[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 347 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 347
To improve the collection and review of maternal health data to address
maternal mortality, severe maternal morbidity, and other adverse
maternal health outcomes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 22, 2021
Ms. Smith (for herself, Mr. Blumenthal, Ms. Klobuchar, and Mr. Markey)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To improve the collection and review of maternal health data to address
maternal mortality, severe maternal morbidity, and other adverse
maternal health outcomes.
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 ``Data to Save Moms Act''.
SEC. 2. DEFINITIONS.
In this Act:
(1) 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.
(2) 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.
(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)).
(6) 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.
(7) Social determinants of maternal health.--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.
SEC. 3. FUNDING FOR MATERNAL MORTALITY REVIEW COMMITTEES TO PROMOTE
REPRESENTATIVE COMMUNITY ENGAGEMENT.
(a) In General.--Section 317K(d) of the Public Health Service Act
(42 U.S.C. 247b-12(d)) is amended by adding at the end the following:
``(9) Grants to promote representative community engagement
in maternal mortality review committees.--
``(A) In general.--The Secretary may, using funds
made available pursuant to subparagraph (C), provide
assistance to an applicable maternal mortality review
committee of a State, Indian tribe, tribal
organization, or urban Indian organization--
``(i) to select for inclusion in the
membership of such a committee community
members from the State, Indian tribe, tribal
organization, or urban Indian organization by--
``(I) prioritizing community
members who can increase the diversity
of the committee's membership with
respect to race and ethnicity,
location, and professional background,
including members with non-clinical
experiences; and
``(II) to the extent applicable,
using funds reserved under subsection
(f), to address barriers to maternal
mortality review committee
participation for community members,
including required training,
transportation barriers, compensation,
and other supports as may be necessary;
``(ii) to establish initiatives to conduct
outreach and community engagement efforts
within communities throughout the State or
Tribe to seek input from community members on
the work of such maternal mortality review
committee, with a particular focus on outreach
to minority women; and
``(iii) to release public reports
assessing--
``(I) the pregnancy-related death
and pregnancy-associated death review
processes of the maternal mortality
review committee, with a particular
focus on the maternal mortality review
committee's sensitivity to the unique
circumstances of pregnant and
postpartum individuals from racial and
ethnic minority groups (as such term is
defined in section 1707(g)(1)) who have
suffered pregnancy-related deaths; and
``(II) the impact of the use of
funds made available pursuant to
subparagraph (C) on increasing the
diversity of the maternal mortality
review committee membership and
promoting community engagement efforts
throughout the State or Tribe.
``(B) Technical assistance.--The Secretary shall
provide (either directly through the Department of
Health and Human Services or by contract) technical
assistance to any maternal mortality review committee
receiving a grant under this paragraph on best
practices for increasing the diversity of the maternal
mortality review committee's membership and for
conducting effective community engagement throughout
the State or Tribe.
``(C) Authorization of appropriations.--In addition
to any funds made available under subsection (f), there
are authorized to be appropriated to carry out this
paragraph $10,000,000 for each of fiscal years 2022
through 2026.''.
(b) Definitions.--Section 317K(e) of the Public Health Service Act
(42 U.S.C. 247b-12(e)) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3)(B), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following:
``(4) the term `urban Indian organization' has the meaning
given such term in section 4 of the Indian Health Care
Improvement Act.''.
(c) Reservation of Funds.--Section 317K(f) of the Public Health
Service Act (42 U.S.C. 247b-12(f)) is amended by adding at the end the
following: ``Of the amount made available under the preceding sentence
for a fiscal year, not less than $1,500,000 shall be reserved for
grants to Indian tribes, tribal organizations, or urban Indian
organizations.''.
SEC. 4. DATA COLLECTION AND REVIEW.
