[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1212 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 1212
To end preventable maternal mortality and severe maternal morbidity in
the United States and close disparities in maternal health outcomes,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 23, 2021
Ms. Adams (for herself, Ms. Underwood, Mr. Khanna, Ms. Velazquez, Mrs.
McBath, Mr. Smith of Washington, Ms. Scanlon, Mr. Lawson of Florida,
Mrs. Hayes, Mr. Butterfield, Ms. Moore of Wisconsin, Ms. Strickland,
Mr. Ryan, Mr. Schiff, Mr. Johnson of Georgia, Mr. Horsford, Ms.
Wasserman Schultz, Ms. Barragan, Mr. Deutch, Mr. Blumenauer, Mr.
Moulton, Mr. Soto, Mr. Nadler, Mr. Trone, Ms. Clarke of New York, Ms.
Schakowsky, Ms. Bass, Ms. Pressley, Mr. Evans, Ms. Blunt Rochester, Ms.
Castor of Florida, Ms. Sewell, and Ms. Williams of Georgia) introduced
the following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To end preventable maternal mortality and severe maternal morbidity in
the United States and close disparities in maternal health outcomes,
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.
This Act may be cited as the ``Kira Johnson Act''.
SEC. 2. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE BLACK
MATERNAL HEALTH OUTCOMES.
(a) Awards.--Following the 1-year period described in subsection
(c), the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall award grants to eligible
entities to establish or expand programs to prevent maternal mortality
and severe maternal morbidity among Black pregnant and postpartum
individuals.
(b) Eligibility.--To be eligible to seek a grant under this
section, an entity shall be a community-based organization offering
programs and resources aligned with evidence-based practices for
improving maternal health outcomes for Black pregnant and postpartum
individuals.
(c) Outreach and Technical Assistance Period.--During the 1-year
period beginning on the date of enactment of this Act, the Secretary
shall--
(1) conduct outreach to encourage eligible entities to
apply for grants under this section; and
(2) provide technical assistance to eligible entities on
best practices for applying for grants under this section.
(d) Special Consideration.--
(1) Outreach.--In conducting outreach under subsection (c),
the Secretary shall give special consideration to eligible
entities that--
(A) are based in, and provide support for,
communities with high rates of adverse maternal health
outcomes or significant racial and ethnic disparities
in maternal health outcomes, to the extent such data
are available;
(B) are led by Black women; and
(C) offer programs and resources that are aligned
with evidence-based practices for improving maternal
health outcomes for Black pregnant and postpartum
individuals.
(2) Awards.--In awarding grants under this section, the
Secretary shall give special consideration to eligible entities
that--
(A) are described in subparagraphs (A), (B), and
(C) of paragraph (1);
(B) offer programs and resources designed in
consultation with and intended for Black pregnant and
postpartum individuals; and
(C) offer programs and resources in the communities
in which the respective eligible entities are located
that--
(i) promote maternal mental health and
maternal substance use disorder treatments and
supports that are aligned with evidence-based
practices for improving maternal mental and
behavioral health outcomes for Black pregnant
and postpartum individuals;
(ii) address social determinants of
maternal health for pregnant and postpartum
individuals;
(iii) promote evidence-based health
literacy and pregnancy, childbirth, and
parenting education for pregnant and postpartum
individuals;
(iv) provide support from perinatal health
workers to pregnant and postpartum individuals;
(v) provide culturally congruent training
to perinatal health workers;
(vi) conduct or support research on
maternal health issues disproportionately
impacting Black pregnant and postpartum
individuals;
(vii) provide support to family members of
individuals who suffered a pregnancy-associated
death or pregnancy-related death;
(viii) operate midwifery practices that
provide culturally congruent maternal health
care and support, including for the purposes
of--
(I) supporting additional
education, training, and certification
programs, including support for
distance learning;
(II) providing financial support to
current and future midwives to address
education costs, debts, and other
needs;
(III) clinical site investments;
(IV) supporting preceptor
development trainings;
(V) expanding the midwifery
practice; or
(VI) related needs identified by
the midwifery practice and described in
the practice's application; or
(ix) have developed other programs and
resources that address community-specific needs
for pregnant and postpartum individuals and are
aligned with evidence-based practices for
improving maternal health outcomes for Black
pregnant and postpartum individuals.
