nutrition within the community in which the individual resides—

(A) by serving as a liaison between communities and health care agencies;

(B) by providing guidance and social assistance to community residents;

(C) by enhancing community residents’ ability to effectively communicate with health care providers;

(D) by providing culturally and linguistically appropriate health or nutrition education;

(E) by advocating for individual and community health, including dental, oral, mental, and environmental health, or nutrition needs;

(F) by taking into consideration the needs of the communities served, including the prevalence rates of risk factors that impede achieving positive healthy outcomes among pregnant, birthing, and postpartum people and children, especially among racial and ethnic minority pregnant, birthing, and postpartum people and children; or

(G) by providing referral and followup services.

(2) Community setting.— The term community setting means a home or a community organization that serves a population.

(3) Eligible entity.— The term eligible entity means—

(A) a unit of State, territorial, local, or Tribal government (including a federally recognized Tribe or Alaska Native village); or

(B) a community-based organization.

(4) Medically underserved community.— The term medically underserved community means a community—

(A) that has a substantial number of individuals who are members of a medically underserved population, as defined by section 330(b)(3);

(B) a significant portion of which is a health professional shortage area as designated under section 332; and

(C) that includes populations that are linguistically isolated, such as geographic areas with a shortage of health professionals able to provide linguistically appropriate services.

(5) Support.— The term support means the provision of training, supervision, and materials needed to effectively deliver the services described in subsection (b), reimbursement for services, and other benefits.

(k) Authorization of Appropriations.— There are authorized to be appropriated to carry out this section $15,000,000 for each of fiscal years 2027 through 2031.”.

Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following:

“399V–8. Pregnancy intention screening initiative demonstration program.—

(a) Program establishment.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish a demonstration program to facilitate the clinical adoption of pregnancy intention screening initiatives by health care and social services providers.

(b) Grants.— The Secretary may carry out the demonstration program through awarding grants to eligible entities to implement pregnancy intention screening initiatives, collect data, and evaluate such initiatives.

(c) Eligible entities.— To be eligible for a grant under this section, an entity shall—

(1) provide non-directive, comprehensive, medically accurate information; and

(2) be a community-based organization, voluntary health organization, public health department, community health center, or other interested public or private primary, behavioral, or other health care or social service provider or organization.

(d) Pregnancy intention screening initiative.— For purposes of this section, the term pregnancy intention screening initiative means any initiative by an eligible entity to routinely screen people with respect to their pregnancy intentions and goals to either prevent unintended pregnancies or improve the likelihood of healthy pregnancies, in order to better provide health care that meets the contraceptive or pre-pregnancy needs and goals of such people.

(e) Evaluation.—

(1) In general.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall, by grant or contract, and after consultation as described in paragraph (2), conduct an evaluation of the demonstration program, with respect to pregnancy intention screening initiatives, conducted under this section. Such evaluation shall include:

(A) Assessment of the implementation of pregnancy intention screening protocols among a diverse group of patients and providers, including collecting data on the experiences and outcomes for diverse patient populations in a variety of clinical settings.

(B) Analysis of outcome measures that will facilitate effective and widespread adoption of such protocols by health care providers for inquiring about and responding to pregnancy goals of people with both contraceptive and pre-pregnancy care.

(C) Consideration of health inequities among the population served.

(D) Assessment of the equitable and voluntary application of such initiatives to minority and medically underserved communities.

(E) Assessment of the training, capacity, and ongoing technical assistance needed for providers to effectively implement such pregnancy intention screening protocols.

(F) Assessment of whether referral systems for selected protocols follow evidence-based standards that ensure access to comprehensive health services and appropriate follow-up care.

(G) Measuring through rigorous methods the effect of such initiatives on key health outcomes.

(2) Consultation with independent, expert advisory panel.— In conducting the evaluation under paragraph (1), the Director of the Centers for Disease Control and Prevention shall consult with physicians, physician assistants, advanced practice registered nurses, nurse midwives, and other health care providers who specialize in women’s health, and other experts in public health, clinical practice, program evaluation, and research.

(3) Report.— Not later than one year after the last day of the demonstration program under this section, the Director of the Centers for Disease Control and Prevention shall—

(A) submit to Congress a report on the results of the evaluation conducted under paragraph (1); and

(B) make the report publicly available.

(f) Funding.—

(1) Authorization of appropriations.— To carry out this section, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.

(2) Limitation.— Not more than 20 percent of funds appropriated to carry out this section pursuant to paragraph (1) for a fiscal year may be used for purposes of the evaluation under subsection (e).”.

(a) In general.— The Secretary shall establish and implement a birth defects prevention and public awareness program, consisting of the activities described in subsections (b) and (c).

(b) Nationwide media campaign.— In carrying out subsection (a), the Secretary shall conduct or support a nationwide media campaign to increase awareness among health care providers and at-risk populations about pregnancy and breastfeeding information services.

(c) Grants for pregnancy and breastfeeding information services.—

(1) In general.— In carrying out subsection (a), the Secretary shall award grants to State or regional agencies or organizations for any of the following:

(A) Information services.— The provision of, or campaigns to increase awareness about, pregnancy and breastfeeding information services.

(B) Surveillance and research.— The conduct or support of—

(i) surveillance of or research on—

(I) maternal exposures and maternal health conditions that may influence the risk of birth defects, prematurity, or other adverse pregnancy outcomes; and

(II) maternal exposures that may influence health risks to a breastfed infant; or

(ii) networking to facilitate surveillance or research described in this subparagraph.

(2) Preference for certain States.— The Secretary, in making any grant under this subsection, shall give preference to States, otherwise equally qualified, that have pregnancy and breastfeeding information services in place.

(3) Matching funds.— The Secretary may only award a grant under this subsection to a State or regional agency or organization that agrees, with respect to the costs to be incurred in carrying out the grant activities, to make available (directly or through donations from public or private entities) non-Federal funds toward such costs in an amount equal to not less than 25 percent of the amount of the grant.

(4) Coordination.— The Secretary shall ensure that activities funded through a grant under this subsection are coordinated, to the maximum extent practicable, with other birth defects prevention and environmental health activities of the Federal Government, including with respect to pediatric environmental health specialty units and children’s environmental health centers.

(d) Evaluation.— The Secretary shall provide for an evaluation of pregnancy and breastfeeding information services carried out by States to identify efficient and effective models of—

(1) providing information;

(2) raising awareness and increasing knowledge about birth defects prevention measures and targeting education to at-risk groups;

(3) modifying risk behaviors; or

(4) other outcome measures as determined appropriate by the Secretary.

(e) Definitions.— In this section:

(1) Maternal.— The term maternal refers to people who are pregnant or breastfeeding.

(2) Pregnancy and breastfeeding information services.— The term pregnancy and breastfeeding information services includes only—

(A) information services to provide accurate, evidence-based, clinical information regarding maternal exposures during pregnancy or breastfeeding that may be associated with birth defects, health risks to a breastfed infant, or other health risks, such as exposures to medications, chemicals, infections, foodborne pathogens, illnesses, nutrition, lifestyle, or climate- and weather-related factors;

(B) the provision of accurate, evidence-based information weighing risks of exposures during breastfeeding against the benefits of breastfeeding; and

(C) the provision of information described in subparagraph (A) or (B) through counselors, websites, fact sheets, telephonic or electronic communication, community outreach efforts, or other appropriate means.

(3) Secretary.— The term Secretary means the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention.

(f) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated—

(1) $5,000,000 for fiscal year 2027;

(2) $6,000,000 for fiscal year 2028;

(3) $7,000,000 for fiscal year 2029;

(4) $8,000,000 for fiscal year 2030; and

(5) $9,000,000 for fiscal year 2031.

(a) Short title.— This section may be cited as the “Community Access, Resources, and Empowerment for Moms Act” or the “CARE for Moms Act”.

(b) Improving Federal efforts with respect to prevention of maternal mortality.—

(1) Funding for State-based perinatal quality collaboratives development and sustainability.—

(A) In general.— Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Division of Reproductive Health of the Centers for Disease Control and Prevention (referred to in this paragraph as the “Secretary”), shall establish a grant program to be known as the “State-Based Perinatal Quality Collaborative Grant Program”, under which the Secretary shall award grants to eligible entities for the purpose of development and sustainability of State-based perinatal quality collaboratives in every State, the District of Columbia, and eligible territories, in order to measurably improve perinatal care and perinatal health outcomes for pregnant and postpartum women and their infants.

(B) Grant amounts.— Grants awarded under this paragraph shall be in amounts not to exceed $250,000 per year, for the duration of the grant period.

(C) State-based perinatal quality collaborative defined.— For purposes of this paragraph, the term State-based perinatal quality collaborative means a network of teams that—

(i) is multidisciplinary in nature and includes the full range of perinatal and maternity care providers;

(ii) works to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles;

(iii) works with hospital-based or outpatient facility-based clinical teams, experts, and stakeholders, including patients and families, to spread best practices and optimize resources to improve perinatal care and outcomes;

(iv) employs strategies that include the use of the collaborative learning model to provide opportunities for hospitals and clinical teams to collaborate on improvement strategies, rapid-response data to provide timely feedback to hospital and other clinical teams to track progress, and quality improvement science to provide support and coaching to hospital and clinical teams;

(v) has the goal of improving population-level outcomes in maternal and infant health; and

(vi) has the goal of improving outcomes of all birthing people, through the coordination, integration, and collaboration across birth settings.

(D) Authorization of appropriations.— For purposes of carrying out this paragraph, there is authorized to be appropriated $35,000,000 for each of fiscal years 2027 through 2031.

(2) Expansion of Medicaid and CHIP coverage for pregnant and postpartum women.—

(A) Requiring coverage of oral health services for pregnant and postpartum women.—

(i) Medicaid.— Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 4251(d)(3)(A), is amended—

(I) in subsection (a)(4)—

(aa) by striking “; and (D)” and inserting “; (D)”;

(bb) by striking “; and (E)” and inserting “; (E)”;

(cc) by striking “; and (F)” and inserting “; (F)”; and

(dd) by striking the semicolon at the end and inserting “; and (G) oral health services for pregnant and postpartum women (as defined in subsection (nn));”; and

(II) by adding at the end the following new subsection:

“(nn) Oral health services for pregnant and postpartum women.—

(1) In general.— For purposes of this title, the term oral health services for pregnant and postpartum women means dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions that are furnished to a woman during pregnancy (or during the 1-year period beginning on the last day of the pregnancy).

(2) Coverage requirements.— To satisfy the requirement to provide oral health services for pregnant and postpartum women, a State shall, at a minimum, provide coverage for preventive, diagnostic, periodontal, and restorative care consistent with recommendations for perinatal oral health care and dental care during pregnancy from the American Academy of Pediatric Dentistry and the American College of Obstetricians and Gynecologists.”.

(ii) CHIP.— Section 2103(c)(6) of the Social Security Act (42 U.S.C. 1397cc(c)(6)) is amended—

(I) in subparagraph (A)—

(aa) by inserting “or a targeted low-income pregnant woman” after “targeted low-income child”; and

(bb) by inserting “, and, in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman, satisfy the coverage requirements specified in section 1905(nn)” after “emergency conditions”; and

(II) in subparagraph (B), by inserting “(but only if, in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman, the benchmark dental benefit package satisfies the coverage requirements specified in section 1905(nn))” after “subparagraph (C)”.

(B) Requiring 12-month continuous coverage of full benefits for pregnant and postpartum individuals under Medicaid and CHIP.—

(i) Medicaid.— Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—

(I) in subsection (a)—

(aa) in paragraph (89), by striking “and” at the end;

(bb) in paragraph (90)(C), by striking the period at the end and inserting “; and”; and

(cc) by inserting after paragraph (90)(C) the following new paragraph:

“(91) provide that the State plan is in compliance with subsection (e)(16).”; and

(II) in subsection (e)(16)—

(aa) in subparagraph (A), by striking “At the option of the State, the State plan (or waiver of such State plan) may provide” and inserting “A State plan (or waiver of such State plan) shall provide”;

(bb) in subparagraph (B), in the matter preceding clause (i), by striking “by a State making an election under this paragraph” and inserting “under a State plan (or a waiver of such State plan)”; and

(cc) by striking subparagraph (C).

(ii) CHIP.—

(I) In general.— Section 2107(e)(1)(K) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(J)) is amended to read as follows:

“(K) Paragraphs (5) and (16) of section 1902(e) (relating to the requirement to provide medical assistance under the State plan or waiver consisting of full benefits during pregnancy and throughout the 12-month postpartum period under title XIX).”.

(II) Conforming.— Section 2112(d)(2)(A) of the Social Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by striking “the month in which the 60-day period” and all that follows through “pursuant to section 2107(e)(1),”.

(C) Maintenance of effort.—

(i) Medicaid.— Section 1902(l) of the Social Security Act (42 U.S.C. 1396a(l)) is amended by adding at the end the following new paragraph:

“(5) During the period that begins on the date of enactment of this paragraph and ends on the date that is 5 years after such date of enactment, as a condition for receiving any Federal payments under section 1903(a) for calendar quarters occurring during such period, a State shall not have in effect, with respect to women who are eligible for medical assistance under the State plan or under a waiver of such plan on the basis of being pregnant or having been pregnant, eligibility standards, methodologies, or procedures under the State plan or waiver that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan or waiver that are in effect on the date of enactment of this paragraph.”.

(ii) CHIP.— Section 2105(d) of the Social Security Act (42 U.S.C. 1397ee(d)) is amended by adding at the end the following new paragraph:

“(4) In eligibility standards for targeted low-income pregnant women.— During the period that begins on the date of enactment of this paragraph and ends on the date that is 5 years after such date of enactment, as a condition of receiving payments under subsection (a) and section 1903(a), a State that elects to provide assistance to women on the basis of being pregnant (including pregnancy-related assistance provided to targeted low-income pregnant women (as defined in section 2112(d)), pregnancy-related assistance provided to women who are eligible for such assistance through application of section 1903(v)(4)(A)(i) under section 2107(e)(1), or any other assistance under the State child health plan (or a waiver of such plan) which is provided to women on the basis of being pregnant) shall not have in effect, with respect to such women, eligibility standards, methodologies, or procedures under such plan (or waiver) that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) that are in effect on the date of enactment of this paragraph.”.

(D) Information on benefits.— The Secretary of Health and Human Services shall make publicly available on the internet website of the Department of Health and Human Services, information regarding benefits available to pregnant and postpartum women and under the Medicaid program and the Children's Health Insurance Program, including information on—

(i) benefits that States are required to provide to pregnant and postpartum women under such programs;

(ii) optional benefits that States may provide to pregnant and postpartum women under such programs; and

(iii) the availability of different kinds of benefits for pregnant and postpartum women, including oral health and mental health benefits and breastfeeding services and supplies, under such programs.

(E) Federal funding for cost of extended Medicaid and CHIP coverage for postpartum women.—

(i) Medicaid.— Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by title IV and subparagraph (A)(i)(II), is further amended—

(I) in subsection (b), by striking “and (mm)” and inserting “(mm), and (oo)”; and

(II) by adding at the end the following:

“(oo) Increased FMAP for extended medical assistance for postpartum individuals.—

(1) In general.— Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for an individual who is eligible for such assistance on the basis of being pregnant or having been pregnant that is provided during the 305-day period that begins on the 60th day after the last day of the individual's pregnancy (including any such assistance provided during the month in which such period ends), shall be equal to—

(A) during the first 20-quarter period for which this subsection is in effect with respect to a State, 100 percent; and

(B) with respect to a State, during each quarter thereafter, 90 percent.

(2) Exclusion from territorial caps.— Any payment made to a territory for expenditures for medical assistance for an individual described in paragraph (1) that is subject to the Federal medical assistance percentage specified under paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.”.