Section 317K(d)(3)(A)(i) of the Public Health Service Act (42
U.S.C. 247b-12(d)(3)(A)(i)) is amended--
(1) by redesignating subclauses (II) and (III) as
subclauses (V) and (VI), respectively; and
(2) by inserting after subclause (I) the following:
``(II) to the extent practicable,
reviewing cases of severe maternal
morbidity, according to the most up-to-
date indicators;
``(III) to the extent practicable,
reviewing deaths during pregnancy or up
to 1 year after the end of a pregnancy
from suicide, overdose, or other death
from a mental health condition or
substance use disorder attributed to or
aggravated by pregnancy or childbirth
complications;
``(IV) to the extent practicable,
consulting with local community-based
organizations representing pregnant and
postpartum individuals from demographic
groups disproportionately impacted by
poor maternal health outcomes to ensure
that, in addition to clinical factors,
non-clinical factors that might have
contributed to a pregnancy-related
death are appropriately considered;''.
SEC. 5. REVIEW OF MATERNAL HEALTH DATA COLLECTION PROCESSES AND QUALITY
MEASURES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator for Centers for Medicare & Medicaid Serves
and the Director of the Agency for Healthcare Research and Quality,
shall consult with relevant stakeholders--
(1) to review existing maternal health data collection
processes and quality measures; and
(2) make recommendations to improve such processes and
measures, including topics described in subsection (c).
(b) Collaboration.--In carrying out this section, the Secretary
shall consult with a diverse group of maternal health stakeholders,
which may include--
(1) pregnant and postpartum individuals and their family
members, and nonprofit organizations representing such
individuals, with a particular focus on patients from racial
and ethnic minority groups;
(2) community-based organizations that provide support for
pregnant and postpartum individuals, with a particular focus on
patients from racial and ethnic minority groups;
(3) membership organizations for maternity care providers;
(4) organizations representing perinatal health workers;
(5) organizations that focus on maternal mental or
behavioral health;
(6) organizations that focus on intimate partner violence;
(7) institutions of higher education, with a particular
focus on minority-serving institutions;
(8) licensed and accredited hospitals, birth centers,
midwifery practices, or other medical practices that provide
maternal health care services to pregnant and postpartum
patients;
(9) relevant State and local public agencies, including
State maternal mortality review committees; and
(10) the National Quality Forum, or such other standard-
setting organizations specified by the Secretary.
(c) Topics.--The review of maternal health data collection
processes and recommendations to improve such processes and measures
required under subsection (a) shall assess all available relevant
information, including information from State-level sources, and shall
consider at least the following:
(1) Current State and Tribal practices for maternal health,
maternal mortality, and severe maternal morbidity data
collection and dissemination, including consideration of--
(A) the timeliness of processes for amending a
death certificate when new information pertaining to
the death becomes available to reflect whether the
death was a pregnancy-related death;
(B) relevant data collected with electronic health
records, including data on race, ethnicity,
socioeconomic status, insurance type, and other
relevant demographic information;
(C) maternal health data collected and publicly
reported by hospitals, health systems, midwifery
practices, and birth centers;
(D) the barriers preventing States from correlating
maternal outcome data with race and ethnicity data;
(E) processes for determining the cause of a
pregnancy-associated death in States that do not have a
maternal mortality review committee;
(F) whether maternal mortality review committees
include multidisciplinary and diverse membership (as
described in section 317K(d)(1)(A) of the Public Health
Service Act (42 U.S.C. 247b-12(d)(1)(A));
(G) whether members of maternal mortality review
committees participate in trainings on bias, racism, or
discrimination, and the quality of such trainings;
(H) the extent to which States have implemented
systematic processes of listening to the stories of
pregnant and postpartum individuals and their family
members, with a particular focus on pregnant and
postpartum individuals 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))) and their family members, to fully understand
the causes of, and inform potential solutions to, the
maternal mortality and severe maternal morbidity crisis
within their respective States;
(I) the extent to which maternal mortality review
committees are considering social determinants of
maternal health when examining the causes of pregnancy-
associated and pregnancy-related deaths;
(J) the extent to which maternal mortality review
committees are making actionable recommendations based
on their reviews of adverse maternal health outcomes
and the extent to which such recommendations are being
implemented by appropriate stakeholders;
(K) the legal and administrative barriers
preventing the collection, collation, and dissemination
of State maternity care data;
(L) the effectiveness of data collection and
reporting processes in separating pregnancy-associated
deaths from pregnancy-related deaths;
(M) the current Federal, State, local, and Tribal
funding support for the activities referred to in
subparagraphs (A) through (L).
