Massachusetts 2023-2024 Regular Session

Massachusetts Senate Bill S1415 Compare Versions

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2	2	SENATE DOCKET, NO. 2401 FILED ON: 1/20/2023
3	3	SENATE . . . . . . . . . . . . . . No. 1415
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Liz Miranda
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to birthing justice in the Commonwealth.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :Liz MirandaSecond SuffolkLindsay N. Sabadosa1st Hampshire1/30/2023Paul W. MarkBerkshire, Hampden, Franklin and
16	16	Hampshire
17	17	1/30/2023Tram T. Nguyen18th Essex1/30/2023David M. Rogers24th Middlesex1/30/2023Christine P. Barber34th Middlesex1/30/2023Carmine Lawrence Gentile13th Middlesex1/30/2023Rebecca L. RauschNorfolk, Worcester and Middlesex2/7/2023Samantha Montaño15th Suffolk2/7/2023Ruth B. Balser12th Middlesex2/7/2023Jack Patrick Lewis7th Middlesex2/8/2023David Henry Argosky LeBoeuf17th Worcester2/8/2023Jason M. LewisFifth Middlesex2/8/2023Joanne M. ComerfordHampshire, Franklin and Worcester2/8/2023Steven Owens29th Middlesex2/8/2023David Paul Linsky5th Middlesex2/8/2023Lydia EdwardsThird Suffolk2/8/2023 2 of 2
18	18	Patricia A. Duffy5th Hampden2/8/2023Antonio F. D. Cabral13th Bristol2/8/2023Anne M. GobiWorcester and Hampshire2/8/2023Thomas M. Stanley9th Middlesex2/8/2023Sal N. DiDomenicoMiddlesex and Suffolk2/8/2023Sean Garballey23rd Middlesex2/8/2023James C. Arena-DeRosa8th Middlesex2/14/2023Jacob R. OliveiraHampden, Hampshire and Worcester2/14/2023Michael O. MooreSecond Worcester2/21/2023Adrianne Pusateri Ramos14th Essex2/21/2023Daniel Cahill10th Essex2/21/2023James B. EldridgeMiddlesex and Worcester2/21/2023Natalie M. Higgins4th Worcester3/2/2023Christopher Richard Flanagan1st Barnstable3/2/2023Michael P. Kushmerek3rd Worcester3/2/2023James J. O'Day14th Worcester3/2/2023Patricia D. JehlenSecond Middlesex3/2/2023Paul R. FeeneyBristol and Norfolk3/6/2023 1 of 104
19	19	SENATE DOCKET, NO. 2401 FILED ON: 1/20/2023
20	20	SENATE . . . . . . . . . . . . . . No. 1415
21	21	By Ms. Miranda, a petition (accompanied by bill, Senate, No. 1415) of Liz Miranda, Lindsay N.
22	22	Sabadosa, Paul W. Mark, Tram T. Nguyen and other members of the General Court for
23	23	legislation relative to birthing justice in the Commonwealth. Public Health.
24	24	The Commonwealth of Massachusetts
25	25	_______________
26	26	In the One Hundred and Ninety-Third General Court
27	27	(2023-2024)
28	28	_______________
29	29	An Act relative to birthing justice in the Commonwealth.
30	30	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
31	31	of the same, as follows:
32	32	1 SECTION 1. Chapter 118E of the General Laws, as appearing in the 2014 Official 2
33	33	2Edition, is hereby amended by inserting after Section 10L the following: -
34	34	3 Section 10M. The division shall provide coverage of screenings by pediatricians for
35	35	4postpartum depression in mothers of newly born children during any visit to a pediatrician’s
36	36	5office taking place for up to one year from the date of the child’s birth.
37	37	6 SECTION 2. Chapter 38 of the general laws is hereby amended by inserting after section
38	38	72A the following section: --
39	39	8 Section 2B. As used in this section, the term below shall have the following meaning: -
40	40	9 “Authorized local health agency”, shall mean a health board, department, or other
41	41	10governmental entity that is authorized by the department of public health to receive timely data 2 of 104
42	42	11relative to fetal and infant deaths for assessing, planning, improving and monitoring the service
43	43	12systems and community resources that support child and maternal health.
44	44	13 The department of public health shall establish a process for designating authorized local
45	45	14health agencies. This process may include reasonable criteria regarding the level of expertise,
46	46	15workforce capacity, or organizational capacity. Authorized local health agencies shall be
47	47	16authorized to conduct in-depth fetal infant mortality review of each individual infant and fetal
48	48	17death occurring within their jurisdiction, in order to identify local factors associated with fetal
49	49	18and infant deaths and inform public health policy programs.
50	50	19 For each case of fetal or infant death to be reviewed, authorized local health agencies are
51	51	20hereby authorized to collect relevant data from a variety of sources, which may include physician
52	52	21and hospital records in addition to relevant community program records. Authorized local health
53	53	22agencies are authorized to collect, and the department is authorized to provide, timely access to
54	54	23vital records and other data reasonably necessary for fetal and infant mortality review.
55	55	24 The department may issue additional guidance through policy or regulation, consistent
56	56	25with this section, regarding the process for conducting fetal infant mortality reviews by
57	57	26authorized local health agencies, which may include guidance from the National Fetal and Infant
58	58	27Mortality Review Program.
59	59	28 SECTION 3. Section 9 of chapter 13 of the General Laws, as appearing in the 2020
60	60	29Official Edition, is hereby amended by inserting, in line 7, after the word “counselors” the
61	61	30following words:- , the board of registration in midwifery.
62	62	31 SECTION 4. Said chapter 13, as so appearing, is hereby further amended by adding the
63	63	32following section:- 3 of 104
64	64	33 Section 110. (a) There shall be within the department of public health a board of
65	65	34registration in midwifery. The board shall consist of 8 members to be appointed by the governor,
66	66	355 of whom shall be midwives with not less than 5 years of experience in the practice of
67	67	36midwifery and who shall be licensed under sections 276 to 289, inclusive, of chapter 112, 1 of
68	68	37whom shall be a physician licensed to practice medicine under section 2 of said chapter 112 with
69	69	38experience working with midwives, 1 of whom shall be a certified nurse-midwife licensed to
70	70	39practice midwifery under section 80B of said chapter 112 and 1 of whom shall be a member of
71	71	40the public. Four of the members of the board of registration in midwifery shall have experience
72	72	41working on the issue of racial disparities in maternal health or be a member of a population that
73	73	42is underrepresented in the midwifery profession. When making the appointments, the governor
74	74	43shall consider the recommendations of organizations representing certified professional
75	75	44midwives in the commonwealth. The appointed members shall serve for terms of 3 years. Upon
76	76	45the expiration of a term of office, a member shall continue to serve until a successor has been
77	77	46appointed and qualified. A member shall not serve for more than 2 consecutive terms; provided,
78	78	47however, that a person who is chosen to fill a vacancy in an unexpired term of a prior board
79	79	48member may serve for 2 consecutive terms in addition to the remainder of that unexpired term. A
80	80	49member may be removed by the governor for neglect of duty, misconduct, malfeasance or
81	81	50misfeasance in the office after a written notice of the charges against the member and sufficient
82	82	51opportunity to be heard thereon. Upon the death or removal for cause of a member of the board,
83	83	52the governor shall fill the vacancy for the remainder of that member’s term after considering
84	84	53suggestions from a list of nominees provided by organizations representing certified professional
85	85	54midwives in the commonwealth. For the initial appointment of the board, the 5 members
86	86	55required to be licensed midwives shall be persons with at least 5 years of experience in the 4 of 104
87	87	56practice of midwifery who meet the eligibility requirements set forth in subsection (a) of section
88	88	57281 of chapter 112. Members of the board shall be residents of the commonwealth.
89	89	58 (b) Annually, the board shall elect from its membership a chair and a secretary who shall
90	90	59serve until their successors have been elected and qualified. The board shall meet not less than 4
91	91	60times annually and may hold additional meetings at the call of the chair or upon the request of
92	92	61not less than 4 members. A quorum for the conduct of official business shall be a majority of
93	93	62those appointed. Board members shall serve without compensation but shall be reimbursed for
94	94	63actual and reasonable expenses incurred in the performance of their duties. The members shall be
95	95	64public employees for the purposes of chapter 258 for all acts or omissions within the scope of
96	96	65their duties as board members.
97	97	66 SECTION 5. Section 1E of chapter 46 of the General Laws, as appearing in the 2020
98	98	67Official Edition, is hereby amended by inserting after the definition of “Physician” the following
99	99	68definition:-
100	100	69 “Licensed midwife,” a midwife licensed to practice by the board of registration in
101	101	70midwifery as provided in sections 276 to 289 of chapter 112.
102	102	71 SECTION 6. Section 3B of said chapter 46, as so appearing, is hereby amended by
103	103	72inserting after the word “physician”, in line 1, the following words:- or licensed midwife.
104	104	73 SECTION 7. Section 1 of chapter 94C of the general laws, as appearing in the 2020
105	105	74Official Edition, is hereby amended by inserting after the definition of “Isomer” the following
106	106	75definition:- 5 of 104
107	107	76 “Licensed midwife,” a midwife licensed to practice by the board of registration in
108	108	77midwifery as provided in sections 276 to 289 of chapter 112.
109	109	78 SECTION 8. Section 7 of said chapter 94C, as so appearing, is hereby amended by
110	110	79adding the following new subsection:-
111	111	80 (j) The commissioner shall promulgate regulations which provide for the automatic
112	112	81registration of licensed midwives, upon the receipt of the fee as herein provided, to issue written
113	113	82prescriptions in accordance with the provisions of sections 279 of chapter 112 and the
114	114	83regulations issued by the board of registration in midwifery under said section 279 of chapter
115	115	84112, unless the registration of such licensed midwife has been suspended or revoked pursuant to
116	116	85the provisions of section 13 or section 14 or unless such registration is denied for cause by the
117	117	86commissioner pursuant to the provisions of chapter 30A. Prior to promulgating such regulations,
118	118	87the commissioner shall consult with the board of registration in midwifery.
119	119	88 SECTION 9. Section 9 of said chapter 94C, as so appearing, is hereby amended by
120	120	89inserting in paragraph (a), after the words “certified nurse midwife as provided in section 80C of
121	121	90said chapter 112” the following words:- , licensed midwife as limited by subsection (j) of said
122	122	91section 7 and section 279 of said chapter 112.
123	123	92 SECTION 10. Section 9 of said chapter 94C, as so appearing, is hereby further amended
124	124	93in paragraph (b), by inserting after the words “midwife” in each place that they appear, the
125	125	94following words:- , licensed midwife.
126	126	95 SECTION 11. Said section 9 of said chapter 94C, as so appearing, is hereby further
127	127	96amended in paragraph (b), by inserting after the words “nurse-midwifery” in each place that they
128	128	97appear, the following words:- , midwifery. 6 of 104
129	129	98 SECTION 12. Section 9 of said chapter 94C is further amended in paragraph (c), by
130	130	99inserting after the words “certified nurse midwife” in each place that they appear, the following
131	131	100words:- , licensed midwife.
132	132	101 SECTION 13. The definition of “medical peer review committee” in section 1 of chapter
133	133	102111 of the General Laws, as appearing in the 2020 official edition, is hereby amended by adding
134	134	103the following sentence:- “Medical peer review committee” shall include a committee or
135	135	104association that is authorized by a midwifery society or association to evaluate the quality of
136	136	105midwifery services or the competence of midwives and suggest improvements in midwifery
137	137	106practices to improve patient care.
138	138	107 SECTION 14. Section 202 of said chapter 111, as so appearing, is hereby amended by
139	139	108inserting, in the second and third paragraphs, after the word “attendance”, in each instance, the
140	140	109following words:- or midwife in attendance.
141	141	110 SECTION 15. Said section 202, as so appearing, is hereby further amended by inserting,
142	142	111in the fourth paragraph, after the word “attendance” the following words:- or without the
143	143	112attendance of a midwife,.
144	144	113 SECTION 16. Section 204 of said chapter 111, as so appearing, is hereby amended by
145	145	114inserting, in lines 7, 12 and 28, after the word “medicine”, in each instance, the following word:-
146	146	115, midwifery.
147	147	116 SECTION 17. Chapter 112 of the General Laws, as appearing in the 2020 Official
148	148	117Edition, is hereby amended by adding the following new sections:- 7 of 104
149	149	118 Section 276. As used in sections 276 to 288, inclusive, of this chapter, the following
150	150	119words shall have the following meanings unless the context clearly requires otherwise:
151	151	120 “Board”, the board of registration in midwifery, established under section 110 of chapter
152	152	12113.
153	153	122 “Certified nurse-midwife”, a nurse with advanced training and who has obtained
154	154	123certification by the American Midwifery Certification Board.
155	155	124 “Certified professional midwife”, a professional independent midwifery practitioner who
156	156	125has obtained certification by the NARM."
157	157	126 “Client”, a person under the care of a licensed midwife, as described by a written
158	158	127statement pursuant to section 284 of this chapter.
159	159	128 “Licensed midwife”, a person registered by the board to practice midwifery in the
160	160	129commonwealth under sections 276 to 288, inclusive, of this chapter.
161	161	130 “MBC”, the midwifery bridge certificate issued by the NARM or its successor credential.
162	162	131 “MEAC”, the Midwifery Education Accreditation Council or its successor organization.
163	163	132 “Midwifery”, the practice of providing primary care to a client and newborn during the
164	164	133preconception, antepartum, intrapartum and postpartum periods.
165	165	134 “NARM”, the North American Registry of Midwives or its successor organization.
166	166	135 Section 277. Nothing in sections 276 to 288, inclusive, of this chapter shall limit or
167	167	136regulate the practice of a licensed physician, certified nurse-midwife, or licensed basic or 8 of 104
168	168	137advanced emergency medical technician. The practice of midwifery shall not constitute the
169	169	138practice of medicine, certified nurse-midwifery or emergency medical care.
170	170	139 Section 278. (a) The board shall:
171	171	140 (i) adopt rules and promulgate regulations governing licensed midwives and the practice
172	172	141of midwifery to promote public health, welfare and safety, consistent with the essential
173	173	142competencies identified by the NARM;
174	174	143 (ii) administer the licensing process, including, but not limited to:
175	175	144 (A) receiving, reviewing, approving, rejecting and issuing applications for licensure;
176	176	145 (B) renewing, suspending, revoking and reinstating licenses;
177	177	146 (C) investigating complaints against persons licensed under sections 276 to 288,
178	178	147inclusive, of this chapter;
179	179	148 (D) holding hearings and ordering the disciplinary sanction of a person who violates
180	180	149sections 276 to 288, inclusive, of this chapter or a regulation of the board;
181	181	150 (iii) establish administrative procedures for processing applications and renewals;
182	182	151 (iv) have the authority to adopt and provide a uniform, proctored examination for
183	183	152applicants to measure the qualifications necessary for licensure;
184	184	153 (v) develop practice standards for licensed midwives that shall include, but not be limited
185	185	154to:
186	186	155 (A) adoption of ethical standards for licensed midwives and apprentice midwives; 9 of 104
187	187	156 (B) maintenance of records of care, including client charts;
188	188	157 (C) participation in peer review; and
189	189	158 (D) development of standardized informed consent, reporting and written emergency
190	190	159transport plan forms;
191	191	160 (vi) establish and maintain records of its actions and proceedings in accordance with
192	192	161public records laws; and
193	193	162 (vii) adopt professional continuing education requirements for licensed midwives seeking
194	194	163renewal consistent with those maintained by the NARM.
195	195	164 (b) Nothing in this section shall limit the board’s authority to impose sanctions that are
196	196	165considered reasonable and appropriate by the board. A person subject to any disciplinary action
197	197	166taken by the board under this section or taken due to a violation of any other law, rule or
198	198	167regulation may file a petition for judicial review pursuant to section 64 of this chapter.
199	199	168 (c) A licensed midwife shall accept and provide care to clients only in accordance with
200	200	169the scope and standards of practice identified in the rules adopted pursuant to this section.
201	201	170 (d) Notwithstanding any other provision in this section, the board shall not issue any
202	202	171regulations that require a licensed midwife to practice under the supervision of or in
203	203	172collaboration with another healthcare provider or to enter into an agreement, written or
204	204	173otherwise, with another healthcare provider.
205	205	174 Section 279. A licensed midwife duly registered to issue written prescriptions in
206	206	175accordance with the provisions of subsection (j) of section 7 of chapter 94C may order, possess,
207	207	176purchase, and administer pharmaceutical agents consistent with the scope of midwifery practice, 10 of 104
208	208	177including without limitation antihemorrhagic agents including but not limited to oxytocin,
209	209	178misoprostol and methergine; intravenous fluids for stabilization; vitamin K; eye prophylaxes;
210	210	179oxygen; antibiotics for Group B Streptococcal antibiotic prophylaxes; Rho (D) immune globulin;
211	211	180local anesthetic; epinephrine; and other pharmaceutical agents identified by the board, however,
212	212	181that nothing in this section shall be construed to permit a licensed midwife’s use of
213	213	182pharmaceutical agents which are (a) controlled substances as described by Title 21 U.S.C.
214	214	183Section 812 or in chapter 94C, except for those listed in schedule VI; or (b) not identified by
215	215	184rules and regulations promulgated by the board of registration in midwifery as consistent with
216	216	185the scope of midwifery practice.
217	217	186 Section 280. A person who desires to be licensed and registered as a licensed midwife
218	218	187shall apply to the board in writing on an application form prescribed and furnished by the board.
219	219	188The applicant shall include in the application statements under oath satisfactory to the board
220	220	189showing that the applicant possesses the qualifications described under section 281 prior to any
221	221	190examination which may be required under section 278. The secretary of administration and
222	222	191finance, pursuant to section 3B of chapter 7, shall establish a license application fee, a license
223	223	192renewal fee and any other fee applicable under sections 276 to 288, inclusive, of this chapter;
224	224	193provided, however, that such license applicant and license renewal fees shall not exceed $200
225	225	194biennially. The board, in consultation with the secretary of administration and finance, shall
226	226	195institute a process for applicants to apply for a financial hardship waiver, which may reduce or
227	227	196fully exempt an applicant from paying the fee pursuant to this section. Fees collected by the
228	228	197board shall be deposited into the Quality in Health Professions Trust Fund pursuant to section
229	229	19835X of chapter 10 to support board operations and administration and to reimburse board
230	230	199members for actual and necessary expenses incurred in the performance of their official duties. 11 of 104
231	231	200 Section 281. (a) To be eligible for registration and licensure by the board as a licensed
232	232	201midwife, an applicant shall: (i) be of good moral character; (ii) be a graduate of a high school or
233	233	202its equivalent; and (iii) possess a valid certified professional midwife credential from the NARM.
234	234	203 (b) An applicant for a license to practice midwifery as a certified professional midwife
235	235	204shall submit to the board proof of successful completion of a formal midwifery education and
236	236	205training program as follows:
237	237	206 (i) a certificate of completion or equivalent from an educational program or institution
238	238	207accredited by the MEAC; or
239	239	208 (ii) an MBC, provided that an applicant: (1) is certified as a certified professional
240	240	209midwife within 5 years after the effective date of this section and completed a midwifery
241	241	210education and training program from an educational program or institution that is not accredited
242	242	211by the MEAC; or (2) is licensed as a professional midwife in a state that does not require
243	243	212completion of a midwifery education and training program from an educational program or
244	244	213institution that is accredited by the MEAC.
245	245	214 Section 282.
246	246	215 The board may license in a like manner, without examination, any midwife who has been
247	247	216licensed in another state under laws which, in the opinion of the board, require qualifications and
248	248	217maintain standards substantially the same as those of this commonwealth for licensed midwives,
249	249	218provided, however, that such midwife applies and remits fees as provided for in section 279. 12 of 104
250	250	219 Section 283. (a) The board may, after a hearing pursuant to chapter 30A, revoke, suspend
251	251	220or cancel the license of a licensed midwife, or reprimand or censure a licensed midwife, for any
252	252	221of the reasons set forth in section 61.
253	253	222 (b) No person filing a complaint or reporting information pursuant to this section or
254	254	223assisting the board at its request in any manner in discharging its duties and functions shall be
255	255	224liable in any cause of action arising out of providing such information or assistance; provided,
256	256	225however, that the person making the complaint or reporting or providing such information or
257	257	226assistance does so in good faith and without malice.