(ii) CHIP.— Section 2105(c) of the Social Security Act (42 U.S.C. 1397ee(c)) is amended by adding at the end the following new paragraph:

“(13) Enhanced payment for extended assistance provided to pregnant women.— Notwithstanding subsection (b), the enhanced FMAP, with respect to payments under subsection (a) for expenditures under the State child health plan (or a waiver of such plan) for assistance provided under the plan (or waiver) to a woman who is eligible for such assistance on the basis of being pregnant (including pregnancy-related assistance provided to a targeted low-income pregnant woman (as defined in section 2112(d)), pregnancy-related assistance provided to a woman who is eligible for such assistance through application of section 1903(v)(4)(A)(i) under section 2107(e)(1), or any other assistance under the plan (or waiver) provided to a woman who is eligible for such assistance on the basis of being pregnant) during the 305-day period that begins on the 60th day after the last day of her pregnancy (including any such assistance provided during the month in which such period ends), shall be equal to—

(A) during the first 20-quarter period for which this subsection is in effect with respect to a State, 100 percent; and

(B) with respect to a State, during each quarter thereafter, 90 percent.”.

(F) Guidance on State options for Medicaid coverage of doula services.— Not later than 1 year after the date of the enactment of this section, the Secretary of Health and Human Services shall issue guidance for the States concerning options for Medicaid coverage and payment for support services provided by doulas.

(G) Enhanced FMAP for rural obstetric and gynecological services.— Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by title IV and subparagraphs (A) and (E), is further amended—

(i) in subsection (b), by striking “and (oo)” and inserting “(oo), and (pp)”; and

(ii) by adding at the end the following new subsection:

“(pp) Increased FMAP for medical assistance for obstetric and gynecological services furnished at rural hospitals.—

(1) In general.— Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for obstetric or gynecological services that are furnished in a hospital that is located in a rural area (as defined for purposes of section 1886) shall be equal to 90 percent for each calendar quarter beginning with the first calendar quarter during which this subsection is in effect.

(2) Exclusion from territorial caps.— Any payment made to a territory for expenditures for medical assistance described in paragraph (1) that is subject to the Federal medical assistance percentage specified under paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108.”.

(H) Effective dates.—

(i) In general.— Subject to clauses (ii) and (iii)—

(I) the amendments made by subparagraphs (A), (B), and (E) shall take effect on the first day of the first calendar quarter that begins on or after the date that is 1 year after the date of enactment of this section;

(II) the amendments made by subparagraph (C) shall take effect on the date of enactment of this section; and

(III) the amendments made by subparagraph (G) shall take effect on the first day of the first calendar quarter that begins on or after the date of enactment of this section.

(ii) Exception for State legislation.— In the case of a State plan under title XIX of the Social Security Act or a State child health plan under title XXI of such Act 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 paragraph, 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 enactment of this section. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.

(iii) State option for earlier effective date.— A State may elect to have subsection (e)(16) of section 1902 of the Social Security Act (42 U.S.C. 1396a) and subparagraph (K) of section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)), as amended by subparagraph (B), and subsection (oo) of section 1905 of the Social Security Act (42 U.S.C. 1396d) and paragraph (13) of section 2105(c) of the Social Security Act (42 U.S.C. 1397ee(c)), as added by subparagraph (E), take effect with respect to the State on the first day of any fiscal quarter that begins before the date described in clause (i) and apply to amounts payable to the State for expenditures for medical assistance, child health assistance, or pregnancy-related assistance to pregnant or postpartum individuals furnished on or after such day.

(3) Regional centers of excellence.— Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) (as amended by section 5101) is amended by adding at the end the following:

“399V–9. Regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education.—

(a) In general.— Not later than one year after the date of enactment of this section, the Secretary, in consultation with such other agency heads as the Secretary determines appropriate, shall award cooperative agreements for the establishment or support of regional centers of excellence addressing implicit bias, cultural competency, and respectful care practices in patient-provider interactions education for the purpose of enhancing and improving how health care professionals are educated in implicit bias and delivering culturally competent health care.

(b) Eligibility.— To be eligible to receive a cooperative agreement under subsection (a), an entity shall—

(1) be a public or other nonprofit entity specified by the Secretary that provides educational and training opportunities for students and health care professionals, which may be a health system, teaching hospital, community health center, medical school, school of public health, school of nursing, dental school, social work school, school of professional psychology, or any other health professional school or program at an institution of higher education (as defined in section 101 of the Higher Education Act of 1965) focused on the prevention, treatment, or recovery of health conditions that contribute to maternal mortality and the prevention of maternal mortality and severe maternal morbidity;

(2) demonstrate community engagement and participation, such as through partnerships with home visiting and case management programs and community-based organizations serving minority populations;

(3) demonstrate engagement with groups engaged in the implementation of health care professional training in implicit bias and delivering culturally competent care, such as departments of public health, perinatal quality collaboratives, hospital systems, and health care professional groups, in order to obtain input on resources needed for effective implementation strategies; and

(4) provide to the Secretary such information, at such time and in such manner, as the Secretary may require.

(c) Diversity.— In awarding a cooperative agreement under subsection (a), the Secretary shall take into account any regional differences among eligible entities and make an effort to ensure geographic diversity among award recipients.

(d) Dissemination of information.—

(1) Public availability.— The Secretary shall make publicly available on the internet website of the Department of Health and Human Services information submitted to the Secretary under subsection (b)(4).

(2) Evaluation.— The Secretary shall evaluate each regional center of excellence established or supported pursuant to subsection (a) and disseminate the findings resulting from each such evaluation to the appropriate public and private entities.

(3) Distribution.— The Secretary shall share evaluations and overall findings with State departments of health and other relevant State level offices to inform State and local best practices.

(e) Maternal mortality defined.— In this section, the term maternal mortality means death of a woman that occurs during pregnancy or within the one-year period following the end of such pregnancy.

(f) Authorization of appropriations.— For purposes of carrying out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2027 through 2031.”.

(4) Special supplemental nutrition program for women, infants, and children.— Section 17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended—

(A) by striking the clause designation and heading and all that follows through “A State” and inserting the following:

“(ii) Women.—

(I) Breastfeeding women.— A State”;

(B) in subclause (I) (as so designated), by striking “1 year” and all that follows through “earlier” and inserting “2 years postpartum”; and

(C) by adding at the end the following:

“(II) Postpartum women.— A State may elect to certify a postpartum woman for a period of 2 years.”.

(c) Full spectrum doula workforce.—

(1) In general.— The Secretary of Health and Human Services shall establish and implement a program to award grants or contracts to health professions schools, schools of public health, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, Urban Indian organizations, Native Hawaiian organizations, or other appropriate public or private nonprofit entities or community-based organizations (or consortia of any such entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the doula workforce, including through improving the capacity and supply of health care providers.

(2) Use of funds.— Amounts made available by paragraph (1) shall be used for the following activities:

(A) Establishing programs that provide education and training to individuals seeking appropriate training or certification as full spectrum doulas.

(B) Expanding the capacity of existing programs described in subparagraph (A), for the purpose of increasing the number of students enrolled in such programs, including by awarding scholarships for students who agree to work in underserved communities after receiving such education and training.

(C) Developing and implementing strategies to recruit and retain students from underserved communities, particularly from demographic groups experiencing high rates of maternal mortality and severe maternal morbidity, including racial and ethnic minority groups, into programs described in subparagraphs (A) and (B).

(3) Funding.— In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2027, out of any money in the Treasury not otherwise appropriated, $50,000,000, to remain available until expended, for carrying out this subsection.

(d) Grants for rural obstetric mobile health units.— Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by adding at the end the following:

“320C. Grants for rural obstetric mobile health units.—

(a) In general.— The Secretary, acting through the Administrator of the Health Resources and Services Administration (referred to in this section as the “Secretary”), shall establish a pilot program under which the Secretary shall make grants to States—

(1) to purchase and equip rural mobile health units for the purpose of providing pre-conception, pregnancy, postpartum, and obstetric emergency services in rural and underserved communities;

(2) to train providers including obstetrician-gynecologists, certified nurse-midwives, nurse practitioners, nurses, and midwives to operate and provide obstetric services, including training and planning for obstetric emergencies, in such mobile health units; and

(3) to address access issues, including social determinants of health and wrap-around clinical and community services including nutrition, housing, lactation services, and transportation support and referrals.

(b) No sharing of data with law enforcement.— As a condition of receiving a grant under this section, a State shall submit to the Secretary an assurance that the State will not make available to Federal or State law enforcement any personally identifiable information regarding any pregnant or postpartum individual collected pursuant to such grant.

(c) Grant duration.— The period of a grant under this section shall not exceed 5 years.

(d) Implementing and reporting.—

(1) In general.— States that receive pilot grants under this section shall—

(A) implement the program funded by the pilot grants; and

(B) not later than 3 years after the date of enactment of this section, and not later than 6 years after such date of enactment, submit to the Secretary a report that describes the results of such program, including—

(i) relevant information and relevant quantitative indicators of the programs’ success in improving the standard of care and maternal health outcomes for individuals in rural and underserved communities seen for pre-conception, pregnancy, or postpartum visits in the rural mobile health units, stratified by the categories of data specified in paragraph (2);

(ii) relevant qualitative evaluations from individuals receiving pre-conception, pregnant, or postpartum care from rural mobile health units, including measures of patient-reported experience of care and measures of patient-reported issues with access to care without the rural mobile health unit pilot; and

(iii) strategies to sustain such programs beyond the duration of the grant and expand such programs to other rural and underserved communities.

(2) Categories of data.— The categories of data specified in this paragraph are the following:

(A) Race, ethnicity, sex, gender, gender identity, primary language, age, geography, insurance status, disability status.

(B) Number of visits provided for preconception, prenatal, or postpartum care.

(C) Number of repeat visits provided for preconception, prenatal, or postpartum care.

(D) Number of screenings or tests provided for smoking, substance use, hypertension, sexually-transmitted diseases, diabetes, HIV, depression, intimate partner violence, pap smears, and pregnancy.

(3) Data privacy protection.— The reports referred to in paragraph (1)(B) shall not contain any personally identifiable information regarding any pregnant or postpartum individual.

(e) Evaluation.— The Secretary shall conduct an evaluation of the pilot program under this section to determine the impact of the pilot program with respect to—

(1) the effectiveness of the grants awarded under this section to improve maternal health outcomes in rural and underserved communities, with data stratified by race, ethnicity, primary language, socioeconomic status, geography, insurance type, and other factors as the Secretary determines appropriate;

(2) spending on maternity care by States participating in the pilot program;

(3) to the extent practicable, qualitative and quantitative measures of patient experience; and

(4) any other areas of assessment that the Secretary determines relevant.

(f) Report.— Not later than one year after the completion of the pilot program under this section, the Secretary shall submit to Congress, and make publicly available, a report that describes—

(1) the results of the evaluation conducted under subsection (e); and

(2) a recommendation regarding whether the pilot program should be continued after fiscal year 2031 and expanded on a national basis.

(g) Authorization of appropriations.— There is authorized to be appropriated to the Secretary to carry out this section $10,000,000 for each of fiscal years 2027 through 2031.”.

(e) Requiring notification of impending hospital obstetric unit closure.— Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended—

(1) in subparagraph (X), by striking “and” at the end;

(2) in subparagraph (Y)(ii)(V), by striking the period and inserting “, and”; and

(3) by inserting after subparagraph (Y) the following new subparagraph:

“(Z) beginning 180 days after the date of the enactment of this subparagraph, in the case of a hospital, not less than 90 days prior to the closure of any obstetric unit of the hospital, to submit to the Secretary a notification which shall include—

(i) a report analyzing the impact the closure will have on the community;

(ii) steps the hospital will take to identify other health care providers that can alleviate any service gaps as a result of the closure; and

(iii) any additional information as may be required by the Secretary.”.

(f) Evaluation and report on maternal health needs.—

(1) In general.— Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall conduct, and submit to Congress a report that describes the results of, an evaluation of—

(A) where the maternal health needs are greatest in the United States; and

(B) the Federal expenditures made to address such needs.

(2) Period covered.— The evaluation under paragraph (1) shall cover the period of calendar years 2000 through 2026.

(3) Analysis.— The evaluation under paragraph (1) shall include analysis of the following:

(A) How Federal funds provided to States for maternal health were distributed across regions, States, and localities or counties.

(B) Barriers to applying for and receiving Federal funds for maternal health, including, with respect to initial applications—

(i) requirements for submission in partnership with other entities; and

(ii) stringent network requirements.

(C) Why applicants did not receive funding, including limited availability of funds, the strength of the respective applications, and failure to adhere to requirements.

(4) Disaggregation of data.— The report under paragraph (1) shall disaggregate data on mothers served by race, ethnicity, insurance status, and language spoken.

(g) Increasing excise taxes on cigarettes and establishing excise tax equity among all tobacco product tax rates.—

(1) Tax parity for Roll-Your-Own tobacco.— Section 5701(g) of the Internal Revenue Code of 1986 is amended by striking “$24.78” and inserting “$49.56”.

(2) Tax parity for pipe tobacco.— Section 5701(f) of the Internal Revenue Code of 1986 is amended by striking “$2.8311 cents” and inserting “$49.56”.

(3) Tax parity for smokeless tobacco.—

(A) Section 5701(e) of the Internal Revenue Code of 1986 is amended—

(i) in paragraph (1), by striking “$1.51” and inserting “$26.84”;

(ii) in paragraph (2), by striking “50.33 cents” and inserting “$10.74”; and

(iii) by adding at the end the following:

“(3) Smokeless tobacco sold in discrete single-use units.— On discrete single-use units, $100.66 per thousand.”.

(B) Section 5702(m) of such Code is amended—

(i) in paragraph (1), by striking “or chewing tobacco” and inserting “, chewing tobacco, or discrete single-use unit”;

(ii) in paragraphs (2) and (3), by inserting “and which is not a discrete single-use unit” before the period in each such paragraph; and

(iii) by adding at the end the following:

“(4) Discrete single-use unit.— The term discrete single-use unit means any product containing, made from, or derived from tobacco or nicotine that—

(A) is not intended to be smoked; and

(B) is in the form of a lozenge, tablet, pill, pouch, dissolvable strip, or other discrete single-use or single-dose unit.”.

(4) Tax parity for small cigars.— Paragraph (1) of section 5701(a) of the Internal Revenue Code of 1986 is amended by striking “$50.33” and inserting “$100.66”.

(5) Tax parity for large cigars.—

(A) In general.— Paragraph (2) of section 5701(a) of the Internal Revenue Code of 1986 is amended by striking “52.75 percent” and all that follows through the period and inserting the following: “$49.56 per pound and a proportionate tax at the like rate on all fractional parts of a pound but not less than 10.066 cents per cigar.”.

(B) Guidance.— The Secretary of the Treasury, or the Secretary's delegate, may issue guidance regarding the appropriate method for determining the weight of large cigars for purposes of calculating the applicable tax under section 5701(a)(2) of the Internal Revenue Code of 1986.

(C) Conforming amendment.— Section 5702 of such Code is amended by striking subsection (l).

(6) Tax parity for Roll-Your-Own tobacco and certain processed tobacco.— Subsection (o) of section 5702 of the Internal Revenue Code of 1986 is amended by adding at the end the following: “Such term includes processed tobacco that is removed for delivery or delivered to a person other than a person with a permit provided under section 5713, but does not include removals of processed tobacco for exportation.”.

(7) Clarifying tax rate for other tobacco products.—

(A) In general.— Section 5701 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection:

“(i) Other tobacco products.— Any product not otherwise described under this section that has been determined to be a tobacco product by the Food and Drug Administration through its authorities under the Family Smoking Prevention and Tobacco Control Act shall be taxed at a level of tax equivalent to the tax rate for cigarettes on an estimated per use basis as determined by the Secretary.”.

(B) Establishing per use basis.— For purposes of section 5701(i) of the Internal Revenue Code of 1986, not later than 12 months after the later of the date of the enactment of this Act or the date that a product has been determined to be a tobacco product by the Food and Drug Administration, the Secretary of the Treasury (or the Secretary of the Treasury's delegate) shall issue final regulations establishing the level of tax for such product that is equivalent to the tax rate for cigarettes on an estimated per use basis.