(e) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance on--
(1) capacity building to establish or expand programs to
prevent adverse maternal health outcomes among Black pregnant
and postpartum individuals;
(2) best practices in data collection, measurement,
evaluation, and reporting; and
(3) planning for sustaining programs to prevent maternal
mortality and severe maternal morbidity among Black pregnant
and postpartum individuals after the period of the grant.
(f) Evaluation.--Not later than the end of fiscal year 2026, the
Secretary shall submit to the Congress an evaluation of the grant
program under this section that--
(1) assesses the effectiveness of outreach efforts during
the application process in diversifying the pool of grant
recipients;
(2) makes recommendations for future outreach efforts to
diversify the pool of grant recipients for Department of Health
and Human Services grant programs and funding opportunities
related to maternal health;
(3) assesses the effectiveness of programs funded by grants
under this section in improving maternal health outcomes for
Black pregnant and postpartum individuals, to the extent
practicable; and
(4) makes recommendations for future Department of Health
and Human Services grant programs and funding opportunities
that deliver funding to community-based organizations that
provide programs and resources that are aligned with evidence-
based practices for improving maternal health outcomes for
Black pregnant and postpartum individuals.
(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for each of fiscal
years 2022 through 2026.
SEC. 3. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE
MATERNAL HEALTH OUTCOMES IN UNDERSERVED COMMUNITIES.
(a) Awards.--Following the 1-year period described in subsection
(c), the Secretary of Health and Human Services (in this section
referred to as the ``Secretary'') shall award grants to eligible
entities to establish or expand programs to prevent maternal mortality
and severe maternal morbidity among underserved groups.
(b) Eligibility.--To be eligible to seek a grant under this
section, an entity shall be a community-based organization offering
programs and resources aligned with evidence-based practices for
improving maternal health outcomes for pregnant and postpartum
individuals.
(c) Outreach and Technical Assistance Period.--During the 1-year
period beginning on the date of enactment of this Act, the Secretary
shall--
(1) conduct outreach to encourage eligible entities to
apply for grants under this section; and
(2) provide technical assistance to eligible entities on
best practices for applying for grants under this section.
(d) Special Consideration.--
(1) Outreach.--In conducting outreach under subsection (c),
the Secretary shall give special consideration to eligible
entities that--
(A) are based in, and provide support for,
communities with high rates of adverse maternal health
outcomes or significant racial and ethnic disparities
in maternal health outcomes, to the extent such data
are available;
(B) are led by individuals from racially,
ethnically, and geographically diverse backgrounds; and
(C) offer programs and resources that are aligned
with evidence-based practices for improving maternal
health outcomes for pregnant and postpartum
individuals.