258	258	227 Section 284. When accepting a client for care, a licensed midwife shall obtain the client’s
259	259	228informed consent, which shall be evidenced by a written statement in a form prescribed by the
260	260	229board and signed by both the licensed midwife and the client.
261	261	230 Section 285. A licensed midwife shall prepare, in a form prescribed by the board, a
262	262	231written plan for the appropriate delivery of emergency care. The plan shall include, but not be
263	263	232limited to: (i) consultation with other health care providers; (ii) emergency transfer; and (iii)
264	264	233access to neonatal intensive care units and obstetrical units or other patient care areas.
265	265	234 Section 286. A health care provider that consults with or accepts a transport, transfer or
266	266	235referral from a licensed midwife, or that provides care to a client of a licensed midwife or such
267	267	236client’s newborn, shall not be liable in a civil action for personal injury or death resulting from
268	268	237an act or omission by the licensed midwife, unless the professional negligence or malpractice of
269	269	238the health care provider was a proximate cause of the injury or death.
270	270	239 Section 287. (a) The board may petition any court of competent jurisdiction for an
271	271	240injunction against any person practicing midwifery or any branch thereof without a license 13 of 104
272	272	241granted pursuant to sections 276 to 288, inclusive, of this chapter. Proof of damage or harm
273	273	242sustained by any person shall not be required for issuance of such injunction. Nothing in this
274	274	243section shall relieve a person from criminal prosecution for practicing without a license.
275	275	244 (b) Nothing in this section shall prevent or restrict the practice, service or activities of:
276	276	245 (i) a person licensed in the commonwealth from engaging in activities within the scope of
277	277	246practice of the profession or occupation for which such person is licensed; provided, however,
278	278	247that such person does not represent to the public, directly or indirectly, that such person is
279	279	248licensed under sections 276 to 289, inclusive, and that such person does not use any name, title
280	280	249or designation indicating that such person is licensed under said sections 276 to 289, inclusive; or
281	281	250 (ii) a person employed as a midwife by the federal government or an agency thereof if
282	282	251that person provides midwifery services solely under the direction and control of the
283	283	252organization by which such person is employed;
284	284	253 (iii) a traditional birth attendant who provides midwifery services if no fee is
285	285	254contemplated, charged or received, and such person has cultural or religious traditions that have
286	286	255historically included the attendance of traditional birth attendants at birth, and the birth attendant
287	287	256serves only individuals and families in that distinct cultural or religious group;
288	288	257 (iv) persons who are members of Native American communities and provide traditional
289	289	258midwife services to their communities; or
290	290	259 (v) any person rendering aid in an emergency.
291	291	260 Section 288. A licensed midwife, registered by the board of registration in midwifery
292	292	261pursuant to sections 276 to 288, inclusive, of this chapter, who provides services to any person or 14 of 104
293	293	262beneficiary covered by Title XIX of the Social Security Act or MassHealth pursuant to section
294	294	2639A of chapter 118E, may accept the Medicaid or MassHealth approved rate as payment in full
295	295	264for such services; provided, that a licensed midwife who accepts the Medicaid or MassHealth
296	296	265approved rate pursuant to this section shall be reimbursed at said rate for such services
297	297	266 SECTION 18. Chapter 118E of the General Laws, as appearing in the 2020 Official
298	298	267Edition, is hereby amended in section 10A by adding the words “licensed midwife,” after the
299	299	268word “physician,” in line 15 and after the word “pediatrician,” in line 20, and by inserting at the
300	300	269end of the section the following sentence:- The division shall provide coverage for midwifery
301	301	270services including prenatal care, childbirth and postpartum care provided by a licensed midwife
302	302	271regardless of the site of services.
303	303	272 SECTION 19. The board established pursuant to section 110 of chapter 13 of the General
304	304	273Laws shall adopt rules and promulgate regulations pursuant to this act within 1 year from the
305	305	274effective date of this act.
306	306	275 SECTION 20. The board established pursuant to section 110 of chapter 13 of the General
307	307	276Laws shall promulgate regulations for the licensure of individuals practicing midwifery prior to
308	308	277the date on which the board commences issuing licenses; provided, however, that individuals
309	309	278practicing midwifery in the commonwealth as of the date on which the board commences issuing
310	310	279licenses shall have 2 years from that date to complete the requirements necessary for licensure.
311	311	280 SECTION 21. Nothing in this act shall preclude a person who was practicing midwifery
312	312	281before the effective date of this act from practicing midwifery in the commonwealth until the
313	313	282board establishes procedures for the licensure of midwives pursuant to this act. 15 of 104
314	314	283 SECTION 22. The department of public health shall promulgate regulations within 1 year
315	315	284from the effective date of this act, governing birth centers, consistent with standards set forth by
316	316	285the American Association of Birth Centers, including without limitation authorizing licensed
317	317	286professional midwives to practice in birth centers as primary birth attendants, director of birth
318	318	287centers, and director of clinical affairs. Licensed professional midwives practicing in licensed
319	319	288birth centers shall not be required to enter into any agreement for supervision or collaboration
320	320	289with any other healthcare provider or hospital.
321	321	290 SECTION 23. Chapter 118E of the General Laws is hereby amended by inserting after
322	322	291section 10N the following section:-
323	323	292 Section 10O: Medicaid Coverage for Doula Services.
324	324	293 (A) For purposes of this section, the term “doula services” shall have the following
325	325	294meaning:
326	326	295 “Doula Services” are physical, emotional, and informational support, but not medical
327	327	296care, provided by trained doulas to individuals and families during and after pregnancy, labor,
328	328	297childbirth, miscarriage, stillbirth or pregnancy loss. Doula services include but are not limited to:
329	329	298 (1) continuous labor support;
330	330	299 (2) prenatal, postpartum, and bereavement home or in-person visits throughout the
331	331	300perinatal period, lasting until 1 year after birth, pregnancy loss, stillbirth, or miscarriage;
332	332	301 (3) accompanying pregnant individuals to health care and social services appointments;
333	333	302 (4) providing support to individuals for loss of pregnancy or infant from conception 16 of 104
334	334	303 through one year postpartum;
335	335	304 (5) connecting individuals to community-based and state- and federally-funded resources,
336	336	305including those which address social determinants of health;
337	337	306 (6) making oneself available (being on-call) around the time of birth or loss as well as
338	338	307providing support for any concerns of pregnant individuals throughout pregnancy and until one
339	339	308year after birth, pregnancy loss, stillbirth, or miscarriage.
340	340	309 (7) providing support for other individuals providing care for a birthing parent, including
341	341	310a birthing parent’s partner and family members.
342	342	311 (B) Coverage of Doula Services:
343	343	312 (1) The Division shall provide coverage of doula services to pregnant individuals and
344	344	313postpartum individuals up to 12 months following the end of the pregnancy who are eligible for
345	345	314medical assistance under this chapter and/or through Title XIX or Title XXI of the Social
346	346	315Security Act. The Division shall provide the same coverage of doula services to pregnant and
347	347	316postpartum individuals who are not otherwise eligible for medical assistance under this chapter
348	348	317or Titles XIX or XXI of the Social Security Act solely because of their immigration status.
349	349	318 (2) The Division must cover continuous support through labor and childbirth, and at least
350	350	319up to six doula visits across the prenatal and one year postpartum period, including at least two
351	351	320postpartum visits, without the need for prior authorization. The Division must also establish a
352	352	321procedure to cover additional doula visits as needed.
353	353	322 (C) Creation of Doula Advisory Committee: There is hereby created a Doula Advisory
354	354	323Committee. 17 of 104
355	355	324 (1) The committee shall consist of 10-12 members to be appointed by the commissioner
356	356	325of public health, or designee.
357	357	326 (a) All but 2 of the members must be practicing doulas from the community; the
358	358	327remaining 2 members must be individuals from the community who have experienced pregnancy
359	359	328as a MassHealth member and are not practicing doulas.
360	360	329 (b) Among the members described in (a) above:
361	361	330 (i) at least 1 member must be a person who identifies as belonging to the LGBTQIA+
362	362	331community;
363	363	332 (iii) at least 1 member must be a person who has experienced a severe maternal
364	364	333morbidity, a perinatal mental health or mood disorder, or a near-death experience while pregnant
365	365	334or in maternity care;
366	366	335 (iv) at least 1 member must be a person who identifies as a person with disabilities or
367	367	336disabled person;
368	368	337 (c) The members of the committee shall represent a diverse range of experience levels-
369	369	338from doulas new to the practice to more experienced doulas.
370	370	339 (d) The members of the committee shall be from areas within the Commonwealth where
371	371	340maternal and infant outcomes are worse than the state average, as evidenced by the MA
372	372	341Department of Public Health’s most current perinatal data available at the time the member is
373	373	342appointed.
374	374	343 (e) The members of the committee shall represent an equitable geographic distribution
375	375	344from across the Commonwealth. 18 of 104
376	376	345 (2) The committee must be convened within six months of passage of this law.
377	377	346 (3) Of the initial appointments to the Doula Advisory Committee, half shall be appointed
378	378	347to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter, all terms shall
379	379	348be 2 years. The commissioner of public health, or designee, shall fill vacancies as soon as
380	380	349practicable.
381	381	350 (4) At least once every 8 weeks, the Division must meet with the Doula Advisory
382	382	351Committee to consult about at least the following:
383	383	352 (a) the scope of doula services covered by MassHealth;
384	384	353 (b) doula competencies required for reimbursement by MassHealth, and standards of
385	385	354proof or demonstration of those competencies;
386	386	355 (c) the recruitment of a diverse workforce of doulas to provide services to MassHealth
387	387	356members;
388	388	357 (d) the development of comprehensive and high quality continuing education and training
389	389	358that is free or low-cost to doulas committed to providing services to MassHealth members, as
390	390	359well as the development of mentorship and career growth opportunities for doulas providing
391	391	360services to MassHealth members;
392	392	361 (e) the performance of any third party administrators of MassHealth’s doula coverage
393	393	362program, and standards and processes around billing for and prompt reimbursement of doula
394	394	363services; 19 of 104
395	395	364 (f) establishing grievance procedures for doulas, MassHealth members, and health care
396	396	365providers about MassHealth’s coverage of doula services and/or the provision of doula services
397	397	366to MassHealth members;
398	398	367 (g) outreach to the public and stakeholders about how to access doula care for
399	399	368MassHealth members, and about the availability of and advantages of doula care;
400	400	369 (h) the evaluation and collection of data on the provision of, outcomes of, access to, and
401	401	370satisfaction with doula care services provided to MassHealth members;
402	402	371 (i) maintaining a reimbursement rate for doula services that incentivizes and supports a
403	403	372diverse workforce representative of the communities served, and establishing a recurring
404	404	373timeframe to review that rate in light of inflation and changing costs of living in the
405	405	374commonwealth;
406	406	375 (j) how to ensure that MassHealth’s doula reimbursement program is directed towards the
407	407	376goal of reducing inequities in maternal and birth outcomes among racial, ethnic, and cultural
408	408	377populations who reside in all areas within the commonwealth, as evidenced by the most current
409	409	378perinatal data supplied by the department of public health.
410	410	379 (5) Each year, the Doula Advisory Committee must, by a majority vote of a quorum of its
411	411	380members, select an individual to serve as its chairperson for a one year term. The Doula
412	412	381Advisory Committee may replace the chairperson in the same manner mid-term.
413	413	382 (6) The Doula Advisory Committee may, by a majority vote of a quorum of its members,
414	414	383reduce the frequency of meetings with MassHealth to less than once every 8 weeks. 20 of 104
415	415	384 (7) The division and the Department of Public Health shall seek resources to offer
416	416	385reasonable compensation to members of the Doula Advisory Committee for fulfilling their
417	417	386duties, and must reimburse members for actual and necessary expenses incurred while fulfilling
418	418	387their duties.
419	419	388 (8) The division, in partnership with the Doula Advisory Committee, shall conduct at
420	420	389least 1 public hearing or forum each year until three years after passage of this law. The purposes
421	421	390of these hearings or forums shall be to gather feedback from the public and to inform the public
422	422	391about MassHealth’s coverage of doula care.
423	423	392 SECTION 24. Chapter 29 of the Massachusetts General Laws is hereby amended by
424	424	393inserting after section 2QQQQQ the following section:-
425	425	394 Section 2RRRRR. (a) There shall be established and set up on the books of the
426	426	395commonwealth a separate fund known as the Doula Workforce Development Trust Fund,
427	427	396hereinafter called the fund. The fund shall be administered by the department of career services
428	428	397which shall contract with the Commonwealth Corporation to administer the fund. The fund shall
429	429	398be credited with: (i) revenue from appropriations or other money authorized by the general court
430	430	399and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and
431	431	400(iii) funds from public and private sources; and other gifts, grants and donations for the growth,
432	432	401training and continuous support of the doula workforce. Amounts credited to the fund shall not
433	433	402be subject to further appropriation and any money remaining in the fund at the end of a fiscal
434	434	403year shall not revert to the General Fund.
435	435	404 (b) The Commonwealth Corporation shall make expenditures from the fund for the
436	436	405purposes of: 21 of 104
437	437	406 (i) the development and expansion of comprehensive doula training available across the
438	438	407commonwealth. including the development of doula training focused on meeting the needs of
439	439	408MassHealth members;
440	440	409 (ii) ensuring that doulas committed to serving MassHealth members have access to high
441	441	410quality doula training at no- or low-cost to them;
442	442	411 (iii) the recruitment and retention of doulas from communities with high concentrations
443	443	412of MassHealth members, as well as areas within the commonwealth where maternal and infant
444	444	413outcomes are worse than the state average, as evidenced by the MA Department of Public
445	445	414Health’s perinatal data.
446	446	415 (iv) expanding doula mentoring opportunities across the state, which provide new doulas
447	447	416the opportunity to attend births and incentivize experienced practicing doulas to take on mentees.
448	448	417 (v) leveraging funds to secure future federal funding to support doula workforce
449	449	418development in the commonwealth.
450	450	419 (c) The director of career services shall annually, not later than December 31, report to
451	451	420the secretary of administration and finance, the house and senate committees on ways and means
452	452	421and the joint committee on labor and workforce development on the efforts undertaken in
453	453	422support of section (b) above; the number of doulas recruited and trained as a result of activities
454	454	423taken in support of (b) above, including but not limited to sex, gender identity, race, and ethnicity
455	455	424of such doulas; the amount of grants and identities of grantees awarded in support of section (b)
456	456	425above; and the availability of doula training at no- or low-cost to doulas committed to serving
457	457	426MassHealth members. 22 of 104
458	458	427 SECTION 25. Chapter 111 of the General Laws is hereby amended by inserting in
459	459	428section 70E after “Every patient or resident of a facility shall have the right:”:
460	460	429 (p) to have their birth doula’s continuous presence during labor and delivery. Facilities
461	461	430shall not place an undue burden on a patient’s doula’s access to clinical labor and delivery
462	462	431settings, and shall not arbitrarily exclude a patient’s doula from such settings.
463	463	432 SECTION 26. Notwithstanding any general or special law to the contrary the
464	464	433commissioner of the department of development services shall include neonatal abstinence
465	465	434syndrome under the definition of Closely Related Development Conditions as defined under 115
466	466	435CMR 2 and 115 CMR 6.06(1).
467	467	436 SECTION 27. Chapter 123B, section 2 is hereby amended by inserting after the first
468	468	437paragraph the following paragraph:-
469	469	438 The department of developmental services shall promulgate regulations to facilitate
470	470	439interagency coordination with agencies including, but not limited to, the department of public
471	471	440health, the department of mental health, and the department of early and secondary education and
472	472	441continuation of care during and in the transition provision of Children’s Supports to support
473	473	442access to health care and other services to improve social determinants of health.
474	474	443 SECTION 28. Chapter 111 of the General Laws is hereby amended by inserting after
475	475	444section 110H the following sections:-
476	476	445 Section 110I: Required Newborn Screening for Congenital Cytomegalovirus
477	477	446 For the purposes of this section, the following words shall, unless the context clearly
478	478	447requires otherwise, have the following meanings:- 23 of 104
479	479	448 “Birthing facility”, an inpatient or ambulatory health care facility licensed by the
480	480	449department of public health that provides birthing and newborn care services.
481	481	450 “Congenital Cytomegalovirus (hereinafter referred to as cCMV) screening”, the
482	482	451identification of a newborn who may have congenital CMV infection or has cCMV confirmed
483	483	452through the use of a saliva or urine test.
484	484	453 “Department”, the department of public health.
485	485	454 “Newborn,” any liveborn infant who has not yet attained the age of 21 days from a birth
486	486	455occurring in the commonwealth or from a birth prior to transfer to a hospital in the
487	487	456commonwealth.
488	488	457 The department, in consultation with the perinatal advisory committee, shall develop
489	489	458regulations for all hospitals and birthing facilities requiring cCMV screening within one year of
490	490	459the passage of this legislation. These regulations shall consider evidence-based guidance.
491	491	460 The cCMV screening shall be performed using a saliva PCR test unless one is
492	492	461unavailable in which case a urine PCR test may be used. If positive, a saliva PCR test would
493	493	462require a confirmatory urine PCR test. The department may approve another test to conduct
494	494	463cCMV screening; provided, however, that the test shall be, at the discretion of the department, at
495	495	464least as accurate, widely available and cost-effective as a saliva or urine PCR test. A screening
496	496	465shall be performed within 21 days from the date of birth and before the newborn infant is
497	497	466discharged from the birthing facility to the care of the parent or guardian; provided, however,
498	498	467that the screening shall not be performed if the parent or guardian of the newborn infant objects
499	499	468to the screening based upon a sincerely held religious belief of the parent or guardian. The 24 of 104
500	500	469cCMV educational materials outlined in section 70I(b) shall be provided to the parent or
501	501	470guardian of the infant at the time of cCMV screening.
502	502	471 A hospital that provides birthing and newborn services or a birthing facility shall adopt
503	503	472protocols for cCMV screening using a saliva or urine PCR test or another test approved by the
504	504	473department under this section for all newborns prior to discharge, and not to exceed 21 days from
505	505	474the date of birth, based on the department’s regulations, on or before January 1, 2023.
506	506	475 The cost of providing the newborn cCMV screening shall be a covered benefit
507	507	476reimbursable by all health insurers, except for supplemental policies that only provide coverage
508	508	477for specific diseases, hospital indemnity, Medicare supplement or other supplemental policies. In
509	509	478the absence of a third-party payer, the charges for the newborn cCMV screening shall be paid by
510	510	479the Commonwealth.
511	511	480 A hospital or birthing facility shall report annually to the department data including, but
512	512	481not limited to, the number of cCMV tests administered and the outcomes of said tests. The
513	513	482hospital or birthing facility shall inform, orally and in writing, a parent or guardian of the
514	514	483newborn infant the result of the cCMV screening test regardless of its outcome. This information
515	515	484shall also be provided in writing to the newborn infant's primary care physician and to the
516	516	485department through its electronic birth certificate system or such mechanism as specified by the
517	517	486department.
518	518	487 The department shall review the protocols required under this section and the
519	519	488implementation of these protocols as part of its birthing facility licensure review processes.
520	520	489 The department shall promulgate regulations to implement the cCMV screening program. 25 of 104
521	521	490 Nothing in this statute shall preclude newborns born at home from obtaining said cCMV
522	522	491screening.
523	523	492 Section 110J: Advisory Committee for CMV Screening Program
524	524	493 There is hereby established an advisory committee for the purpose of implementing the
525	525	494provisions of Section 110I. The advisory committee shall consist of the following members to be
526	526	495appointed by the commissioner of the department: a representative of the hospital industry; a
527	527	496primary care pediatrician or family practitioner; an otolaryngologist; a neonatologist; an
528	528	497infectious disease specialist; a clinician representing newborn nurseries; an audiologist; an
529	529	498ophthalmologist; an obstetrician-gynecologist; a representative of the commonwealth's early
530	530	499intervention program; 2 parents and/or guardians of a child impacted by cCMV; 2 medical
531	531	500professionals; a developer of preventative and/or therapeutic interventions for cCMV; a teacher
532	532	501of the deaf; and a representative of the department.
533	533	502 The advisory committee shall advise the department regarding the validity and cost of
534	534	503proposed cCMV regulations and/or cCMV screening, and shall recommend standards for
535	535	504performing and interpreting screening tests based on the most current technological methods, for
536	536	505documenting test results and follow-up, and for facilitating interaction between professionals and
537	537	506agencies that participate in follow-up care. Members of the advisory committee shall serve
538	538	507without compensation. The advisory committee shall be provided support services by the
539	539	508department.