(2) Whether the funding support referred to in paragraph
(1)(M) is adequate for States to carry out optimal data
collection and dissemination processes with respect to maternal
health, maternal mortality, and severe maternal morbidity.
(3) Current quality measures for maternity care, including
prenatal measures, labor and delivery measures, and postpartum
measures, including topics such as--
(A) effective quality measures for maternity care
used by hospitals, health systems, midwifery practices,
birth centers, health plans, and other relevant
entities;
(B) the sufficiency of current outcome measures
used to evaluate maternity care for driving improved
care, experiences, and outcomes in maternity care
payment and delivery system models;
(C) maternal health quality measures that other
countries effectively use;
(D) validated measures that have been used for
research purposes that could be tested, refined, and
submitted for national endorsement;
(E) barriers preventing maternity care providers
and insurers from implementing quality measures that
are aligned with best practices;
(F) the frequency with which maternity care quality
measures are reviewed and revised;
(G) the strengths and weaknesses of the Prenatal
and Postpartum Care measures of the Health Plan
Employer Data and Information Set measures established
by the National Committee for Quality Assurance;
(H) the strengths and weaknesses of maternity care
quality measures under the Medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
and the Children's Health Insurance Program under title
XXI of such Act (42 U.S.C. 1397 et seq.), including the
extent to which States voluntarily report relevant
measures;
(I) the extent to which maternity care quality
measures are informed by patient experiences that
include measures of patient-reported experience of
care;
(J) the current processes for collecting stratified
data on the race and ethnicity of pregnant and
postpartum individuals in hospitals, health systems,
midwifery practices, and birth centers, and for
incorporating such racially and ethnically stratified
data in maternity care quality measures;
(K) the extent to which maternity care quality
measures account for the unique experiences of pregnant
and postpartum individuals 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))); and
(L) the extent to which hospitals, health systems,
midwifery practices, and birth centers are implementing
existing maternity care quality measures.
(4) Recommendations on authorizing additional funds and
providing additional technical assistance to improve maternal
mortality review committees and State and Tribal maternal
health data collection and reporting processes.
(5) Recommendations for new authorities that may be granted
to maternal mortality review committees to be able to--
(A) access records from other Federal and State
agencies and departments that may be necessary to
identify causes of pregnancy-associated and pregnancy-
related deaths that are unique to pregnant and
postpartum individuals from specific populations, such
as veterans and individuals who are incarcerated; and
(B) work with relevant experts who are not members
of the maternal mortality review committee to assist in
the review of pregnancy-associated deaths of pregnant
and postpartum individuals from specific populations,
such as veterans and individuals who are incarcerated.
(6) Recommendations to improve and standardize current
quality measures for maternity care, with a particular focus on
racial and ethnic disparities in maternal health outcomes.
(7) Recommendations to improve the coordination by the
Department of Health and Human Services of the efforts
undertaken by the agencies and organizations within the
Department related to maternal health data and quality
measures.
(d) Report.--Not later than 1 year after the date of enactment of
this Act, the Secretary shall submit to Congress and make publicly
available a report on the results of the review of maternal health data
collection processes and quality measures and recommendations to
improve such processes and measures required under subsection (a).
(e) Definitions.--In this section:
(1) Maternal mortality review committee.--The term
``maternal mortality review committee'' means a maternal
mortality review committee duly authorized by a State and
receiving funding under section 317K(a)(2)(D) of the Public
Health Service Act (42 U.S.C. 247b-12(a)(2)(D)).