(2) Awards.--In awarding grants under this section, the
Secretary shall give special consideration to eligible entities
that--
(A) are described in subparagraphs (A), (B), and
(C) of paragraph (1);
(B) offer programs and resources designed in
consultation with and intended for pregnant and
postpartum individuals from underserved groups; and
(C) offer programs and resources in the communities
in which the respective eligible entities are located
that--
(i) promote maternal mental health and
maternal substance use disorder treatments and
support that are aligned with evidence-based
practices for improving maternal mental and
behavioral health outcomes for pregnant and
postpartum individuals;
(ii) address social determinants of
maternal health for pregnant and postpartum
individuals;
(iii) promote evidence-based health
literacy and pregnancy, childbirth, and
parenting education for pregnant and postpartum
individuals;
(iv) provide support from perinatal health
workers to pregnant and postpartum individuals;
(v) provide culturally congruent training
to perinatal health workers;
(vi) conduct or support research on
maternal health outcomes and disparities;
(vii) provide support to family members of
individuals who suffered a pregnancy-associated
death or pregnancy-related death;
(viii) operate midwifery practices that
provide culturally congruent maternal health
care and support, including for the purposes
of--
(I) supporting additional
education, training, and certification
programs, including support for
distance learning;
(II) providing financial support to
current and future midwives to address
education costs, debts, and other
needs;
(III) clinical site investments;
(IV) supporting preceptor
development trainings;
(V) expanding the midwifery
practice; or
(VI) related needs identified by
the midwifery practice and described in
the practice's application; or
(ix) have developed other programs and
resources that address community-specific needs
for pregnant and postpartum individuals and are
aligned with evidence-based practices for
improving maternal health outcomes for pregnant
and postpartum individuals.
(e) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance on--
(1) capacity building to establish or expand programs to
prevent adverse maternal health outcomes among pregnant and
postpartum individuals from underserved groups;
(2) best practices in data collection, measurement,
evaluation, and reporting; and
(3) planning for sustaining programs to prevent maternal
mortality and severe maternal morbidity among pregnant and
postpartum individuals from underserved groups after the period
of the grant.
(f) Evaluation.--Not later than the end of fiscal year 2026, the
Secretary shall submit to the Congress an evaluation of the grant
program under this section that--
(1) assesses the effectiveness of outreach efforts during
the application process in diversifying the pool of grant
recipients;
(2) makes recommendations for future outreach efforts to
diversify the pool of grant recipients for Department of Health
and Human Services grant programs and funding opportunities
related to maternal health;
(3) assesses the effectiveness of programs funded by grants
under this section in improving maternal health outcomes for
pregnant and postpartum individuals from underserved groups, to
the extent practicable; and
(4) makes recommendations for future Department of Health
and Human Services grant programs and funding opportunities
that deliver funding to community-based organizations that
provide programs and resources that are aligned with evidence-
based practices for improving maternal health outcomes for
pregnant and postpartum individuals.
(g) Definition.--In this section, the term ``underserved groups''
refers to pregnant and postpartum individuals--
(1) from racial and ethnic minority groups (as such term is
defined in section 1707(g)(1) of the Public Health Service Act
(42 U.S.C. 300u-6(g)(1)));
(2) whose household income is equal to or less than 150
percent of the Federal poverty line;
(3) who live in health professional shortage areas (as such
term is defined in section 332 of the Public Health Service Act
(42 U.S.C. 254e(a)(1)));
(4) who live in counties with no hospital offering
obstetric care, no birth center, and no obstetric provider; or
(5) who live in counties with a level of vulnerability of
moderate-to-high or higher, according to the Social
Vulnerability Index of the Centers for Disease Control and
Prevention.
(h) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for each of fiscal
years 2022 through 2026.
SEC. 4. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN
MATERNITY CARE SETTINGS.
Part B of title VII of the Public Health Service Act (42 U.S.C. 293
et seq.) is amended by adding at the end the following new section:
``SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN
MATERNITY CARE SETTINGS.
``(a) Grants.--The Secretary shall award grants for programs to
reduce and prevent bias, racism, and discrimination in maternity care
settings and to advance respectful, culturally congruent, trauma-
informed care.
