; and (B) with respect to a State, during each quarter thereafter, 90 percent. . (6) Guidance on State options for Medicaid coverage of doula services Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue guidance for the States concerning options for Medicaid coverage and payment for support services provided by doulas. (7) Enhanced FMAP for rural obstetric and gynecological services Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ), as amended by paragraphs (1) and (5), is further amended— (A) in subsection (b), by striking and (ii) and inserting (ii), (jj), (kk), and (ll) ; and (B) by adding at the end the following new subsection: (ll) Increased FMAP for medical assistance for obstetric and gynecological services furnished at rural hospitals (1) In general Notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to amounts expended by such State for medical assistance for obstetric or gynecological services that are furnished in a hospital that is located in a rural area (as defined for purposes of section 1886) shall be equal to 90 percent for each calendar quarter beginning with the first calendar quarter during which this subsection is in effect. (2) Exclusion from territorial caps Any payment made to a territory for expenditures for medical assistance described in paragraph (1) that is subject to the Federal medical assistance percentage specified under paragraph (1) shall not be taken into account for purposes of applying payment limits under subsections (f) and (g) of section 1108. . (8) Effective dates (A) In general Subject to subparagraphs (B) and (C)— (i) the amendments made by paragraphs (1), (2), and (5) shall take effect on the first day of the first calendar quarter that begins on or after the date that is 1 year after the date of enactment of this Act; (ii) the amendments made by paragraph (3) shall take effect on the date of enactment of this Act