(2) Pregnancy-associated death.--The term ``pregnancy-
associated'', with respect to a 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.
(3) Pregnancy-related death.--The term ``pregnancy-
related'', with respect to a 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.
(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal years 2022 through 2025.
SEC. 6. INDIAN HEALTH SERVICE STUDY AND REPORT ON MATERNAL MORTALITY
AND SEVERE MATERNAL MORBIDITY.
(a) Definitions.--In this section:
(1) Director.--The term ``Director'' means the Director of
the Indian Health Service.
(2) Indian tribe.--The term ``Indian Tribe'' has the
meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304).
(3) Maternal mortality review committee.--The term
``maternal mortality review committee'' means a maternal
mortality review committee duly authorized by a State and
receiving funding under section 317k(a)(2)(D) of the Public
Health Service Act (42 U.S.C. 247b-12(a)(2)(D)).
(4) Tribal epidemiology center.--The term ``Tribal
epidemiology center'' means a Tribal epidemiology center
established under section 214 of the Indian Health Care
Improvement Act (25 U.S.C. 1621m).
(5) Tribal organization.--The term ``tribal organization''
has the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304).
(6) Urban indian organization.--The term ``urban Indian
organization'' has the meaning given the term in section 4 of
the Indian Health Care Improvement Act (25 U.S.C. 1603).
(b) Study and Report.--
(1) Study.--
(A) In general.--Not later than 90 days after the
date of enactment of this Act, the Director, in
coordination with the individuals selected under
subsection (c), shall enter into an agreement with an
independent research organization or a Tribal
epidemiology center to conduct a comprehensive study on
maternal mortality and severe maternal morbidity in
Indian and Alaska Native populations.
(B) Report.--The agreement entered into under
subparagraph (A) shall require that the independent
research organization or Tribal epidemiology center
submit to the Director a report describing the results
of the study conducted pursuant to that agreement by
not later than 2 years after the date of enactment of
this Act.
(2) Contents of study.--The study conducted under paragraph
(1) shall--
(A) examine the causes of maternal mortality and
severe maternal morbidity that are unique to Indians
and Alaska Natives;
(B) include a systematic process of listening to
the stories of pregnant and postpartum Indians and
Alaska Natives to fully understand the causes of, and
inform potential solutions to, the maternal mortality
and severe maternal morbidity crisis within the Indian
and Alaska Native communities;
(C) identify the different settings in which
pregnant and postpartum Indians and Alaska Natives
receive maternity care, such as--
(i) facilities operated by the Indian
Health Service;
(ii) an Indian health program operated by
an Indian Tribe or tribal organization pursuant
to a grant from, or contract, cooperative
agreement, or compact with, the Indian Health
Service pursuant to the Indian Self-
Determination and Education Assistance Act (25
U.S.C. 5301 et seq.); and
(iii) an urban Indian health program
operated by an urban Indian organization
pursuant to a grant from or contract with the
Indian Health Service pursuant to title V of
the Indian Health Care Improvement Act (25
U.S.C. 1651 et seq.);
(D) determine the different landscapes of maternity
care received by pregnant and postpartum Indians and
Alaska Natives at the different settings identified
under subparagraph (C);
(E) review processes for coordinating programs of
the Indian Health Service with social services provided
through other programs administered by the Secretary of
Health and Human Services (other than the Medicare
program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), the Medicaid program under
title XIX of that Act (42 U.S.C. 1396 et seq.), and the
State Children's Health Insurance Program established
under title XXI of that Act (42 U.S.C. 1397aa et
seq.));
(F) review current data collection and quality
measurement processes and practices with respect to
pregnant and postpartum Indians and Alaska Natives;
(G) assess causes and frequency of maternal mental
health conditions and substance use disorders with
respect to Indians and Alaska Natives;
(H) consider social determinants of health,
including poverty, lack of health insurance,
unemployment, sexual violence, and environmental
conditions in Tribal areas;
(I) consider the role that historical mistreatment
of Indian and Alaska Native women has played in causing
currently high rates of maternal mortality and severe
maternal morbidity;
(J) consider how current funding of the Indian
Health Service affects the ability of the Indian Health
Service to deliver quality maternity care; and
(K) consider the extent to which the delivery of
maternity care services is culturally appropriate for
pregnant and postpartum Indians and Alaska Natives.