(8) Clarifying definition of tobacco products.—

(A) In general.— Subsection (c) of section 5702 of the Internal Revenue Code of 1986 is amended to read as follows:

“(c) Tobacco products.— The term tobacco products means—

(1) cigars, cigarettes, smokeless tobacco, pipe tobacco, and roll-your-own tobacco, and

(2) any other product subject to tax pursuant to section 5701(i).”.

(B) Conforming amendments.— Subsection (d) of section 5702 of such Code is amended by striking “cigars, cigarettes, smokeless tobacco, pipe tobacco, or roll-your-own tobacco” each place it appears and inserting “tobacco products”.

(9) Increasing tax on cigarettes.—

(A) Small cigarettes.— Section 5701(b)(1) of such Code is amended by striking “$50.33” and inserting “$100.66”.

(B) Large cigarettes.— Section 5701(b)(2) of such Code is amended by striking “$105.69” and inserting “$211.38”.

(10) Tax rates adjusted for inflation.— Section 5701 of such Code, as amended by paragraph (7), is amended by adding at the end the following new subsection:

“(j) Inflation adjustment.—

(1) In general.— In the case of any calendar year beginning after 2026, the dollar amounts provided under this chapter shall each be increased by an amount equal to—

(A) such dollar amount, multiplied by

(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year, determined by substituting ‘calendar year 2025’ for ‘calendar year 2016’ in subparagraph (A)(ii) thereof.

(2) Rounding.— If any amount as adjusted under paragraph (1) is not a multiple of $0.01, such amount shall be rounded to the next highest multiple of $0.01.”.

(11) Floor Stocks Taxes.—

(A) Imposition of tax.— On tobacco products manufactured in or imported into the United States which are removed before any tax increase date and held on such date for sale by any person, there is hereby imposed a tax in an amount equal to the excess of—

(i) the tax which would be imposed under section 5701 of the Internal Revenue Code of 1986 on the article if the article had been removed on such date, over

(ii) the prior tax (if any) imposed under section 5701 of such Code on such article.

(B) Credit against tax.— Each person shall be allowed as a credit against the taxes imposed by subparagraph (A) an amount equal to the lesser of $1,000 or the amount of such taxes. For purposes of the preceding sentence, all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 person for purposes of this subparagraph.

(C) Liability for tax and method of payment.—

(i) Liability for tax.— A person holding tobacco products on any tax increase date to which any tax imposed by subparagraph (A) applies shall be liable for such tax.

(ii) Method of payment.— The tax imposed by subparagraph (A) shall be paid in such manner as the Secretary shall prescribe by regulations.

(iii) Time for payment.— The tax imposed by subparagraph (A) shall be paid on or before the date that is 120 days after the effective date of the tax rate increase.

(D) Articles in foreign trade zones.— Notwithstanding the Act of June 18, 1934 (commonly known as the Foreign Trade Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other provision of law, any article which is located in a foreign trade zone on any tax increase date shall be subject to the tax imposed by subparagraph (A) if—

(i) internal revenue taxes have been determined, or customs duties liquidated, with respect to such article before such date pursuant to a request made under the first proviso of section 3(a) of such Act, or

(ii) such article is held on such date under the supervision of an officer of the United States Customs and Border Protection of the Department of Homeland Security pursuant to the second proviso of such section 3(a).

(E) Definitions.— For purposes of this paragraph—

(i) In general.— Any term used in this paragraph which is also used in section 5702 of such Code shall have the same meaning as such term has in such section.

(ii) Tax increase date.— The term tax increase date means the effective date of any increase in any tobacco product excise tax rate pursuant to the amendments made by this subsection (other than paragraph (10) thereof).

(iii) Secretary.— The term Secretary means the Secretary of the Treasury or the Secretary’s delegate.

(F) Controlled groups.— Rules similar to the rules of section 5061(e)(3) of such Code shall apply for purposes of this paragraph.

(G) Other laws applicable.— All provisions of law, including penalties, applicable with respect to the taxes imposed by section 5701 of such Code shall, insofar as applicable and not inconsistent with the provisions of this paragraph, apply to the floor stocks taxes imposed by subparagraph (A), to the same extent as if such taxes were imposed by such section 5701. The Secretary may treat any person who bore the ultimate burden of the tax imposed by subparagraph (A) as the person to whom a credit or refund under such provisions may be allowed or made.

(12) Effective dates.—

(A) In general.— Except as provided in subparagraphs (B) and (C), the amendments made by this subsection shall apply to articles removed (as defined in section 5702(j) of the Internal Revenue Code of 1986) after the last day of the month which includes the date of the enactment of this Act.

(B) Discrete single-use units, large cigars, and processed tobacco.— The amendments made by paragraphs (3)(A)(iii), (3)(B), (5), and (6) shall apply to articles removed (as defined in section 5702(j) of the Internal Revenue Code of 1986) after the date that is 6 months after the date of the enactment of this Act.

(C) Other tobacco products.— The amendments made by paragraph (7)(A) shall apply to products removed after the last day of the month which includes the date that the Secretary of the Treasury (or the Secretary of the Treasury's delegate) issues final regulations establishing the level of tax for such product.

(a) GAO study and report.—

(1) In general.— Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the gaps in coverage with respect to—

(A) pregnant individuals enrolled under a State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children's Health Insurance Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.); and

(B) postpartum individuals enrolled under a State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children's Health Insurance Program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) who received assistance under either such program during their pregnancy.

(2) Content of report.— The report required under this subsection shall include the following:

(A) Information about the abilities and successes of State Medicaid agencies in determining whether pregnant and postpartum individuals are eligible under another insurance affordability program, and in transitioning any such individuals who are so eligible to coverage under such a program at the end of their period of eligibility for medical assistance, pursuant to section 435.1200 of the title 42, Code of Federal Regulations (as in effect on September 1, 2018).

(B) Information on factors contributing to gaps in coverage that disproportionately impact underserved populations, including low-income individuals, Black, Indigenous, and other individuals of color, individuals who reside in a health professional shortage area (as defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals who are members of a medically underserved population (as defined by section 330(b)(3) of such Act (42 U.S.C. 254b(b)(3)(A))).

(C) Recommendations for addressing and reducing such gaps in coverage.

(D) Such other information as the Comptroller General deems necessary.

(3) Data disaggregation.— To the greatest extent possible, the Comptroller General shall disaggregate data presented in the report, including by age, gender identity, race, ethnicity, income level, and other demographic factors.

(b) Maternity care home demonstration project.— Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting the following new section after section 1948:

“1949. Maternity Care Home Demonstration Project.—

(a) In general.— Not later than 1 year after the date of the enactment of this section, the Secretary shall establish a demonstration project (in this section referred to as the demonstration project) under which the Secretary shall provide grants to States to enter into arrangements with eligible entities to implement or expand a maternity care home model for eligible individuals.

(b) Goals of demonstration project.— The goals of the demonstration project are the following:

(1) To improve—

(A) maternity and infant care outcomes;

(B) birth equity;

(C) health equity for—

(i) Black, Indigenous, and other people of color;

(ii) lesbian, gay, bisexual, transgender, queer, non-binary, and gender nonconforming individuals;

(iii) individuals with disabilities; and

(iv) other underserved populations;

(D) communication by maternity, infant care, oral health services, and social services providers;

(E) integration of perinatal support services, including community health workers, doulas, social workers, public health nurses, peer lactation counselors, lactation consultants, childbirth educators, peer mental health workers, and others, into health care entities and organizations;

(F) care coordination between maternity, infant care, oral health services, and social services providers within the community;

(G) the quality and safety of maternity and infant care;

(H) the experience of individuals receiving maternity care, including by increasing the ability of an individual to develop and follow their own birthing plans; and

(I) access to adequate prenatal and postpartum care, including—

(i) prenatal care that is initiated in a timely manner;

(ii) not fewer than 5 post-pregnancy visits to a maternity care provider; and

(iii) interpregnancy care.

(2) To provide coordinated, evidence-based, respectful, culturally and linguistically appropriate, and person-centered maternity care management.

(3) To decrease—

(A) severe and preventable maternal morbidity and maternal mortality;

(B) overall health care spending;

(C) unnecessary emergency department visits;

(D) inequities in maternal and infant care outcomes, including racial, economic, disability, gender-based, and geographical inequities;

(E) racial, gender, economic, and other discrimination among health care professionals;

(F) racism, discrimination, disrespect, and abuse in maternity care settings;

(G) the rate of cesarean deliveries for low-risk pregnancies;

(H) the rate of pre-term births and infants born with low birth weight; and

(I) the rate of avoidable maternal and newborn hospitalizations and admissions to intensive care units.

(c) Consultation.— In designing and implementing the demonstration project the Secretary shall consult with stakeholders, including—

(1) States;

(2) organizations representing relevant health care professionals, including oral health services professionals;

(3) organizations (including reproductive justice and birth justice organizations led by people of color) that represent consumers of maternal health care, including consumers of maternal health care who are disproportionately impacted by poor maternal health outcomes;

(4) representatives with experience implementing other maternity care home models, including representatives from the Center for Medicare and Medicaid Innovation;

(5) community-based health care professionals, including doulas, lactation consultants, and other stakeholders;

(6) experts in promoting health equity and combating racial bias in health care settings; and

(7) Black, Indigenous, and other maternal health care consumers of color who have experienced severe maternal morbidity.

(d) Application and selection of States.—

(1) In general.— A State seeking to participate in the demonstration project shall submit an application to the Secretary at such time and in such manner as the Secretary shall require.

(2) Selection of States.—

(A) In general.— The Secretary shall select at least 10 States to participate in the demonstration project.

(B) Selection requirements.— In selecting States to participate in the demonstration project, the Secretary shall—

(i) ensure that there is geographic and regional diversity in the areas in which activities will be carried out under the project;

(ii) ensure that States with significant inequities in maternal and infant health outcomes, including severe maternal morbidity, and other inequities based on race, income, or access to maternity care, are included; and

(iii) ensure that at least 1 territory is included.

(e) Grants.—

(1) In general.— Subject to the availability of appropriations, the Secretary shall award 1 grant for each year of the demonstration project to each State that is selected to participate in the demonstration project.

(2) Use of grant funds.— A State may use funds received under this section to—

(A) award grants or make payments to eligible entities as part of an arrangement described in subsection (f)(2);

(B) provide financial incentives to health care professionals, including community-based health care workers and community-based doulas, who participate in the State's maternity care home model;

(C) provide adequate training for health care professionals, including community-based health care workers, doulas, and care coordinators, who participate in the State's maternity care home model, which may include training for cultural humility and antiracism, racial bias, health equity, reproductive and birth justice, trauma-informed care, home visiting skills, and respectful communication and listening skills, particularly in regards to maternal health;

(D) pay for personnel and administrative expenses associated with designing, implementing, and operating the State's maternity care home model;

(E) pay for items and services that are furnished under the State's maternity care home model and for which payment is otherwise unavailable under this title;

(F) pay for services and materials to ensure culturally and linguistically appropriate communication, including—

(i) language services such as interpreters and translation of written materials; and

(ii) development of culturally and linguistically appropriate materials, as well as auxiliary aids and services; and

(G) pay for other costs related to the State's maternity care home model, as determined by the Secretary.

(3) Grant for national independent evaluator.—

(A) In general.— From the amounts appropriated under subsection (l), prior to awarding any grants under paragraph (1), the Secretary shall enter into a contract with a national external entity to create a single, uniform process to—

(i) ensure that States that receive grants under paragraph (1) comply with the requirements of this section; and

(ii) evaluate the outcomes of the demonstration project in each participating State.

(B) Annual report.— The contract described in subparagraph (A) shall require the national external entity to submit to the Secretary—

(i) a yearly evaluation report for each year of the demonstration project; and

(ii) a final impact report after the demonstration project has concluded.

(C) Secretary's authority.— Nothing in this paragraph shall prevent the Secretary from making a determination that a State is not in compliance with the requirements of this section without the national external entity making such a determination.

(f) Partnership with eligible entities.—

(1) In general.— As a condition of receiving a grant under this section, a State shall enter into an arrangement with 1 or more eligible entities that meet the requirements of paragraph (2).

(2) Arrangements with eligible entities.— Under an arrangement between a State and an eligible entity under this subsection, the eligible entity shall perform the following functions, with respect to eligible individuals enrolled with the entity under the State's maternity care home model:

(A) Provide culturally and linguistically appropriate congruent care, which may include prenatal care, family planning services, medical care, mental and behavioral care, postpartum care, and oral health services to such eligible individuals through a team of health care professionals, which may include obstetrician-gynecologists, maternal-fetal medicine specialists, family physicians, primary care providers, oral health providers, physician assistants, advanced practice registered nurses (such as nurse practitioners and certified nurse midwives), certified midwives, certified professional midwives, physical therapists, social workers, traditional and community-based doulas, lactation consultants, childbirth educators, community health workers, peer mental health supporters, and other health care professionals.

(B) Conduct a risk assessment of each such eligible individual to determine if their pregnancy is high or low risk, and, based on the results of such risk assessment, establish for each such eligible individual a tailored pregnancy care plan, which—

(i) takes into consideration the individual's own preferences, pregnancy care, and birthing plans; and

(ii) determines the appropriate support services to reduce the individual's medical, social, and environmental risk factors.

(C) Assign each such eligible individual to a culturally and linguistically appropriate care coordinator, which may be a nurse, social worker, traditional or community-based doula, community health worker, midwife, or other health care provider, who is responsible for ensuring that such eligible individual receives the necessary medical care and connections to essential support services.

(D) Provide, or arrange for the provision of, essential support services, such as services that address—

(i) food access, nutrition, and exercise;

(ii) smoking cessation;

(iii) substance use disorder and addiction treatment;

(iv) anxiety, depression, trauma, and other mental and behavioral health issues;

(v) breastfeeding, chestfeeding, or other infant feeding options supports, initiation, continuation, and duration;

(vi) stable, affordable, safe, and healthy housing;

(vii) transportation;

(viii) intimate partner violence;

(ix) community and police violence;

(x) home visiting services;

(xi) childbirth and newborn care education;

(xii) oral health education;

(xiii) continuous labor support;

(xiv) group prenatal care;

(xv) family planning and contraceptive care and supplies; and

(xvi) affordable child care.

(E) As appropriate, facilitate connections to a usual primary care provider, which may be a reproductive health care provider.

(F) Refer to guidelines and opinions of medical associations when determining whether an elective delivery should be performed on an eligible individual before 39 weeks of gestation.

(G) Provide such eligible individual with evidence-based and culturally and linguistically appropriate education and resources to identify potential warning signs of pregnancy and postpartum complications, including information regarding when and how to obtain medical attention.

(H) Provide, or arrange for the provision of, culturally and linguistically appropriate pregnancy and postpartum health services, including family planning counseling and services, to eligible individuals.

(I) Track and report postpartum health and birth outcomes of such eligible individuals and their children.

(J) Ensure that care is person-centered, culturally and linguistically appropriate, and patient-led, including by engaging eligible individuals in their own care, including through communication and education.

(K) Ensure adequate training for appropriately serving the population of individuals who are eligible for medical assistance under the State plan (or waiver of such plan), including through reproductive justice, birth justice, birth equity, and anti-racist frameworks, home visiting skills, and knowledge of social services.

(g) Term of demonstration project.— The Secretary shall conduct the demonstration project for a period of 5 years.

(h) Report.— Not later than 18 months after the date of the enactment of this section and annually thereafter for each year of the demonstration project term, the Secretary shall submit a report to Congress on the results of the demonstration project, including—

(1) the results of the final report of the national external entity required under subsection (e)(3)(B)(ii); and

(2) recommendations on whether the model studied in the demonstration project should be continued or more widely adopted, including by private health plans.