540	540	509 SECTION 29. Chapter 111 of the General Laws is hereby further amended by inserting
541	541	510after Section 70H the following section:-
542	542	511 Section 70I: Congenital cytomegalovirus; public information program; annual report 26 of 104
543	543	512 (a) The commissioner of the department shall establish, promote, and maintain a public
544	544	513information program regarding congenital cytomegalovirus, hereinafter referred to as cCMV.
545	545	514Such program shall be conducted throughout the commonwealth, and under said program, a
546	546	515hospital or birthing facility as defined in section 70E or any healthcare provider, physician
547	547	516assistant, nurse or midwife who renders prenatal or postnatal care shall give expectant or new
548	548	517parents or guardians information provided by the department under subsection (b). Such
549	549	518information shall be made available at the first prenatal appointment or at a preconception visit if
550	550	519applicable, whichever is earliest.
551	551	520 (b) The department shall make available to any healthcare provider, physician assistant,
552	552	521nurse or midwife who renders prenatal or postnatal care or offers fertility counseling or care to a
553	553	522parent or guardian the following: (i) up-to-date evidence-based, written information about cCMV
554	554	523and universal cCMV screening that has been vetted by an appropriate group of medical experts
555	555	524as determined by the department in conjunction with the advisory committee as established in
556	556	525section 110J of said Chapter 111; provided, however, that the written information provided shall
557	557	526include preventative measures that can be taken throughout pregnancy, and (ii) contact or other
558	558	527referral information for additional educational and support resources. The department may also
559	559	528make such information available to any other person who seeks information about cCMV
560	560	529infections.
561	561	530 SECTION 30. Section 17C of chapter 32A of the General Laws, as appearing in the 2018
562	562	531Official Edition, is hereby amended by inserting after the words “coverage for”, in line 3, the
563	563	532following words:- abortion and abortion-related care,. 27 of 104
564	564	533 SECTION 31. Said section 17C of said chapter 32A, as so appearing, is hereby further
565	565	534amended by inserting after the second paragraph the following paragraphs:-
566	566	535 Coverage provided under this section shall not be subject to any deductible, coinsurance,
567	567	536copayment or any other cost-sharing requirement. Coverage offered under this section shall not
568	568	537impose unreasonable restrictions or delays in the coverage.
569	569	538 Benefits for an enrollee under this section shall be the same for the enrollee’s covered
570	570	539spouse and covered dependents.
571	571	540 The commission shall ensure plan compliance with this chapter.
572	572	541 SECTION 32. Section 10A of chapter 118E of the General Laws, as appearing in the
573	573	5422018 Official Edition, is hereby amended by inserting after the words “coverage for”, in line 1,
574	574	543the following words:- abortion and abortion-related care,.
575	575	544 SECTION 33. Said section 10A of said chapter 118E, as so appearing, is hereby further
576	576	545amended by adding the following paragraphs:-
577	577	546 Coverage provided under this section shall not be subject to any deductible, coinsurance,
578	578	547copayment or any other cost-sharing requirement. Coverage offered under this section shall not
579	579	548impose unreasonable restrictions or delays in the coverage.
580	580	549 Benefits for an enrollee under this section shall be the same for the enrollee’s covered
581	581	550spouse and covered dependents.
582	582	551 Nothing in this section shall be construed to deny or restrict the division’s authority to
583	583	552ensure its contracted health insurers, health plans, health maintenance organizations, behavioral 28 of 104
584	584	553health management firms and third-party administrators under contract to a Medicaid managed
585	585	554care organization or primary care clinician plan are in compliance with this chapter.
586	586	555 SECTION 34. Section 47F of chapter 175 of the General Laws, as appearing in the 2018
587	587	556Official Edition, is hereby amended by inserting after the words “for the expense of”, in line 20,
588	588	557the following words:- abortion and abortion-related care,.
589	589	558 SECTION 35. Said section 47F of said chapter 175, as so appearing, is hereby further
590	590	559amended by inserting after the third paragraph the following paragraphs:-
591	591	560 Coverage provided under this section shall not be subject to any deductible, coinsurance,
592	592	561copayment or any other cost-sharing requirement. Coverage offered under this section shall not
593	593	562impose unreasonable restrictions or delays in the coverage.
594	594	563 Benefits for an enrollee under this section shall be the same for the enrollee’s covered
595	595	564spouse and covered dependents.
596	596	565 A policy of accident and sickness insurance that is purchased by an employer that is a
597	597	566church or qualified church-controlled organization, as defined in section 47W of this chapter,
598	598	567shall be exempt from covering abortion and abortion-related care at the request of the employer.
599	599	568An employer that invokes the exemption under this section shall provide written notice to
600	600	569prospective enrollees prior to enrollment with the plan and such notice shall list the health care
601	601	570methods and services for which the employer will not provide coverage for religious reasons.
602	602	571 SECTION 36. Section 8H of Chapter 176A of the General Laws, as appearing in the
603	603	5722018 Official Edition, is hereby amended by inserting after the words “expense for”, in line 8,
604	604	573the following words:- abortion and abortion-related care,. 29 of 104
605	605	574 SECTION 37. Said section 8H of said chapter 176A, as so appearing, is hereby further
606	606	575amended by striking out, in lines 9 and 10, the words “to the same extent that benefits are
607	607	576provided for medical conditions not related to pregnancy”.
608	608	577 SECTION 38. Said section 8H of said chapter 176A, as so appearing, is hereby further
609	609	578amended by inserting after the third paragraph the following paragraphs:-
610	610	579 Coverage provided under this section shall not be subject to any deductible, coinsurance,
611	611	580copayment or any other cost-sharing requirement. Coverage offered under this section shall not
612	612	581impose unreasonable restrictions or delays in the coverage.
613	613	582 Benefits for an enrollee under this section shall be the same for the enrollee’s covered
614	614	583spouse and covered dependents.
615	615	584 A policy of accident and sickness insurance that is purchased by an employer that is a
616	616	585church or qualified church-controlled organization, as defined in section 8W of this chapter, shall
617	617	586be exempt from covering abortion and abortion-related care at the request of the employer. An
618	618	587employer that invokes the exemption under this subsection shall provide written notice to
619	619	588prospective enrollees prior to enrollment with the plan and such notice shall list the health care
620	620	589methods and services for which the employer will not provide coverage for religious reasons.
621	621	590 SECTION 39. Section 4H of chapter 176B of the General Laws, as appearing in the 2018
622	622	591Official Edition, is hereby amended by inserting after the words “expense for”, in lines 7 and 8,
623	623	592the following words:- abortion and abortion-related care,. 30 of 104
624	624	593 SECTION 40. Said section 4H of said chapter 176B, as so appearing, is hereby further
625	625	594amended by striking out, in lines 8 to 10, inclusive, the words “to the same extent that benefits
626	626	595are provided for medical conditions not related to pregnancy”.
627	627	596 SECTION 41. Said section 4H of said chapter 176B, as so appearing, is hereby further
628	628	597amended by inserting after the third paragraph the following paragraphs:-
629	629	598 Coverage provided under this section shall not be subject to any deductible, coinsurance,
630	630	599copayment or any other cost-sharing requirement. Coverage offered under this section shall not
631	631	600impose unreasonable restrictions or delays in the coverage.
632	632	601 Benefits for an enrollee under this section shall be the same for the enrollee’s covered
633	633	602spouse and covered dependents.
634	634	603 A policy of accident and sickness insurance that is purchased by an employer that is a
635	635	604church or qualified church-controlled organization, as defined in section 4W of this chapter, shall
636	636	605be exempt from covering abortion and abortion-related care at the request of the employer. An
637	637	606employer that invokes the exemption under this subsection shall provide written notice to
638	638	607prospective enrollees prior to enrollment with the plan and such notice shall list the health care
639	639	608methods and services for which the employer will not provide coverage for religious reasons.
640	640	609 SECTION 42. Section 4I of chapter 176G of the General Laws, as appearing in the 2018
641	641	610Official Edition, is hereby amended by inserting after the words “coverage for”, in lines 1 and 2,
642	642	611the following words:- abortion and abortion-related care,.
643	643	612 SECTION 43. Said section 4I of said chapter 176G, as so appearing, is hereby further
644	644	613amended by inserting after the second paragraph the following paragraphs:- 31 of 104
645	645	614 Coverage provided under this section shall not be subject to any deductible, coinsurance,
646	646	615copayment or any other cost-sharing requirement. Coverage offered under this section shall not
647	647	616impose unreasonable restrictions or delays in the coverage.
648	648	617 Benefits for an enrollee under this section shall be the same for the enrollee’s covered
649	649	618spouse and covered dependents.
650	650	619 A health maintenance contract that is purchased by an employer that is a church or
651	651	620qualified church-controlled organization, as defined in section 40 of this chapter, shall be exempt
652	652	621from covering abortion and abortion-related care at the request of the employer. An employer
653	653	622that invokes the exemption under this subsection shall provide written notice to prospective
654	654	623enrollees prior to enrollment with the plan and such notice shall list the health care methods and
655	655	624services for which the employer will not provide coverage for religious reasons.
656	656	625 SECTION 44. Sections 1 to 14, inclusive, shall apply to all policies, contracts and
657	657	626certificates of health insurance subject to chapters 32A, 118E, 175, 176A, 176B and 176G of the
658	658	627General Laws that are delivered, issued or renewed 6 months from the effective date of this act.
659	659	628 SECTION 45. Section 47C of chapter 175 is hereby amended by striking out the word
660	660	629“annually” and inserting in place thereof the following words:- once per calendar year.
661	661	630 SECTION 46. Chapter 111 of the General Laws, as appearing in the 2016 Official
662	662	631Edition, is hereby amended by inserting, after section 2J, the following new section:-
663	663	632 Section 2K. (a) As used in this section, the following words shall have the following
664	664	633meanings unless context clearly requires otherwise:
665	665	634 “Commissioner,” the commissioner of the department of public health. 32 of 104
666	666	635 “Department,” the department of public health.
667	667	636 “Fund,” the diaper benefits trust fund.
668	668	637 “Organization,” an entity, including but not limited to, that acts in whole or in part as a
669	669	638diaper bank, diaper distribution organization, food bank or food pantry.
670	670	639 “Pilot program,” an organization or organizations receiving funds from the department to
671	671	640provide diapers to low-income families with diaper-wearing infants and/or children.
672	672	641Organizations may collaborate to maximize distribution in their respective regions.
673	673	642 (b) There shall be established and set up on the books of the commonwealth a fund to
674	674	643address diaper insufficiency that shall be administered by the commissioner. The fund shall be
675	675	644credited with: (i) revenue from appropriations or other money authorized by the general court
676	676	645and specifically designated to the fund; (ii) interest earned on such revenues; and (iii) funds from
677	677	646public and private sources such as gifts, grants and donations to further the pilot program.
678	678	647Amounts credited to the fund shall not be subject to further appropriation and any money
679	679	648remaining in the fund at the end of the fiscal year shall not revert to the General Fund.
680	680	649 (c) The department shall distribute resources from the fund by issuing a request for
681	681	650proposal through which an organization or organizations may apply. Funds received shall be
682	682	651used for one or more of the following purposes: (i) acquiring diapers, (ii) storing diapers, (iii)
683	683	652distributing diapers, (iv) organizing diaper drives, or (v) marketing the pilot program.
684	684	653 The department shall grant funds based on the demonstrated capacity and need of the
685	685	654applicant. The department shall fund up to 12 applicants no more than 2 of which shall be from
686	686	655the western region of the commonwealth; no more than 2 of which shall be from the central 33 of 104
687	687	656region of the commonwealth; no more than 2 of which shall be from the eastern region of the
688	688	657commonwealth; no more than 2 of which shall be from the southeastern region of the
689	689	658commonwealth; no more than 2 of which shall be from Cape Cod or the Islands; and no more
690	690	659than 2 of which shall be from the Merrimack valley.
691	691	660 Amounts received from private sources shall be approved by the commissioner of the
692	692	661department and subject to review before being deposited in the fund to ensure that pledged funds
693	693	662are not accompanied by conditions, explicit or implicit, on distributing diapers.
694	694	663 (d) Not later than one year after the implementation of each pilot program said
695	695	664department shall provide a report to the joint committee on children, families and persons with
696	696	665disabilities and to the house and senate committees on ways and means. The report shall include,
697	697	666but not be limited to: (i) the number of children receiving diapers through the pilot program; (ii)
698	698	667the number of households receiving diapers through the pilot program; (iii) the number of
699	699	668diapers distributed through the pilot program to families in each region; (iv) an explanation of
700	700	669the organization's distribution process and allocation determination; (v) the sources and the
701	701	670amounts remaining in the fund; (vi) if and how the pilot program was able to leverage additional
702	702	671support; (vii) the amounts distributed and the purpose of expenditures from the fund; and (viii)
703	703	672the advisability of expanding the pilot program.
704	704	673 SECTION 47. Chapter 32A of the General Laws is hereby amended by adding the
705	705	674following section:-
706	706	675 Section 31. The commission shall provide to any active or retired employee of the
707	707	676commonwealth insured under the group insurance commission coverage for services rendered by
708	708	677a certified nurse midwife designated to engage in the practice of nurse-midwifery by the board of 34 of 104
709	709	678registration in nursing pursuant to section 80C of chapter 112; provided, however, that the
710	710	679following conditions are met: (1) the service rendered is within the scope of the certified nurse
711	711	680midwife’s authorization to practice by the board of registration in nursing; (2) the policy or
712	712	681contract currently provides benefits for identical services rendered by a health care provider
713	713	682licensed by the commonwealth; and (3) the reimbursement for the services provided shall be in
714	714	683the same amount as the reimbursement paid under the policy to a licensed physician performing
715	715	684the service in the area served. An insurer may not reduce the reimbursement paid to a licensed
716	716	685physician to achieve compliance with this section.
717	717	686 SECTION 48. Chapter 118E of the General Laws is hereby amended by adding the
718	718	687following section:-
719	719	688 Section 80. The division shall provide coverage for services rendered by a certified nurse
720	720	689midwife designated to engage in the practice of nurse-midwifery by the board of registration in
721	721	690nursing pursuant to section 80C of chapter 112; provided, however, that the following conditions
722	722	691are met: (1) the service rendered is within the scope of the certified nurse midwife’s
723	723	692authorization to practice by the board of registration in nursing; (2) the policy or contract
724	724	693currently provides benefits for identical services rendered by a health care provider licensed by
725	725	694the commonwealth; and (3) the reimbursement for the services provided shall be in the same
726	726	695amount as the reimbursement paid under the policy to a licensed physician performing the
727	727	696service in the area served. An insurer may not reduce the reimbursement paid to a licensed
728	728	697physician to achieve compliance with this section.
729	729	698 SECTION 49. Section 47E of Chapter 175 of the General Laws, as appearing in the 2018
730	730	699Official Edition, is hereby amended by adding the following sentences:- The reimbursement for 35 of 104
731	731	700the services provided pursuant to this section shall be in the same amount as the reimbursement
732	732	701paid under the policy to a licensed physician performing the service in the area served. An
733	733	702insurer may not reduce the reimbursement paid to a licensed physician in order to comply with
734	734	703this section.
735	735	704 SECTION 50. Chapter 176A of the General Laws is hereby amended by inserting after
736	736	705section 8OO the following section:-
737	737	706 Section 8PP. Any contract between a subscriber and the corporation under an individual
738	738	707or group hospital service plan which is delivered, issued or renewed in the commonwealth shall
739	739	708provide as a benefit to all individual subscribers and members within the commonwealth and to
740	740	709all group members having a principal place of employment within the commonwealth for
741	741	710services rendered by a certified nurse midwife designated to engage in the practice of nurse-
742	742	711midwifery by the board of registration in nursing pursuant to section 80C of chapter 112;
743	743	712provided, however, that the following conditions are met: (1) the service rendered is within the
744	744	713scope of the certified nurse midwife’s authorization to practice by the board of registration in
745	745	714nursing; (2) the policy or contract currently provides benefits for identical services rendered by a
746	746	715health care provider licensed by the commonwealth; and (3) the reimbursement for the services
747	747	716provided shall be in the same amount as the reimbursement paid under the policy to a licensed
748	748	717physician performing the service in the area served. An insurer may not reduce the
749	749	718reimbursement paid to a licensed physician in order to comply with this section.
750	750	719 SECTION 51. Section 4G of Chapter 176B of the General Laws, as appearing in the
751	751	7202018 Official Edition, is hereby amended by adding the following sentences:- The
752	752	721reimbursement for the services provided pursuant to this section shall be in the same amount as 36 of 104
753	753	722the reimbursement paid under the policy to a licensed physician performing the service in the
754	754	723area served. An insurer may not reduce the reimbursement paid to a licensed physician in order
755	755	724to comply with this section.
756	756	725 SECTION 52. Section 4 of Chapter 176G is of the General Laws, as so appearing, is
757	757	726hereby amended by adding the following subsection:-
758	758	727 (g) services rendered by a certified nurse midwife designated to engage in the practice of
759	759	728nurse-midwifery by the board of registration in nursing pursuant to section 80C of chapter 112,
760	760	729subject to the terms of a negotiated agreement between the health maintenance organization and
761	761	730the provider of health care services. The reimbursement for the services provided shall be in the
762	762	731same amount as the reimbursement paid under the policy to a licensed physician performing the
763	763	732service in the area served. An insurer may not reduce the reimbursement paid to a licensed
764	764	733physician in order to comply with this section.
765	765	734 SECTION 53. Chapter 94C, as appearing in the 2018 Official Edition, is hereby
766	766	735amended by inserting, after section 19D, the following section:-
767	767	736 Section 19E. A registered pharmacist may prescribe and dispense hormonal contraceptive
768	768	737patches and self-administered oral hormonal contraceptives to a person who is:
769	769	738 (a) At least 18 years of age, regardless of whether the person has evidence of a previous
770	770	739prescription from a primary care practitioner or women’s health care practitioner for a hormonal
771	771	740contraceptive patch or self-administered oral hormonal contraceptive; or 37 of 104
772	772	741 (b) Under 18 years of age, only if the person has evidence of a previous prescription from
773	773	742a primary care practitioner or women’s health care practitioner for a hormonal contraceptive
774	774	743patch or self-administered oral hormonal contraceptive.
775	775	744 The board shall adopt rules to establish, in consultation with the Massachusetts Medical
776	776	745Board, the Massachusetts State Board of Nursing and the MassHealth, and in consideration of
777	777	746guidelines established by the American Congress of Obstetricians and Gynecologists, standard
778	778	747procedures for the prescribing of hormonal contraceptive patches and self-administered oral
779	779	748hormonal contraceptives by pharmacists. The rules adopted under this subsection must require a
780	780	749pharmacist to:
781	781	750 (a) Complete a training program approved by the State Board of Pharmacy that is related
782	782	751to prescribing hormonal contraceptive patches and self-administered oral hormonal
783	783	752contraceptives;
784	784	753 (b) Provide a self-screening risk assessment tool that the patient must use prior to the
785	785	754pharmacist’s prescribing the hormonal contraceptive patch or self-administered oral hormonal
786	786	755contraceptive;
787	787	756 (c) Refer the patient to the patient’s primary care practitioner or women’s health care
788	788	757practitioner upon prescribing and dispensing the hormonal contraceptive patch or self-
789	789	758administered oral hormonal contraceptive;
790	790	759 (d) Provide the patient with a written record of the hormonal contraceptive patch or self-
791	791	760administered oral hormonal contraceptive prescribed and dispensed and advise the patient to
792	792	761consult with a primary care practitioner or women’s health care practitioner; and 38 of 104
793	793	762 (e) Dispense the hormonal contraceptive patch or self-administered oral hormonal
794	794	763contraceptive to the patient as soon as practicable after the pharmacist issues the prescription.
795	795	764 The rules adopted must prohibit a pharmacist from:
796	796	765 (a) Requiring a patient to schedule an appointment with the pharmacist for the
797	797	766prescribing or dispensing of a hormonal contraceptive patch or self-administered oral hormonal
798	798	767contraceptive; and
799	799	768 (b) Prescribing and dispensing a hormonal contraceptive patch or self-administered oral
800	800	769hormonal contraceptive to a patient who does not have evidence of a clinical visit for women’s
801	801	770health within the three years immediately following the initial prescription and dispensation of a
802	802	771hormonal contraceptive patch or self-administered oral hormonal contraceptive by a pharmacist
803	803	772to the patient.