(3) Report.--Not later than 3 years after the date of
enactment of this Act, the Director shall submit to Congress a
report describing the results of the study conducted under
paragraph (1), including recommendations for policies and
practices that can be adopted to improve maternal health
outcomes for pregnant and postpartum Indians and Alaska
Natives, including recommendations--
(A) on how to improve maternal health outcomes for
Indians and Alaska Natives receiving care at the
different settings identified under paragraph (2)(C);
(B) on how to reduce misclassification of pregnant
and postpartum Indians and Alaska Natives, including
consideration of best practices in training for members
of maternal mortality review committees to be able to
correctly classify Indians and Alaska Natives; and
(C) informed by the stories shared by pregnant and
postpartum Indians and Alaska Natives under paragraph
(2)(B) to improve maternal health outcomes for those
individuals.
(c) Participating Individuals.--
(1) In general.--The Director shall select from among
individuals nominated by Indian Tribes, tribal organizations,
and urban Indian organizations 12 individuals for participation
in the study conducted under subsection (b)(1).
(2) Requirement.--In selecting members under paragraph (1),
the Director shall ensure that each of the 12 service areas of
the Indian Health Service is represented.
(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2022 through 2024.
SEC. 7. GRANTS TO MINORITY-SERVING INSTITUTIONS TO STUDY MATERNAL
MORTALITY, SEVERE MATERNAL MORBIDITY, AND OTHER ADVERSE
MATERNAL HEALTH OUTCOMES.
(a) In General.--The Secretary of Health and Human Services shall
establish a program under which the Secretary shall award grants to
research centers, health professions schools and programs, and other
entities at minority-serving institutions to study specific aspects of
the maternal health crisis among pregnant and postpartum individuals
from racial and ethnic minority groups. Such research may--
(1) include the development and implementation of
systematic processes of listening to the stories of pregnant
and postpartum individuals from racial and ethnic minority
groups, and perinatal health workers supporting such
individuals, to fully understand the causes of, and inform
potential solutions to, the maternal mortality and severe
maternal morbidity crisis within their respective communities;
(2) assess the potential causes of relatively low rates of
maternal mortality among Hispanic individuals, including
potential racial misclassification and other data collection
and reporting issues that might be misrepresenting maternal
mortality rates among Hispanic individuals in the United
States; and
(3) assess differences in rates of adverse maternal health
outcomes among subgroups identifying as Hispanic.
(b) Application.--To be eligible to receive a grant under
subsection (a), an entity described in such subsection shall submit to
the Secretary an application at such time, in such manner, and
containing such information as the Secretary may require.
(c) Technical Assistance.--The Secretary may use not more than 10
percent of the funds made available under subsection (g)--
(1) to conduct outreach to minority-serving institutions to
raise awareness of the availability of grants under this
subsection (a);
(2) to provide technical assistance in the application
process for such a grant; and
(3) to promote capacity building as needed to enable
entities described in such subsection to submit such an
application.
(d) Reporting Requirement.--Each entity awarded a grant under this
section shall periodically submit to the Secretary a report on the
status of activities conducted using the grant.
(e) Evaluation.--Beginning one year after the date on which the
first grant is awarded under this section, the Secretary shall submit
to Congress an annual report summarizing the findings of research
conducted using funds made available under this section.
(f) Minority-Serving Institutions Defined.--In this section, the
term ``minority-serving institution'' has the meaning given the term in
section 371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)).
(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2022 through 2026.
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