(i) Waiver authority.— To the extent that the Secretary determines necessary in order to carry out the demonstration project, the Secretary may waive section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability).

(j) Technical assistance.— The Secretary shall establish a process to provide technical assistance to States that are awarded grants under this section and to eligible entities and other providers participating in a State maternity care home model funded by such a grant.

(k) Definitions.— In this section:

(1) Eligible entity.— The term eligible entity means an entity or organization that provides medically accurate, comprehensive maternity services to individuals who are eligible for medical assistance under a State plan under this title or a waiver of such a plan, and may include:

(A) A freestanding birth center.

(B) An entity or organization receiving assistance under section 330 of the Public Health Service Act.

(C) A federally qualified health center.

(D) A rural health clinic.

(E) A health facility operated by an Indian tribe or tribal organization (as those terms are defined in section 4 of the Indian Health Care Improvement Act).

(2) Eligible individual.— The term eligible individual means a pregnant individual or a formerly pregnant individual during the 1-year period beginning on the last day of the pregnancy, or during such longer period beginning on the last day of the pregnancy as a State may elect, who is—

(A) enrolled in a State plan under this title, a waiver of such a plan, or a State child health plan under title XXI; and

(B) a patient of an eligible entity which has entered into an arrangement with a State under subsection (f).

(l) Authorization of appropriations.— There are authorized to be appropriated to the Secretary, for each of fiscal years 2027 through 2034, such sums as may be necessary to carry out this section.”.

(c) Reapplication of Medicare payment rate floor to primary care services furnished under Medicaid and inclusion of additional providers.—

(1) Reapplication of payment floor; additional providers.—

(A) In general.— Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396a(a)(13)) is amended—

(i) in subparagraph (B), by striking “; and” and inserting a semicolon;

(ii) in subparagraph (C), by striking the semicolon and inserting “; and”; and

(iii) by adding at the end the following new subparagraph:

“(D) payment for primary care services (as defined in subsection (jj)(1)) furnished in the period that begins on the first day of the first month that begins after the date of enactment of this subparagraph by a provider described in subsection (jj)(2)—

(i) at a rate that is not less than 100 percent of the payment rate that applies to such services and the provider of such services under part B of title XVIII;

(ii) in the case of items and services that are not items and services provided under such part, at a rate to be established by the Secretary; and

(iii) in the case of items and services that are furnished in rural areas (as defined in section 1886(d)(2)(D)), health professional shortage areas (as defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A))), or medically underserved areas (according to a designation under section 330(b)(3)(A) of the Public Health Service Act (42 U.S.C. 254b(b)(3)(A))), at the rate otherwise applicable to such items or services under clause (i) or (ii) increased, at the Secretary's discretion, by not more than 25 percent;”.

(B) Conforming amendments.—

(i) Section 1902(a)(13)(C) of the Social Security Act (42 U.S.C. 1396a(a)(13)(C)) is amended by striking “subsection (jj)” and inserting “subsection (jj)(1)”.

(ii) Section 1905(dd) of the Social Security Act (42 U.S.C. 1396d(dd)) is amended—

(I) by striking “Notwithstanding” and inserting the following:

“(1) In general.— Notwithstanding”;

(II) by striking “section 1902(a)(13)(C)” and inserting “subparagraph (C) of section 1902(a)(13)”;

(III) by inserting “or for services described in subparagraph (D) of section 1902(a)(13) furnished during an additional period specified in paragraph (2),” after “2015,”;

(IV) by striking “under such section” and inserting “under subparagraph (C) or (D) of section 1902(a)(13), as applicable”; and

(V) by adding at the end the following:

“(2) Additional periods.— For purposes of paragraph (1), an additional period includes the period that begins on the first day of the first month that begins after the date of enactment of this paragraph.”.

(2) Improved targeting of primary care.— Section 1902(jj) of the Social Security Act (42 U.S.C. 1396a(jj)) is amended—

(A) by redesignating paragraphs (1) and (2) as clauses (i) and (ii), respectively, and realigning the left margins accordingly;

(B) by striking “For purposes of subsection (a)(13)(C)” and inserting the following:

“(1) In general.—

(A) Definition.— For purposes of subparagraphs (C) and (D) of subsection (a)(13)”; and

(C) by inserting after clause (ii) (as so redesignated) the following:

“(B) Exclusions.— Such term does not include any services described in subparagraph (A) if such services are provided in an emergency department of a hospital.

(2) Additional providers.— For purposes of subparagraph (D) of subsection (a)(13), a provider described in this paragraph is any of the following:

(A) A physician with a primary specialty designation of family medicine, general internal medicine, pediatric medicine, or obstetrics and gynecology.

(B) An advanced practice clinician, as defined by the Secretary, that works under the supervision of—

(i) a physician that satisfies the criteria specified in subparagraph (A);

(ii) a nurse practitioner or a physician assistant (as such terms are defined in section 1861(aa)(5)(A)) who is working in accordance with State law; or

(iii) or a certified nurse-midwife (as defined in section 1861(gg)) or a certified professional midwife who is working in accordance with State law.

(C) A rural health clinic, federally qualified health center, health center that receives funding under title X of the Public Health Service Act, or other health clinic that receives reimbursement on a fee schedule applicable to a physician.

(D) An advanced practice clinician supervised by a physician described in subparagraph (A), another advanced practice clinician, or a certified nurse-midwife.

(E) A midwife who is working in accordance with State law.”.

(3) Ensuring payment by managed care entities.—

(A) In general.— Section 1903(m)(2)(A) of the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended—

(i) in clause (xii), by striking “and” after the semicolon;

(ii) by realigning the left margin of clause (xiii) so as to align with the left margin of clause (xii) and by striking the period at the end of clause (xiii) and inserting “; and”; and

(iii) by inserting after clause (xiii) the following:

“(xiv) such contract provides that (I) payments to providers specified in section 1902(a)(13)(D) for primary care services (as defined in section 1902(jj)(1)) that are furnished during a year or period (as specified in section 1902(a)(13)(D) and section 1905(dd)) are at least equal to the amounts set forth and required by the Secretary by regulation; (II) the entity shall, upon request, provide documentation to the State, sufficient to enable the State and the Secretary to ensure compliance with subclause (I); and (III) the Secretary shall approve payments described in subclause (I) that are furnished through an agreed upon capitation, partial capitation, or other value-based payment arrangement if the capitation, partial capitation, or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the State sufficient to enable the State and the Secretary to ensure compliance with subclause (I).”.

(B) Conforming amendment.— Section 1932(f) of the Social Security Act (42 U.S.C. 1396u–2(f)) is amended—

(i) by striking “section 1902(a)(13)(C)” and inserting “subsections (C) and (D) of section 1902(a)(13)”; and

(ii) by inserting “, and clause (xiv) of section 1903(m)(2)(A)” before the period.

(d) MACPAC report and CMS guidance on increasing access to doula services for Medicaid beneficiaries.—

(1) MACPAC Report.—

(A) In general.— Not later than 1 year after the date of the enactment of this Act, the Medicaid and CHIP Payment and Access Commission (referred to in this subsection as MACPAC) shall publish a report on the coverage of doula services under State Medicaid programs, which shall at a minimum include the following:

(i) Information about coverage for doula services under State Medicaid programs that, as of the date of enactment of this Act, provide coverage for such care, including the type of doula services offered (such as prenatal, labor and delivery, postpartum support, as well as community-based and traditional doula services).

(ii) An analysis of barriers to covering doula services under State Medicaid programs.

(iii) An identification of effective strategies to increase the use of doula services in order to provide better care and achieve better maternal and infant health outcomes, including strategies that States may use to recruit, train, and certify a diverse doula workforce, particularly from underserved communities, communities of color, and communities facing linguistic or cultural barriers.

(iv) Recommendations for legislative and administrative actions to increase access to doula services in State Medicaid programs, including actions that ensure doulas may earn a living wage that accounts for their time and costs associated with providing care, and to provide for the administration and operation of community-based doula programs.

(B) Stakeholder consultation.— In developing the report required under subparagraph (A), MACPAC shall consult with relevant stakeholders, including—

(i) States;

(ii) organizations (especially reproductive justice and birth justice organizations led by people of color) representing consumers of maternal health care, including those that are disproportionately impacted by poor maternal health outcomes;

(iii) organizations and individuals representing doulas, including community-based doula programs and those who serve underserved communities (including communities of color, and communities facing linguistic or cultural barriers);

(iv) organizations representing health care providers; and

(v) Black, Indigenous, and other maternal health care consumers of color who have experienced severe maternal morbidity.

(2) CMS guidance.—

(A) In general.— Not later than 1 year after the date that MACPAC publishes the report required under paragraph (1)(A), the Administrator of the Centers for Medicare & Medicaid Services shall issue guidance to States on increasing access to doula services under Medicaid. Such guidance shall, at a minimum, include—

(i) options for States to provide medical assistance for doula services under State Medicaid programs;

(ii) best practices for ensuring that doulas, including community-based doulas, receive reimbursement for doula services provided under a State Medicaid program at a level that allows doulas to earn a living wage that accounts for their time and costs associated with providing care and community-based doula program administration; and

(iii) best practices for increasing access to doula services, including services provided by community-based doulas, under State Medicaid programs.

(B) Stakeholder consultation.— In developing the guidance required under subparagraph (A), the Administrator of the Centers for Medicare & Medicaid Services shall consult with MACPAC and other relevant stakeholders, including—

(i) State Medicaid officials;

(ii) organizations representing consumers of maternal health care, including those that are disproportionately impacted by poor maternal health outcomes;

(iii) organizations representing doulas, including community-based doulas and those who serve underserved communities, such as communities of color and communities facing linguistic or cultural barriers; and

(iv) organizations representing medical professionals.

(e) GAO report on State Medicaid programs’ use of telehealth to increase access to maternity care.— Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit a report to Congress on State Medicaid programs’ use of telehealth to increase access to maternity care. Such report shall include the following:

(1) The number of State Medicaid programs that utilize telehealth that increases access to maternity care.

(2) With respect to State Medicaid programs that utilize telehealth that increases access to maternity care, information about—

(A) common characteristics of such programs' approaches to utilizing telehealth that increases access to maternity care;

(B) differences in States’ approaches to utilizing telehealth to improve access to maternity care, and the resulting differences in State maternal health outcomes, as determined by factors described in subsection (C); and

(C) when compared to patients who receive maternity care in person, what is known about—

(i) the demographic characteristics, such as race, ethnicity, sex, sexual orientation, gender identity, disability status, age, and preferred language of the individuals enrolled in such programs who use telehealth to access maternity care;

(ii) health outcomes for such individuals, including frequency of mortality and severe morbidity, as compared to individuals with similar characteristics who did not use telehealth to access maternity care;

(iii) the services provided to individuals through telehealth, including family planning services, mental health care services, and oral health services;

(iv) the devices and equipment provided to individuals for remote patient monitoring and telehealth, including blood pressure monitors and blood glucose monitors;

(v) the quality of maternity care provided through telehealth, including whether maternity care provided through telehealth is culturally and linguistically appropriate;

(vi) the level of patient satisfaction with maternity care provided through telehealth to individuals enrolled in State Medicaid programs;

(vii) the impact of utilizing telehealth to increase access to maternity care on spending, cost savings, access to care, and utilization of care under State Medicaid programs; and

(viii) the accessibility and effectiveness of telehealth for maternity care during the COVID–19 pandemic.

(3) An identification and analysis of the barriers to using telehealth to increase access to maternity care under State Medicaid programs.

(4) Recommendations for such legislative and administrative actions related to increasing access to telehealth maternity services under Medicaid as the Comptroller General deems appropriate.

(a) Task force To develop a strategy To address social determinants of maternal health.—

(1) In general.— The Secretary of Health and Human Services shall convene a task force (in this subsection referred to as the “Task Force”) to develop a strategy to coordinate efforts between Federal agencies to address social determinants of maternal health with respect to pregnant and postpartum individuals.

(2) Ex officio members.— The ex officio members of the Task Force shall consist of the following:

(A) The Secretary of Health and Human Services (or a designee thereof).

(B) The Secretary of Housing and Urban Development (or a designee thereof).

(C) The Secretary of Transportation (or a designee thereof).

(D) The Secretary of Agriculture (or a designee thereof).

(E) The Secretary of Labor (or a designee thereof).

(F) The Administrator of the Environmental Protection Agency (or a designee thereof).

(G) The Assistant Secretary for the Administration for Children and Families (or a designee thereof).

(H) The Administrator of the Centers for Medicare & Medicaid Services (or a designee thereof).

(I) The Director of the Indian Health Service (or a designee thereof).

(J) The Director of the National Institutes of Health (or a designee thereof).

(K) The Administrator of the Health Resources and Services Administration (or a designee thereof).

(L) The Deputy Assistant Secretary for Minority Health of the Department of Health and Human Services (or a designee thereof).

(M) The Deputy Assistant Secretary for Women’s Health of the Department of Health and Human Services (or a designee thereof).

(N) The Director of the Centers for Disease Control and Prevention (or a designee thereof).

(O) The Director of the Office on Violence Against Women of the Department of Justice (or a designee thereof).

(3) Appointed members.— In addition to the ex officio members of the Task Force, the Secretary of Health and Human Services shall appoint the following members of the Task Force:

(A) At least two representatives of patients, to include—

(i) a representative of patients who have suffered from severe maternal morbidity; or

(ii) a representative of patients who is a family member of an individual who suffered a pregnancy-related death.

(B) At least two leaders of community-based organizations that address maternal mortality and severe maternal morbidity with a specific focus on racial and ethnic inequities. In appointing such leaders under this subparagraph, the Secretary of Health and Human Services shall give priority to individuals who are leaders of organizations led by individuals from racial and ethnic minority groups.

(C) At least two perinatal health workers.

(D) A professionally diverse panel of maternity care providers.

(4) Chair.— The Secretary of Health and Human Services shall select the chair of the Task Force from among the members of the Task Force.

(5) Report.— Not later than 2 years after the date of enactment of this Act, the Task Force shall submit to Congress a report on—

(A) the strategy developed under paragraph (1);

(B) recommendations on funding amounts with respect to implementing such strategy; and

(C) recommendations for how to expand coverage of social services to address social determinants of maternal health under Medicaid managed care organizations and State Medicaid programs.

(6) Termination.— Section 1013 of title 5, United States Code, shall not apply to the Task Force with respect to termination.

(b) Housing for Moms grant program.—

(1) Definitions.— In this subsection:

(A) Eligible entity.— The term eligible entity means—

(i) a community-based organization;

(ii) a State or local governmental entity, including a State or local public health department;

(iii) an Indian tribe or Tribal organization (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)); or

(iv) an Urban Indian organization (as such term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).

(B) Secretary.— The term Secretary means the Secretary of Housing and Urban Development.

(2) Establishment.— The Secretary shall establish a Housing for Moms grant program to make grants to eligible entities to increase access to safe, stable, affordable, and adequate housing for pregnant and postpartum individuals and their families.

(3) Application.— To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may provide.

(4) Priority.— In awarding grants under this subsection, the Secretary shall give priority to an eligible entity that—

(A) is a community-based organization or will partner with a community-based organization to implement initiatives to increase access to safe, stable, affordable, and adequate housing for pregnant and postpartum individuals and their families;

(B) is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic inequities in maternal health outcomes, to the extent such data are available; and

(C) is operating in an area with a high poverty rate or a significant number of individuals who lack consistent access to safe, stable, affordable, and adequate housing.