804	804	773 SECTION 54. Section 51A of chapter 119 of the general laws is hereby amended in
805	805	774subsection (a) in the first paragraph by striking out the words:-
806	806	775 (iii) physical dependence upon an addictive drug at birth,
807	807	776 SECTION 55. Said section 51A is hereby further amended by inserting in subsection (a)
808	808	777after the second paragraph a new subsection:
809	809	778 (a ½) Separate from the reporting requirements under subsection (a), health care
810	810	779providers involved in the delivery or care of infants affected by in-utero substance exposure or a
811	811	780Fetal Alcohol Spectrum disorder, shall notify the Department of such condition in such infants as
812	812	781required under 42 U.S.C. § 1506a(b)(2)(B)(ii). Such notification shall not include the names or 39 of 104
813	813	782identifying information of the parents or the infant, shall not constitute a report that any parent
814	814	783has abused or neglected a child, and shall not trigger or require prosecution for any illegal action.
815	815	784 SECTION 56. Chapter 111 of the General Laws, as appearing in the 2018 Official
816	816	785Edition, is hereby amended by striking subsection (4) of section 51G and inserting in place
817	817	786thereof the following section:
818	818	787 (4) (a) A hospital shall notify the department of a proposed closure at least one calendar
819	819	788year in advance of the date of the proposed closure or discontinuance of an essential health
820	820	789service.
821	821	790 (b) At least 30 days prior to notifying the department of the proposed closure or
822	822	791discontinuance of an essential health service, the hospital shall inform either electronically or in
823	823	792writing the Department and the following parties of its intent to submit notice: (a) The hospital’s
824	824	793patient and family council; (b) Each staff member of the hospital; (c) Every labor organization
825	825	794that represents the hospital’s workforce during the period of the essential services closure; (d)
826	826	795The members of the General Court who represent the city or town in which the hospital is
827	827	796located; and; (e) A representative of the local officials of the city or town in which the hospital is
828	828	797located. The department shall define essential services according to 105 CMR 130.
829	829	798 (c) At least 30 days prior to notifying the department of the proposed closure of an
830	830	799essential health service, a detailed account of any community engagement and planning which
831	831	800has occurred prior to such filing, and such other information as the Commissioner may require
832	832	801shall be presented to the department. With respect to the proposed closure of an essential health
833	833	802service, the hospital shall also send a copy of the notice that it submits to the Department to the
834	834	803Health Policy Commission, Office of the Attorney General, Center for Health Information and 40 of 104
835	835	804Analysis, and Executive Office of Labor and Workforce Development as well as each of the
836	836	805health care coalitions and community groups identified by the hospital in its notice to the
837	837	806department.
838	838	807 (d) The hospital proposing the discontinuance shall provide, with their initial notice to the
839	839	808department, evidence of support or non-opposition to the proposed change from each
840	840	809municipality to which it provides the service as a health care resource, as determined pursuant to
841	841	810section 16T of chapter 6A of the General Laws, or, if a statement of non-opposition cannot be
842	842	811obtained, evidence of having given notice and allowed an opportunity for comment from said
843	843	812municipalities. Any notice given without meeting the requirements of this paragraph shall not
844	844	813constitute notice to the department for the purpose of establishing the earliest date on which the
845	845	814hospital may close or discontinue an essential health service.
846	846	815 (e) The department shall, in the event that a hospital proposes to discontinue an essential
847	847	816health service or services, determine whether any such discontinued services are necessary for
848	848	817preserving access and health status in the hospital’s service area, require the hospital to submit a
849	849	818plan for assuring access to such necessary services following the hospital’s closure of the
850	850	819service, and assure continuing access to such services in the event that the department determines
851	851	820that their closure will significantly reduce access to necessary services. This plan shall include
852	852	821the creation of a community oversight committee comprised of a representative from each
853	853	822municipality to which the hospital provides the service as a health care resource as well as non-
854	854	823managerial employees, including registered nurses and ancillary staff, from the hospital, and a
855	855	824representative from a local interfaith organization to ensure that any plan approved by the
856	856	825department is followed. The community oversight group shall inform the department in the event
857	857	826the plan is not executed and followed by the hospital. If the hospital's plan for assuring 41 of 104
858	858	827continued access to a necessary service relies upon the availability of similar services at another
859	859	828hospital or health facility with which it does not share common ownership, the department shall
860	860	829require the hospital to submit with said plan a statement from each other hospital or health
861	861	830facility listed in the plan, affirming their capacity to provide continued access as described in the
862	862	831plan. The department shall conduct a public hearing prior to a determination on the closure of
863	863	832said essential services or of the hospital. No original license shall be granted to establish or
864	864	833maintain an acute-care hospital, as defined by section 25B, unless the applicant submits a plan, to
865	865	834be approved by the department, for the provision of community benefits, including the
866	866	835identification and provision of essential health services. In approving the plan, the department
867	867	836may take into account the applicants existing commitment to primary and preventive health care
868	868	837services and community contributions as well as the primary and preventive health care services
869	869	838and community contributions of the predecessor hospital. The department may waive this
870	870	839requirement, in whole or in part, at the request of the applicant which has provided or at the time
871	871	840the application is filed, is providing, substantial primary and preventive health care services and
872	872	841community contributions in its service area.
873	873	842 (f) If a hospital executes a plan to discontinue an essential health service, said plan not
874	874	843having been approved by the department pursuant to this section, the Attorney General shall seek
875	875	844an injunction to require that the essential health service be maintained for the duration of the
876	876	845notice period outlined in subsection (a). Additionally, that hospital shall not be eligible to have
877	877	846an application approved pursuant to section 25C for a period of three years from the date the
878	878	847service is discontinued, or until the essential health service is restored, or until such time as the
879	879	848department is satisfied that a plan is in place that, at the time of the discontinuance, would have
880	880	849met the requirements of paragraph (c). 42 of 104
881	881	850 SECTION 57. Section 51 of chapter 111 of the General Laws, as appearing in the 2020
882	882	851Official Edition, is hereby amended by adding after the word “Gynecologists,” in line 106, the
883	883	852following words:- , American College of Nurse Midwives, American Association of Birth
884	884	853Centers.
885	885	854 SECTION 58. (a) The department of public health shall promulgate revised regulations
886	886	855under the Code of Massachusetts Regulations 105 CMR 140.000 and 142.000 governing the
887	887	856facility and operation of licensed birth centers in consultation with Seven Sisters Birth Center,
888	888	857Neighborhood Birth Center, American College of Nurse Midwives Massachusetts Affiliate, and
889	889	858other entities operating or planning to open birth centers in Massachusetts to bring the
890	890	859regulations in accordance with chapter 111 of the General Laws and the standards of the
891	891	860American Association of Birth Centers or any successor organization, and to ensure safe,
892	892	861equitable and accessible birth options for birth center clients.
893	893	862 (b) The regulations shall include, but not be limited to, the following provisions:
894	894	863 (i) a licensed free-standing birth center shall have a detailed and written plan on the
895	895	864premises for transfer of a client to a nearby hospital providing obstetrical and newborn services
896	896	865as needed for emergency treatment beyond that provided by the birth center;
897	897	866 (ii) a licensed free-standing birth center shall develop policies and procedures to ensure
898	898	867coordination of ongoing care and transfer when complications occur which render the patient
899	899	868ineligible for birth center care during the antepartum, intrapartum or postpartum period;
900	900	869 (iii) the department shall not require a licensed free-standing birth center or the directors
901	901	870and providers on staff to practice under the supervision of a hospital or another health care 43 of 104
902	902	871provider or to enter into an agreement, written or otherwise, with another hospital or health care
903	903	872provider, or maintain privileges at a hospital;
904	904	873 (iv) a licensed free-standing birth center shall have an administrative director responsible
905	905	874for implementing and overseeing the operational policies of the birth center;
906	906	875 (v) a licensed free-standing birth center shall have a director of clinical affairs on staff
907	907	876who shall be a nurse midwife or physician licensed and in good standing in Massachusetts whose
908	908	877professional scope of practice includes preconception, prenatal, labor, birth, and postpartum care
909	909	878and early care of the newborn and who may be the primary attendants during the perinatal period
910	910	879in accordance with chapter 112 of the General Laws; and
911	911	880 (vi) birth attendants at licensed free-standing birth centers shall be midwives, physicians,
912	912	881or other providers licensed and in good standing in Massachusetts whose professional scope of
913	913	882practice includes preconception, prenatal, labor, birth, and postpartum care and early care of the
914	914	883newborn and who may be the primary attendants in accordance with chapter 112 of the General
915	915	884Laws.
916	916	885 SECTION 59. The department shall issue the revised regulations under section 2 of this
917	917	886act no later than 180 days after the effective date of this act.
918	918	887 SECTION 60. Chapter 118E of the General Laws is hereby amended by inserting after
919	919	888section 10N the following section:-
920	920	889 Section 10O: Medicaid Coverage for Doula Services.
921	921	890 (A) For purposes of this section, the term “doula services” shall have the following
922	922	891meaning: 44 of 104
923	923	892 “Doula Services” are physical, emotional, and informational support, but not medical
924	924	893care, provided by trained doulas to individuals and families during and after pregnancy, labor,
925	925	894childbirth, miscarriage, stillbirth or pregnancy loss. Doula services include but are not limited to:
926	926	895 (1) continuous labor support;
927	927	896 (2) prenatal, postpartum, and bereavement home or in-person visits throughout the
928	928	897perinatal period, lasting until 1 year after birth, pregnancy loss, stillbirth, or miscarriage;
929	929	898 (3) accompanying pregnant individuals to health care and social services appointments;
930	930	899 (4) providing support to individuals for loss of pregnancy or infant from conception
931	931	900through one year postpartum;
932	932	901 (5) connecting individuals to community-based and state- and federally-funded resources,
933	933	902including those which address social determinants of health;
934	934	903 (6) making oneself available (being on-call) around the time of birth or loss as well as
935	935	904providing support for any concerns of pregnant individuals throughout pregnancy and until one
936	936	905year after birth, pregnancy loss, stillbirth, or miscarriage.
937	937	906 (7) providing support for other individuals providing care for a birthing parent, including
938	938	907a birthing parent’s partner and family members.
939	939	908 (B) Coverage of Doula Services:
940	940	909 (1) The Division shall provide coverage of doula services to pregnant individuals and
941	941	910postpartum individuals up to 12 months following the end of the pregnancy who are eligible for
942	942	911medical assistance under this chapter and/or through Title XIX or Title XXI of the Social 45 of 104
943	943	912Security Act. The Division shall provide the same coverage of doula services to pregnant and
944	944	913postpartum individuals who are not otherwise eligible for medical assistance under this chapter
945	945	914or Titles XIX or XXI of the Social Security Act solely because of their immigration status.
946	946	915 (2) The Division must cover continuous support through labor and childbirth, and at least
947	947	916up to six doula visits across the prenatal and one year postpartum period, including at least two
948	948	917postpartum visits, without the need for prior authorization. The Division must also establish a
949	949	918procedure to cover additional doula visits as needed.
950	950	919 (C) Creation of Doula Advisory Committee: There is hereby created a Doula Advisory
951	951	920Committee.
952	952	921 (1) The committee shall consist of 10-12 members to be appointed by the commissioner
953	953	922of public health, or designee.
954	954	923 (a) All but 2 of the members must be practicing doulas from the community; the
955	955	924remaining 2 members must be individuals from the community who have experienced pregnancy
956	956	925as a MassHealth member and are not practicing doulas.
957	957	926 (b) Among the members described in (a) above:
958	958	927 (i) at least 1 member must be a person who identifies as belonging to the LGBTQIA+
959	959	928community;
960	960	929 (iii) at least 1 member must be a person who has experienced a severe maternal
961	961	930morbidity, a perinatal mental health or mood disorder, or a near-death experience while pregnant
962	962	931or in maternity care; 46 of 104
963	963	932 (iv) at least 1 member must be a person who identifies as a person with disabilities or
964	964	933disabled person;
965	965	934 (c) The members of the committee shall represent a diverse range of experience levels-
966	966	935from doulas new to the practice to more experienced doulas.
967	967	936 (d) The members of the committee shall be from areas within the Commonwealth where
968	968	937maternal and infant outcomes are worse than the state average, as evidenced by the MA
969	969	938Department of Public Health’s most current perinatal data available at the time the member is
970	970	939appointed.
971	971	940 (e) The members of the committee shall represent an equitable geographic distribution
972	972	941from across the Commonwealth.
973	973	942 (2) The committee must be convened within six months of passage of this law.
974	974	943 (3) Of the initial appointments to the Doula Advisory Committee, half shall be appointed
975	975	944to a term of 2 years and half shall be appointed to a term of 18 months. Thereafter, all terms shall
976	976	945be 2 years. The commissioner of public health, or designee, shall fill vacancies as soon as
977	977	946practicable.
978	978	947 (4) At least once every 8 weeks, the Division must meet with the Doula Advisory
979	979	948Committee to consult about at least the following:
980	980	949 (a) the scope of doula services covered by MassHealth;
981	981	950 (b) doula competencies required for reimbursement by MassHealth, and standards of
982	982	951proof or demonstration of those competencies; 47 of 104
983	983	952 (c) the recruitment of a diverse workforce of doulas to provide services to MassHealth
984	984	953members;
985	985	954 (d) the development of comprehensive and high quality continuing education and training
986	986	955that is free or low-cost to doulas committed to providing services to MassHealth members, as
987	987	956well as the development of mentorship and career growth opportunities for doulas providing
988	988	957services to MassHealth members;
989	989	958 (e) the performance of any third party administrators of MassHealth’s doula coverage
990	990	959program, and standards and processes around billing for and prompt reimbursement of doula
991	991	960services;
992	992	961 (f) establishing grievance procedures for doulas, MassHealth members, and health care
993	993	962providers about MassHealth’s coverage of doula services and/or the provision of doula services
994	994	963to MassHealth members;
995	995	964 (g) outreach to the public and stakeholders about how to access doula care for
996	996	965MassHealth members, and about the availability of and advantages of doula care;
997	997	966 (h) the evaluation and collection of data on the provision of, outcomes of, access to, and
998	998	967satisfaction with doula care services provided to MassHealth members;
999	999	968 (i) maintaining a reimbursement rate for doula services that incentivizes and supports a
1000	1000	969diverse workforce representative of the communities served, and establishing a recurring
1001	1001	970timeframe to review that rate in light of inflation and changing costs of living in the
1002	1002	971commonwealth; 48 of 104
1003	1003	972 (j) how to ensure that MassHealth’s doula reimbursement program is directed towards the
1004	1004	973goal of reducing inequities in maternal and birth outcomes among racial, ethnic, and cultural
1005	1005	974populations who reside in all areas within the commonwealth, as evidenced by the most current
1006	1006	975perinatal data supplied by the department of public health.
1007	1007	976 (5) Each year, the Doula Advisory Committee must, by a majority vote of a quorum of its
1008	1008	977members, select an individual to serve as its chairperson for a one year term. The Doula
1009	1009	978Advisory Committee may replace the chairperson in the same manner mid-term.
1010	1010	979 (6) The Doula Advisory Committee may, by a majority vote of a quorum of its members,
1011	1011	980reduce the frequency of meetings with MassHealth to less than once every 8 weeks.
1012	1012	981 (7) The division and the Department of Public Health shall seek resources to offer
1013	1013	982reasonable compensation to members of the Doula Advisory Committee for fulfilling their
1014	1014	983duties, and must reimburse members for actual and necessary expenses incurred while fulfilling
1015	1015	984their duties.
1016	1016	985 (8) The division, in partnership with the Doula Advisory Committee, shall conduct at
1017	1017	986least 1 public hearing or forum each year until three years after passage of this law. The purposes
1018	1018	987of these hearings or forums shall be to gather feedback from the public and to inform the public
1019	1019	988about MassHealth’s coverage of doula care.
1020	1020	989 SECTION 61. Chapter 32A of the General Laws, as appearing in the 2014 Official
1021	1021	990Edition, is hereby amended by inserting after section 27 the following section: 49 of 104
1022	1022	991 Section 28. (a) Any coverage offered by the commission to any active or retired
1023	1023	992employee of the commonwealth insured under the group insurance commission shall provide
1024	1024	993coverage for all doula services as defined in Section XX.
1025	1025	994 (b) Nothing in this section shall be construed to deny or restrict in any way the group
1026	1026	995insurance commission’s authority to ensure plan compliance with this chapter.
1027	1027	996 SECTION 3. Chapter 118E of the General Laws, as so appearing, is hereby amended by
1028	1028	997inserting after section 10I the following section:
1029	1029	998 10J (a) The division and its contracted health insurers, health plans, health maintenance
1030	1030	999organizations, behavioral health management firms and third-party administrators under contract
1031	1031	1000to a Medicaid managed care organization or primary care clinician plan shall provide coverage
1032	1032	1001for all doula services as defined in Section XX.
1033	1033	1002 (b) Nothing in this section shall be construed to deny or restrict in any way the group
1034	1034	1003insurance commission’s authority to ensure plan compliance with this chapter.
1035	1035	1004 SECTION 62. Chapter 175 of the General Laws, as so appearing, is hereby amended by
1036	1036	1005inserting after section 47W(c) the following:
1037	1037	1006 (d) An individual policy of accident and sickness insurance issued pursuant to section
1038	1038	1007108 that provides hospital expense and surgical expense and any group blanket policy of accident
1039	1039	1008and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical
1040	1040	1009expense insurance, delivered, issued or renewed by agreement between the insurer and the
1041	1041	1010policyholder, within or without the Commonwealth, (hereinafter “policy”) shall provide benefits 50 of 104
1042	1042	1011for residents of the Commonwealth and all group members having a principal place of
1043	1043	1012employment within the Commonwealth coverage for all doula services as defined in Section XX.
1044	1044	1013 (e) Nothing in this section shall be construed to deny or restrict in any way the division of
1045	1045	1014insurance’s authority to ensure compliance with this chapter.
1046	1046	1015 SECTION 63. Chapter 176A of the General Laws, as so appearing, is hereby amended by
1047	1047	1016inserting after section 8W(c) the following:
1048	1048	1017 (d) Any contract between a subscriber and the corporation under an individual or group
1049	1049	1018hospital service plan that is delivered, issued or renewed within or without the Commonwealth
1050	1050	1019and that provides benefits for outpatient services shall provide to all individual subscribers and
1051	1051	1020members within the Commonwealth and to all group members having a principal place of
1052	1052	1021employment within the Commonwealth coverage for all doula services as defined in Section XX.
1053	1053	1022 (e) Nothing in this section shall be construed to deny or restrict in any way the division of
1054	1054	1023insurance’s authority to ensure compliance with this chapter.
1055	1055	1024 SECTION 64. Chapter 176B of the General Laws, as so appearing, is hereby amended by
1056	1056	1025inserting after section 4W(c) the following:
1057	1057	1026 (d) Any subscription certificate under an individual or group medical service agreement
1058	1058	1027that is delivered, issued or renewed within or without the Commonwealth and that provides
1059	1059	1028benefits for outpatient services shall provide to all individual subscribers and members within the
1060	1060	1029Commonwealth and to all group members having a principal place of employment within the
1061	1061	1030Commonwealth coverage for all doula services as defined in Section XX. 51 of 104
1062	1062	1031 (e) Nothing in this subsection shall be construed to deny or restrict in any way the
1063	1063	1032division of insurance’s authority to ensure medical service agreement compliance with this
1064	1064	1033chapter.
1065	1065	1034 SECTION 65. Chapter 176G of the General Laws, as so appearing, is hereby amended by
1066	1066	1035inserting after section 4O(c) the following:
1067	1067	1036 (d) Any individual or group health maintenance contract that is issued, renewed or
1068	1068	1037delivered within or without the Commonwealth and that provides benefits for outpatient
1069	1069	1038prescription drugs or devices shall provide to residents of the Commonwealth and to persons
1070	1070	1039having a principal place of employment within the Commonwealth coverage for all doula
1071	1071	1040services as defined in Section XX.
1072	1072	1041 (e) Nothing in this subsection shall be construed to deny or restrict in any way the
1073	1073	1042division of insurance’s authority to ensure health maintenance contract compliance with this
1074	1074	1043chapter.
