[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5163 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 5163
To facilitate support and services to women who find themselves with an
unexpected pregnancy, to meet the emotional, physical, social,
financial, and other needs women encounter during pregnancy,
childbirth, and child-rearing, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 3, 2021
Mr. Fortenberry (for himself, Ms. Salazar, Mrs. Wagner, Ms. Stefanik,
Ms. Cheney, Ms. Tenney, Mrs. Kim of California, Mr. Moore of Utah, Ms.
Malliotakis, and Miss Gonzalez-Colon) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committees on Ways and Means, Education and Labor,
Agriculture, the Judiciary, and Financial Services, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To facilitate support and services to women who find themselves with an
unexpected pregnancy, to meet the emotional, physical, social,
financial, and other needs women encounter during pregnancy,
childbirth, and child-rearing, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Care for Her
Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Sense of Congress.
Sec. 3. Definitions.
Sec. 4. Applicability of certain provisions.
Sec. 5. Religious and moral objections.
TITLE I--PREGNANCY AND PARENTING SUPPORT COLLABORATIVE
Sec. 101. Establishment.
Sec. 102. Pregnant and Parenting Women's Care Information Service.
Sec. 103. Education and training support.
Sec. 104. Toll-free number.
Sec. 105. Annual review of successful models.
Sec. 106. Recognizing successful workplace policies and practices.
Sec. 107. Public Health Service Act programs.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Sec. 201. Pregnancy and parenting support and services.
Sec. 202. Housing.
Sec. 203. Assessing outcomes and applying optimal incentives to improve
maternal and child health outcomes.
TITLE III--INTERNAL REVENUE SERVICE
Sec. 301. Child tax credit improvements.
SEC. 2. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) many women find themselves with an unexpected pregnancy
without knowledge of what resources might be available to them
at the local, State, and Federal levels to support emotional,
physical, social, financial, and other needs that they may
encounter during pregnancy, childbirth, and child-rearing;
(2) gaps exist in support and services provided throughout
communities;
(3) Federal and State governments, according to the Supreme
Court ruling in Harris v. McRae, 448 U.S. 297 (1980), have a
vested interest in assuring optimal support and outcomes for
women and their children, and this ruling supports the decided
interest of the United States Government to help a woman
through childbirth and child-rearing;
(4) women and communities alike have universally voiced the
need for safe, affordable, and supportive housing for expectant
mothers;
(5) maternity housing needs in rural and urban communities
differ, and, as a result, community needs should be evaluated
and gaps filled where lack of housing support and services
exist;
(6) group housing has been shown to be valuable to improve
health outcomes;
(7) institutions of higher education should provide
information regarding resources available for parenting and
pregnant students;
(8) communities should work together to provide support and
services, and fulfill unmet needs of pregnant and parenting
students;
(9) expectant mothers begin to provide for their child as
soon as they come to learn of their pregnancy, and expenses may
include clothing, furniture, toys, and food, and, for this
reason, a child tax credit for women who are pregnant should be
applied;
(10) information on support and services available should
be readily available to women during pregnancy, birth, and
child-rearing;
(11) health care services are covered through various
insurances including the Medicaid program;
(12) linking health care services to broader support and
services for a mother and her child, including housing,
nutrition, education, job training, job placement, and
childcare, is critical to help facilitate a woman through her
journey;
(13) a committed community of care working with State and
Federal governments has an opportunity to build comprehensive
support systems that improve pregnancy outcomes significantly;
(14) a community of care can help with--
(A) health care and material support;
(B) mentorship and parenting resources during
pregnancy and following the birth of a child;
(C) opportunities for completion of education,
employment, and job training;
(D) safe, affordable, and supportive housing during
pregnancy; and
(E) workplace and college campus accommodation,
including child care and lactation support; and
(15) to assure consistent access to information about
available support and services for a woman with an unexpected
pregnancy, to fill additional gaps that exist in support and
services, and to support expectant mothers, Congress proposes--
(A) a new Federal-State entity to assure all
parties are satisfied with the context of support and
services;
(B) a clearinghouse with geographically relevant
programs for women seeking support during pregnancy;
(C) an assessment of gaps within support and
services;
(D) an assessment and sharing of successful models
in local, State, and Federal programs;
(E) provision of grants to support certain services
such as maternity housing, mentorship programs, job-
training programs, and childcare;
(F) engagement with women who have experienced
available support and services to understand what
services are useful and gaps that exist in services and
support;
(G) an annual report from the Department of Health
and Human Services on successes and opportunities for
improvement;
(H) a pregnancy child tax credit; and
(I) establishing new incentives structures to
improve maternal and child outcomes.