``(b) Special Consideration.--In awarding grants under subsection
(a), the Secretary shall give special consideration to applications for
programs that would--
``(1) apply to all maternity care providers (as defined in
section 8 of the Kira Johnson Act) and any employees who
interact with pregnant and postpartum individuals in the
provider setting, including front desk employees, sonographers,
schedulers, health care professionals, hospital or health
system administrators, security staff, and other employees;
``(2) emphasize periodic, as opposed to one-time, trainings
for all birthing professionals and employees described in
paragraph (1);
``(3) address implicit bias, racism, and cultural humility;
``(4) be delivered in ongoing education settings for
providers maintaining their licenses, with a preference for
trainings that provide continuing education units;
``(5) include trauma-informed care best practices and an
emphasis on shared decision making between providers and
patients;
``(6) include antiracism training and programs;
``(7) be delivered in undergraduate programs that funnel
into health professions schools;
``(8) be delivered in settings that apply to providers of
the special supplemental nutrition program for women, infants,
and children under section 17 of the Child Nutrition Act of
1966;
``(9) integrate bias training in obstetric emergency
simulation trainings or related trainings;
``(10) include training for emergency department employees
and emergency medical technicians on recognizing warning signs
for severe pregnancy-related complications;
``(11) offer training to all maternity care providers on
the value of racially, ethnically, and professionally diverse
maternity care teams to provide culturally congruent care; or
``(12) be based on one or more programs designed by a
historically Black college or university or other minority-
serving institution.
``(c) Application.--To seek a grant under subsection (a), an entity
shall submit an application at such time, in such manner, and
containing such information as the Secretary may require.
``(d) Reporting.--Each recipient of a grant under this section
shall annually submit to the Secretary a report on the status of
activities conducted using the grant, including, as applicable, a
description of the impact of training provided through the grant on
patient outcomes and patient experience for pregnant and postpartum
individuals from racial and ethnic minority groups and their families.
``(e) Best Practices.--Based on the annual reports submitted
pursuant to subsection (d), the Secretary--
``(1) shall produce an annual report on the findings
resulting from programs funded through this section;
``(2) shall disseminate such report to all recipients of
grants under this section and to the public; and
``(3) may include in such report findings on best practices
for improving patient outcomes and patient experience for
pregnant and postpartum individuals from racial and ethnic
minority groups and their families in maternity care settings.
``(f) Definitions.--In this section:
``(1) The term `postpartum' means the one-year period
beginning on the last day of an individual's pregnancy.
``(2) The term `culturally congruent' means in agreement
with the preferred cultural values, beliefs, world view,
language, and practices of the health care consumer and other
stakeholders.
``(3) The term `racial and ethnic minority group' has the
meaning given such term in section 1707(g)(1).
``(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $5,000,000 for each of fiscal
years 2022 through 2026.''.
SEC. 5. STUDY ON REDUCING AND PREVENTING BIAS, RACISM, AND
DISCRIMINATION IN MATERNITY CARE SETTINGS.
(a) In General.--The Secretary of Health and Human Services shall
seek to enter into an agreement, not later than 90 days after the date
of enactment of this Act, with the National Academies of Sciences,
Engineering, and Medicine (referred to in this section as the
``National Academies'') under which the National Academies agree to--
(1) conduct a study on the design and implementation of
programs to reduce and prevent bias, racism, and discrimination
in maternity care settings and to advance respectful,
culturally congruent, trauma-informed care; and
(2) not later than 24 months after the date of enactment of
this Act--
(A) complete the study; and
(B) transmit a report on the results of the study
to the Congress.
(b) Possible Topics.--The agreement entered into pursuant to
subsection (a) may provide for the study of any of the following:
(1) The development of a scorecard or other evaluation
standards for programs designed to reduce and prevent bias,
racism, and discrimination in maternity care settings to assess
the effectiveness of such programs in improving patient
outcomes and patient experience for pregnant and postpartum
individuals from racial and ethnic minority groups and their
families.
(2) Determination of the types and frequency of training to
reduce and prevent bias, racism, and discrimination in
maternity care settings that are demonstrated to improve
patient outcomes or patient experience for pregnant and
postpartum individuals from racial and ethnic minority groups
and their families.
SEC. 6. RESPECTFUL MATERNITY CARE COMPLIANCE PROGRAM.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall award grants
to accredited hospitals, health systems, and other maternity care
settings to establish as an integral part of quality implementation
initiatives within one or more hospitals or other birth settings a
respectful maternity care compliance program.