1075	1075	1044 SECTION 66. Sections 1 through 6 of this act shall apply to all policies, contracts and
1076	1076	1045certificates of health insurance subject to chapters 32A, chapter 118E, chapter 175, chapter
1077	1077	1046176A, chapter 176B, and chapter 176G which are delivered, issued or renewed on or after
1078	1078	1047September 1, 2024.
1079	1079	1048 SECTION 67. Chapter 29 of the Massachusetts General Laws is hereby amended by
1080	1080	1049inserting after section 2QQQQQ the following section:-
1081	1081	1050 Section 2RRRRR. (a) There shall be established and set up on the books of the
1082	1082	1051commonwealth a separate fund known as the Doula Workforce Development Trust Fund, 52 of 104
1083	1083	1052hereinafter called the fund. The fund shall be administered by the department of career services
1084	1084	1053which shall contract with the Commonwealth Corporation to administer the fund. The fund shall
1085	1085	1054be credited with: (i) revenue from appropriations or other money authorized by the general court
1086	1086	1055and specifically designated to be credited to the fund; (ii) interest earned on such revenues; and
1087	1087	1056(iii) funds from public and private sources; and other gifts, grants and donations for the growth,
1088	1088	1057training and continuous support of the doula workforce. Amounts credited to the fund shall not
1089	1089	1058be subject to further appropriation and any money remaining in the fund at the end of a fiscal
1090	1090	1059year shall not revert to the General Fund.
1091	1091	1060 (b) The Commonwealth Corporation shall make expenditures from the fund for the
1092	1092	1061purposes of:
1093	1093	1062 (i) the development and expansion of comprehensive doula training available across the
1094	1094	1063commonwealth. including the development of doula training focused on meeting the needs of
1095	1095	1064MassHealth members;
1096	1096	1065 (ii) ensuring that doulas committed to serving MassHealth members have access to high
1097	1097	1066quality doula training at no- or low-cost to them;
1098	1098	1067 (iii) the recruitment and retention of doulas from communities with high concentrations
1099	1099	1068of MassHealth members, as well as areas within the commonwealth where maternal and infant
1100	1100	1069outcomes are worse than the state average, as evidenced by the MA Department of Public
1101	1101	1070Health’s perinatal data.
1102	1102	1071 (iv) expanding doula mentoring opportunities across the state, which provide new doulas
1103	1103	1072the opportunity to attend births and incentivize experienced practicing doulas to take on mentees. 53 of 104
1104	1104	1073 (v) leveraging funds to secure future federal funding to support doula workforce
1105	1105	1074development in the commonwealth.
1106	1106	1075 (c) The director of career services shall annually, not later than December 31, report to
1107	1107	1076the secretary of administration and finance, the house and senate committees on ways and means
1108	1108	1077and the joint committee on labor and workforce development on the efforts undertaken in
1109	1109	1078support of section (b) above; the number of doulas recruited and trained as a result of activities
1110	1110	1079taken in support of (b) above, including but not limited to sex, gender identity, race, and ethnicity
1111	1111	1080of such doulas; the amount of grants and identities of grantees awarded in support of section (b)
1112	1112	1081above; and the availability of doula training at no- or low-cost to doulas committed to serving
1113	1113	1082MassHealth members.
1114	1114	1083 SECTION 68. Chapter 111 of the General Laws is hereby amended by inserting in
1115	1115	1084section 70E after “Every patient or resident of a facility shall have the right:”:
1116	1116	1085 (p) to have their birth doula’s continuous presence during labor and delivery. Facilities
1117	1117	1086shall not place an undue burden on a patient’s doula’s access to clinical labor and delivery
1118	1118	1087settings, and shall not arbitrarily exclude a patient’s doula from such settings.
1119	1119	1088 SECTION 69. Section 17C of chapter 32A of the General Laws, as most recently
1120	1120	1089amended by section 8 of chapter 127 of the acts of 2022, is hereby amended by striking out the
1121	1121	1090third paragraph and inserting in place thereof the following paragraph:-
1122	1122	1091 Coverage provided under this section shall not be subject to any deductible, coinsurance,
1123	1123	1092copayment or any other cost-sharing requirement; provided, however, that deductibles,
1124	1124	1093coinsurance or copayments shall be required if the applicable plan is governed by the federal
1125	1125	1094Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on 54 of 104
1126	1126	1095deductibles, coinsurance or copayments for these services. Coverage offered under this section
1127	1127	1096shall not impose unreasonable restrictions or delays in the coverage.
1128	1128	1097 SECTION 70. Said section 17C of said chapter 32A, as most recently amended by
1129	1129	1098section 8 of chapter 127, is hereby further amended by adding the following sentence:-
1130	1130	1099 The commission shall ensure plan compliance with this section.
1131	1131	1100 SECTION 71. Section 10A of chapter 118E of the General Laws, as most recently
1132	1132	1101amended by section 19 of chapter 127 of the acts of 2022, is hereby amended by adding the
1133	1133	1102following paragraphs:-
1134	1134	1103 Nothing in this section shall be construed to deny or restrict the division’s authority to
1135	1135	1104ensure its contracted health insurers, health plans, health maintenance organizations, behavioral
1136	1136	1105health management firms and third-party administrators under contract to a Medicaid managed
1137	1137	1106care organization or primary care clinician plan are in compliance with this chapter.
1138	1138	1107 The division shall ensure plan compliance with this chapter.
1139	1139	1108 SECTION 72. Section 47F of chapter 175 of the General Laws, as most recently
1140	1140	1109amended by section 22 of chapter 127 of the acts of 2022, is hereby amended by striking out the
1141	1141	1110fourth paragraph and inserting in place thereof the following paragraph:-
1142	1142	1111 Coverage provided under this section shall not be subject to any deductible, coinsurance,
1143	1143	1112copayment or any other cost-sharing requirement; provided, however, that deductibles,
1144	1144	1113coinsurance or copayments shall be required if the applicable plan is governed by the federal
1145	1145	1114Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on 55 of 104
1146	1146	1115deductibles, coinsurance or copayments for these services. Coverage offered under this section
1147	1147	1116shall not impose unreasonable restrictions or delays in the coverage.
1148	1148	1117 SECTION 73. Said section 47F of said chapter 175, as recently amended by section 22 of
1149	1149	1118chapter 127 of the acts of 2022, is hereby further amended by adding the following sentence:-
1150	1150	1119 The commissioner shall ensure plan compliance with this section.
1151	1151	1120 SECTION 74. Section 8H of chapter 176A of the General Laws, as most recently
1152	1152	1121amended by section 26 of chapter 127 of the acts of 2022, is hereby amended by striking out the
1153	1153	1122fourth paragraph and inserting in place thereof the following paragraph:-
1154	1154	1123 Coverage provided under this section shall not be subject to any deductible, coinsurance,
1155	1155	1124copayment or any other cost-sharing requirement; provided, however, that deductibles,
1156	1156	1125coinsurance or copayments shall be required if the applicable plan is governed by the federal
1157	1157	1126Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on
1158	1158	1127deductibles, coinsurance or copayments for these services. Coverage offered under this section
1159	1159	1128shall not impose unreasonable restrictions or delays in the coverage.
1160	1160	1129 SECTION 75. Said section 8H of said chapter 176A, as most recently amended by
1161	1161	1130section 26 of chapter 127 of the acts of 2022, is hereby further amended by adding the following
1162	1162	1131sentence:-
1163	1163	1132 The commissioner shall ensure plan compliance with this section.
1164	1164	1133 SECTION 76. Section 4H of chapter 176B of the General Laws, as most recently
1165	1165	1134amended by section 29 of chapter 127 of the acts of 2022, is hereby amended by striking out the
1166	1166	1135fourth paragraph and inserting in place thereof the following paragraph:- 56 of 104
1167	1167	1136 Coverage provided under this section shall not be subject to any deductible, coinsurance,
1168	1168	1137copayment or any other cost-sharing requirement; provided, however, that deductibles,
1169	1169	1138coinsurance or copayments shall be required if the applicable plan is governed by the federal
1170	1170	1139Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on
1171	1171	1140deductibles, coinsurance or copayments for these services. Coverage offered under this section
1172	1172	1141shall not impose unreasonable restrictions or delays in the coverage.
1173	1173	1142 SECTION 77. Said section 4H of said chapter 176B, as most recently amended by
1174	1174	1143section 29 of chapter 127 of the acts of 2022, is hereby further amended by adding the following
1175	1175	1144sentence:-
1176	1176	1145 The commissioner shall ensure plan compliance with this section.
1177	1177	1146 SECTION 78. Section 4I of chapter 176G of the General Laws, as most recently
1178	1178	1147amended by section 31 of chapter 127 of the acts of 2022, is hereby amended by striking out the
1179	1179	1148third paragraph and inserting in place thereof the following paragraph:-
1180	1180	1149 Coverage provided under this section shall not be subject to any deductible, coinsurance,
1181	1181	1150copayment or any other cost-sharing requirement; provided, however, that deductibles,
1182	1182	1151coinsurance or copayments shall be required if the applicable plan is governed by the federal
1183	1183	1152Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on
1184	1184	1153deductibles, coinsurance or copayments for these services. Coverage offered under this section
1185	1185	1154shall not impose unreasonable restrictions or delays in the coverage.
1186	1186	1155 SECTION 79. Said section 4I of said chapter 176G, as most recently amended by section
1187	1187	115631 of chapter 127 of the acts of 2022, is hereby amended by adding the following sentence:- 57 of 104
1188	1188	1157 The commissioner shall ensure plan compliance with this section.
1189	1189	1158 SECTION 80. Sections 1 to 11, inclusive, shall apply to all policies, contracts and
1190	1190	1159certificates of health insurance subject to chapters 32A, 118E, 175, 176A, 176B and 176G of the
1191	1191	1160General Laws that are delivered, issued or renewed 6 months from the effective date of this act.
1192	1192	1161 SECTION 81. (A) There is hereby created in the department of job and family services
1193	1193	1162the Massachusetts commission on fatherhood. The commission shall consist of the following
1194	1194	1163members:
1195	1195	1164 (1) (a) Four members of the house of representatives appointed by the speaker of the
1196	1196	1165house, not more than two of whom are members of the same political party. Two of the members
1197	1197	1166must be from legislative districts that include a county or part of a county that is among the one-
1198	1198	1167third of counties in this state with the highest number per capita of households headed by
1199	1199	1168females.
1200	1200	1169 (b) Two members of the senate appointed by the president of the senate, each from a
1201	1201	1170different political party. One of the members must be from a legislative district that includes a
1202	1202	1171county or part of a county that is among the one-third of counties in this state with the highest
1203	1203	1172number per capita of households headed by females.
1204	1204	1173 (2) The governor, or the governor's designee;
1205	1205	1174 (3) One representative of the judicial branch of government appointed by the chief justice
1206	1206	1175of the supreme court;
1207	1207	1176 (4) The directors of health, job and family services, rehabilitation and correction, and
1208	1208	1177youth services and the superintendent of public instruction, or their designees; 58 of 104
1209	1209	1178 (5) Two representative of the Massachusetts family and children first cabinet council
1210	1210	1179created under section 121.37 of the Revised Code appointed by the chairperson of the council;
1211	1211	1180 (6) Five representatives of the general public appointed by the governor. These members
1212	1212	1181shall have extensive experience in issues related to fatherhood.
1213	1213	1182 (B) The appointing authorities of the Massachusetts commission on fatherhood shall
1214	1214	1183make initial appointments to the commission within thirty days after the effective date of this
1215	1215	1184section. Of the initial appointments to the commission made pursuant to divisions (A)(3), (5),
1216	1216	1185and (6) of this section, three of the members shall serve a term of one year and four shall serve a
1217	1217	1186term of two years. Members so appointed subsequently shall serve two-year terms. A member
1218	1218	1187appointed pursuant to division (A)(I) of this section shall serve on the commission until the end
1219	1219	1188of the general assembly from which the member was appointed or until the member ceases to
1220	1220	1189serve in the chamber of the general assembly in which the member serves at the time of
1221	1221	1190appointment, whichever occurs first. The governor or the governor's designee shall serve on the
1222	1222	1191commission until the governor ceases to be governor. The directors and superintendent or their
1223	1223	1192designees shall serve on the commission until they cease, or the director or superintendent a
1224	1224	1193designee represents ceases, to be director or superintendent. Each member shall serve on the
1225	1225	1194commission from the date of appointment until the end of the term for which the member was
1226	1226	1195appointed. Members may be reappointed.
1227	1227	1196 Vacancies shall be filled in the manner provided for original appointments. Any member
1228	1228	1197appointed to fill a vacancy occurring prior to the expiration date of the term for which the
1229	1229	1198member's predecessor was appointed shall serve on the commission for the remainder of that
1230	1230	1199term. A member shall continue to serve on the commission subsequent to the expiration date of 59 of 104
1231	1231	1200the member's term until the member's successor is appointed or until a period of sixty days has
1232	1232	1201elapsed, whichever occurs first. Members shall serve without compensation but shall be
1233	1233	1202reimbursed for necessary expenses
1234	1234	1203 SECTION 82. Chapter 32A of the General Laws, is hereby amended by inserting after
1235	1235	1204section 30 the following section:-
1236	1236	1205 Section 31. The commission shall provide to any active or retired employee of the
1237	1237	1206commonwealth who is insured under the group insurance commission coverage for the universal
1238	1238	1207postpartum home visiting program administered by the department of public health. Such
1239	1239	1208coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and
1240	1240	1209shall not be subject to any deductible.
1241	1241	1210 SECTION 83. Chapter 111 is hereby amended by adding after Section 243 the following
1242	1242	1211section:-
1243	1243	1212 Section 244. (a) For the purposes of this section, the following words shall have the
1244	1244	1213following meanings:-
1245	1245	1214 “Department”, the department of public health.
1246	1246	1215 “Provider”, an entity or individual that provides universal postpartum home visiting
1247	1247	1216services.
1248	1248	1217 “Programs”, entities or providers qualified by the department of public health to provide
1249	1249	1218universal postpartum home visiting services.
1250	1250	1219 “Universal postpartum home visiting services”, evidence-based, voluntary home or
1251	1251	1220community-based services for birthing people and caregivers with newborns, regardless of age, 60 of 104
1252	1252	1221income, number of children, or other criteria. Services shall be delivered by a qualified health
1253	1253	1222professional with maternal and child health training, as defined by the department of public
1254	1254	1223health, during at least one visit in the family’s home or a mutually agreed upon location within
1255	1255	1224eight weeks postpartum, and one follow-up visit no later than three months after the first visit.
1256	1256	1225Services shall include, but not be limited to, screenings for unmet health needs including
1257	1257	1226reproductive health services, maternal and infant nutritional needs, substance use, emotional
1258	1258	1227health including postpartum depression personal safety/domestic violence; clinical assessment of
1259	1259	1228the birthing person and infant; brief intervention; education and support; referrals to community
1260	1260	1229resources, such as breastfeeding supports; and follow up phone calls.
1261	1261	1230 (b) The department shall establish and administer a statewide system of programs
1262	1262	1231providing universal postpartum home visiting services. The department shall be the lead agency
1263	1263	1232for the coordination of all government funding, both state and federal, for such programs. The
1264	1264	1233department may contract with agencies, individuals or groups for the provision of such services,
1265	1265	1234subject to appropriation. The department shall begin implementation of the universal newborn
1266	1266	1235nurse home visiting program first in those communities with the greatest inequities in maternal
1267	1267	1236health outcomes, as identified by the department. The department shall scale up the program to
1268	1268	1237achieve universal, statewide access within six years of the passage of this act.
1269	1269	1238 (c) In designing the program designed in subsection (b) of this section, the department
1270	1270	1239shall consult, coordinate, and collaborate, as necessary, with insurers that offer health benefit
1271	1271	1240plans in the commonwealth, MassHealth officials, hospitals, local public health departments,
1272	1272	1241birthing centers, existing early childhood home visiting programs, community-based
1273	1273	1242organizations, and social service providers. 61 of 104
1274	1274	1243 (d) A provider of universal postpartum home visiting services shall determine whether
1275	1275	1244any recipient for whom it provides said services are or may be eligible for coverage of said
1276	1276	1245services through an alternative source. The department is the payer of last resort, and a provider
1277	1277	1246shall request payment for services it provides from third-party payers pursuant to chapters 32A,
1278	1278	1247118E, 175, 176A, 176B, or 176G of the General Laws, before payment is requested from the
1279	1279	1248department.
1280	1280	1249 (e) The department shall collect and analyze data generated by the program to monitor
1281	1281	1250and assess the effectiveness of universal postpartum home visiting services. The department shall
1282	1282	1251work with other state agencies to develop protocols for sharing data, including the timely sharing
1283	1283	1252of data with primary care providers of care to the families with newborns receiving the services.
1284	1284	1253Programs which are in receipt of state or federal funding for said services shall report such
1285	1285	1254information as requested by the department for the purpose of monitoring, assessing the
1286	1286	1255effectiveness of such programs, initiating quality improvement, and reducing health disparities.
1287	1287	1256 SECTION 84. Chapter 118E of the General Laws, is hereby amended by inserting after
1288	1288	1257section 10N the following section:-
1289	1289	1258 Section 10O. The division and its contracted managed care organizations, accountable
1290	1290	1259care organizations, health plans, integrated care organizations, third-party administrators, or
1291	1291	1260other entities contracting with the division to administer benefits, shall provide coverage for
1292	1292	1261universal postpartum home visiting services, in accordance with operational standards set by the
1293	1293	1262department of public health pursuant to section 244 of chapter 111 of the General Laws. Such
1294	1294	1263coverage shall not be subject to any cost-sharing. 62 of 104
1295	1295	1264 SECTION 85. Chapter 175 of the General Laws, is hereby amended by inserting after
1296	1296	1265section 47PP the following section:-
1297	1297	1266 Section 47QQ. An individual policy of accident and sickness insurance issued pursuant to
1298	1298	1267section 108 that provides hospital expense and surgical expense insurance or a group blanket or
1299	1299	1268general policy of accident and sickness insurance issued pursuant to section 110 that provides
1300	1300	1269hospital expense and surgical expense insurance that is issued or renewed within the
1301	1301	1270commonwealth shall provide coverage for universal postpartum home visiting services, in
1302	1302	1271accordance with operational standards set by the department of public health pursuant to section
1303	1303	1272244 of chapter 111 of the General Laws. Such coverage shall not be subject to any cost-sharing,
1304	1304	1273including co-payments and co-insurance, and shall not be subject to any deductible; provided,
1305	1305	1274however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is
1306	1306	1275governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result
1307	1307	1276of the prohibition on co-payments, coinsurance or deductibles for these services.
1308	1308	1277 SECTION 86. Chapter 176A of the General Laws, is hereby amended by inserting after
1309	1309	1278section 8KK the following section:-
1310	1310	1279 Section 8LL. Any contract between a subscriber and the corporation under an individual
1311	1311	1280or group hospital service plan which is delivered, issued or renewed within the commonwealth
1312	1312	1281 shall provide coverage for universal postpartum home visiting services, in accordance
1313	1313	1282with operational standards set by the department of public health pursuant to section 244 of
1314	1314	1283chapter 111 of the General Laws. Such coverage shall not be subject to any cost-sharing,
1315	1315	1284including co-payments and co-insurance, and shall not be subject to any deductible; provided,
1316	1316	1285however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is 63 of 104
1317	1317	1286governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result
1318	1318	1287of the prohibition on co-payments, coinsurance or deductibles for these services.
1319	1319	1288 SECTION 87. Chapter 176B of the General Laws, is hereby amended by inserting after
1320	1320	1289section 4KK the following section:-
1321	1321	1290 Section 4LL. Any subscription certificate under an individual or group medical service
1322	1322	1291agreement delivered, issued or renewed within the commonwealth shall provide coverage for
1323	1323	1292universal postpartum home visiting services, in accordance with operational standards set by the
1324	1324	1293department of public health pursuant to section 244 of chapter 111 of the General Laws. Such
1325	1325	1294coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and
1326	1326	1295shall not be subject to any deductible; provided, however, that co-payments, coinsurance or
1327	1327	1296deductibles shall be required if the applicable plan is governed by the Federal Internal Revenue
1328	1328	1297Code and would lose its tax-exempt status as a result of the prohibition on co-payments,
1329	1329	1298coinsurance or deductibles for these services.