SEC. 3. DEFINITIONS.
In this Act:
(1) The terms ``Collaborative'' and ``State Pregnancy
Collaborative'' mean the Pregnancy Support Collaborative
established under section 101.
(2) The terms ``pregnancy and parenting support and
services'' and ``pregnancy or parenting support or services''
refer to support or services, as applicable, offered during or
after pregnancy to pregnant women or new mothers in order to
help such women to alleviate the physical, financial, social,
emotional, and other difficulties that may be encountered
during or after pregnancy, including the following:
(A) Material assistance, including maternity and
baby clothing, diapers and wipes, food supporting a
child's nutrition, baby furniture, and car seats.
(B) Housing for women and children.
(C) Provision of information on available resources
regarding pregnancy and childbirth, infant feeding,
time management, parenting special needs children, and
nutrition during and after pregnancy.
(D) Referrals for secondary and postsecondary
education, including with respect to vocational
training and community college, job training and
placement, housing, personal safety, food stamps,
adoption, and other governmental assistance.
(E) Wrap-around health care and social support
services for a woman carrying a child to term, and
neonatal care services.
(F) Access to nutrition programs for pregnant women
and mothers, including the program under section 17 of
the Child Nutrition Act of 1966 (42 U.S.C. 1786;
commonly known as ``WIC''), the program under section 4
of the Food and Nutrition Act of 2008 (7 U.S.C. 2013;
commonly known as ``SNAP''), the consolidated block
grants for Puerto Rico and American Samoa under section
19 of the Food and Nutrition Act of 2008 (7 U.S.C.
2028), and similar programs for the Commonwealth of the
Northern Mariana Islands.
(G) Legal services, including pro bono, to assist
women who wish to give birth and parents with newborn
children.
(H) Childcare services.
(I) Pursuing collection of child support and
alimony from uncooperative parents.
(J) Services to assist parents--
(i) to care for, and prepare to care for, a
newborn, including a newborn with Down syndrome
or another prenatally diagnosed condition or
disability; and
(ii) to facilitate the adoption of such
children according to the desire of the mother.
(K) Life-skills mentoring, including to enhance the
following competencies:
(i) Strengthening capacities for fostering
long-term relationships with others.
(ii) Communication and conflict management.
(iii) Decision-making and relationship-
building skills prior to marriage.
(iv) High-risk behavior awareness.
(L) Life-skills counseling.
(M) Mammograms and services for postpartum
depression treatment.
(N) Provision of any of the services identified in
subparagraphs (A) through (M) through pregnancy support
centers.
(3) The term ``Secretary'' means the Secretary of Health
and Human Services.
(4) The term ``State'' includes, in addition to the several
States, the District of Columbia, and each territory or
possession of the United States.
SEC. 4. APPLICABILITY OF CERTAIN PROVISIONS.
Sections 506 and 507 of division A of the Further Consolidated
Appropriations Act, 2020 (Public Law 116-94; 133 Stat. 2534, 2606-2607)
apply with respect to any funds made available to carry out this Act to
the same extent and in the same manner as such sections apply with
respect to funds appropriated to carry out such division A.
SEC. 5. RELIGIOUS AND MORAL OBJECTIONS.
A provider, including a faith-based provider, that is otherwise
eligible to be listed in the clearinghouse under section 102, or to
receive assistance under this Act--
(1) shall not be required, as a condition of such listing
or receiving such assistance, to endorse, utilize, make a
referral to, become integrated with, or otherwise participate
in any program or activity to which the provider has a
religious or moral objection; and
(2) shall not be discriminated against in the solicitation
or issuance of grants, contracts, or cooperative agreements
under this Act for refusing to meet any requirement described
in paragraph (1).
TITLE I--PREGNANCY AND PARENTING SUPPORT COLLABORATIVE
SEC. 101. ESTABLISHMENT.
(a) In General.--The Secretary shall establish within the
Department of Health and Human Services a Federal-State collaborative,
to be known as the Pregnancy Support Collaborative.