(b) Program Requirements.--A respectful maternity care compliance
program funded through a grant under this section shall--
(1) institutionalize mechanisms to allow patients receiving
maternity care services, the families of such patients, or
perinatal health workers supporting such patients to report
instances of racism or evidence of bias on the basis of race,
ethnicity, or another protected class;
(2) institutionalize response mechanisms through which
representatives of the program can directly follow up with the
patient, if possible, and the patient's family in a timely
manner;
(3) prepare and make publicly available a hospital- or
health system-wide strategy to reduce bias on the basis of
race, ethnicity, or another protected class in the delivery of
maternity care that includes--
(A) information on the training programs to reduce
and prevent bias, racism, and discrimination on the
basis of race, ethnicity, or another protected class
for all employees in maternity care settings;
(B) information on the number of cases reported to
the compliance program; and
(C) the development of methods to routinely assess
the extent to which bias, racism, or discrimination on
the basis of race, ethnicity, or another protected
class are present in the delivery of maternity care to
patients from racial and ethnic minority groups; and
(4) develop mechanisms to routinely collect and publicly
report hospital-level data related to patient-reported
experience of care; and
(5) provide annual reports to the Secretary with
information about each case reported to the compliance program
over the course of the year containing such information as the
Secretary may require, such as--
(A) de-identified demographic information on the
patient in the case, such as race, ethnicity, gender
identity, and primary language;
(B) the content of the report from the patient or
the family of the patient to the compliance program;
(C) the response from the compliance program; and
(D) to the extent applicable, institutional changes
made as a result of the case.
(c) Secretary Requirements.--
(1) Processes.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall establish processes
for--
(A) disseminating best practices for establishing
and implementing a respectful maternity care compliance
program within a hospital or other birth setting;
(B) promoting coordination and collaboration
between hospitals, health systems, and other maternity
care delivery settings on the establishment and
implementation of respectful maternity care compliance
programs; and
(C) evaluating the effectiveness of respectful
maternity care compliance programs on maternal health
outcomes and patient and family experiences, especially
for patients from racial and ethnic minority groups and
their families.
(2) Study.--
(A) In general.--Not later than 2 years after the
date of enactment of this Act, the Secretary shall,
through a contract with an independent research
organization, conduct a study on strategies to
address--
(i) racism or bias on the basis of race,
ethnicity, or another protected class in the
delivery of maternity care services; and
(ii) successful implementation of
respectful care initiatives.
(B) Components of study.--The study shall include
the following:
(i) An assessment of the reports submitted
to the Secretary from the respectful maternity
care compliance programs pursuant to subsection
(b)(5).
(ii) Based on such assessment,
recommendations for potential accountability
mechanisms related to cases of racism or bias
on the basis of race, ethnicity, or another
protected class in the delivery of maternity
care services at hospitals and other birth
settings. Such recommendations shall take into
consideration medical and non-medical factors
that contribute to adverse patient experiences
and maternal health outcomes.
(C) Report.--The Secretary shall submit to the
Congress and make publicly available a report on the
results of the study under this paragraph.
(d) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated such sums as may be necessary
for fiscal years 2022 through 2027.
SEC. 7. GAO REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act and annually thereafter, the Comptroller General of the
United States shall submit to the Congress and make publicly available
a report on the establishment of respectful maternity care compliance
programs within hospitals, health systems, and other maternity care
settings.
(b) Matters Included.--The report under paragraph (1) shall include
the following:
(1) Information regarding the extent to which hospitals,
health systems, and other maternity care settings have elected
to establish respectful maternity care compliance programs,
including--
(A) which hospitals and other birth settings elect
to establish compliance programs and when such programs
are established;
(B) to the extent practicable, impacts of the
establishment of such programs on maternal health
outcomes and patient and family experiences in the
hospitals and other birth settings that have
established such programs, especially for patients from
racial and ethnic minority groups and their families;
(C) information on geographic areas, and types of
hospitals or other birth settings, where respectful
maternity care compliance programs are not being
established and information on factors contributing to
decisions to not establish such programs; and
(D) recommendations for establishing respectful
maternity care compliance programs in geographic areas,
and types of hospitals or other birth settings, where
such programs are not being established.