1330	1330	1299 SECTION 88. Chapter 176G of the General Laws, is hereby amended by inserting after
1331	1331	1300section 4KK the following section:-
1332	1332	1301 Section 4LL. Any individual or group health maintenance contract that is issued or
1333	1333	1302renewed within the commonwealth shall provide coverage for universal postpartum home
1334	1334	1303visiting services, in accordance with operational standards set by the department of public health
1335	1335	1304pursuant to section 244 of chapter 111 of the General Laws. Such coverage shall not be subject
1336	1336	1305to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any
1337	1337	1306deductible; provided, however, that co-payments, coinsurance or deductibles shall be required if
1338	1338	1307the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax- 64 of 104
1339	1339	1308exempt status as a result of the prohibition on co-payments, coinsurance or deductibles for these
1340	1340	1309services.
1341	1341	1310 SECTION 89. Chapter 32A of the General Laws, is hereby amended by inserting after
1342	1342	1311section 30 the following section:-
1343	1343	1312 Section 31. The commission shall provide to any active or retired employee of the
1344	1344	1313commonwealth who is insured under the group insurance commission coverage for the universal
1345	1345	1314postpartum home visiting program administered by the department of public health. Such
1346	1346	1315coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and
1347	1347	1316shall not be subject to any deductible.
1348	1348	1317 SECTION 90. Chapter 111 is hereby amended by adding after Section 243 the following
1349	1349	1318section:-
1350	1350	1319 Section 244. (a) For the purposes of this section, the following words shall have the
1351	1351	1320following meanings:-
1352	1352	1321 “Department”, the department of public health.
1353	1353	1322 “Provider”, an entity or individual that provides universal postpartum home visiting
1354	1354	1323services.
1355	1355	1324 “Programs”, entities or providers qualified by the department of public health to provide
1356	1356	1325universal postpartum home visiting services.
1357	1357	1326 “Universal postpartum home visiting services”, evidence-based, voluntary home or
1358	1358	1327community-based services for birthing people and caregivers with newborns, regardless of age,
1359	1359	1328income, number of children, or other criteria. Services shall be delivered by a qualified health 65 of 104
1360	1360	1329professional with maternal and child health training, as defined by the department of public
1361	1361	1330health, during at least one visit in the family’s home or a mutually agreed upon location within
1362	1362	1331eight weeks postpartum, and one follow-up visit no later than three months after the first visit.
1363	1363	1332Services shall include, but not be limited to, screenings for unmet health needs including
1364	1364	1333reproductive health services, maternal and infant nutritional needs, substance use, emotional
1365	1365	1334health including postpartum depression personal safety/domestic violence; clinical assessment of
1366	1366	1335the birthing person and infant; brief intervention; education and support; referrals to community
1367	1367	1336resources, such as breastfeeding supports; and follow up phone calls.
1368	1368	1337 (b) The department shall establish and administer a statewide system of programs
1369	1369	1338providing universal postpartum home visiting services. The department shall be the lead agency
1370	1370	1339for the coordination of all government funding, both state and federal, for such programs. The
1371	1371	1340department may contract with agencies, individuals or groups for the provision of such services,
1372	1372	1341subject to appropriation. The department shall begin implementation of the universal newborn
1373	1373	1342nurse home visiting program first in those communities with the greatest inequities in maternal
1374	1374	1343health outcomes, as identified by the department. The department shall scale up the program to
1375	1375	1344achieve universal, statewide access within six years of the passage of this act.
1376	1376	1345 (c) In designing the program designed in subsection (b) of this section, the department
1377	1377	1346shall consult, coordinate, and collaborate, as necessary, with insurers that offer health
1378	1378	1347 benefit plans in the commonwealth, MassHealth officials, hospitals, local public health
1379	1379	1348departments, birthing centers, existing early childhood home visiting programs, community-
1380	1380	1349based organizations, and social service providers. 66 of 104
1381	1381	1350 (d) A provider of universal postpartum home visiting services shall determine whether
1382	1382	1351any recipient for whom it provides said services are or may be eligible for coverage of said
1383	1383	1352services through an alternative source. The department is the payer of last resort, and a provider
1384	1384	1353shall request payment for services it provides from third-party payers pursuant to chapters 32A,
1385	1385	1354118E, 175, 176A, 176B, or 176G of the General Laws, before payment is requested from the
1386	1386	1355department.
1387	1387	1356 (e) The department shall collect and analyze data generated by the program to monitor
1388	1388	1357and assess the effectiveness of universal postpartum home visiting services. The department shall
1389	1389	1358work with other state agencies to develop protocols for sharing data, including the timely sharing
1390	1390	1359of data with primary care providers of care to the families with newborns receiving the services.
1391	1391	1360Programs which are in receipt of state or federal funding for said services shall report such
1392	1392	1361information as requested by the department for the purpose of monitoring, assessing the
1393	1393	1362effectiveness of such programs, initiating quality improvement, and reducing health disparities.
1394	1394	1363 SECTION 91. Chapter 118E of the General Laws, is hereby amended by inserting after
1395	1395	1364section 10N the following section:-
1396	1396	1365 Section 10O. The division and its contracted managed care organizations, accountable
1397	1397	1366care organizations, health plans, integrated care organizations, third-party administrators, or
1398	1398	1367other entities contracting with the division to administer benefits, shall provide coverage for
1399	1399	1368universal postpartum home visiting services, in accordance with operational standards set by the
1400	1400	1369department of public health pursuant to section 244 of chapter 111 of the General Laws. Such
1401	1401	1370coverage shall not be subject to any cost-sharing. 67 of 104
1402	1402	1371 SECTION 92. Chapter 175 of the General Laws, is hereby amended by inserting after
1403	1403	1372section 47PP the following section:-
1404	1404	1373 Section 47QQ. An individual policy of accident and sickness insurance issued pursuant to
1405	1405	1374section 108 that provides hospital expense and surgical expense insurance or a group blanket or
1406	1406	1375general policy of accident and sickness insurance issued pursuant to section 110 that provides
1407	1407	1376hospital expense and surgical expense insurance that is issued or renewed within the
1408	1408	1377commonwealth shall provide coverage for universal postpartum home visiting services, in
1409	1409	1378accordance with operational standards set by the department of public health pursuant to section
1410	1410	1379244 of chapter 111 of the General Laws. Such coverage shall not be subject to any cost-sharing,
1411	1411	1380including co-payments and co-insurance, and shall not be subject to any deductible; provided,
1412	1412	1381however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is
1413	1413	1382governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result
1414	1414	1383of the prohibition on co-payments, coinsurance or deductibles for these services.
1415	1415	1384 SECTION 93. Chapter 176A of the General Laws, is hereby amended by inserting after
1416	1416	1385section 8KK the following section:-
1417	1417	1386 Section 8LL. Any contract between a subscriber and the corporation under an individual
1418	1418	1387or group hospital service plan which is delivered, issued or renewed within the commonwealth
1419	1419	1388 shall provide coverage for universal postpartum home visiting services, in accordance
1420	1420	1389with operational standards set by the department of public health pursuant to section 244 of
1421	1421	1390chapter 111 of the General Laws. Such coverage shall not be subject to any cost-sharing,
1422	1422	1391including co-payments and co-insurance, and shall not be subject to any deductible; provided,
1423	1423	1392however, that co-payments, coinsurance or deductibles shall be required if the applicable plan is 68 of 104
1424	1424	1393governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result
1425	1425	1394of the prohibition on co-payments, coinsurance or deductibles for these services.
1426	1426	1395 SECTION 94. Chapter 176B of the General Laws, is hereby amended by inserting after
1427	1427	1396section 4KK the following section:-
1428	1428	1397 Section 4LL. Any subscription certificate under an individual or group medical service
1429	1429	1398agreement delivered, issued or renewed within the commonwealth shall provide coverage for
1430	1430	1399universal postpartum home visiting services, in accordance with operational standards set by the
1431	1431	1400department of public health pursuant to section 244 of chapter 111 of the General Laws. Such
1432	1432	1401coverage shall not be subject to any cost-sharing, including co-payments and co-insurance, and
1433	1433	1402shall not be subject to any deductible; provided, however, that co-payments, coinsurance or
1434	1434	1403deductibles shall be required if the applicable plan is governed by the Federal Internal Revenue
1435	1435	1404Code and would lose its tax-exempt status as a result of the prohibition on co-payments,
1436	1436	1405coinsurance or deductibles for these services.
1437	1437	1406 SECTION 95. Chapter 176G of the General Laws, is hereby amended by inserting after
1438	1438	1407section 4KK the following section:-
1439	1439	1408 Section 4LL. Any individual or group health maintenance contract that is issued or
1440	1440	1409renewed within the commonwealth shall provide coverage for universal postpartum home
1441	1441	1410visiting services, in accordance with operational standards set by the department of public health
1442	1442	1411pursuant to section 244 of chapter 111 of the General Laws. Such coverage shall not be subject
1443	1443	1412to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any
1444	1444	1413deductible; provided, however, that co-payments, coinsurance or deductibles shall be required if
1445	1445	1414the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax- 69 of 104
1446	1446	1415exempt status as a result of the prohibition on co-payments, coinsurance or deductibles for these
1447	1447	1416services.
1448	1448	1417 SECTION 96. Only free-standing and hospital-affiliated birth centers licensed pursuant
1449	1449	1418to 105 CMR 140.000 and 105 CMR 142.000 shall use the terms birth center or birthing center in
1450	1450	1419their clinic's name.
1451	1451	1420 SECTION 97. (a) In General. —Beginning on the date that is 6 months after the date of
1452	1452	1421enactment of this Act, and annually thereafter, in each State that receives a grant under subpart 1
1453	1453	1422of part E of title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151
1454	1454	1423et seq.) (commonly referred to as the “Edward Byrne Memorial Justice Grant Program”) and that
1455	1455	1424does not have in effect throughout the State for such fiscal year laws restricting the use of
1456	1456	1425restraints on pregnant individuals in prison that are substantially similar to the rights, procedures,
1457	1457	1426requirements, effects, and penalties set forth in section 4322 of title 18, United States Code, the
1458	1458	1427amount of such grant that would otherwise be allocated to such State under such subpart for the
1459	1459	1428fiscal year shall be decreased by 25 percent.
1460	1460	1429 (b) Reallocation.—Amounts not allocated to a State for failure to comply with subsection
1461	1461	1430(a) shall be reallocated in accordance with subpart 1 of part E of title I of the Omnibus Crime
1462	1462	1431Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) to States that have complied with
1463	1463	1432such subsection.
1464	1464	1433 SECTION 98. (a) In General. —Not later than 1 year after the date of enactment of this
1465	1465	1434Act, the Attorney General, acting through the Director of the Bureau of Prisons, shall establish,
1466	1466	1435in not fewer than 6 Bureau of Prisons facilities, programs to optimize maternal health outcomes 70 of 104
1467	1467	1436for pregnant and postpartum individuals incarcerated in such facilities. The Attorney General
1468	1468	1437shall establish such programs in consultation with stakeholders such as—
1469	1469	1438 (1) relevant community-based organizations, particularly organizations that represent
1470	1470	1439incarcerated and formerly incarcerated individuals and organizations that seek to improve
1471	1471	1440maternal health outcomes for pregnant and postpartum individuals from racial and ethnic
1472	1472	1441minority groups;
1473	1473	1442 (2) relevant organizations representing patients, with a particular focus on patients from
1474	1474	1443racial and ethnic minority groups;
1475	1475	1444 (3) organizations representing maternity care providers and maternal health care
1476	1476	1445education programs;
1477	1477	1446 (4) perinatal health workers; and
1478	1478	1447 (5) researchers and policy experts in fields related to maternal health care for incarcerated
1479	1479	1448individuals.
1480	1480	1449 (b) Start Date.—Each selected facility shall begin facility programs not later than 18
1481	1481	1450months after the date of enactment of this Act.
1482	1482	1451 (c) Facility Priority.—In carrying out subsection (a), the Director shall give priority to a
1483	1483	1452facility based on—
1484	1484	1453 (1) the number of pregnant and postpartum individuals incarcerated in such facility and,
1485	1485	1454among such individuals, the number of pregnant and postpartum individuals from racial and
1486	1486	1455ethnic minority groups; and 71 of 104
1487	1487	1456 (2) the extent to which the leaders of such facility have demonstrated a commitment to
1488	1488	1457developing exemplary programs for pregnant and postpartum individuals incarcerated in such
1489	1489	1458facility.
1490	1490	1459 (d) Program Duration.—The programs established under this section shall be for a 5-year
1491	1491	1460period.
1492	1492	1461 (e) Programs.—Bureau of Prisons facilities selected by the Director shall establish
1493	1493	1462programs for pregnant and postpartum incarcerated individuals, and such programs may—
1494	1494	1463 (1) provide access to perinatal health workers from pregnancy through the postpartum
1495	1495	1464period;
1496	1496	1465 (2) provide access to healthy foods and counseling on nutrition, recommended activity
1497	1497	1466levels, and safety measures throughout pregnancy;
1498	1498	1467 (3) train correctional officers to ensure that pregnant incarcerated individuals receive safe
1499	1499	1468and respectful treatment;
1500	1500	1469 (4) train medical personnel to ensure that pregnant incarcerated individuals receive
1501	1501	1470trauma-informed, culturally congruent care that promotes the health and safety of the pregnant
1502	1502	1471individuals;
1503	1503	1472 (5) provide counseling and treatment for individuals who have suffered from—
1504	1504	1473 (A) diagnosed mental or behavioral health conditions, including trauma and substance
1505	1505	1474use disorders;
1506	1506	1475 (B) trauma or violence, including domestic violence; 72 of 104
1507	1507	1476 (C) human immunodeficiency virus;
1508	1508	1477 (D) sexual abuse;
1509	1509	1478 (E) pregnancy or infant loss; or
1510	1510	1479 (F) chronic conditions;
1511	1511	1480 (6) provide evidence-based pregnancy and childbirth education, parenting support, and
1512	1512	1481other relevant forms of health literacy;
1513	1513	1482 (7) provide clinical education opportunities to maternity care providers in training to
1514	1514	1483expand pathways into maternal health care careers serving incarcerated individuals;
1515	1515	1484 (8) offer opportunities for postpartum individuals to maintain contact with the
1516	1516	1485individual’s newborn child to promote bonding, including enhanced visitation policies, access to
1517	1517	1486prison nursery programs, or breastfeeding support;
1518	1518	1487 (9) provide reentry assistance, particularly to—
1519	1519	1488 (A) ensure access to health insurance coverage and transfer of health records to
1520	1520	1489community providers if an incarcerated individual exits the criminal justice system during such
1521	1521	1490individual’s pregnancy or in the postpartum period; and
1522	1522	1491 (B) connect individuals exiting the criminal justice system during pregnancy or in the
1523	1523	1492postpartum period to community-based resources, such as referrals to health care providers,
1524	1524	1493substance use disorder treatments, and social services that address social determinants maternal
1525	1525	1494of health; or 73 of 104
1526	1526	1495 (10) establish partnerships with local public entities, private community entities,
1527	1527	1496community-based organizations, Indian Tribes and tribal organizations (as such terms are
1528	1528	1497defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C.
1529	1529	14985304)), and urban Indian organizations (as such term is defined in section 4 of the Indian Health
1530	1530	1499Care Improvement Act (25 U.S.C. 1603)) to establish or expand pretrial diversion programs as
1531	1531	1500an alternative to incarceration for pregnant and postpartum individuals. Such programs may
1532	1532	1501include—
1533	1533	1502 (A) evidence-based childbirth education or parenting classes;
1534	1534	1503 (B) prenatal health coordination;
1535	1535	1504 (C) family and individual counseling;
1536	1536	1505 (D) evidence-based screenings, education, and, as needed, treatment for mental and
1537	1537	1506behavioral health conditions, including drug and alcohol treatments;
1538	1538	1507 (E) family case management services;
1539	1539	1508 (F) domestic violence education and prevention;
1540	1540	1509 (G) physical and sexual abuse counseling; and
1541	1541	1510 (H) programs to address social determinants of health such as employment, housing,
1542	1542	1511education, transportation, and nutrition.
1543	1543	1512 (f) Implementation And Reporting.—A selected facility shall be responsible for—
1544	1544	1513 (1) implementing programs, which may include the programs described in subsection (e);
1545	1545	1514and 74 of 104
1546	1546	1515 (2) not later than 3 years after the date of enactment of this Act, and 6 years after the date
1547	1547	1516of enactment of this Act, reporting results of the programs to the Director, including information
1548	1548	1517describing—
1549	1549	1518 (A) relevant quantitative indicators of success in improving the standard of care and
1550	1550	1519health outcomes for pregnant and postpartum incarcerated individuals in the facility, including
1551	1551	1520data stratified by race, ethnicity, sex, gender, age, geography, disability status, the category of
1552	1552	1521the criminal charge against such individual, rates of pregnancy-related deaths, pregnancy-
1553	1553	1522associated deaths, cases of infant mortality and morbidity, rates of preterm births and low-
1554	1554	1523birthweight births, cases of severe maternal morbidity, cases of violence against pregnant or
1555	1555	1524postpartum individuals, diagnoses of maternal mental or behavioral health conditions, and other
1556	1556	1525such information as appropriate;
1557	1557	1526 (B) relevant qualitative and quantitative evaluations from pregnant and postpartum
1558	1558	1527incarcerated individuals who participated in such programs, including measures of patient-
1559	1559	1528reported experience of care; and
1560	1560	1529 (C) strategies to sustain such programs after fiscal year 2026 and expand such programs
1561	1561	1530to other facilities.
1562	1562	1531 (g) Report.—Not later than 6 years after the date of enactment of this Act, the Director
1563	1563	1532shall submit to the Attorney General and to the Congress a report describing the results of the
1564	1564	1533programs funded under this section.
1565	1565	1534 (h) Oversight.—Not later than 1 year after the date of enactment of this Act, the Attorney
1566	1566	1535General shall award a contract to an independent organization or independent organizations to
1567	1567	1536conduct oversight of the programs described in subsection (e). 75 of 104
1568	1568	1537 (i) Authorization Of Appropriations.—There is authorized to be appropriated to carry out
1569	1569	1538this section $10,000,000 for each of fiscal years 2022 through 2026.
1570	1570	1539 SECTION 99. (a) Establishment.—Not later than 1 year after the date of enactment of
1571	1571	1540this Act, the Attorney General, acting through the Director of the Bureau of Justice Assistance,
1572	1572	1541shall award Justice for Incarcerated Moms grants to States to establish or expand programs in
1573	1573	1542State and local prisons and jails for pregnant and postpartum incarcerated individuals. The
1574	1574	1543Attorney General shall award such grants in consultation with stakeholders such as—
1575	1575	1544 (1) relevant community-based organizations, particularly organizations that represent
1576	1576	1545incarcerated and formerly incarcerated individuals and organizations that seek to improve
1577	1577	1546maternal health outcomes for pregnant and postpartum individuals from racial and ethnic
1578	1578	1547minority groups;
1579	1579	1548 (2) relevant organizations representing patients, with a particular focus on patients from
1580	1580	1549racial and ethnic minority groups;
1581	1581	1550 (3) organizations representing maternity care providers and maternal health care
1582	1582	1551education programs;
1583	1583	1552 (4) perinatal health workers; and
1584	1584	1553 (5) researchers and policy experts in fields related to maternal health care for incarcerated
1585	1585	1554individuals.
