[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 287 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 287
To direct the Secretary of Health and Human Services to issue guidance
to States to educate providers, managed care entities, and other
insurers about the value and process of delivering respectful maternal
health care through diverse and multidisciplinary care provider models,
and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 8, 2021
Ms. Baldwin (for herself and Mr. Merkley) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To direct the Secretary of Health and Human Services to issue guidance
to States to educate providers, managed care entities, and other
insurers about the value and process of delivering respectful maternal
health care through diverse and multidisciplinary care provider models,
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. HHS AGENCY DIRECTIVES.
(a) Guidance to States.--
(1) In general.--Not later than 2 years after the date of
enactment of this Act, the Secretary of Health and Human
Services shall issue and disseminate guidance to States to
educate providers, managed care entities, and other insurers
about the value and process of delivering respectful maternal
health care through diverse and multidisciplinary care provider
models.
(2) Contents.--The guidance required by paragraph (1) shall
address how States can encourage and incentivize hospitals,
health systems, midwifery practices, freestanding birth
centers, other maternity care provider groups, managed care
entities, and other insurers--
(A) to recruit and retain maternity care providers,
mental and behavioral health care providers acting in
accordance with State law, registered dietitians or
nutrition professionals (as such term is defined in
section 1861(vv)(2) of the Social Security Act (42
U.S.C. 1395x(vv)(2))), and lactation consultants
certified by the International Board of Lactation
Consultants Examiners--
(i) from racially, ethnically, and
linguistically diverse backgrounds;
(ii) with experience practicing in racially
and ethnically diverse communities; and
(iii) who have undergone training on
implicit bias and racism;
(B) to incorporate into maternity care teams--
(i) midwives who meet at a minimum the
international definition of the midwife and
global standards for midwifery education as
established by the International Confederation
of Midwives; and
(ii) perinatal health workers;
(C) to provide collaborative, culturally congruent
care; and
(D) to provide opportunities for individuals
enrolled in accredited midwifery education programs to
participate in job shadowing with maternity care teams
in hospitals, health systems, midwifery practices, and
freestanding birth centers.
(b) Study on Respectful and Culturally Congruent Maternity Care.--
(1) Study.--The Secretary of Health and Human Services
acting through the Director of the National Institutes of
Health (in this subsection referred to as the ``Secretary'')
shall conduct a study on best practices in respectful and
culturally congruent maternity care.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall--
(A) complete the study required by paragraph (1);
(B) submit to the Congress and make publicly
available a report on the results of such study; and
(C) include in such report--
(i) a compendium of examples of hospitals,
health systems, midwifery practices,
freestanding birth centers, other maternity
care provider groups, managed care entities,
and other insurers that are delivering
respectful and culturally congruent maternal
health care;
(ii) a compendium of examples of hospitals,
health systems, midwifery practices,
freestanding birth centers, other maternity
care provider groups, managed care entities,
and other insurers that have made progress in
reducing disparities in maternal health
outcomes and improving birthing experiences for
pregnant and postpartum individuals from racial
and ethnic minority groups; and
(iii) recommendations to hospitals, health
systems, midwifery practices, freestanding
birth centers, other maternity care provider
groups, managed care entities, and other
insurers, for best practices in respectful and
culturally congruent maternity care.
SEC. 2. GRANTS TO GROW AND DIVERSIFY THE PERINATAL WORKFORCE.
Title VII of the Public Health Service Act is amended by inserting
after section 757 (42 U.S.C. 294f) the following new section:
``SEC. 758. PERINATAL WORKFORCE GRANTS.
``(a) In General.--The Secretary shall award grants to entities to
establish or expand programs described in subsection (b) to grow and
diversify the perinatal workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the perinatal workforce by--
``(1) establishing schools or programs that provide
education and training to individuals seeking appropriate
licensing or certification as--
``(A) physician assistants who will complete
clinical training in the field of maternal and
perinatal health; or
``(B) perinatal health workers; and
``(2) expanding the capacity of existing schools or
programs described in paragraph (1), for the purposes of
increasing the number of students enrolled in such schools or
programs, including by awarding scholarships for students.
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to any entity that--
``(1) has demonstrated a commitment to recruiting and
retaining students and faculty from racial and ethnic minority
groups;
``(2) has developed a strategy to recruit and retain a
diverse pool of students into the perinatal workforce program
or school supported by funds received through the grant,
particularly from racial and ethnic minority groups and other
underserved populations;
``(3) has developed a strategy to recruit and retain
students who plan to practice in a health professional shortage
area designated under section 332;
``(4) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(5) includes in the standard curriculum for all students
within the perinatal workforce program or school a bias,
racism, or discrimination training program that includes
training on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section for a perinatal workforce program or school, an entity shall
agree to submit to the Secretary an annual report on the activities
conducted through the grant, including--
``(1) the number and demographics of students participating
in the program or school;
``(2) the extent to which students in the program or school
are entering careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with significant racial and ethnic
disparities in maternal health outcomes, to the extent
such data are available; and
``(3) whether the program or school has included in the
standard curriculum for all students a bias, racism, or
discrimination training program that includes explicit and
implicit bias, and if so the effectiveness of such training
program.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to entities seeking or receiving a
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the perinatal workforce programs or
schools proposed to be, or being, established or expanded through the
grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups;
``(2) increasing the number of physician assistants who
will complete clinical training in the field of maternal and
perinatal health, and perinatal health workers, from racial and
ethnic minority groups and other underserved populations;
``(3) increasing the number of physician assistants who
will complete clinical training in the field of maternal and
perinatal health, and perinatal health workers, working in
health professional shortage areas designated under section
332; and
``(4) increasing the number of physician assistants who
will complete clinical training in the field of maternal and
perinatal health, and perinatal health workers, working in
areas with significant racial and ethnic disparities in
maternal health outcomes, to the extent such data are
available.