(b) Membership.--The members of the Collaborative shall consist of
the following:
(1) The Secretary (or the Secretary's designee), who shall
serve as the chair of the Collaborative.
(2) The chief executive officer of each State that chooses
to participate in the Collaborative (or the chief executive
officer's designee).
(c) Staff; Single Point of Contact; Federal Experts.--The
Secretary--
(1) shall assign to the Collaborative such personnel as the
Secretary determines appropriate to assist the Collaborative in
carrying out its duties under this Act;
(2) from among the personnel assigned pursuant to paragraph
(1), shall designate an Executive Director of the
Collaborative;
(3) may request that Federal departments and agencies
detail relevant experts to the Collaborative to assist the
Collaborative in carrying out its duties under this Act; and
(4) on an annual basis, shall publish a list of the members
of the Collaborative.
(d) Two-Thirds Vote Required.--The Collaborative may not take any
action or make any recommendation or decision unless such action,
decision, or recommendation is authorized by a vote of at least two-
thirds of the members of the Collaborative.
(e) Responsibilities.--The Collaborative shall--
(1) work with States and localities to learn about existing
successful models for pregnancy and parenting support and
services;
(2) on an annual basis, submit a report to the Congress--
(A) describing the activities of the Collaborative,
the funds expended on such activities, and the results
achieved through such activities; and
(B) recommending--
(i) how to fill gaps experienced by women
who have benefited from pregnancy and parenting
support and services; and
(ii) how to maintain and expand Federal
funding levels for pregnancy and parenting
support and services;
(3) develop and maintain the Pregnant and Parenting Women's
Care Information Service, in accordance with section 102;
(4) provide educational support in accordance with section
103;
(5) provide for a toll-free number in accordance with
section 104;
(6) conduct an annual review of nationwide successful
models in accordance with section 105; and
(7) recognize successful workplace policies and practices
in accordance with section 106.
(f) Avoiding Duplication of Effort.--The Collaborative shall, where
possible, avoid duplicating the programs and activities of other
entities.
SEC. 102. PREGNANT AND PARENTING WOMEN'S CARE INFORMATION SERVICE.
(a) In General.--The Collaborative shall develop and maintain a
comprehensive, publicly accessible, and user-friendly clearinghouse to
be known as the Pregnant and Parenting Women's Care Information Service
(in this section referred to as the ``clearinghouse'') to serve as a
consolidated source of information on qualified public and private
service providers that provide pregnancy and parenting support and
services, including in low-income, urban, suburban, and rural areas.
(b) Identification of Providers, Support, and Services.--The
Collaborative--
(1) shall request that each State identify, and enter into
a template provided by the Collaborative, each provider,
support, and service in the State to be included in the
clearinghouse; and
(2) shall not include in the clearinghouse any provider,
support, or service in a State unless the State involved has
requested pursuant to paragraph (1) (and not withdrawn its
request) to include such provider, support, or service in the
clearinghouse.
(c) Qualified Providers.--For a provider to be qualified to be
listed in the clearinghouse--
(1) the provider shall have been engaged in providing
pregnancy or parenting support or services for mothers and
infants for a minimum of 3 consecutive years; and
(2) pregnancy support or services for mothers and infants
shall be the primary focus of the provider's work.
(d) Input.--In developing and maintaining the clearinghouse, the
Collaborative shall seek the input of--
(1) qualified experts involved in providing pregnancy and
parenting support and services; and
(2) relevant State officials.
(e) Contents.--Subject to subsections (b)(2) and (c), the
clearinghouse shall include each of the following:
(1) A complete list of Federal, State, and local programs
that provide pregnancy and parenting support and services.
(2) A rating system that allows clients to rate qualified
providers of pregnancy and parenting support and services after
receiving such services.
(3) Information on qualified providers of pregnancy and
parenting resources, including--
(A) contact information;
(B) years in service;
(C) qualifications;
(D) references;
(E) women's ratings under the system under
paragraph (2); and
(F) links to the providers' websites.
(4) Information on the education and training opportunities
identified pursuant to section 103.
SEC. 103. EDUCATION AND TRAINING SUPPORT.