1586	1586	1555 (b) Applications.—Each applicant for a grant under this section shall submit to the
1587	1587	1556Director of the Bureau of Justice Assistance an application at such time, in such manner, and
1588	1588	1557containing such information as the Director may require. 76 of 104
1589	1589	1558 (c) Use Of Funds.—A State that is awarded a grant under this section shall use such grant
1590	1590	1559to establish or expand programs for pregnant and postpartum incarcerated individuals, and such
1591	1591	1560programs may —
1592	1592	1561 (1) provide access to perinatal health workers from pregnancy through the post-partum
1593	1593	1562period;
1594	1594	1563 (2) provide access to healthy foods and counseling on nutrition, recommended activity
1595	1595	1564levels, and safety measures throughout pregnancy;
1596	1596	1565 (3) train correctional officers to ensure that pregnant incarcerated individuals receive safe
1597	1597	1566and respectful treatment;
1598	1598	1567 (4) train medical personnel to ensure that pregnant incarcerated individuals receive
1599	1599	1568trauma-informed, culturally congruent care that promotes the health and safety of the pregnant
1600	1600	1569individuals;
1601	1601	1570 (5) provide counseling and treatment for individuals who have suffered from—
1602	1602	1571 (A) diagnosed mental or behavioral health conditions, including trauma and substance
1603	1603	1572use disorders;
1604	1604	1573 (B) trauma or violence, including domestic violence;
1605	1605	1574 (C) human immunodeficiency virus;
1606	1606	1575 (D) sexual abuse;
1607	1607	1576 (E) pregnancy or infant loss; or 77 of 104
1608	1608	1577 (F) chronic conditions;
1609	1609	1578 (6) provide evidence-based pregnancy and childbirth education, parenting support, and
1610	1610	1579other relevant forms of health literacy;
1611	1611	1580 (7) provide clinical education opportunities to maternity care providers in training to
1612	1612	1581expand pathways into maternal health care careers serving incarcerated individuals;
1613	1613	1582 (8) offer opportunities for postpartum individuals to maintain contact with the
1614	1614	1583individual’s newborn child to promote bonding, including enhanced visitation policies, access to
1615	1615	1584prison nursery programs, or breastfeeding support;
1616	1616	1585 (9) provide reentry assistance, particularly to—
1617	1617	1586 (A) ensure access to health insurance coverage and transfer of health records to
1618	1618	1587community providers if an incarcerated individual exits the criminal justice system during such
1619	1619	1588individual’s pregnancy or in the postpartum period; and
1620	1620	1589 (B) connect individuals exiting the criminal justice system during pregnancy or in the
1621	1621	1590postpartum period to community-based resources, such as referrals to health care providers,
1622	1622	1591substance use disorder treatments, and social services that address social determinants of
1623	1623	1592maternal health; or
1624	1624	1593 (10) establish partnerships with local public entities, private community entities,
1625	1625	1594community-based organizations, Indian Tribes and tribal organizations (as such terms are
1626	1626	1595defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C.
1627	1627	15965304)), and urban Indian organizations (as such term is defined in section 4 of the Indian Health
1628	1628	1597Care Improvement Act (25 U.S.C. 1603)) to establish or expand pretrial diversion programs as 78 of 104
1629	1629	1598an alternative to incarceration for pregnant and postpartum individuals. Such programs may
1630	1630	1599include—
1631	1631	1600 (A) evidence-based childbirth education or parenting classes;
1632	1632	1601 (B) prenatal health coordination;
1633	1633	1602 (C) family and individual counseling;
1634	1634	1603 (D) evidence-based screenings, education, and, as needed, treatment for mental and
1635	1635	1604behavioral health conditions, including drug and alcohol treatments;
1636	1636	1605 (E) family case management services;
1637	1637	1606 (F) domestic violence education and prevention;
1638	1638	1607 (G) physical and sexual abuse counseling; and
1639	1639	1608 (H) programs to address social determinants of health such as employment, housing,
1640	1640	1609education, transportation, and nutrition.
1641	1641	1610 (d) Priority.—In awarding grants under this section, the Director of the Bureau of Justice
1642	1642	1611Assistance shall give priority to applicants based on—
1643	1643	1612 (1) the number of pregnant and postpartum individuals incarcerated in the State and,
1644	1644	1613among such individuals, the number of pregnant and postpartum individuals from racial and
1645	1645	1614ethnic minority groups; and 79 of 104
1646	1646	1615 (2) the extent to which the State has demonstrated a commitment to developing
1647	1647	1616exemplary programs for pregnant and postpartum individuals incarcerated in the prisons and jails
1648	1648	1617in the State.
1649	1649	1618 (e) Grant Duration. —A grant awarded under this section shall be for a 5-year period.
1650	1650	1619 (f) Implementing And Reporting.—A State that receives a grant under this section shall
1651	1651	1620be responsible for—
1652	1652	1621 (1) implementing the program funded by the grant; and
1653	1653	1622 (2) not later than 3 years after the date of enactment of this Act, and 6 years after the date
1654	1654	1623of enactment of this Act, reporting results of such program to the Attorney General, including
1655	1655	1624information describing—
1656	1656	1625 (A) relevant quantitative indicators of the program’s success in improving the standard of
1657	1657	1626care and health outcomes for pregnant and postpartum incarcerated individuals in the facility,
1658	1658	1627including data stratified by race, ethnicity, sex, gender, age, geography, disability status,
1659	1659	1628category of the criminal charge against such individual, incidence rates of pregnancy-related
1660	1660	1629deaths, pregnancy-associated deaths, cases of infant mortality and morbidity, rates of preterm
1661	1661	1630births and low-birthweight births, cases of severe maternal morbidity, cases of violence against
1662	1662	1631pregnant or postpartum individuals, diagnoses of maternal mental or behavioral health
1663	1663	1632conditions, and other such information as appropriate;
1664	1664	1633 (B) relevant qualitative and quantitative evaluations from pregnant and postpartum
1665	1665	1634incarcerated individuals who participated in such programs, including measures of patient-
1666	1666	1635reported experience of care; and 80 of 104
1667	1667	1636 (C) strategies to sustain such programs beyond the duration of the grant and expand such
1668	1668	1637programs to other facilities.
1669	1669	1638 (g) Report.—Not later than 6 years after the date of enactment of this Act, the Attorney
1670	1670	1639General shall submit to the Congress a report describing the results of such grant programs.
1671	1671	1640 (h) Oversight.—Not later than 1 year after the date of enactment of this Act, the Attorney
1672	1672	1641General shall award a contract to an independent organization or independent organizations to
1673	1673	1642conduct oversight of the programs described in subsection (c).
1674	1674	1643 (i) Authorization Of Appropriations.—There is authorized to be appropriated to carry out
1675	1675	1644this section $10,000,000 for each of fiscal years 2022 through 2026.
1676	1676	1645 SECTION 100. (a) In General.—Not later than 2 years after the date of enactment of this
1677	1677	1646Act, the Comptroller General of the United States shall submit to Congress a report on adverse
1678	1678	1647maternal and infant health outcomes among incarcerated individuals and infants born to such
1679	1679	1648individuals, with a particular focus on racial and ethnic disparities in maternal and infant health
1680	1680	1649outcomes for incarcerated individuals.
1681	1681	1650 (b) Contents Of Report.—The report described in this section shall include—
1682	1682	1651 (1) to the extent practicable—
1683	1683	1652 (A) the number of pregnant individuals who are incarcerated in Bureau of Prisons
1684	1684	1653facilities;
1685	1685	1654 (B) the number of incarcerated individuals, including those incarcerated in Federal, State,
1686	1686	1655and local correctional facilities, who have experienced a pregnancy-related death, pregnancy-
1687	1687	1656associated death, or the death of an infant in the most recent 10 years of available data; 81 of 104
1688	1688	1657 (C) the number of cases of severe maternal morbidity among incarcerated individuals,
1689	1689	1658including those incarcerated in Federal, State, and local detention facilities, in the most recent 10
1690	1690	1659years of available data;
1691	1691	1660 (D) the number of preterm and low-birthweight births of infants born to incarcerated
1692	1692	1661individuals, including those incarcerated in Federal, State, and local correctional facilities, in the
1693	1693	1662most recent 10 years of available data; and
1694	1694	1663 (E) statistics on the racial and ethnic disparities in maternal and infant health outcomes
1695	1695	1664and severe maternal morbidity rates among incarcerated individuals, including those incarcerated
1696	1696	1665in Federal, State, and local detention facilities;
1697	1697	1666 (2) in the case that the Comptroller General of the United States is unable determine the
1698	1698	1667information required in subparagraphs (A) through (C) of paragraph (1), an assessment of the
1699	1699	1668barriers to determining such information and recommendations for improvements in tracking
1700	1700	1669maternal health outcomes among incarcerated individuals, including those incarcerated in
1701	1701	1670Federal, State, and local detention facilities;
1702	1702	1671 (3) causes of adverse maternal health outcomes that are unique to incarcerated
1703	1703	1672individuals, including those incarcerated in Federal, State, and local detention facilities;
1704	1704	1673 (4) causes of adverse maternal health outcomes and severe maternal morbidity that are
1705	1705	1674unique to incarcerated individuals from racial and ethnic minority groups;
1706	1706	1675 (5) recommendations to reduce maternal mortality and severe maternal morbidity among
1707	1707	1676incarcerated individuals and to address racial and ethnic disparities in maternal health outcomes 82 of 104
1708	1708	1677for incarcerated individuals in Bureau of Prisons facilities and State and local prisons and jails;
1709	1709	1678and
1710	1710	1679 (6) such other information as may be appropriate to reduce the occurrence of adverse
1711	1711	1680maternal health outcomes among incarcerated individuals and to address racial and ethnic
1712	1712	1681disparities in maternal health outcomes for such individuals.
1713	1713	1682 SECTION 101. (a) In General.—Not later than 2 years after the date of enactment of this
1714	1714	1683Act, the Medicaid and CHIP Payment and Access Commission (referred to in this section as
1715	1715	1684“MACPAC”) shall publish a report on the implications of pregnant and postpartum incarcerated
1716	1716	1685individuals being ineligible for medical assistance under a State plan under title XIX of the
1717	1717	1686Social Security Act (42 U.S.C. 1396 et seq.) that contains the information described in
1718	1718	1687subsection.
1719	1719	1688 (b) Information Described.—For purposes of subsection (a), the information described in
1720	1720	1689this subsection includes —
1721	1721	1690 (1) information on the effect of ineligibility for medical assistance under a State plan
1722	1722	1691under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) on maternal health outcomes
1723	1723	1692for pregnant and postpartum incarcerated individuals, concentrating on the effects of such
1724	1724	1693ineligibility for pregnant and postpartum individuals from racial and ethnic minority groups; and
1725	1725	1694 (2) the potential implications on maternal health outcomes resulting from suspending
1726	1726	1695eligibility for medical assistance under a State plan under such title of such Act when a pregnant
1727	1727	1696or postpartum individual is incarcerated.
1728	1728	1697 SECTION 102. In this title, the following definitions apply: 83 of 104
1729	1729	1698 (1) ADVERSE MATERNAL AND INFANT HEALTH OUTCOMES. —The term
1730	1730	1699“adverse maternal and infant health outcomes” includes the outcomes of preterm birth, low birth
1731	1731	1700weight, stillbirth, infant or maternal mortality, and severe maternal morbidity.
1732	1732	1701 (2) INSTITUTION OF HIGHER EDUCATION.—The term “institution of higher
1733	1733	1702education” has the meaning given such term in section 101 of the Higher Education Act of 1965
1734	1734	1703(20 U.S.C. 1001).
1735	1735	1704 (3) MINORITY-SERVING INSTITUTION. —The term “minority-serving institution”
1736	1736	1705means an entity specified in any of paragraphs (1) through (7) of section 371(a) of the Higher
1737	1737	1706Education Act of 1965 (20 U.S.C. 1067q(a)).
1738	1738	1707 (4) RACIAL AND ETHNIC MINORITY GROUP.—The term “racial and ethnic
1739	1739	1708minority group” has the meaning given such term in section 1707(g) of the Public Health Service
1740	1740	1709Act (42 U.S.C. 300u–6(g)).
1741	1741	1710 (5) RISKS ASSOCIATED WITH CLIMATE CHANGE.—The term “risks associated
1742	1742	1711with climate change” includes risks associated with extreme heat, air pollution, extreme weather
1743	1743	1712events, and other environmental issues associated with climate change that can result in adverse
1744	1744	1713maternal and infant health outcomes.
1745	1745	1714 (6) STAKEHOLDER ORGANIZATION.—The term “stakeholder organization”
1746	1746	1715means—
1747	1747	1716 (A) a community-based organization with expertise in providing assistance to vulnerable
1748	1748	1717individuals; 84 of 104
1749	1749	1718 (B) a nonprofit organization with expertise in maternal or infant health or environmental
1750	1750	1719justice; and
1751	1751	1720 (C) a patient advocacy organization representing vulnerable individuals.
1752	1752	1721 (7) VULNERABLE INDIVIDUAL.—The term “vulnerable individual” means—
1753	1753	1722 (A) an individual who is pregnant;
1754	1754	1723 (B) an individual who was pregnant during any portion of the preceding 1-year period;
1755	1755	1724and
1756	1756	1725 (C) an individual under 3 years of age.
1757	1757	1726 SECTION 103. (a) In General.—Not later than 180 days after the date of the enactment
1758	1758	1727of this Act, the Secretary of Health and Human Services shall establish a grant program (in this
1759	1759	1728section referred to as the “Program”) to protect vulnerable individuals from risks associated with
1760	1760	1729climate change.
1761	1761	1730 (b) Grant Authority.—In carrying out the Program, the Secretary may award, on a
1762	1762	1731competitive basis, grants to 10 covered entities.
1763	1763	1732 (c) Applications.—To be eligible for a grant under the Program, a covered entity shall
1764	1764	1733submit to the Secretary an application at such time, in such form, and containing such
1765	1765	1734information as the Secretary may require, which shall include, at a minimum, a description of the
1766	1766	1735following:
1767	1767	1736 (1) Plans for the use of grant funds awarded under the Program and how patients and
1768	1768	1737stakeholder organizations were involved in the development of such plans. 85 of 104
1769	1769	1738 (2) How such grant funds will be targeted to geographic areas that have
1770	1770	1739disproportionately high levels of risks associated with climate change for vulnerable individuals.
1771	1771	1740 (3) How such grant funds will be used to address racial and ethnic disparities in—
1772	1772	1741 (A) adverse maternal and infant health outcomes; and
1773	1773	1742 (B) exposure to risks associated with climate change for vulnerable individuals.
1774	1774	1743 (4) Strategies to prevent an initiative assisted with such grant funds from causing—
1775	1775	1744 (A) adverse environmental impacts;
1776	1776	1745 (B) displacement of residents and businesses;
1777	1777	1746 (C) rent and housing price increases; or
1778	1778	1747 (D) disproportionate adverse impacts on racial and ethnic minority groups and other
1779	1779	1748underserved populations.
1780	1780	1749 (d) Selection Of Grant Recipients.—
1781	1781	1750 (1) TIMING.—Not later than 270 days after the date of the enactment of this Act, the
1782	1782	1751Secretary shall select the recipients of grants under the Program.
1783	1783	1752 (2) CONSULTATION. —In selecting covered entities for grants under the Program, the
1784	1784	1753Secretary shall consult with —
1785	1785	1754 (A) representatives of stakeholder organizations;
1786	1786	1755 (B) the Administrator of the Environmental Protection Agency; 86 of 104
1787	1787	1756 (C) the Administrator of the National Oceanic and Atmospheric Administration; and
1788	1788	1757 (D) from the Department of Health and Human Services—
1789	1789	1758 (i) the Deputy Assistant Secretary for Minority Health;
1790	1790	1759 (ii) the Administrator of the Centers for Medicare & Medicaid Services;
1791	1791	1760 (iii) the Administrator of the Health Resources and Services Administration;
1792	1792	1761 (iv) the Director of the National Institutes of Health; and
1793	1793	1762 (v) the Director of the Centers for Disease Control and Prevention.
1794	1794	1763 (3) PRIORITY.—In selecting a covered entity to be awarded a grant under the Program,
1795	1795	1764the Secretary shall give priority to covered entities that serve a county—
1796	1796	1765 (A) designated, or located in an area designated, as a nonattainment area pursuant to
1797	1797	1766section 107 of the Clean Air Act (42 U.S.C. 7407) for any air pollutant for which air quality
1798	1798	1767criteria have been issued under section 108(a) of such Act (42 U.S.C. 7408(a));
1799	1799	1768 (B) with a level of vulnerability of moderate-to-high or higher, according to the Social
1800	1800	1769Vulnerability Index of the Centers for Disease Control and Prevention; or
1801	1801	1770 (C) with temperatures that pose a risk to human health, as determined by the Secretary, in
1802	1802	1771consultation with the Administrator of the National Oceanic and Atmospheric Administration
1803	1803	1772and the Chair of the United States Global Change Research Program, based on the best available
1804	1804	1773science. 87 of 104
1805	1805	1774 (4) LIMITATION.—A recipient of grant funds under the Program may not use such
1806	1806	1775grant funds to serve a county that is served by any other recipient of a grant under the Program.
1807	1807	1776 (e) Use Of Funds.—A covered entity awarded grant funds under the Program may only
1808	1808	1777use such grant funds for the following:
1809	1809	1778 (1) Initiatives to identify risks associated with climate change for vulnerable individuals
1810	1810	1779and to provide services and support to such individuals that address such risks, which may
1811	1811	1780include—
1812	1812	1781 (A) training for health care providers, doulas, and other employees in hospitals, birth
1813	1813	1782centers, midwifery practices, and other health care practices that provide prenatal or labor and
1814	1814	1783delivery services to vulnerable individuals on the identification of, and patient counseling
1815	1815	1784relating to, risks associated with climate change for vulnerable individuals;
1816	1816	1785 (B) hiring, training, or providing resources to community health workers and perinatal
1817	1817	1786health workers who can help identify risks associated with climate change for vulnerable
1818	1818	1787individuals, provide patient counseling about such risks, and carry out the distribution of relevant
1819	1819	1788services and support;
1820	1820	1789 (C) enhancing the monitoring of risks associated with climate change for vulnerable
1821	1821	1790individuals, including by—
1822	1822	1791 (i) collecting data on such risks in specific census tracts, neighborhoods, or other
1823	1823	1792geographic areas; and 88 of 104
1824	1824	1793 (ii) sharing such data with local health care providers, doulas, and other employees in
1825	1825	1794hospitals, birth centers, midwifery practices, and other health care practices that provide prenatal
1826	1826	1795or labor and delivery services to local vulnerable individuals; and
1827	1827	1796 (D) providing vulnerable individuals—
1828	1828	1797 (i) air conditioning units, residential weatherization support, filtration systems, household
1829	1829	1798appliances, or related items;
1830	1830	1799 (ii) direct financial assistance; and
1831	1831	1800 (iii) services and support, including housing and transportation assistance, to prepare for
1832	1832	1801or recover from extreme weather events, which may include floods, hurricanes, wildfires,
1833	1833	1802droughts, and related events.
1834	1834	1803 (2) Initiatives to mitigate levels of and exposure to risks associated with climate change
1835	1835	1804for vulnerable individuals, which shall be based on the best available science and which may
1836	1836	1805include initiatives to—
1837	1837	1806 (A) develop, maintain, or expand urban or community forestry initiatives and tree canopy
1838	1838	1807coverage initiatives;
1839	1839	1808 (B) improve infrastructure, including buildings and paved surfaces;
1840	1840	1809 (C) develop or improve community outreach networks to provide culturally and
1841	1841	1810linguistically appropriate information and notifications about risks associated with climate
1842	1842	1811change for vulnerable individuals; and 89 of 104
1843	1843	1812 (D) provide enhanced services to racial and ethnic minority groups and other underserved
1844	1844	1813populations.
1845	1845	1814 (f) Length Of Award.—A grant under this section shall be disbursed over 4 fiscal years.
1846	1846	1815 (g) Technical Assistance.—The Secretary shall provide technical assistance to a covered
1847	1847	1816entity awarded a grant under the Program to support the development, implementation, and
1848	1848	1817evaluation of activities funded with such grant.
1849	1849	1818 (h) Reports To Secretary.—
1850	1850	1819 (1) ANNUAL REPORT.—For each fiscal year during which a covered entity is
1851	1851	1820disbursed grant funds under the Program, such covered entity shall submit to the Secretary a
1852	1852	1821report that summarizes the activities carried out by such covered entity with such grant funds
1853	1853	1822during such fiscal year, which shall include a description of the following:
1854	1854	1823 (A) The involvement of stakeholder organizations in the implementation of initiatives
1855	1855	1824assisted with such grant funds.
1856	1856	1825 (B) Relevant health and environmental data, disaggregated, to the extent practicable, by
1857	1857	1826race, ethnicity, gender, and pregnancy status.
1858	1858	1827 (C) Qualitative feedback received from vulnerable individuals with respect to initiatives
1859	1859	1828assisted with such grant funds.
1860	1860	1829 (D) Criteria used in selecting the geographic areas assisted with such grant funds.