(5) Use of funds.— An eligible entity that receives a grant under this subsection shall use funds from the grant for the purposes of—

(A) identifying and conducting outreach to pregnant and postpartum individuals who are low-income and lack consistent access to safe, stable, affordable, and adequate housing;

(B) providing safe, stable, affordable, and adequate housing options to such individuals;

(C) connecting such individuals with local organizations offering safe, stable, affordable, and adequate housing options;

(D) providing application assistance to such individuals seeking to enroll in programs offering safe, stable, affordable, and adequate housing options;

(E) providing direct financial assistance to such individuals for the purposes of maintaining safe, stable, and adequate housing for the duration of the individual’s pregnancy and postpartum periods; and

(F) working with relevant stakeholders to ensure that local housing and homeless shelter infrastructure is supportive to pregnant and postpartum individuals, including through—

(i) health-promoting housing codes;

(ii) enforcement of housing codes;

(iii) proactive rental inspection programs;

(iv) code enforcement officer training; and

(v) partnerships between regional offices of the Department of Housing and Urban Development and community-based organizations to ensure housing laws are understood and violations are discovered.

(6) Reporting.—

(A) Eligible entities.— The Secretary shall require each eligible entity receiving a grant under this subsection to annually submit to the Secretary and make publicly available a report on the status of activities conducted using the grant.

(B) Secretary.— Not later than the end of each fiscal year in which grants are made under this subsection, the Secretary shall submit to Congress and make publicly available a report that—

(i) summarizes the reports received under subparagraph (A);

(ii) evaluates the effectiveness of grants awarded under this subsection in increasing access to safe, stable, affordable, and adequate housing for pregnant and postpartum individuals and their families; and

(iii) makes recommendations with respect to ensuring activities described in paragraph (5) continue after grant amounts made available under this subsection are expended.

(7) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection $10,000,000 for fiscal year 2027, which shall remain available until expended.

(c) Department of Transportation.—

(1) Report.— Not later than 1 year after the date of enactment of this Act, the Secretary of Transportation shall submit to Congress and make publicly available a report containing—

(A) an assessment of transportation barriers preventing individuals from attending prenatal and postpartum appointments, accessing maternal health care services, or accessing services and resources related to social determinants of maternal health;

(B) recommendations on how to overcome the barriers assessed under subparagraph (A); and

(C) an assessment of transportation safety risks for pregnant individuals and recommendations on how to mitigate those risks.

(2) Considerations.— In carrying out paragraph (1), the Secretary of Transportation shall give special consideration to solutions for—

(A) pregnant and postpartum individuals living in a health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e);

(B) pregnant and postpartum individuals living in areas with high maternal mortality or severe morbidity rates or significant racial or ethnic inequities in maternal health outcomes; and

(C) pregnant and postpartum individuals with a disability that impacts mobility.

(d) Department of Agriculture.—

(1) Special supplemental nutrition program for women, infants, and children.—

(A) Extension of postpartum period.— Section 17(b)(10) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(b)(10)) is amended by striking “six” and inserting “24”.

(B) Report.— Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report that evaluates the effect of the amendment made by subparagraph (A) on—

(i) maternal and infant health outcomes, including racial and ethnic inequities with respect to those outcomes;

(ii) breastfeeding rates among postpartum individuals;

(iii) qualitative evaluations of family experiences under the special supplemental nutrition program for women, infants, and children established under section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786); and

(iv) other relevant information as determined by the Secretary.

(2) Grant program for healthy food and clean water for pregnant and postpartum individuals.—

(A) In general.— The Secretary shall establish a program (referred to in this paragraph as the “program”) to award grants, on a competitive basis, to eligible entities to carry out the activities described in subparagraph (D).

(B) Application.— To be eligible for a grant under the program, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary determines appropriate.

(C) Priority.— In awarding grants under the program, the Secretary shall give priority to an eligible entity that—

(i) is, or will partner with, an eligible entity described in paragraph (3)(A)(i); and

(ii) is operating in an area with a high rate of—

(I) adverse maternal health outcomes; or

(II) significant racial or ethnic inequities in maternal health outcomes.

(D) Use of funds.— An eligible entity shall use a grant awarded under the program to deliver healthy food, infant formula, clean water, or diapers to pregnant and postpartum individuals located in areas that are food deserts, as determined by the Secretary using data from the Food Access Research Atlas of the Department of Agriculture.

(E) Reports.—

(i) Eligible entities.— Not later than 1 year after the date on which an eligible entity receives a grant under the program, and annually thereafter, the eligible entity shall submit to the Secretary a report on the status of activities conducted using the grant, which shall contain such information as the Secretary may require.

(ii) Secretary.—

(I) In general.— Not later than 2 years after the date on which the first grant is awarded under the program, the Secretary shall submit to Congress a report that includes—

(aa) a summary of the reports submitted by eligible entities under clause (i);

(bb) an assessment of the extent to which food distributed using grants awarded under the program was purchased from local and regional food systems;

(cc) an evaluation of the effect of the program on maternal and infant health outcomes, including racial and ethnic inequities with respect to those outcomes; and

(dd) recommendations with respect to ensuring the activities described in subparagraph (D) continue after the grant period funding those activities expires.

(II) Publication.— The Secretary shall make the report submitted under subclause (I) publicly available on the website of the Department of Agriculture.

(F) Authorization of appropriations.— There is authorized to be appropriated to carry out the program $5,000,000 for the period of fiscal years 2027 through 2031.

(3) Definitions.— In this subsection:

(A) Eligible entity.— The term eligible entity means—

(i) a community-based organization;

(ii) a State or local governmental entity, including a State or local public health department;

(iii) an Indian Tribe or Tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)); and

(iv) an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).

(B) Secretary.— The term Secretary means the Secretary of Agriculture.

(e) Environmental study through National Academies.—

(1) In general.— Not later than 60 days after the date of enactment of this Act, the Administrator of the Environmental Protection Agency shall seek to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine (referred to in this subsection as the “National Academies”) under which the National Academies agree to conduct a study on the impacts of, with respect to maternal and infant health incomes, water and air quality, exposure to extreme temperatures, environmental chemicals, environmental risks in the workplace and the home, and pollution levels.

(2) Study requirements.— The agreement under paragraph (1) shall direct the National Academies to make recommendations for—

(A) improving environmental conditions to improve maternal and infant health outcomes; and

(B) reducing or eliminating racial and ethnic inequities in those outcomes.

(3) Report.— The agreement under paragraph (1) shall direct the National Academies to complete the study under this subsection, and submit to Congress and make publicly available a report on the results of the study, not later than 1 year after the date of enactment of this Act.

(f) Child care access.—

(1) Grant program.— The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall award grants to eligible organizations to carry out programs to provide pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments.

(2) Application.— To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(3) Eligible organizations.—

(A) Eligibility.— To be eligible to receive a grant under this subsection, an organization shall be an organization that—

(i) provides child care services; and

(ii) can carry out a program providing pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments.

(B) Prioritization.— In selecting grant recipients under this subsection, the Secretary shall give priority to eligible organizations that operate in an area that has, to the extent data with respect to such an area are available—

(i) high rates of adverse maternal health outcomes; or

(ii) significant racial or ethnic inequities in maternal health outcomes.

(4) Timing.— The Secretary shall commence the grant program under paragraph (1) not later than 1 year after the date of enactment of this Act.

(5) Reporting.—

(A) Grantees.— Each recipient of a grant under this subsection shall annually submit to the Secretary and make publicly available a report on the status of activities conducted using the grant. Each such report shall include—

(i) an analysis of the effect of the funded program on prenatal and postpartum appointment attendance rates;

(ii) summaries of qualitative assessments of the funded program from—

(I) pregnant and postpartum individuals participating in the program; and

(II) the families of such individuals; and

(iii) such additional information as the Secretary may require.

(B) Secretary.— Not later than the end of fiscal year 2027, the Secretary shall submit to the Congress, and make publicly available, a report containing each of the following:

(i) A summary of the reports received under subparagraph (A).

(ii) An assessment of the effects, if any, of the funded programs on maternal health outcomes, with a specific focus on racial and ethnic inequities in such outcomes.

(iii) A description of actions the Secretary can take to ensure that pregnant and postpartum individuals eligible for medical assistance under a State plan under title XIX of the Social Security Act (42 U.S.C. 1936 et seq.) have access to free and accessible drop-in child care services during prenatal and postpartum appointments, including identification of the funding necessary to carry out such actions.

(6) Drop-In child care services defined.— In this subsection, the term drop-in child care services means child care (including early childhood education) services that are—

(A) delivered at a facility that meets the requirements of all applicable laws and regulations of the State or local government in which it is located, including the requirements for licensing of the facility as a child care facility; and

(B) provided in single encounters without requiring full-time enrollment of a person in a child care program.

(7) Authorization of appropriations.— To carry out this subsection, there is authorized to be appropriated $5,000,000 for the period of fiscal years 2027 through 2029.

(g) Grants to local entities addressing social determinants of maternal health.—

(1) In general.— The Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall award grants to eligible entities to—

(A) address social determinants of maternal health for pregnant and postpartum individuals; and

(B) eliminate racial and ethnic inequities in maternal health outcomes.

(2) Application.— To be eligible to receive a grant under this subsection an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may provide.

(3) Prioritization.— In awarding grants under paragraph (1), the Secretary shall give priority to an eligible entity that—

(A) is a community-based organization, or will partner with a community-based organization to carry out the activities under paragraph (4);

(B) is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic inequities in maternal health outcomes; and

(C) is operating in an area with a high poverty rate.

(4) Activities.— An eligible entity that receives a grant under this subsection may use funds received through the grant to—

(A) hire and retain staff;

(B) develop and distribute a list of available resources with respect to social service programs in a community;

(C) establish a resource center that provides multiple social service programs in a single location;

(D) offer programs and resources in the communities in which the respective eligible entities are located to address social determinants of health for pregnant and postpartum individuals; and

(E) consult with such pregnant and postpartum individuals to conduct an assessment of the activities under this paragraph.

(5) Technical assistance.— The Secretary shall provide to grant recipients under this subsection technical assistance to plan for sustaining programs to address social determinants of maternal health among pregnant and postpartum individuals after the period of the grant.

(6) Reporting.—

(A) Grantees.— Not later than 1 year after the date on which an eligible entity first receives a grant under this subsection, and annually thereafter, an eligible entity shall submit to the Secretary, and make publicly available, a report on the status of activities conducted using the grant. Each such report shall include data on the effects of such activities, disaggregated by race, ethnicity, gender, and other relevant factors.

(B) Secretary.— Not later than the end of fiscal year 2031, the Secretary shall submit to Congress a report that includes—

(i) a summary of the reports received under subparagraph (A); and

(ii) recommendations for—

(I) improving maternal health outcomes; and

(II) reducing or eliminating racial and ethnic inequities in maternal health outcomes.

(7) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection $15,000,000 for each of fiscal years 2027 through 2031.

(h) Definitions.— In this section:

(1) Culturally congruent.— The term culturally congruent, with respect to care or maternity care provided to a health care consumer, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other relevant stakeholders.

(2) Maternity care provider.— The term maternity care provider means a health care provider who—

(A) is a physician, physician assistant, 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 Midwives, nurse practitioner, or clinical nurse specialist; and

(B) has a focus on maternal or perinatal health.

(3) Maternal mortality.— The term maternal mortality means a death occurring during or within a one-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.

(4) Perinatal health worker.— The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.

(5) Postpartum and postpartum period.— The terms postpartum and postpartum period refer to the 1-year period beginning on the last day of the pregnancy of an individual.

(6) Racial and ethnic minority group.— The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).

(7) Severe maternal morbidity.— The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.

(8) Social determinants of maternal health defined.— The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—

(A) economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;

(B) neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;

(C) social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;

(D) household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;

(E) education access and quality factors, which may include educational attainment, language and literacy, and related factors; and

(F) health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.

(a) Investments in community-Based organizations To improve Black maternal health outcomes.—

(1) Awards.— Following the 1-year period described in paragraph (3), the Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall award grants to eligible entities to establish or expand programs to prevent maternal mortality and severe maternal morbidity among Black pregnant and postpartum individuals.

(2) Eligibility.— To be eligible to seek a grant under this subsection, an entity shall be a community-based organization offering programs and resources aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.

(3) Outreach and technical assistance period.— During the 1-year period beginning on the date of enactment of this Act, the Secretary shall—

(A) conduct outreach to encourage eligible entities to apply for grants under this subsection; and

(B) provide technical assistance to eligible entities on best practices for applying for grants under this subsection.

(4) Special consideration.—

(A) Outreach.— In conducting outreach under paragraph (3), the Secretary shall give special consideration to eligible entities that—

(i) are based in, and provide support for, communities with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available;

(ii) are led by Black people; and

(iii) offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.

(B) Awards.— In awarding grants under this subsection, the Secretary shall give special consideration to eligible entities that—

(i) are described in clauses (i), (ii), and (iii) of subparagraph (A);

(ii) offer programs and resources designed in consultation with and intended for Black pregnant and postpartum individuals; and

(iii) offer programs and resources in the communities in which the respective eligible entities are located that—

(I) promote maternal mental health and maternal substance use disorder treatments and supports that are aligned with evidence-based practices for improving maternal mental and behavioral health outcomes for Black pregnant and postpartum individuals;

(II) address social determinants of maternal health for pregnant and postpartum individuals;

(III) promote evidence-based health literacy and pregnancy, childbirth, and parenting education for pregnant and postpartum individuals;

(IV) provide support from perinatal health workers to pregnant and postpartum individuals;

(V) provide culturally congruent training to perinatal health workers;

(VI) conduct or support research on maternal health issues disproportionately impacting Black pregnant and postpartum individuals;

(VII) provide support to family members of individuals who suffered a pregnancy-associated death or pregnancy-related death;

(VIII) operate midwifery practices that provide culturally congruent maternal health care and support, including for the purposes of—

(aa) supporting additional education, training, and certification programs, including support for distance learning;

(bb) providing financial support to current and future midwives to address education costs, debts, and other needs;

(cc) clinical site investments;

(dd) supporting preceptor development trainings;

(ee) expanding the midwifery practice; or

(ff) related needs identified by the midwifery practice and described in the practice’s application; or

(IX) have developed other programs and resources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.

(5) Technical assistance.— The Secretary shall provide to grant recipients under this subsection technical assistance on—

(A) capacity building to establish or expand programs to prevent adverse maternal health outcomes among Black pregnant and postpartum individuals;

(B) best practices in data collection, measurement, evaluation, and reporting; and

(C) planning for sustaining programs to prevent maternal mortality and severe maternal morbidity among Black pregnant and postpartum individuals after the period of the grant.

(6) Evaluation.— Not later than the end of fiscal year 2031, the Secretary shall submit to the Congress an evaluation of the grant program under this subsection that—

(A) assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients;

(B) makes recommendations for future outreach efforts to diversify the pool of grant recipients for Department of Health and Human Services grant programs and funding opportunities related to maternal health;

(C) assesses the effectiveness of programs funded by grants under this subsection in improving maternal health outcomes for Black pregnant and postpartum individuals, to the extent practicable; and

(D) makes recommendations for future Department of Health and Human Services grant programs and funding opportunities that deliver funding to community-based organizations that provide programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for Black pregnant and postpartum individuals.

(7) Authorization of appropriations.— To carry out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.

(b) Investments in community-Based organizations To improve maternal health outcomes in underserved communities.—

(1) Awards.— Following the 1-year period described in paragraph (3), the Secretary of Health and Human Services (in this subsection referred to as the “Secretary”) shall award grants to eligible entities to establish or expand programs to prevent maternal mortality and severe maternal morbidity among underserved groups.

(2) Eligibility.— To be eligible to seek a grant under this subsection, an entity shall be a community-based organization offering programs and resources aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.

(3) Outreach and technical assistance period.— During the 1-year period beginning on the date of enactment of this Act, the Secretary shall—

(A) conduct outreach to encourage eligible entities to apply for grants under this subsection; and

(B) provide technical assistance to eligible entities on best practices for applying for grants under this subsection.

(4) Special consideration.—

(A) Outreach.— In conducting outreach under paragraph (3), the Secretary shall give special consideration to eligible entities that—

(i) are based in, and provide support for, communities with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available;

(ii) are led by individuals from racially, ethnically, and geographically diverse backgrounds; and

(iii) offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.