(a) In General.--The Collaborative, in collaboration with State and
local governments, shall--
(1) identify, assess, and increase understanding and
awareness of--
(A) appropriate education and training
opportunities to ensure that women have access to all
available programs, funding, and support to maximize
their employment opportunities; and
(B) specific supports and services for women during
pregnancy, nursing, and child-rearing; and
(2) direct individuals to information on such
opportunities, and such supports and services, in a manner that
is geographically relevant.
(b) Support for Students.--The Collaborative shall work with
secondary schools, institutions of higher education, and other entities
providing education or job training to maximize support within the
learning setting, including with respect to--
(1) childcare services, family housing, health insurance
(for students and their families), flexible academic scheduling
(such as telecommuting programs), parenting classes and
programs, and postpartum counseling and support groups;
(2) access to locations designated for breastfeeding within
the learning setting;
(3) identifying scholarships, financial and in-kind
resources, grants, and loans for which such students may be
eligible;
(4) job placement and apprenticeship;
(5) working with employers to optimize work site support
for child care and breastfeeding, transportation, or other
services to assist a mother to achieve successful employment;
and
(6) options for tele-education.
(c) Provision of Information.--As a condition on receipt of Federal
funds for providing education or job training, an entity shall agree to
provide to the Collaborative such information as the Collaborative may
request on education and training opportunities for purposes of
carrying out subsections (a) and (b).
SEC. 104. TOLL-FREE NUMBER.
If approved by a vote of at least two-thirds of the members of the
Collaborative, as described in section 101(d), the Collaborative shall
enter into a contract, through the use of competitive procedures, with
an entity to establish and operate a toll-free number to provide women
with referrals for obtaining pregnancy and parenting support and
services, including services to support mental and emotional health.
SEC. 105. ANNUAL REVIEW OF SUCCESSFUL MODELS.
(a) Annual Review.--The Collaborative shall conduct an annual
review of nationwide successful models in women's pregnancy and
parenting support and services.
(b) Input.--In conducting each annual review under subsection (a),
the Collaborative shall--
(1) gather input from qualified providers listed in the
clearinghouse under section 102 and qualified experts referred
to in section 102(d), including such providers and experts
from--
(A) State and local governments;
(B) the private and faith-based sectors;
(C) prenatal and parenting care centers; and
(D) other qualified providers; and
(2) in gathering such input, encourage such qualified
providers and experts--
(A) to share information on successful models in
pregnancy and parenting support and services; and
(B) to identify and address--
(i) key burdens or adverse circumstances
facing pregnant women; and
(ii) the challenges for providers.
SEC. 106. RECOGNIZING SUCCESSFUL WORKPLACE POLICIES AND PRACTICES.
(a) In General.--The Collaborative shall--
(1) recognize employers that successfully implement
innovative policies and practices to meet the needs of pregnant
and parenting employees with respect to children below school
age;
(2) make recommendations regarding such innovative policies
and practices; and
(3) publicize such policies and practices that prove to be
successful.
(b) Policies and Practices.--The innovative policies and practices
referred to in subsection (a) may include--
(1) family friendly policies proposed by both employees and
the employer;
(2) childcare facilities;
(3) family cafeterias and separate areas for those who do
not have children and may prefer not to eat with other
families;
(4) small employer family leave policies not covered by the
Family and Medical Leave Act of 1993 (29 U.S.C. 2601 et seq.);
(5) paid family leave policies for larger employers with a
sliding scale for medium-sized companies;
(6) rooms set aside for mothers to breastfeed in comfort,
with refrigerators for the storage of breast milk;
(7) telecommuting and flexible work schedules for jobs that
do not require being on-site, and meeting times set for the
convenience of caregivers, implemented in a manner that is not
at the expense of traditional full-time employees; and
(8) establishment of a committee comprised of employers,
human resource staff, and employees at all levels to discuss
matters related to employer support for employees who are
pregnant or parenting.
SEC. 107. PUBLIC HEALTH SERVICE ACT PROGRAMS.