1861	1861	1830 (E) Efforts to address racial and ethnic disparities in adverse maternal and infant health
1862	1862	1831outcomes and in exposure to risks associated with climate change for vulnerable individuals. 90 of 104
1863	1863	1832 (F) Any negative and unintended impacts of initiatives assisted with such grant funds,
1864	1864	1833including—
1865	1865	1834 (i) adverse environmental impacts;
1866	1866	1835 (ii) displacement of residents and businesses;
1867	1867	1836 (iii) rent and housing price increases; and
1868	1868	1837 (iv) disproportionate adverse impacts on racial and ethnic minority groups and other
1869	1869	1838underserved populations.
1870	1870	1839 (G) How the covered entity will address and prevent any impacts described in
1871	1871	1840subparagraph (F).
1872	1872	1841 (2) PUBLICATION.—Not later than 30 days after the date on which a report is
1873	1873	1842submitted under paragraph (1), the Secretary shall publish such report on a public website of the
1874	1874	1843Department of Health and Human Services.
1875	1875	1844 (i) Report To Congress.—Not later than the date that is 5 years after the date on which
1876	1876	1845the Program is established, the Secretary shall submit to Congress and publish on a public
1877	1877	1846website of the Department of Health and Human Services a report on the results of the Program,
1878	1878	1847including the following:
1879	1879	1848 (1) Summaries of the annual reports submitted under subsection (h).
1880	1880	1849 (2) Evaluations of the initiatives assisted with grant funds under the Program.
1881	1881	1850 (3) An assessment of the effectiveness of the Program in — 91 of 104
1882	1882	1851 (A) identifying risks associated with climate change for vulnerable individuals;
1883	1883	1852 (B) providing services and support to such individuals;
1884	1884	1853 (C) mitigating levels of and exposure to such risks; and
1885	1885	1854 (D) addressing racial and ethnic disparities in adverse maternal and infant health
1886	1886	1855outcomes and in exposure to such risks.
1887	1887	1856 (4) A description of how the Program could be expanded, including—
1888	1888	1857 (A) monitoring efforts or data collection that would be required to identify areas with
1889	1889	1858high levels of risks associated with climate change for vulnerable individuals;
1890	1890	1859 (B) how such areas could be identified using the strategy developed under section 5; and
1891	1891	1860 (C) recommendations for additional funding.
1892	1892	1861 (j) Covered Entity Defined.—In this section, the term “covered entity” means a
1893	1893	1862consortium of organizations serving a county that—
1894	1894	1863 (1) shall include a community-based organization; and
1895	1895	1864 (2) may include—
1896	1896	1865 (A) another stakeholder organization;
1897	1897	1866 (B) the government of such county;
1898	1898	1867 (C) the governments of one or more municipalities within such county;
1899	1899	1868 (D) a State or local public health department or emergency management agency; 92 of 104
1900	1900	1869 (E) a local health care practice, which may include a licensed and accredited hospital,
1901	1901	1870birth center, midwifery practice, or other health care practice that provides prenatal or labor and
1902	1902	1871delivery services to vulnerable individuals;
1903	1903	1872 (F) an Indian tribe or tribal organization (as such terms are defined in section 4 of the
1904	1904	1873Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304));
1905	1905	1874 (G) an Urban Indian organization (as defined in section 4 of the Indian Health Care
1906	1906	1875Improvement Act (25 U.S.C. 1603)); and
1907	1907	1876 (H) an institution of higher education.
1908	1908	1877 (k) Authorization Of Appropriations. —There is authorized to be appropriated to carry out
1909	1909	1878this section $100,000,000 for the period of fiscal years 2022 through 2025.
1910	1910	1879 SECTION 104. (a) In General.—Not later than 1 year after the date of the enactment of
1911	1911	1880this Act, the Secretary of Health and Human Services shall establish a grant program (in this
1912	1912	1881section referred to as the “Program”) to provide funds to health profession schools to support the
1913	1913	1882development and integration of education and training programs for identifying and addressing
1914	1914	1883risks associated with climate change for vulnerable individuals.
1915	1915	1884 (b) Grant Authority.—In carrying out the Program, the Secretary may award, on a
1916	1916	1885competitive basis, grants to health profession schools.
1917	1917	1886 (c) Application.—To be eligible for a grant under the Program, a health profession school
1918	1918	1887shall submit to the Secretary an application at such time, in such form, and containing such
1919	1919	1888information as the Secretary may require, which shall include, at a minimum, a description of the
1920	1920	1889following: 93 of 104
1921	1921	1890 (1) How such health profession school will engage with vulnerable individuals, and
1922	1922	1891stakeholder organizations representing such individuals, in developing and implementing the
1923	1923	1892education and training programs supported by grant funds awarded under the Program.
1924	1924	1893 (2) How such health profession school will ensure that such education and training
1925	1925	1894programs will address racial and ethnic disparities in exposure to, and the effects of, risks
1926	1926	1895associated with climate change for vulnerable individuals.
1927	1927	1896 (d) Use Of Funds.—A health profession school awarded a grant under the Program shall
1928	1928	1897use the grant funds to develop, and integrate into the curriculum and continuing education of
1929	1929	1898such health profession school, education and training on each of the following:
1930	1930	1899 (1) Identifying risks associated with climate change for vulnerable individuals and
1931	1931	1900individuals with the intent to become pregnant.
1932	1932	1901 (2) How risks associated with climate change affect vulnerable individuals and
1933	1933	1902individuals with the intent to become pregnant.
1934	1934	1903 (3) Racial and ethnic disparities in exposure to, and the effects of, risks associated with
1935	1935	1904climate change for vulnerable individuals and individuals with the intent to become pregnant.
1936	1936	1905 (4) Patient counseling and mitigation strategies relating to risks associated with climate
1937	1937	1906change for vulnerable individuals.
1938	1938	1907 (5) Relevant services and support for vulnerable individuals relating to risks associated
1939	1939	1908with climate change and strategies for ensuring vulnerable individuals have access to such
1940	1940	1909services and support.
1941	1941	1910 (6) Implicit and explicit bias, racism, and discrimination. 94 of 104
1942	1942	1911 (7) Related topics identified by such health profession school based on the engagement of
1943	1943	1912such health profession school with vulnerable individuals and stakeholder organizations
1944	1944	1913representing such individuals.
1945	1945	1914 (e) Partnerships.—In carrying out activities with grant funds, a health profession school
1946	1946	1915awarded a grant under the Program may partner with one or more of the following:
1947	1947	1916 (1) A State or local public health department.
1948	1948	1917 (2) A health care professional membership organization.
1949	1949	1918 (3) A stakeholder organization.
1950	1950	1919 (4) A health profession school.
1951	1951	1920 (5) An institution of higher education.
1952	1952	1921 (f) Reports To Secretary.—
1953	1953	1922 (1) ANNUAL REPORT.—For each fiscal year during which a health profession school is
1954	1954	1923disbursed grant funds under the Program, such health profession school shall submit to the
1955	1955	1924Secretary a report that describes the activities carried out with such grant funds during such fiscal
1956	1956	1925year.
1957	1957	1926 (2) FINAL REPORT.—Not later than the date that is 1 year after the end of the last fiscal
1958	1958	1927year during which a health profession school is disbursed grant funds under the Program, the
1959	1959	1928health profession school shall submit to the Secretary a final report that summarizes the activities
1960	1960	1929carried out with such grant funds. 95 of 104
1961	1961	1930 (g) Report To Congress. —Not later than the date that is 6 years after the date on which
1962	1962	1931the Program is established, the Secretary shall submit to Congress and publish on a public
1963	1963	1932website of the Department of Health and Human Services a report that includes the following:
1964	1964	1933 (1) A summary of the reports submitted under subsection (f).
1965	1965	1934 (2) Recommendations to improve education and training programs at health profession
1966	1966	1935schools with respect to identifying and addressing risks associated with climate change for
1967	1967	1936vulnerable individuals.
1968	1968	1937 (h) Health Profession School Defined. —In this section, the term “health profession
1969	1969	1938school” means an accredited—
1970	1970	1939 (1) medical school;
1971	1971	1940 (2) school of nursing;
1972	1972	1941 (3) midwifery program;
1973	1973	1942 (4) physician assistant education program;
1974	1974	1943 (5) teaching hospital;
1975	1975	1944 (6) residency or fellowship program; or
1976	1976	1945 (7) other school or program determined appropriate by the Secretary.
1977	1977	1946 (i) Authorization Of Appropriations.—There is authorized to be appropriated to carry out
1978	1978	1947this section $5,000,000 for the period of fiscal years 2022 through 2025. 96 of 104
1979	1979	1948 SECTION 105. (a) Establishment.—Not later than one year after the date of the
1980	1980	1949enactment of this Act, the Director of the National Institutes of Health shall establish the
1981	1981	1950Consortium on Birth and Climate Change Research (in this section referred to as the
1982	1982	1951“Consortium”).
1983	1983	1952 (b) Duties.—
1984	1984	1953 (1) IN GENERAL. —The Consortium shall coordinate, across the institutes, centers, and
1985	1985	1954offices of the National Institutes of Health, research on the risks associated with climate change
1986	1986	1955for vulnerable individuals.
1987	1987	1956 (2) REQUIRED ACTIVITIES.—In carrying out paragraph (1), the Consortium shall—
1988	1988	1957 (A) establish research priorities, including by prioritizing research that—
1989	1989	1958 (i) identifies the risks associated with climate change for vulnerable individuals with a
1990	1990	1959particular focus on disparities in such risks among racial and ethnic minority groups and other
1991	1991	1960underserved populations; and
1992	1992	1961 (ii) identifies strategies to reduce levels of, and exposure to, such risks, with a particular
1993	1993	1962focus on risks among racial and ethnic minority groups and other underserved populations;
1994	1994	1963 (B) identify gaps in available data related to such risks;
1995	1995	1964 (C) identify gaps in, and opportunities for, research collaborations;
1996	1996	1965 (D) identify funding opportunities for community-based organizations and researchers
1997	1997	1966from racially, ethnically, and geographically diverse backgrounds; and 97 of 104
1998	1998	1967 (E) publish annual reports on the work and findings of the Consortium on a public
1999	1999	1968website of the National Institutes of Health.
2000	2000	1969 (c) Membership.—The Director shall appoint to the Consortium representatives of such
2001	2001	1970institutes, centers, and offices of the National Institutes of Health as the Director considers
2002	2002	1971appropriate, including, at a minimum, representatives of—
2003	2003	1972 (1) the National Institute of Environmental Health Sciences;
2004	2004	1973 (2) the National Institute on Minority Health and Health Disparities;
2005	2005	1974 (3) the Eunice Kennedy Shriver National Institute of Child Health and Human
2006	2006	1975Development;
2007	2007	1976 (4) the National Institute of Nursing Research; and
2008	2008	1977 (5) the Office of Research on Women’s Health.
2009	2009	1978 (d) Chairperson.—The Chairperson of the Consortium shall be designated by the Director
2010	2010	1979and selected from among the representatives appointed under subsection (c).
2011	2011	1980 (e) Consultation.— In carrying out the duties described in subsection (b), the Consortium
2012	2012	1981shall consult with—
2013	2013	1982 (1) the heads of relevant Federal agencies, including—
2014	2014	1983 (A) the Environmental Protection Agency;
2015	2015	1984 (B) the National Oceanic and Atmospheric Administration;
2016	2016	1985 (C) the Occupational Safety and Health Administration; and 98 of 104
2017	2017	1986 (D) from the Department of Health and Human Services—
2018	2018	1987 (i) the Office of Minority Health in the Office of the Secretary;
2019	2019	1988 (ii) the Centers for Medicare & Medicaid Services;
2020	2020	1989 (iii) the Health Resources and Services Administration;
2021	2021	1990 (iv) the Centers for Disease Control and Prevention;
2022	2022	1991 (v) the Indian Health Service; and
2023	2023	1992 (vi) the Administration for Children and Families; and
2024	2024	1993 (2) representatives of—
2025	2025	1994 (A) stakeholder organizations;
2026	2026	1995 (B) health care providers and professional membership organizations with expertise in
2027	2027	1996maternal health or environmental justice;
2028	2028	1997 (C) State and local public health departments;
2029	2029	1998 (D) licensed and accredited hospitals, birth centers, midwifery practices, or other health
2030	2030	1999care practices that provide prenatal or labor and delivery services to vulnerable individuals; and
2031	2031	2000 (E) institutions of higher education, including such institutions that are minority-serving
2032	2032	2001institutions or have expertise in maternal health or environmental justice.
2033	2033	2002 SECTION 106. (a) In General.—The Secretary of Health and Human Services, acting
2034	2034	2003through the Director of the Centers for Disease Control and Prevention, shall develop a strategy
2035	2035	2004(in this section referred to as the “Strategy”) for designating areas that the Secretary determines 99 of 104
2036	2036	2005to have a high risk of adverse maternal and infant health outcomes among vulnerable individuals
2037	2037	2006as a result of risks associated with climate change.
2038	2038	2007 (b) Strategy Requirements.—
2039	2039	2008 (1) IN GENERAL. —In developing the Strategy, the Secretary shall establish a process to
2040	2040	2009identify areas where vulnerable individuals are exposed to a high risk of adverse maternal and
2041	2041	2010infant health outcomes as a result of risks associated with climate change in conjunction with
2042	2042	2011other factors that can impact such health outcomes, including—
2043	2043	2012 (A) the incidence of diseases associated with air pollution, extreme heat, and other
2044	2044	2013environmental factors;
2045	2045	2014 (B) the availability and accessibility of maternal and infant health care providers;
2046	2046	2015 (C) English-language proficiency among women of reproductive age;
2047	2047	2016 (D) the health insurance status of women of reproductive age;
2048	2048	2017 (E) the number of women of reproductive age who are members of racial or ethnic
2049	2049	2018groups with disproportionately high rates of adverse maternal and infant health outcomes;
2050	2050	2019 (F) the socioeconomic status of women of reproductive age, including with respect to—
2051	2051	2020 (i) poverty;
2052	2052	2021 (ii) unemployment;
2053	2053	2022 (iii) household income; and
2054	2054	2023 (iv) educational attainment; and 100 of 104
2055	2055	2024 (G) access to quality housing, transportation, and nutrition.
2056	2056	2025 (2) RESOURCES. —In developing the Strategy, the Secretary shall identify, and
2057	2057	2026incorporate a description of, the following:
2058	2058	2027 (A) Existing mapping tools or Federal programs that identify—
2059	2059	2028 (i) risks associated with climate change for vulnerable individuals; and
2060	2060	2029 (ii) other factors that can influence maternal and infant health outcomes, including the
2061	2061	2030factors described in paragraph (1).
2062	2062	2031 (B) Environmental, health, socioeconomic, and demographic data relevant to identifying
2063	2063	2032risks associated with climate change for vulnerable individuals.
2064	2064	2033 (C) Existing monitoring networks that collect data described in subparagraph (B), and
2065	2065	2034any gaps in such networks.
2066	2066	2035 (D) Federal, State, and local stakeholders involved in maintaining monitoring networks
2067	2067	2036identified under subparagraph (C), and how such stakeholders are coordinating their monitoring
2068	2068	2037efforts.
2069	2069	2038 (E) Additional monitoring networks, and enhancements to existing monitoring networks,
2070	2070	2039that would be required to address gaps identified under subparagraph (C), including at the
2071	2071	2040subcounty and census tract level.
2072	2072	2041 (F) Funding amounts required to establish the monitoring networks identified under
2073	2073	2042subparagraph (E) and recommendations for Federal, State, and local coordination with respect to
2074	2074	2043such networks. 101 of 104
2075	2075	2044 (G) Potential uses for data collected and generated as a result of the Strategy, including
2076	2076	2045how such data may be used in determining recipients of grants under the program established by
2077	2077	2046section 2 or other similar programs.
2078	2078	2047 (H) Other information the Secretary considers relevant for the development of the
2079	2079	2048Strategy.
2080	2080	2049 (c) Coordination And Consultation.—In developing the Strategy, the Secretary shall—
2081	2081	2050 (1) coordinate with the Administrator of the Environmental Protection Agency and the
2082	2082	2051Administrator of the National Oceanic and Atmospheric Administration; and
2083	2083	2052 (2) consult with—
2084	2084	2053 (A) stakeholder organizations;
2085	2085	2054 (B) health care providers and professional membership organizations with expertise in
2086	2086	2055maternal health or environmental justice;
2087	2087	2056 (C) State and local public health departments;
2088	2088	2057 (D) licensed and accredited hospitals, birth centers, midwifery practices, or other health
2089	2089	2058care providers that provide prenatal or labor and delivery services to vulnerable individuals; and
2090	2090	2059 (E) institutions of higher education, including such institutions that are minority-serving
2091	2091	2060institutions or have expertise in maternal health or environmental justice.
2092	2092	2061 (d) Notice And Comment.—At least 240 days before the date on which the Strategy is
2093	2093	2062published in accordance with subsection (e), the Secretary shall provide— 102 of 104
2094	2094	2063 (1) notice of the Strategy on a public website of the Department of Health and Human
2095	2095	2064Services; and
2096	2096	2065 (2) an opportunity for public comment of at least 90 days.
2097	2097	2066 (e) Publication.—Not later than 18 months after the date of the enactment of this Act, the
2098	2098	2067Secretary shall publish on a public website of the Department of Health and Human Services—
2099	2099	2068 (1) the Strategy;
2100	2100	2069 (2) the public comments received under subsection (d); and
2101	2101	2070 (3) the responses of the Secretary to such public comments.
2102	2102	2071 SECTION 107. Create a temporary or permanent birthing justice steering committee that
2103	2103	2072closely resembles the 2020 Health Equity Task Force formed by the legislature to address the
2104	2104	2073impact of Covid 19. The tenants of that task force include: The Birthing Justice task force shall
2105	2105	2074include:
2106	2106	2075 ● 4 members appointed by the Senate President, not more than 2 shall be members
2107	2107	2076of the Senate
2108	2108	2077 ● 4 members Speaker of the house, not more than
2109	2109	2078 ● 2 of whom shall be members of the House of
2110	2110	2079 ● Representatives
2111	2111	2080 ● 1 member appointed by the minority leader of
2112	2112	2081 ● the Senate 103 of 104
2113	2113	2082 ● 1 member appointed by the minority leader of the House of Representatives
2114	2114	2083 ● The chair of the Massachusetts Asian-American
2115	2115	2084 ● Legislative Caucus or a designee
2116	2116	2085 ● The chair of the Massachusetts Black and Latino
2117	2117	2086 ● Legislative Caucus or a designee
2118	2118	2087 ● 2 Co-chairs of the Birthing Justice taskforce and the MA Women’s Caucus
2119	2119	2088 ● 4 residents who are recommended that work in birthing and reproductive justice
2120	2120	2089in the Commonwealth
2121	2121	2090 ● At least 2 members who have not been recommended by Senate President or
2122	2122	2091Speaker that served in the 2021 Special Commission on Racial Inequities in Maternal Health
2123	2123	2092 ● Steering Committee membership shall reflect diverse representation in the
2124	2124	2093commonwealth including, but not limited to, diverse cultures, races, ethnicities, languages,
2125	2125	2094disabilities, gender identities, sexual orientations, geographic locations and ages.
2126	2126	2095 ● Appointees of the Senate President, Speaker of the House, Minority Leader of the
2127	2127	2096Senate and Minority Leader of the House who are not members of the general court shall be
2128	2128	2097knowledgeable in public health or healthcare. When making appointments, the Senate President,
2129	2129	2098Speaker of the House, Minority Leader of the Senate and Minority Leader of the House shall
2130	2130	2099give consideration to individuals who have experience addressing disparities in underserved or
2131	2131	2100underrepresented populations based on culture, race, ethnicity, language, disability, gender
2132	2132	2101identity, sexual orientation, geographic location and age or who work in the healthcare system 104 of 104
2133	2133	2102with a diverse patient population. Two members of the task force shall be elected by a majority
2134	2134	2103of the task force membership to serve as co-chairs; provided, however, that neither member shall
2135	2135	2104be a member of the general court.
2136	2136	2105 ● The Steering Committee should consult with the Massachusetts Department of
2137	2137	2106Public Health (MDPH) to inform its work. MDPH shall provide requested information to the
2138	2138	2107task force whenever possible.
2139	2139	2108 ● The Steering Committee shall hold at least 2 public conversations to share and
2140	2140	2109accept public testimony regarding the birthing justice omnibus bill.