(B) Awards.— In awarding grants under this subsection, the Secretary shall give special consideration to eligible entities that—

(i) are described in clauses (i), (ii), and (iii) of subparagraph (A);

(ii) offer programs and resources designed in consultation with and intended for pregnant and postpartum individuals from underserved groups;

(iii) offer programs and resources in the communities in which the respective eligible entities are located that—

(I) promote maternal mental health and maternal substance use disorder treatments and support that are aligned with evidence-based practices for improving maternal mental and behavioral health outcomes for pregnant and postpartum individuals;

(II) address social determinants of maternal health for pregnant and postpartum individuals;

(III) promote evidence-based health literacy and pregnancy, childbirth, and parenting education for pregnant and postpartum individuals;

(IV) provide support from perinatal health workers to pregnant and postpartum individuals;

(V) provide culturally congruent training to perinatal health workers;

(VI) conduct or support research on maternal health outcomes and inequities;

(VII) provide support to family members of individuals who suffered a pregnancy-associated death or pregnancy-related death; or

(VIII) operate midwifery practices that provide culturally congruent maternal health care and support, including for the purposes of—

(aa) supporting additional education, training, and certification programs, including support for distance learning;

(bb) providing financial support to current and future midwives to address education costs, debts, and other needs;

(cc) clinical site investments;

(dd) supporting preceptor development trainings;

(ee) expanding the midwifery practice; or

(ff) related needs identified by the midwifery practice and described in the practice’s application; or

(iv) have developed other programs and resources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.

(5) Technical assistance.— The Secretary shall provide to grant recipients under this subsection technical assistance on—

(A) capacity building to establish or expand programs to prevent adverse maternal health outcomes among pregnant and postpartum individuals from underserved groups;

(B) best practices in data collection, measurement, evaluation, and reporting; and

(C) planning for sustaining programs to prevent maternal mortality and severe maternal morbidity among pregnant and postpartum individuals from underserved groups after the period of the grant.

(6) Evaluation.— Not later than the end of fiscal year 2031, the Secretary shall submit to the Congress an evaluation of the grant program under this subsection that—

(A) assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients;

(B) makes recommendations for future outreach efforts to diversify the pool of grant recipients for Department of Health and Human Services grant programs and funding opportunities related to maternal health;

(C) assesses the effectiveness of programs funded by grants under this subsection in improving maternal health outcomes for pregnant and postpartum individuals from underserved groups, to the extent practicable; and

(D) makes recommendations for future Department of Health and Human Services grant programs and funding opportunities that deliver funding to community-based organizations that provide programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals.

(7) Definition.— In this subsection, the term underserved groups refers to pregnant and postpartum individuals—

(A) from racial and ethnic minority groups;

(B) whose household income is equal to or less than 150 percent of the Federal poverty line;

(C) who live in health professional shortage areas (as such term is defined in section 332 of the Public Health Service Act (42 U.S.C. 254e));

(D) who live in counties with no hospital offering obstetric care, no birth center, and no obstetric provider; or

(E) who live in counties with a level of vulnerability of moderate-to-high or higher, according to the Social Vulnerability Index of the Centers for Disease Control and Prevention.

(8) Authorization of appropriations.— To carry out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.

(c) Respectful maternity care training for all employees in maternity care settings.— Part B of title VII of the Public Health Service Act (42 U.S.C. 293 et seq.) (as amended by section 3002), is amended by adding at the end the following:

“743. Respectful maternity care training for all employees in maternity care settings.—

(a) Grants.— The Secretary shall award grants for programs to reduce and prevent bias, racism, and discrimination in maternity care settings and to advance respectful, culturally congruent, trauma-informed care.

(b) Special consideration.— In awarding grants under subsection (a), the Secretary shall give special consideration to applications for programs that would—

(1) apply to all maternity care providers and any employees who interact with pregnant and postpartum individuals in the provider setting, including front desk employees, sonographers, schedulers, health care professionals, hospital or health system administrators, security staff, and other employees;

(2) emphasize periodic, as opposed to one-time, trainings for all birthing professionals and employees described in paragraph (1);

(3) address implicit bias, racism, and cultural humility;

(4) be delivered in ongoing education settings for providers maintaining their licenses, with a preference for trainings that provide continuing education units;

(5) include trauma-informed care best practices and an emphasis on shared decision making between providers and patients;

(6) include antiracism training and programs;

(7) be delivered in undergraduate programs that funnel into health professions schools;

(8) be delivered in settings that apply to providers of the special supplemental nutrition program for women, infants, and children under section 17 of the Child Nutrition Act of 1966;

(9) integrate bias training in obstetric emergency simulation trainings or related trainings;

(10) include training for emergency department employees and emergency medical technicians on recognizing warning signs for severe pregnancy-related complications;

(11) offer training to all maternity care providers on the value of racially, ethnically, and professionally diverse maternity care teams to provide culturally congruent care; or

(12) be based on one or more programs designed by a historically Black college or university or other minority-serving institution.

(c) Application.— To seek a grant under subsection (a), an entity shall submit an application at such time, in such manner, and containing such information as the Secretary may require.

(d) Reporting to Secretary.— Each recipient of a grant under this section shall annually submit to the Secretary a report on the status of activities conducted using the grant, including, as applicable, a description of the impact of training provided through the grant on patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.

(e) Dissemination of findings.— Based on the annual reports submitted pursuant to subsection (d), the Secretary—

(1) shall produce an annual report on the findings resulting from programs funded through this section;

(2) shall disseminate such report to all recipients of grants under this section and to the public; and

(3) may include in such report findings on best practices for improving patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families in maternity care settings.

(f) Definitions.— In this section:

(1) Culturally congruent.— The term culturally congruent means in agreement with the preferred cultural values, beliefs, world view, language, and practices of the health care consumer and other stakeholders.

(2) Maternity care provider.— The term maternity care provider means a health care provider who—

(A) is a physician, physician assistant, 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 Midwives, nurse practitioner, or clinical nurse specialist; and

(B) has a focus on maternal or perinatal health.

(3) Postpartum.— The term postpartum means the one-year period beginning on the last day of an individual’s pregnancy.

(4) Racial and ethnic minority group.— The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1).

(g) Authorization of appropriations.— To carry out this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2027 through 2031.”.

(d) Study on reducing and preventing bias, racism, and discrimination in maternity care settings.—

(1) In general.— The Secretary of Health and Human Services shall seek to enter into an agreement, not later than 90 days after the date of enactment of this Act, with the National Academies of Sciences, Engineering, and Medicine (referred to in this subsection as the “National Academies”) under which the National Academies agree to—

(A) conduct a study on the design and implementation of programs to reduce and prevent bias, racism, and discrimination in maternity care settings and to advance respectful, culturally congruent, trauma-informed care; and

(B) not later than 2 years after the date of enactment of this Act—

(i) complete the study; and

(ii) transmit a report on the results of the study to the Congress.

(2) Possible topics.— The agreement entered into pursuant to paragraph (1) may provide for the study of any of the following:

(A) The development of a scorecard or other evaluation standards for programs designed to reduce and prevent bias, racism, and discrimination in maternity care settings to assess the effectiveness of such programs in improving patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.

(B) Determination of the types and frequency of training to reduce and prevent bias, racism, and discrimination in maternity care settings that are demonstrated to improve patient outcomes or patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.

(e) Respectful maternity care compliance program.—

(1) In general.— The Secretary of Health and Human Services (referred to in this subsection as the “Secretary”) shall award grants to accredited hospitals, health systems, and other maternity care settings to establish as an integral part of quality implementation initiatives within one or more hospitals or other birth settings a respectful maternity care compliance program.

(2) Program requirements.— A respectful maternity care compliance program funded through a grant under this subsection shall—

(A) institutionalize mechanisms to allow patients receiving maternity care services, the families of such patients, or perinatal health workers supporting such patients to report instances of racism or evidence of bias on the basis of race, ethnicity, or another protected class;

(B) institutionalize response mechanisms through which representatives of the program can directly follow up with the patient, if possible, and the patient’s family in a timely manner;

(C) prepare, and make publicly available, a hospital- or health system-wide strategy to reduce bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care that includes—

(i) information on the training programs to reduce and prevent bias, racism, and discrimination on the basis of race, ethnicity, or another protected class for all employees in maternity care settings;

(ii) information on the number of cases reported to the compliance program; and

(iii) the development of methods to routinely assess the extent to which bias, racism, or discrimination on the basis of race, ethnicity, or another protected class are present in the delivery of maternity care to patients from racial and ethnic minority groups;

(D) develop mechanisms to routinely collect and publicly report hospital-level data related to patient-reported experience of care; and

(E) provide annual reports to the Secretary with information about each case reported to the compliance program over the course of the year containing such information as the Secretary may require, such as—

(i) de-identified demographic information on the patient in the case, such as race, ethnicity, gender identity, and primary language;

(ii) the content of the report from the patient or the family of the patient to the compliance program;

(iii) the response from the compliance program; and

(iv) to the extent applicable, institutional changes made as a result of the case.

(3) Secretary requirements.—

(A) Processes.— Not later than 180 days after the date of enactment of this Act, the Secretary shall establish processes for—

(i) disseminating best practices for establishing and implementing a respectful maternity care compliance program within a hospital or other birth setting;

(ii) promoting coordination and collaboration between hospitals, health systems, and other maternity care delivery settings on the establishment and implementation of respectful maternity care compliance programs; and

(iii) evaluating the effectiveness of respectful maternity care compliance programs on maternal health outcomes and patient and family experiences, especially for patients from racial and ethnic minority groups and their families.

(B) Study.—

(i) In general.— Not later than 2 years after the date of enactment of this Act, the Secretary shall, through a contract with an independent research organization, conduct a study on strategies to address—

(I) racism or bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care services; and

(II) successful implementation of respectful care initiatives.

(ii) Components of study.— The study shall include the following:

(I) An assessment of the reports submitted to the Secretary from the respectful maternity care compliance programs pursuant to paragraph (2)(E).

(II) Based on such assessment, recommendations for potential accountability mechanisms related to cases of racism or bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care services at hospitals and other birth settings. Such recommendations shall take into consideration medical and non-medical factors that contribute to adverse patient experiences and maternal health outcomes.

(iii) Report.— The Secretary shall submit to the Congress, and make publicly available, a report on the results of the study under this subparagraph.

(4) Authorization of appropriations.— To carry out this subsection, there is authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2032.

(f) GAO report.—

(1) In general.— Not later than 2 years after the date of enactment of this Act and annually thereafter, the Comptroller General of the United States shall submit to the Congress, and make publicly available, a report on the establishment of respectful maternity care compliance programs within hospitals, health systems, and other maternity care settings.

(2) Matters included.— The report under paragraph (1) shall include the following:

(A) Information regarding the extent to which hospitals, health systems, and other maternity care settings have elected to establish respectful maternity care compliance programs, including—

(i) which hospitals and other birth settings elect to establish compliance programs and when such programs are established;

(ii) to the extent practicable, impacts of the establishment of such programs on maternal health outcomes and patient and family experiences in the hospitals and other birth settings that have established such programs, especially for patients from racial and ethnic minority groups and their families;

(iii) information on geographic areas, and types of hospitals or other birth settings, where respectful maternity care compliance programs are not being established and information on factors contributing to decisions to not establish such programs; and

(iv) recommendations for establishing respectful maternity care compliance programs in geographic areas, and types of hospitals or other birth settings, where such programs are not being established.

(B) Whether the funding made available to carry out this subsection has been sufficient and, if applicable, recommendations for additional appropriations to carry out this subsection.

(C) Such other information as the Comptroller General determines appropriate.

(g) Definitions.— In this section:

(1) Culturally congruent.— The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.

(2) Maternity care provider.— The term maternity care provider means a health care provider who—

(A) is a physician, physician assistant, 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 Midwives, nurse practitioner, or clinical nurse specialist; and

(B) has a focus on maternal or perinatal health.

(3) Maternal mortality.— The term maternal mortality means a death occurring during or within a one-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.

(4) Perinatal health worker.— The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.

(5) Postpartum and postpartum period.— The terms postpartum and postpartum period mean the 1-year period beginning on the last day of the pregnancy of an individual.

(6) Pregnancy-associated death.— The term pregnancy-associated death means a death of a pregnant or postpartum individual, by any cause, that occurs during, or within 1 year following, the individual’s pregnancy, regardless of the outcome, duration, or site of the pregnancy.

(7) Pregnancy-related death.— The term pregnancy-related death means a death of a pregnant or postpartum individual that occurs during, or within 1 year following, the individual’s pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

(8) Racial and ethnic minority group.— The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).

(9) Severe maternal morbidity.— The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.

(10) Social determinants of maternal health defined.— The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—

(A) economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;

(B) neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;

(C) social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;

(D) household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;

(E) education access and quality factors, which may include educational attainment, language and literacy, and related factors; and

(F) health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.

(a) HHS agency directives.—

(1) Guidance to States.—

(A) In general.— Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall issue and disseminate guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models.

(B) Contents.— The guidance required by subparagraph (A) shall address how States can encourage and incentivize hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers—

(i) to recruit and retain maternity care providers, mental and behavioral health care providers acting in accordance with State law, registered dietitians or nutrition professionals (as such term is defined in section 1861(vv)(2) of the Social Security Act (42 U.S.C. 1395x(vv)(2))), and lactation consultants certified by the International Board of Lactation Consultants Examiners—

(I) from racially, ethnically, and linguistically diverse backgrounds;

(II) with experience practicing in racially and ethnically diverse communities; and

(III) who have undergone training on implicit bias and racism;

(ii) to incorporate into maternity care teams—

(I) midwives who meet, at a minimum, the international definition of the midwife and global standards for midwifery education, as established by the International Confederation of Midwives; and

(II) perinatal health workers;

(iii) to provide collaborative, culturally congruent care; and

(iv) to provide opportunities for individuals enrolled in accredited midwifery education programs to participate in job shadowing with maternity care teams in hospitals, health systems, midwifery practices, and freestanding birth centers.

(2) Study on respectful and culturally congruent maternity care.—

(A) Study.— The Secretary of Health and Human Services, acting through the Director of the National Institutes of Health (in this paragraph referred to as the “Secretary”), shall conduct a study on best practices in respectful and culturally congruent maternity care.

(B) Report.— Not later than 2 years after the date of enactment of this Act, the Secretary shall—

(i) complete the study required by subparagraph (A);

(ii) submit to the Congress, and make publicly available, a report on the results of such study; and

(iii) include in such report—

(I) a compendium of examples of hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers that are delivering respectful and culturally congruent maternal health care;

(II) a compendium of examples of hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers that have made progress in reducing inequities in maternal health outcomes and improving birthing experiences for pregnant and postpartum individuals from racial and ethnic minority groups; and

(III) recommendations to hospitals, health systems, midwifery practices, freestanding birth centers, other maternity care provider groups, managed care entities, and other insurers, for best practices in respectful and culturally congruent maternity care.

(b) Grants To grow and diversify the perinatal workforce.— Title VII of the Public Health Service Act is amended by inserting after section 757 (42 U.S.C. 294f) the following:

“758. Perinatal workforce grants.—

(a) In general.— The Secretary shall award grants to entities to establish or expand programs described in subsection (b) to grow and diversify the perinatal workforce.

(b) Use of funds.— Recipients of grants under this section shall use the grants to grow and diversify the perinatal workforce by—

(1) establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as—

(A) physician assistants who will complete clinical training in the field of maternal and perinatal health; or

(B) perinatal health workers; and

(2) expanding the capacity of existing schools or programs described in paragraph (1), for the purposes of increasing the number of students enrolled in such schools or programs, including by awarding scholarships for students.