(a) Safe Motherhood.--Section 317K of the Public Health Service Act
(42 U.S.C. 247b-12) is amended--
(1) in subsection (a)(2), by adding at the end the
following:
``(E) Assessment of the role of the State Pregnancy
Collaborative in--
``(i) improving perinatal outcomes,
including maternal and infant morbidity and
mortality; and
``(ii) data collection for the community
shared savings accounts under section 203(c) of
the Care for Her Act.'';
(2) in subsection (b)(2)--
(A) in subparagraph (L), by striking ``and'' at the
end;
(B) in subparagraph (M), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following:
``(N) the prevention role of the State Pregnancy
Collaborative for mothers and children based on the
support of the whole community.'';
(3) by amending subsection (c)(3) to read as follows:
``(3) activities to promote community support services for
pregnant women, including providers listed in the clearinghouse
of the State Pregnancy Collaborative under section 102 of the
Care for Her Act; and''; and
(4) in subsection (e), by adding at the end the following:
``(4) The term `State Pregnancy Collaborative' has the
meaning given to that term in section 3 of the Care for Her
Act.''.
(b) Infant Mortality Grants.--Section 330(f) of the Public Health
Service Act (42 U.S.C. 254b(f)) is amended--
(1) in the matter before subparagraph (A) in paragraph (1),
by striking ``health centers'' each place it appears and
inserting ``health centers and providers listed in the
clearinghouse of the State Pregnancy Collaborative under
section 102 of the Care for Her Act (in this subsection
referred to as `listed providers')'';
(2) except in the matter before subparagraph (A) in
paragraph (1), by striking ``health centers'' each place it
appears and inserting ``health centers and listed providers'';
(3) by striking ``such centers'' each place it appears and
inserting ``such centers and providers'';
(4) by striking ``the health center'' each place it appears
and inserting ``the health center or listed provider'';
(5) by striking ``the center'' each place it appears and
inserting ``the center or listed provider''; and
(6) in paragraph (2)--
(A) by striking ``shall give priority to health
centers'' and inserting ``shall give priority to--
``(A) health centers'';
(B) by striking the period at the end and inserting
``; and''; and
(C) by adding at the end the following:
``(B) listed providers that offer support services
for a mother and infant as a known benefit for
improving pregnancy outcomes.''.
(c) Certain Services for Pregnant Women.--Section 330F(a)(1) of the
Public Health Service Act (42 U.S.C. 254c-6(a)(1)) is amended by
striking ``to train the designated staff of eligible health centers''
and inserting ``to train the designated staff of eligible health
centers and providers listed in the clearinghouse of the State
Pregnancy Collaborative under section 102 of the Care for Her Act''.
(d) Projects To Improve Maternal, Infant, and Child Health.--
(1) In general.--Section 399(a)(1) of the Public Health
Service Act (42 U.S.C. 280c-6(a)(1)) is amended by striking
``shall make grants to eligible entities to pay the Federal
share of the cost of providing'' and inserting ``shall make
grants to eligible entities, including providers listed in the
clearinghouse of the State Pregnancy Collaborative under
section 102 of the Care for Her Act, to pay the Federal share
of the cost of providing''.
(2) Requirement of status as medicaid provider.--Section
399(a)(3) of the Public Health Service Act (42 U.S.C. 280c-
6(a)(3)) is amended by inserting after ``only if, in the case
of any service under such paragraph that is covered in the
State plan approved under title XIX of the Social Security Act
for the State involved'' the following: ``, the State plan
includes providers listed in the clearinghouse of the State
Pregnancy Collaborative under section 102 of the Care for Her
Act, and''.
(3) Home visiting services for eligible families.--The
matter before paragraph (1) is section 399(b) of the Public
Health Service Act (42 U.S.C. 280c-6(b)) is amended by
inserting after ``directly or through arrangement with other
public or nonprofit private entities,'' the following:
``including providers listed in the clearinghouse of the State
Pregnancy Collaborative under section 102 of the Care for Her
Act,''.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
SEC. 201. PREGNANCY AND PARENTING SUPPORT AND SERVICES.
(a) Healthy Birth and Healthy Life Grants.--
(1) In general.--The Secretary, with the approval of the
Collaborative, may award grants to qualified providers listed
in the clearinghouse under section 102 to provide pregnancy and
parenting support and services.
(2) Supplement, not supplant.--The Secretary may award a
grant to a qualified provider under this subsection only if the
qualified provider agrees that the grant will be used to
supplement, and not supplant, pregnancy and parenting support
and services.
(b) Mentorship and Job Training Grants.--The Secretary, with the
approval of the Collaborative, shall award grants to qualified
providers listed in the clearinghouse under section 102 for the
exclusive purpose of providing mentorships or job training to pregnant
women and new mothers.
SEC. 202. HOUSING.