(2) Whether the funding made available to carry out this
section has been sufficient and, if applicable, recommendations
for additional appropriations to carry out this section.
(3) Such other information as the Comptroller General
determines appropriate.
SEC. 8. DEFINITIONS.
In this Act:
(1) Culturally congruent.--The term ``culturally
congruent'', with respect to care or maternity care, means care
that is in agreement with the preferred cultural values,
beliefs, worldview, language, and practices of the health care
consumer and other stakeholders.
(2) Maternity care provider.--The term ``maternity care
provider'' means a health care provider who--
(A) is a physician, physician assistant, midwife
who meets at a minimum the international definition of
the midwife and global standards for midwifery
education as established by the International
Confederation of Midwives, nurse practitioner, or
clinical nurse specialist; and
(B) has a focus on maternal or perinatal health.
(3) Maternal mortality.--The term ``maternal mortality''
means a death occurring during or within a one-year period
after pregnancy, caused by pregnancy-related or childbirth
complications, including a suicide, overdose, or other death
resulting from a mental health or substance use disorder
attributed to or aggravated by pregnancy-related or childbirth
complications.
(4) Perinatal health worker.--The term ``perinatal health
worker'' means a doula, community health worker, peer
supporter, breastfeeding and lactation educator or counselor,
nutritionist or dietitian, childbirth educator, social worker,
home visitor, language interpreter, or navigator.
(5) Postpartum and postpartum period.--The terms
``postpartum'' and ``postpartum period'' refer to the 1-year
period beginning on the last day of the pregnancy of an
individual.
(6) Pregnancy-associated death.--The term ``pregnancy-
associated death'' means a death of a pregnant or postpartum
individual, by any cause, that occurs during, or within 1 year
following, the individual's pregnancy, regardless of the
outcome, duration, or site of the pregnancy.
(7) Pregnancy-related death.--The term ``pregnancy-related
death'' means a death of a pregnant or postpartum individual
that occurs during, or within 1 year following, the
individual's pregnancy, from a pregnancy complication, a chain
of events initiated by pregnancy, or the aggravation of an
unrelated condition by the physiologic effects of pregnancy.
(8) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term in
section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
300u-6(g)(1)).
(9) Severe maternal morbidity.--The term ``severe maternal
morbidity'' means a health condition, including mental health
conditions and substance use disorders, attributed to or
aggravated by pregnancy or childbirth that results in
significant short-term or long-term consequences to the health
of the individual who was pregnant.
(10) Social determinants of maternal health defined.--The
term ``social determinants of maternal health'' means non-
clinical factors that impact maternal health outcomes,
including--
(A) economic factors, which may include poverty,
employment, food security, support for and access to
lactation and other infant feeding options, housing
stability, and related factors;
(B) neighborhood factors, which may include quality
of housing, access to transportation, access to child
care, availability of healthy foods and nutrition
counseling, availability of clean water, air and water
quality, ambient temperatures, neighborhood crime and
violence, access to broadband, and related factors;
(C) social and community factors, which may include
systemic racism, gender discrimination or
discrimination based on other protected classes,
workplace conditions, incarceration, and related
factors;
(D) household factors, which may include ability to
conduct lead testing and abatement, car seat
installation, indoor air temperatures, and related
factors;
(E) education access and quality factors, which may
include educational attainment, language and literacy,
and related factors; and
(F) health care access factors, including health
insurance coverage, access to culturally congruent
health care services, providers, and non-clinical
support, access to home visiting services, access to
wellness and stress management programs, health
literacy, access to telehealth and items required to
receive telehealth services, and related factors.
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