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