(a) Identification of Gaps.--The Secretary, with the approval of
the Collaborative, shall identify gaps in maternity housing within
rural and urban communities.
(b) Grants.--The Secretary, with approval of the Collaborative,
shall award grants to qualified public and private service providers
listed in the clearinghouse under section 102 for addressing gaps in
maternity housing identified pursuant to subsection (a).
SEC. 203. ASSESSING OUTCOMES AND APPLYING OPTIMAL INCENTIVES TO IMPROVE
MATERNAL AND CHILD HEALTH OUTCOMES.
(a) Making Epidemiology and Health Encounter Data Relevant to
Maternal Child Health Improvement.--Beginning not later than April 1,
2022, the Secretary, acting through the Director of the Centers for
Disease Control and Prevention in collaboration with the Administrator
of the Centers for Medicare & Medicaid Services, in conjunction with
local programs supporting pregnant women, shall provide for the
maintenance of a database of deidentified epidemiological and claims
health information for the purpose of making such information available
in a useful and informative manner to participating communities in
participating States to assess the outcome impact of maternity homes in
improving pregnancy outcomes and reducing maternal mortality; and
improving infant mortality including reduction of preterm deliveries,
and low-birth-rate incidence. In carrying out this subsection, the
Secretary shall provide--
(1) for a mechanism that enables the integration of such
epidemiological and claims health information within the
Medicaid program under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.);
(2) that pregnancy and newborns will be assessed based on
clinical outcomes and costs related to the Medicaid program
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.);
(3) that such epidemiological and claims health information
is made available to participating States in a manner that
enables participating communities within such States to access
such information that is relevant to improving maternal child
health outcomes in such communities; and
(4) for a mechanism by which the Secretary, working in
collaboration with the Governor of the respective State of each
participating community, may--
(A) update such information specific to each
participating community, to the extent practicable, in
real-time or near real-time and as specified by the
Secretary;
(B) verify the validity of such information and the
validity of the changes in such information for each
such participating community over a specified period;
and
(C) assess and measure the extent of such changes
for each participating community, including--
(i) the amount of any reductions in
expenditures under the State plan under the
Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.); and
(ii) the extent to which such reductions
are attributable to such changes with respect
to each participating community.
(b) Localized Community Health Improvement Program Grants.--
(1) In general.--The Collaborative shall award grants to
States for purposes of carrying out localized community health
improvement programs described in paragraph (3).
(2) Application.--To be eligible for a grant under this
subsection, a State shall--
(A) submit to the Collaborative an application in
such manner, at such time, and containing such
information as specified by the Collaborative; and
(B) enter into an arrangement with the
Collaborative under which--
(i) the State agrees to establish and
maintain a localized community health
improvement program described in paragraph (3);
(ii) the Collaborative agrees to provide
the State with integrated epidemiological and
claims health information maintained in the
database established under subsection (a)
specific to each participating community within
the State;
(iii) the State and each participating
community in the State will assess the impact
of the localized community health improvement
program on outcomes, including reductions in
cost to the Medicaid program under title XIX of
the Social Security Act (42 U.S.C. 1396 et
seq.);
(iv) each participating community in the
State has a community shared savings board that
will establish and maintain a community shared
savings account in accordance with subsection
(c), including the terms listed in subsection
(c)(2);
(v) 70 percent of savings from health
improvements and cost reductions will be
verified by the Collaborative and transferred
to the community shared savings account of the
respective participating communities in
accordance with subsection (c)(2)(A); and
(vi) savings in a community shared savings
account will be used for pregnancy and
parenting support and services.
(3) Localized community health improvement program.--For
purposes of this section, a localized community health
improvement program of a State is a program under which the
State--
(A) maintains the integrated health information
provided to the State by the Collaborative pursuant to
the arrangement described in paragraph (2)(B);
(B) makes such information available to qualifying
communities (as defined in paragraph (4)) within such
State which request such information and agree to the
terms described in subsection (c), in a secure manner
and format that is most informative to such communities
in assisting such communities in analyzing and applying
such data to the specific needs of such communities to
reduce the rates of illness and reduce the costs of
health care within such communities;
(C) submits such data as is required by the
Collaborative to assess the extent to which the health
care interventions implemented to address needs of such
communities identified through the program are
affecting the rates of illness and costs of health care
within the State and communities within the State; and
(D) requires that in order for communities to
participate in such program, the communities agree--
(i) to provide for a secure method to make
such information available to health care and
other relevant community workers, including
through an interactive dashboard system; and
(ii) to submit such data as is required by
the State or Collaborative to assess the extent
to which health care interventions implemented
to address needs of such communities identified
through the program are affecting the rates of
illness and costs of health care within the
communities.