(c) Prioritization.— In awarding grants under this section, the Secretary shall give priority to any entity that—

(1) has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups;

(2) has developed a strategy to recruit and retain a diverse pool of students into the perinatal workforce program or school supported by funds received through the grant, particularly from racial and ethnic minority groups and other underserved populations;

(3) has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section 332;

(4) has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes, to the extent practicable; and

(5) includes in the standard curriculum for all students within the perinatal workforce program or school a bias, racism, or discrimination training program that includes training on implicit bias and racism.

(d) Reporting.— As a condition on receipt of a grant under this section for a perinatal workforce program or school, an entity shall agree to submit to the Secretary an annual report on the activities conducted through the grant, including—

(1) the number and demographics of students participating in the program or school;

(2) the extent to which students in the program or school are entering careers in—

(A) health professional shortage areas designated under section 332; and

(B) areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available; and

(3) whether the program or school has included in the standard curriculum for all students a bias, racism, or discrimination training program that includes explicit and implicit bias, and if so the effectiveness of such training program.

(e) Period of grants.— The period of a grant under this section shall not exceed 5 years.

(f) Application.— To seek a grant under this section, an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including any information necessary for prioritization under subsection (c).

(g) Technical assistance.— The Secretary shall provide, directly or by contract, technical assistance to entities seeking or receiving a grant under this section on the development, use, evaluation, and post-grant period sustainability of the perinatal workforce programs or schools proposed to be, or being, established or expanded through the grant.

(h) Report by the Secretary.— Not later than 4 years after the date of enactment of this section, the Secretary shall prepare and submit to the Congress, and post on the internet website of the Department of Health and Human Services, a report on the effectiveness of the grant program under this section at—

(1) recruiting students from racial and ethnic minority groups;

(2) increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health, and perinatal health workers, from racial and ethnic minority groups and other underserved populations;

(3) increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health, and perinatal health workers, working in health professional shortage areas designated under section 332; and

(4) increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health, and perinatal health workers, working in areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available.

(i) Definition of racial and ethnic minority group.— In this section, the term racial and ethnic minority group has the meaning given such term in section 1707(g).

(j) Authorization of appropriations.— To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2027 through 2031.”.

(c) Grants To grow and diversify the nursing workforce in maternal and perinatal health.— Title VIII of the Public Health Service Act is amended by inserting after section 811 (42 U.S.C. 296j) the following:

“812. Perinatal nursing workforce grants.—

(a) In general.— The Secretary shall award grants to schools of nursing to grow and diversify the perinatal nursing workforce.

(b) Use of funds.— Recipients of grants under this section shall use the grants to grow and diversify the perinatal nursing workforce by providing scholarships to students seeking to become—

(1) nurse practitioners whose education includes a focus on maternal and perinatal health; or

(2) clinical nurse specialists whose education includes a focus on maternal and perinatal health.

(c) Prioritization.— In awarding grants under this section, the Secretary shall give priority to any school of nursing that—

(1) has developed a strategy to recruit and retain a diverse pool of students seeking to enter careers focused on maternal and perinatal health, particularly students from racial and ethnic minority groups and other underserved populations;

(2) has developed a partnership with a practice setting in a health professional shortage area designated under section 332 for the clinical placements of the school’s students;

(3) has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes, to the extent practicable; and

(4) includes in the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health a bias, racism, or discrimination training program that includes education on implicit bias and racism.

(d) Reporting.— As a condition on receipt of a grant under this section, a school of nursing shall agree to submit to the Secretary an annual report on the activities conducted through the grant, including, to the extent practicable—

(1) the number and demographics of students in the school of nursing seeking to enter careers focused on maternal and perinatal health;

(2) the extent to which such students are preparing to enter careers in—

(A) health professional shortage areas designated under section 332; and

(B) areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available; and

(3) whether the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health includes a bias, racism, or discrimination training program that includes education on implicit bias and racism.

(e) Period of grants.— The period of a grant under this section shall be up to 5 years.

(f) Application.— To seek a grant under this section, an entity shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require, including any information necessary for prioritization under subsection (c).

(g) Technical assistance.— The Secretary shall provide, directly or by contract, technical assistance to schools of nursing seeking or receiving a grant under this section on the processes of awarding and evaluating scholarships through the grant.

(h) Report by the Secretary.— Not later than 4 years after the date of enactment of this section, the Secretary shall prepare and submit to the Congress, and post on the internet website of the Department of Health and Human Services, a report on the effectiveness of the grant program under this section at—

(1) recruiting students from racial and ethnic minority groups and other underserved populations;

(2) increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health from racial and ethnic minority groups and other underserved populations;

(3) increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health working in health professional shortage areas designated under section 332; and

(4) increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health working in areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available.

(i) Authorization of appropriations.— To carry out this section, there is authorized to be appropriated $15,000,000 for each of fiscal years 2027 through 2031.”.

(d) GAO report.—

(1) In general.— Not later than 2 years after the date of enactment of this Act, and every 5 years thereafter, the Comptroller General of the United States shall submit to Congress a report on barriers to maternal health education and access to care in the United States. Such report shall include the information and recommendations described in paragraph (2).

(2) Content of report.— The report under paragraph (1) shall include—

(A) an assessment of current barriers to entering accredited midwifery education programs, and recommendations for addressing such barriers, particularly for low-income people and people from racial and ethnic minority groups;

(B) an assessment of current barriers to entering and successfully completing accredited education programs for other health professional careers related to maternity care, including maternity care providers, mental and behavioral health care providers acting in accordance with State law, registered dietitians or nutrition professionals (as such term is defined in section 1861(vv)(2) of the Social Security Act (42 U.S.C. 1395x(vv)(2))), and lactation consultants certified by the International Board of Lactation Consultants Examiners, particularly for low-income people and people from racial and ethnic minority groups;

(C) an assessment of current barriers that prevent midwives from meeting the international definition of the midwife and global standards for midwifery education as established by the International Confederation of Midwives, and recommendations for addressing such barriers, particularly for low-income people and people from racial and ethnic minority groups;

(D) an assessment of inequities in access to maternity care providers, mental or behavioral health care providers acting in accordance with State law, registered dietitians or nutrition professionals (as such term is defined in section 1861(vv)(2) of the Social Security Act (42 U.S.C. 1395x(vv)(2))), lactation consultants certified by the International Board of Lactation Consultants Examiners, and perinatal health workers, stratified by race, ethnicity, gender identity, geographic location, and insurance type and recommendations to promote greater access equity; and

(E) recommendations to promote greater equity in compensation for perinatal health workers under public and private insurers, particularly for such individuals from racially and ethnically diverse backgrounds.

(e) Definitions.— In this section:

(1) Culturally congruent.— The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.

(2) Maternity care provider.— The term maternity care provider means a health care provider who—

(A) is a physician, physician assistant, 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 Midwives, nurse practitioner, or clinical nurse specialist; and

(B) has a focus on maternal or perinatal health.

(3) Perinatal health worker.— The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.

(4) Postpartum.— The terms postpartum means the 1-year period beginning on the last day of the pregnancy of an individual.

(5) Racial and ethnic minority group.— The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).

(a) Short title.— This section may be cited as the “Data To Save Moms Act”.

(b) Funding for maternal mortality review committees To promote representative community engagement.—

(1) In general.— Section 317K(d) of the Public Health Service Act (42 U.S.C. 247b–12(d)) is amended by adding at the end the following:

“(9) Grants to promote representative community engagement in maternal mortality review committees.—

(A) In general.— The Secretary may, using funds made available pursuant to subparagraph (C), provide assistance to an applicable maternal mortality review committee of a State, Indian tribe, tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act)—

(i) to select for inclusion in the membership of such a committee community members from the State, Indian tribe, tribal organization, or Urban Indian organization by—

(I) prioritizing community members who can increase the diversity of the committee’s membership with respect to race and ethnicity, location, and professional background, including members with non-clinical experiences; and

(II) to the extent applicable, using funds reserved under subsection (g), to address barriers to maternal mortality review committee participation for community members, including through providing required training, reducing transportation barriers, providing compensation, and providing other supports as may be necessary;

(ii) to establish initiatives to conduct outreach and community engagement efforts within communities throughout the State or Indian tribe to seek input from community members on the work of such maternal mortality review committee, with a particular focus on outreach to people who are members of minority groups; and

(iii) to release public reports assessing—

(I) the pregnancy-related death and pregnancy-associated death review processes of the maternal mortality review committee, with a particular focus on the maternal mortality review committee’s sensitivity to the unique circumstances of pregnant and postpartum individuals from racial and ethnic minority groups (as such term is defined in section 1707(g)(1)) who have suffered pregnancy-related deaths; and

(II) the impact of the use of funds made available pursuant to paragraph (C) on increasing the diversity of the maternal mortality review committee membership and promoting community engagement efforts throughout the State or Indian tribe.

(B) Technical assistance.— The Secretary shall provide (either directly through the Department of Health and Human Services or by contract) technical assistance to any maternal mortality review committee receiving a grant under this paragraph on best practices for increasing the diversity of the maternal mortality review committee’s membership and for conducting effective community engagement throughout the State or Indian tribe.

(C) Authorization of appropriations.— In addition to any funds made available under subsection (g), there are authorized to be appropriated to carry out this paragraph $10,000,000 for each of fiscal years 2027 through 2031.”.

(2) Reservation of funds.— Section 317K(g) of the Public Health Service Act (42 U.S.C. 247b–12(g)) is amended—

(A) by striking “2026 through 2030” and inserting “2027 through 2031”; and

(B) by adding at the end the following: “Of the amount made available under the preceding sentence for a fiscal year, not less than $1,500,000 shall be reserved for grants awarded under subsection (d)(9) to Indian tribes, tribal organizations, or Urban Indian organizations (as such terms are defined in section 4 of the Indian Health Care Improvement Act).”.

(c) Data collection and review.— Section 317K(d)(3)(A)(i) of the Public Health Service Act (42 U.S.C. 247b–12(d)(3)(A)(i)) is amended—

(1) by redesignating subclauses (II) and (III) as subclauses (V) and (VI), respectively; and

(2) by inserting after subclause (I) the following:

“(II) to the extent practicable, reviewing cases of severe maternal morbidity, according to the most up-to-date indicators;

(III) to the extent practicable, reviewing deaths during pregnancy or up to 1 year after the end of a pregnancy from suicide, overdose, or other death from a mental health condition or substance use disorder attributed to, or aggravated by, pregnancy or childbirth complications;

(IV) to the extent practicable, consulting with local community-based organizations representing pregnant and postpartum individuals from demographic groups disproportionately impacted by poor maternal health outcomes to ensure that, in addition to clinical factors, non-clinical factors that might have contributed to a pregnancy-related death are appropriately considered;”.

(d) Review of maternal health data collection processes and quality measures.—

(1) In general.— The Secretary of Health and Human Services, acting through the Administrator for the Centers for Medicare & Medicaid Services and the Director of the Agency for Healthcare Research and Quality (referred to in this subsection as the “Secretary”), shall consult with relevant stakeholders—

(A) to review existing maternal health data collection processes and quality measures; and

(B) to make recommendations to improve such processes and measures, including topics described in paragraph (3).

(2) Collaboration.— In carrying out this subsection, the Secretary shall consult with a diverse group of maternal health stakeholders, which may include—

(A) pregnant and postpartum individuals and their family members, and nonprofit organizations representing such individuals, with a particular focus on patients from racial and ethnic minority groups;

(B) community-based organizations that provide support for pregnant and postpartum individuals, with a particular focus on patients from racial and ethnic minority groups;

(C) membership organizations for maternity care providers;

(D) organizations representing perinatal health workers;

(E) organizations that focus on maternal mental or behavioral health;

(F) organizations that focus on intimate partner violence;

(G) institutions of higher education, with a particular focus on minority-serving institutions;

(H) licensed and accredited hospitals, birth centers, midwifery practices, or other medical practices that provide maternal health care services to pregnant and postpartum patients;

(I) relevant State and local public agencies, including State maternal mortality review committees; and

(J) the National Quality Forum, or such other standard-setting organizations specified by the Secretary.

(3) Topics.— The review of maternal health data collection processes and recommendations to improve such processes and measures required under paragraph (1) shall assess all available relevant information, including information from State-level sources, and shall consider at least the following:

(A) Current State and Tribal practices for maternal health, maternal mortality, and severe maternal morbidity data collection and dissemination, including consideration of—

(i) the timeliness of processes for amending a death certificate when new information pertaining to the death becomes available to reflect whether the death was a pregnancy-related death;

(ii) relevant data collected with electronic health records, including data on race, ethnicity, socioeconomic status, insurance type, and other relevant demographic information;

(iii) maternal health data collected and publicly reported by hospitals, health systems, midwifery practices, and birth centers;

(iv) the barriers preventing States from correlating maternal outcome data with race and ethnicity data;

(v) processes for determining the cause of a pregnancy-associated death in States that do not have a maternal mortality review committee;

(vi) whether maternal mortality review committees include multidisciplinary and diverse membership (as described in section 317K(d)(1)(A) of the Public Health Service Act (42 U.S.C. 247b–12(d)(1)(A)));

(vii) whether members of maternal mortality review committees participate in trainings on bias, racism, or discrimination, and the quality of such trainings;

(viii) the extent to which States have implemented systematic processes of listening to the stories of pregnant and postpartum individuals and their family members, with a particular focus on pregnant and postpartum individuals from racial and ethnic minority groups and their family members, to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within their respective States;

(ix) the extent to which maternal mortality review committees are considering social determinants of maternal health when examining the causes of pregnancy-associated and pregnancy-related deaths;

(x) the extent to which maternal mortality review committees are making actionable recommendations based on their reviews of adverse maternal health outcomes and the extent to which such recommendations are being implemented by appropriate stakeholders;

(xi) the legal and administrative barriers preventing the collection, collation, and dissemination of State maternity care data;

(xii) the effectiveness of data collection and reporting processes in separating pregnancy-associated deaths from pregnancy-related deaths; and

(xiii) the current Federal, State, local, and Tribal funding support for the activities referred to in clauses (i) through (xii).

(B) Whether the funding support referred to in subparagraph (A)(xiii) is adequate for States to carry out optimal data collection and dissemination processes with respect to maternal health, maternal mortality, and severe maternal morbidity.

(C) Current quality measures for maternity care, including prenatal measures, labor and delivery measures, and postpartum measures, including topics such as—

(i) effective quality measures for maternity care used by hospitals, health systems, midwifery practices, birth centers, health plans, and other relevant entities;

(ii) the sufficiency of current outcome measures used to evaluate maternity care for driving improved care, experiences, and outcomes in maternity care payment and delivery system models;

(iii) maternal health quality measures that other countries effectively use;

(iv) validated measures that have been used for research purposes that could be tested, refined, and submitted for national endorsement;

(v) barriers preventing maternity care providers and insurers from implementing quality measures that are aligned with best practices;

(vi) the frequency with which maternity care quality measures are reviewed and revised;

(vii) the strengths and weaknesses of the Prenatal and Postpartum Care measures of the Health Plan Employer Data and Information Set measures established by the National Committee for Quality Assurance;

(viii) the strengths and weaknesses of maternity care quality measures under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.), including the extent to which States voluntarily report relevant measures;

(ix) the extent to which maternity care quality measures are informed by patient experiences that include measures of patient-reported experience of care;

(x) the current processes for collecting stratified data on the race and ethnicity of pregnant and postpartum individuals in hospitals, health systems, midwifery practices, and birth centers, and for incorporating such racially and ethnically stratified data in maternity care quality measures;

(xi) the extent to which maternity care quality measures account for the unique experiences of pregnant and postpartum individuals from racial and ethnic minority groups; and

(xii) the extent to which hospitals, health systems, midwifery practices, and birth centers are implementing existing maternity care quality measures.

(D) Recommendations on authorizing additional funds and providing additional technical assistance to improve maternal mortality review committees and State and Tribal maternal health data collection and reporting processes.