``(i) Definition.--In this section, the term `racial and ethnic
minority group' has the meaning given such term in section 1707(g).
``(j) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2022 through 2026.''.
SEC. 3. GRANTS TO GROW AND DIVERSIFY THE NURSING WORKFORCE IN MATERNAL
AND PERINATAL HEALTH.
Title VIII of the Public Health Service Act is amended by inserting
after section 811 of that Act (42 U.S.C. 296j) the following:
``SEC. 812. PERINATAL NURSING WORKFORCE GRANTS.
``(a) In General.--The Secretary shall award grants to schools of
nursing to grow and diversify the perinatal nursing workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the perinatal nursing workforce by
providing scholarships to students seeking to become--
``(1) nurse practitioners whose education includes a focus
on maternal and perinatal health; or
``(2) clinical nurse specialists whose education includes a
focus on maternal and perinatal health.
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to any school of nursing that--
``(1) has developed a strategy to recruit and retain a
diverse pool of students seeking to enter careers focused on
maternal and perinatal health, particularly students from
racial and ethnic minority groups and other underserved
populations;
``(2) has developed a partnership with a practice setting
in a health professional shortage area designated under section
332 for the clinical placements of the school's students;
``(3) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(4) includes in the standard curriculum for all students
seeking to enter careers focused on maternal and perinatal
health a bias, racism, or discrimination training program that
includes education on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section, a school of nursing shall agree to submit to the Secretary an
annual report on the activities conducted through the grant, including,
to the extent practicable--
``(1) the number and demographics of students in the school
of nursing seeking to enter careers focused on maternal and
perinatal health;
``(2) the extent to which such students are preparing to
enter careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with significant racial and ethnic
disparities in maternal health outcomes, to the extent
such data are available; and
``(3) whether the standard curriculum for all students
seeking to enter careers focused on maternal and perinatal
health includes a bias, racism, or discrimination training
program that includes education on implicit bias and racism.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application, at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to schools of nursing seeking or
receiving a grant under this section on the processes of awarding and
evaluating scholarships through the grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups and other underserved populations;
``(2) increasing the number of nurse practitioners and
clinical nurse specialists entering careers focused on maternal
and perinatal health from racial and ethnic minority groups and
other underserved populations;
``(3) increasing the number of nurse practitioners and
clinical nurse specialists entering careers focused on maternal
and perinatal health working in health professional shortage
areas designated under section 332; and
``(4) increasing the number of nurse practitioners and
clinical nurse specialists entering careers focused on maternal
and perinatal health working in areas with significant racial
and ethnic disparities in maternal health outcomes, to the
extent such data are available.
``(i) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2022 through 2026.''.
SEC. 4. GAO REPORT.
(a) In General.--Not later than two years after the date of
enactment of this Act and every five years thereafter, the Comptroller
General of the United States shall submit to Congress a report on
barriers to maternal health education and access to care in the United
States. Such report shall include the information and recommendations
described in subsection (b).
(b) Content of Report.--The report under subsection (a) shall
include--
(1) an assessment of current barriers to entering
accredited midwifery education programs, and recommendations
for addressing such barriers, particularly for low-income women
and women from racial and ethnic minority groups;
(2) an assessment of current barriers to entering and
successfully completing accredited education programs for other
health professional careers related to maternity care,
including maternity care providers, mental and behavioral
health care providers acting in accordance with State law,
registered dietitians or nutrition professionals (as such term
is defined in section 1861(vv)(2) of the Social Security Act
(42 U.S.C. 1395x(vv)(2))), and lactation consultants certified
by the International Board of Lactation Consultants Examiners,
particularly for low-income women and women from racial and
ethnic minority groups;
(3) an assessment of current barriers that prevent midwives
from meeting the international definition of the midwife and
global standards for midwifery education as established by the
International Confederation of Midwives, and recommendations
for addressing such barriers, particularly for low-income women
and women from racial and ethnic minority groups;
(4) an assessment of disparities in access to maternity
care providers, mental or behavioral health care providers
acting in accordance with State law, registered dietitians or
nutrition professionals (as such term is defined in section
1861(vv)(2) of the Social Security Act (42 U.S.C.
1395x(vv)(2))), lactation consultants certified by the
International Board of Lactation Consultants Examiners, and
perinatal health workers, stratified by race, ethnicity, gender
identity, geographic location, and insurance type and
recommendations to promote greater access equity; and
(5) recommendations to promote greater equity in
compensation for perinatal health workers under public and
private insurers, particularly for such individuals from
racially and ethnically diverse backgrounds.
SEC. 5. 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) 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.
(4) 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.
(5) 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)).
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