(c) Community Shared Savings Accounts.--
(1) In general.--For purposes of this section, a community
shared savings account shall, with respect to a participating
community within a participating State, be a trust created or
organized in the United States for the exclusive benefit of the
community, as defined by the community shared savings board for
such participating community, but only if the written governing
instrument creating the trust meets the following requirements:
(A) The trustee is--
(i) a bank (as defined in section 408(n) of
the Internal Revenue Code of 1986 (26 U.S.C.
408(n)); or
(ii) a person who demonstrates to the
satisfaction of the State that the manner in
which such person will administer the trust
will be consistent with the requirements of
this section.
(B) Withdrawals may only be made by the fiduciary
agent referred to in paragraph (3)(C) pursuant to a
plan--
(i) developed by the community; and
(ii) approved by the State and local
governments.
(2) Terms.--For purposes of subsection (b)(2)(B)(iv), the
terms described in this subsection, with respect to the
Collaborative, a participating State, and participating
communities within such State, are the following:
(A) In the case that the database maintained under
subsection (a), through the mechanism provided for
under subsection (a)(4), demonstrates for any specified
period (as determined by the Collaborative) that there
are verified reductions in expenditures under the State
plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.), which results in reductions in
expenditures by the Federal Government under such
title, and attributes such reductions to one or more of
the participating communities within such State, the
Collaborative shall transfer to the community shared
savings account established pursuant to subparagraph
(B) an amount equal to 70 percent of the amount of such
reduction so demonstrated for such specified period.
(B) The respective community shared savings board
establishes such a community shared savings account in
accordance with paragraph (1) for receipt of amounts
transferred pursuant to subparagraph (A).
(C) Each participating community in such State
shall--
(i) establish a community shared savings
board described in paragraph (3) that
determines how funds transferred to such
community under subparagraph (A) are to be used
for purposes of promoting the health and
wellness of pregnant women, new mothers, and
their children of such community; and
(ii) uses such funds only for such purposes
and in accordance with the uses determined by
such board.
(3) Community shared savings board.--For purposes of this
section, a community shared savings board, with respect to a
participating community within a participating State, shall be
a board--
(A) consisting of at least 7 members, appointed by
the governing officials of the community through a
process that is specified by the community (and
approved by the State), including--
(i) at least 1 member with public health
experience; and
(ii) members with business, civic,
educational, or faith-based experience;
(B) that is representative of the geographic
components that are included in the community; and
(C) that hires a fiduciary agent to manage a
community shared savings account on behalf of the
board.
(d) Definitions.--In this section:
(1) The term ``community shared savings account'' means a
community shared savings account meeting the criteria in
subsection (c)(1).
(2) The term ``community shared savings board'' means a
community shared savings board meeting the criteria of
subsection (c)(4).
(3) The term ``participating community'' means a qualifying
community that enters into an agreement with a participating
State as described in subsection (b)(3)(B).
(4) The term ``participating State'' means a State
receiving a grant under subsection (b)(1).
(5) The term ``qualifying community'' means a local
community--
(A) that has the capacity to assess health data,
including epidemiology and health encounter data, for a
census track or block that can be extrapolated into a
geographic information system to support analysis of
health outcomes; and
(B) whose geographic boundary corresponds to the
boundary of--
(i) a municipality;
(ii) a county; or
(iii) a high school feeder pattern.
TITLE III--INTERNAL REVENUE SERVICE
SEC. 301. CHILD TAX CREDIT IMPROVEMENTS.
(a) In General.--Section 24(c)(1) of the Internal Revenue Code of
1986 is amended by adding at the end the following new sentence: ``Such
term shall include a child of an eligible taxpayer for the taxable year
immediately preceding the year in which such child is born, if such
child is born alive on or before the due date of the return of tax for
such taxable year (not including extensions)''.
(b) Effective Date.--The amendment made by this section shall apply
to taxable years beginning after December 31, 2020.
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