(E) Recommendations for new authorities that may be granted to maternal mortality review committees to be able to—

(i) access records from other Federal and State agencies and departments that may be necessary to identify causes of pregnancy-associated and pregnancy-related deaths that are unique to pregnant and postpartum individuals from specific populations, such as veterans and individuals who are incarcerated; and

(ii) work with relevant experts who are not members of the maternal mortality review committee to assist in the review of pregnancy-associated deaths of pregnant and postpartum individuals from specific populations, such as veterans and individuals who are incarcerated.

(F) Recommendations to improve and standardize current quality measures for maternity care, with a particular focus on racial and ethnic inequities in maternal health outcomes.

(G) Recommendations to improve the coordination by the Department of Health and Human Services of the efforts undertaken by the agencies and organizations within the Department related to maternal health data and quality measures.

(4) Report.— Not later than 1 year after the date of enactment of this Act, the Secretary shall submit to Congress, and make publicly available, a report on the results of the review of maternal health data collection processes and quality measures and recommendations to improve such processes and measures required under paragraph (1).

(5) Definition of maternal mortality review committee.— In this subsection, the term maternal mortality review committee means a maternal mortality review committee duly authorized by a State and receiving funding under section 317K(a)(2)(D) of the Public Health Service Act (42 U.S.C. 247b–12(a)(2)(D)).

(6) Authorization of appropriations.— There are authorized to be appropriated such sums as may be necessary to carry out this subsection for each of fiscal years 2027 through 2031.

(e) Indian Health Service study on maternal mortality and severe maternal morbidity.—

(1) In general.— The Director of the Indian Health Service (referred to in this subsection as the “Director”) shall, in coordination with entities described in paragraph (2)—

(A) not later than 90 days after the date of enactment of this Act, enter into a contract with an independent research organization or Tribal Epidemiology Center to conduct a comprehensive study on maternal mortality and severe maternal morbidity in the populations of American Indian and Alaska Native individuals; and

(B) not later than 3 years after the date of enactment of this Act, submit to Congress a report on that study that contains recommendations for policies and practices that can be adopted to improve maternal health outcomes for pregnant and postpartum American Indian and Alaska Native individuals.

(2) Participating entities.—

(A) In general.— The entities referred to in paragraph (1) shall consist of 12 members, selected by the Director from among individuals nominated by Indian Tribes and Tribal organizations (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)) and Urban Indian organizations (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).

(B) Requirement.— In selecting members under subparagraph (A), the Director shall ensure that each of the 12 service areas of the Indian Health Service are represented.

(3) Contents of study.— The study conducted pursuant to paragraph (1)(A) shall—

(A) examine the causes of maternal mortality and severe maternal morbidity that are unique to American Indian and Alaska Native individuals;

(B) include a systematic process of listening to the stories of American Indian and Alaska Native pregnant and postpartum individuals to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within the communities of those individuals;

(C) distinguish between the causes of, landscape of maternity care at, and recommendations to improve maternal health outcomes within the different settings in which American Indian and Alaska Native pregnant and postpartum individuals receive maternity care, including—

(i) facilities operated by the Indian Health Service;

(ii) an Indian health program operated by an Indian Tribe or a Tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)) pursuant to a contract, grant, cooperative agreement, or compact with the Indian Health Service pursuant to the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5301 et seq.); and

(iii) an Urban Indian health program operated by an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) pursuant to a grant or contract with the Indian Health Service pursuant to title V of the Indian Health Care Improvement Act (25 U.S.C. 1651 et seq.);

(D) review processes for coordinating programs of the Indian Health Service with social services provided through other programs administered by the Secretary of Health and Human Services (other than the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of that Act (42 U.S.C. 1396 et seq.), and the State Children’s Health Insurance Program under title XXI of that Act (42 U.S.C. 1397aa et seq.));

(E) review current data collection and quality measurement processes and practices;

(F) assess causes and frequency of maternal mental health conditions and substance use disorders;

(G) consider social determinants of health, including poverty, lack of health insurance, unemployment, sexual violence, and environmental conditions in Tribal areas;

(H) consider the role that historical mistreatment of American Indian and Alaska Native people has played in causing currently high rates of maternal mortality and severe maternal morbidity;

(I) consider how current funding of the Indian Health Service affects the ability of the Indian Health Service to deliver quality maternity care;

(J) consider the extent to which the delivery of maternity care services is culturally appropriate for American Indian and Alaska Native pregnant and postpartum individuals;

(K) make recommendations to reduce misclassification of American Indian and Alaska Native pregnant and postpartum individuals, including consideration of best practices in training for maternal mortality review committee members to be able to correctly classify American Indian and Alaska Native individuals; and

(L) make recommendations informed by the stories shared by American Indian and Alaska Native pregnant and postpartum individuals pursuant to subparagraph (B) to improve maternal health outcomes for those individuals.

(4) Report.— The agreement entered into under paragraph (1)(A) with an independent research organization or Tribal Epidemiology Center shall require that the independent research organization or Tribal Epidemiology Center, as applicable, submit to Congress a report on the results of the study conducted pursuant to that agreement not later than 36 months after the date of enactment of this Act.

(5) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection $2,000,000 for each of fiscal years 2027 through 2029.

(f) Grants to minority-Serving institutions To study maternal mortality, severe maternal morbidity, and other adverse maternal health outcomes.—

(1) In general.— The Secretary of Health and Human Services (referred to in this subsection as the “Secretary”) shall establish a program under which the Secretary shall award grants to research centers, health professions schools and programs, and other entities at minority-serving institutions to study specific aspects of the maternal health crisis among pregnant and postpartum individuals from racial and ethnic minority groups. Such research may—

(A) include the development and implementation of systematic processes of listening to the stories of pregnant and postpartum individuals from racial and ethnic minority groups, and perinatal health workers supporting such individuals, to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within their respective communities;

(B) assess the potential causes of relatively low rates of maternal mortality among Hispanic individuals, including potential racial misclassification and other data collection and reporting issues that might be misrepresenting maternal mortality rates among Hispanic individuals in the United States; and

(C) assess differences in rates of adverse maternal health outcomes among subgroups identifying as Hispanic.

(2) Application.— To be eligible to receive a grant under paragraph (1), an entity described in such paragraph shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

(3) Technical assistance.— The Secretary may use not more than 10 percent of the funds made available under paragraph (7)—

(A) to conduct outreach to minority-serving institutions to raise awareness of the availability of grants under paragraph (1);

(B) to provide technical assistance in the application process for such a grant; and

(C) to promote capacity building, as needed to enable entities described in such paragraph to submit such an application.

(4) Reporting requirement.— Each entity awarded a grant under this subsection shall periodically submit to the Secretary a report on the status of activities conducted using the grant.

(5) Evaluation.— Beginning one year after the date on which the first grant is awarded under this subsection, the Secretary shall submit to Congress an annual report summarizing the findings of research conducted using funds made available under this subsection.

(6) Minority-Serving institutions defined.— In this subsection, the term minority-serving institution means an eligible institution described in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a)).

(7) Authorization of appropriations.— There are authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.

(g) Definitions.— In this section:

(1) Culturally congruent.— The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.

(2) Maternity care provider.— The term maternity care provider means a health care provider who—

(A) is a physician, physician assistant, 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 Midwives, nurse practitioner, or clinical nurse specialist; and

(B) has a focus on maternal or perinatal health.

(3) Maternal mortality.— The term maternal mortality means a death occurring during or within a one-year period after pregnancy, caused by pregnancy-related or childbirth complications, including a suicide, overdose, or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications.

(4) Perinatal health worker.— The term perinatal health worker means a doula, community health worker, peer supporter, breastfeeding and lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, language interpreter, or navigator.

(5) Postpartum and postpartum period.— The terms postpartum and postpartum period mean the 1-year period beginning on the last day of the pregnancy of an individual.

(6) Pregnancy-associated.— The term pregnancy-associated, with respect to a death, means a death of a pregnant or postpartum individual, by any cause, that occurs during, or within 1 year following, the individual’s pregnancy, regardless of the outcome, duration, or site of the pregnancy.

(7) Pregnancy-related.— The term pregnancy-related, with respect to a death, means a death of a pregnant or postpartum individual that occurs during, or within 1 year following, the individual’s pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy.

(8) Racial and ethnic minority group.— The term racial and ethnic minority group has the meaning given such term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)).

(9) Severe maternal morbidity.— The term severe maternal morbidity means a health condition, including mental health conditions and substance use disorders, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant.

(10) Social determinants of maternal health.— The term social determinants of maternal health means non-clinical factors that impact maternal health outcomes, including—

(A) economic factors, which may include poverty, employment, food security, support for and access to lactation and other infant feeding options, housing stability, and related factors;

(B) neighborhood factors, which may include quality of housing, access to transportation, access to child care, availability of healthy foods and nutrition counseling, availability of clean water, air and water quality, ambient temperatures, neighborhood crime and violence, access to broadband, and related factors;

(C) social and community factors, which may include systemic racism, gender discrimination or discrimination based on other protected classes, workplace conditions, incarceration, and related factors;

(D) household factors, which may include ability to conduct lead testing and abatement, car seat installation, indoor air temperatures, and related factors;

(E) education access and quality factors, which may include educational attainment, language and literacy, and related factors; and

(F) health care access factors, including health insurance coverage, access to culturally congruent health care services, providers, and non-clinical support, access to home visiting services, access to wellness and stress management programs, health literacy, access to telehealth and items required to receive telehealth services, and related factors.

(a) Maternal mental health equity grant program.—

(1) In general.— The Secretary shall establish a program to award grants to eligible entities to address maternal mental health conditions and substance use disorders with respect to pregnant and postpartum individuals, with a focus on racial and ethnic minority groups.

(2) Application.— To be eligible to receive a grant under this subsection, an eligible entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may provide, including how such entity will use funds for activities described in paragraph (4) that are culturally congruent.

(3) Priority.— In awarding grants under this subsection, the Secretary shall give priority to an eligible entity that—

(A) is, or will partner with, a community-based organization to address maternal mental health conditions and substance use disorders described in paragraph (1);

(B) is operating in an area with high rates of—

(i) adverse maternal health outcomes; or

(ii) significant racial or ethnic inequities in maternal health outcomes; and

(C) is operating in a health professional shortage area designated under section 332 of the Public Health Service Act (42 U.S.C. 254e).

(4) Use of funds.— An eligible entity that receives a grant under this subsection shall use funds for the following:

(A) Establishing or expanding maternity care programs to improve the integration of maternal health and behavioral health care services into primary care settings where pregnant individuals regularly receive health care services.

(B) Establishing or expanding group prenatal care programs or postpartum care programs.

(C) Expanding existing programs that improve maternal mental and behavioral health during the prenatal and postpartum periods, with a focus on individuals from racial and ethnic minority groups.

(D) Providing services and support for pregnant and postpartum individuals with maternal mental health conditions and substance use disorders, including referrals to addiction treatment centers that offer evidence-based treatment options.

(E) Addressing stigma associated with maternal mental health conditions and substance use disorders, with a focus on racial and ethnic minority groups.

(F) Raising awareness of warning signs of maternal mental health conditions and substance use disorders, with a focus on pregnant and postpartum individuals from racial and ethnic minority groups.

(G) Establishing or expanding programs to prevent suicide or self-harm among pregnant and postpartum individuals.

(H) Offering evidence-aligned programs at freestanding birth centers that provide maternal mental and behavioral health care education, treatments, and services, and other services for individuals throughout the prenatal and postpartum period.

(I) Establishing or expanding programs to provide education and training to maternity care providers with respect to—

(i) identifying potential warning signs for maternal mental health conditions or substance use disorders in pregnant and postpartum individuals, with a focus on individuals from racial and ethnic minority groups; and

(ii) in the case where such providers identify such warning signs, offering referrals to mental and behavioral health care professionals.

(J) Developing a website, or other source, that includes information on health care providers who treat maternal mental health conditions and substance use disorders.

(K) Establishing or expanding programs in communities to improve coordination between maternity care providers and mental and behavioral health care providers who treat maternal mental health conditions and substance use disorders, including through the use of toll-free hotlines.

(L) Carrying out other programs aligned with evidence-based practices for addressing maternal mental health conditions and substance use disorders for pregnant and postpartum individuals from racial and ethnic minority groups.

(5) Reporting.—

(A) Eligible entities.— An eligible entity that receives a grant under paragraph (1) shall submit annually to the Secretary, and make publicly available, a report on the activities conducted using funds received through a grant under this subsection. Such reports shall include quantitative and qualitative evaluations of such activities, including the experience of individuals who received health care through such grant.

(B) Secretary.— Not later than the end of fiscal year 2028, the Secretary shall submit to Congress a report that includes—

(i) a summary of the reports received under subparagraph (A);

(ii) an evaluation of the effectiveness of grants awarded under this subsection;

(iii) recommendations with respect to expanding coverage of evidence-based screenings and treatments for maternal mental health conditions and substance use disorders; and

(iv) recommendations with respect to ensuring activities described under paragraph (4) continue after the end of a grant period.

(6) Definitions.— In this subsection:

(A) Culturally congruent.— The term culturally congruent, with respect to care or maternity care, means care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders.

(B) Eligible entity.— The term eligible entity means—

(i) a community-based organization serving pregnant and postpartum individuals, including such organizations serving individuals from racial and ethnic minority groups and other underserved populations;

(ii) a nonprofit or patient advocacy organization with expertise in maternal mental and behavioral health;

(iii) a maternity care provider;

(iv) a mental or behavioral health care provider who treats maternal mental health conditions or substance use disorders;

(v) a State or local governmental entity, including a State or local public health department;

(vi) an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)); and

(vii) an Urban Indian organization (as such term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)).

(C) Freestanding birth center.— The term freestanding birth center has the meaning given that term under section 1905(l) of the Social Security Act (42 U.S.C. 1396d(1)).

(D) Maternity care provider.— The term maternity care provider means a health care provider who—

(i) is a physician, physician assistant, 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 Midwives, nurse practitioner, or clinical nurse specialist; and

(ii) has a focus on maternal or perinatal health.

(E) Secretary.— The term Secretary means the Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use.

(7) Authorization of appropriations.— To carry out this subsection, there is authorized to be appropriated $25,000,000 for each of fiscal years 2027 through 2030.

(b) Grants To grow and diversify the maternal mental and behavioral health care workforce.— Title VII of the Public Health Service Act is amended by inserting after section 758 (as added by section 5205(b)) the following:

“758A. Maternal mental and behavioral health care workforce grants.—

(a) In general.— The Secretary may award grants to entities to establish or expand programs described in subsection (b) to grow and diversify the maternal mental and behavioral health care workforce.

(b) Use of funds.— Recipients of grants under this section shall use the grants to grow and diversify the maternal mental and behavioral health care workforce by—

(1) establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as mental or behavioral health care providers who will specialize in maternal mental health conditions or substance use disorders; or

(2) expanding the capacity of existing schools or programs described in paragraph (1), for the purposes of increasing the number of students enrolled in such schools or programs, including by awarding scholarships for students.

(c) Prioritization.— In awarding grants under this section, the Secretary shall give priority to any entity that—

(1) has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups;

(2) has developed a strategy to recruit and retain a diverse pool of students into the maternal mental or behavioral health care workforce program or school supported by funds received through the grant, particularly from racial and ethnic minority groups and other underserved populations;

(3) has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section 332;

(4) has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes, to the extent practicable; and

(5) includes in the standard curriculum for all students within the maternal mental or behavioral health care workforce program or school a bias, racism, or discrimination training program that includes training on implicit bias and racism.

(d) Reporting.— As a condition on receipt of a grant under this section for a maternal mental or behavioral health care workforce program or school, an entity shall agree to submit to the Secretary an annual report on the activities conducted through the grant, including—

(1) the number and demographics of students participating in the program or school;

(2) the extent to which students in the program or school are entering careers in—

(A) health professional shortage areas designated under section 332; and

(B) areas with significant racial and ethnic inequities in maternal health outcomes, to the extent such data are available; and