[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 851 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 851
To address social determinants of maternal health.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 18, 2021
Mr. Blumenthal introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To address social determinants of maternal health.
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 ``Social Determinants for 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) 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.
(6) 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)).
(7) 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.
(8) 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. TASK FORCE TO DEVELOP A STRATEGY TO ADDRESS SOCIAL DETERMINANTS
OF MATERNAL HEALTH.
(a) In General.--The Secretary of Health and Human Services shall
convene a task force (in this section referred to as the ``Task
Force'') to develop a strategy to coordinate efforts between Federal
agencies to address social determinants of maternal health with respect
to pregnant and postpartum individuals.
(b) Ex Officio Members.--The ex officio members of the Task Force
shall consist of the following:
(1) The Secretary of Health and Human Services (or a
designee thereof).
(2) The Secretary of Housing and Urban Development (or a
designee thereof).
(3) The Secretary of Transportation (or a designee
thereof).
(4) The Secretary of Agriculture (or a designee thereof).
(5) The Secretary of Labor (or a designee thereof).
(6) The Secretary of Defense (or a designee thereof).
(7) The Secretary of Veterans Affairs (or a designee
thereof).
(8) The Administrator of the Environmental Protection
Agency (or a designee thereof).
(9) The Assistant Secretary for the Administration for
Children and Families (or a designee thereof).
(10) The Administrator of the Centers for Medicare &
Medicaid Services (or a designee thereof).
(11) The Director of the Indian Health Service (or a
designee thereof).
(12) The Director of the National Institutes of Health (or
a designee thereof).
(13) The Administrator of the Health Resources and Services
Administration (or a designee thereof).
(14) The Deputy Assistant Secretary for Minority Health of
the Department of Health and Human Services (or a designee
thereof).
(15) The Deputy Assistant Secretary for Women's Health of
the Department of Health and Human Services (or a designee
thereof).
(16) The Director of the Centers for Disease Control and
Prevention (or a designee thereof).
(17) The Director of the Office on Violence Against Women
at the Department of Justice (or a designee thereof).
(c) Appointed Members.--In addition to the ex officio members of
the Task Force, the Secretary of Health and Human Services shall
appoint the following members of the Task Force:
(1) At least 2 representatives of patients, to include--
(A) a representative of patients who have suffered
from severe maternal morbidity; or
(B) a representative of patients who is a family
member of an individual who suffered a pregnancy-
related death.
(2) At least 2 leaders of community-based organizations
that address maternal mortality and severe maternal morbidity
with a specific focus on racial and ethnic disparities. In
appointing such leaders under this paragraph, the Secretary of
Health and Human Services shall give priority to individuals
who are leaders of organizations led by individuals from racial
and ethnic minority groups.
(3) At least 2 perinatal health workers.
(4) A professionally diverse panel of maternity care
providers.
(d) Chair.--The Secretary of Health and Human Services shall select
the chair of the Task Force from among the members of the Task Force.
(e) Report.--Not later than 2 years after the date of enactment of
this Act, the Task Force shall submit to Congress a report on--
(1) the strategy developed under subsection (a);
(2) recommendations on funding amounts with respect to
implementing such strategy; and
(3) recommendations for how to expand coverage of social
services to address social determinants of maternal health
under Medicaid managed care organizations and State Medicaid
programs.
(f) Termination.--Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Task Force with respect to
termination.
SEC. 4. HOUSING FOR MOMS GRANT PROGRAM.
(a) In General.--The Secretary of Housing and Urban Development
shall establish a Housing for Moms grant program under this section to
make grants to eligible entities to increase access to safe, stable,
affordable, and adequate housing for pregnant and postpartum
individuals and their families.
(b) Application.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may provide.
(c) Priority.--In awarding grants under this section, the Secretary
shall give priority to an eligible entity that--
(1) is a community-based organization or will partner with
a community-based organization to implement initiatives to
increase access to safe, stable, affordable, and adequate
housing for pregnant and postpartum individuals and their
families;
(2) is operating in an area with high rates of adverse
maternal health outcomes or significant racial or ethnic
disparities in maternal health outcomes, to the extent such
data are available; and
(3) is operating in an area with a high poverty rate or
significant number of individuals who lack consistent access to
safe, stable, affordable, and adequate housing.
(d) Use of Funds.--An eligible entity that receives a grant under
this section shall use funds under the grant for the purposes of--
(1) identifying and conducting outreach to pregnant and
postpartum individuals who are low income and lack consistent
access to safe, stable, affordable, and adequate housing;
(2) providing safe, stable, affordable, and adequate
housing options to such individuals;
(3) connecting such individuals with local organizations
offering safe, stable, affordable, and adequate housing
options;
(4) providing application assistance to such individuals
seeking to enroll in programs offering safe, stable,
affordable, and adequate housing options;
(5) providing direct financial assistance to such
individuals for the purposes of maintaining safe, stable, and
adequate housing for the duration of the individual's pregnancy
and postpartum periods; and
(6) working with relevant stakeholders to ensure that local
housing and homeless shelter infrastructure is supportive to
pregnant and postpartum individuals, including through--
(A) health-promoting housing codes;
(B) enforcement of housing codes;
(C) proactive rental inspection programs;
(D) code enforcement officer training; and
(E) partnerships between regional offices of the
Department of Housing and Urban Development and
community-based organizations to ensure housing laws
are understood and violations are discovered.
(e) Reporting.--
(1) Eligible entities.--The Secretary shall require each
eligible entity receiving a grant under this section to
annually submit to the Secretary and make publicly available a
report on the status of activities conducted using the grant.
(2) Secretary.--Not later than the end of each fiscal year
in which grants are made under this section, the Secretary
shall submit to Congress and make publicly available a report
that--
(A) summarizes the reports received under paragraph
(1);
(B) evaluates the effectiveness of grants awarded
under this section in increasing access to safe,
stable, affordable, and adequate housing for pregnant
and postpartum individuals and their families; and
(C) makes recommendations with respect to ensuring
activities described in subsection (d) continue after
grant amounts made available under this section are
expended.
(f) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) a community-based organization;
(B) a State or local governmental entity, including
a State or local public health department;
(C) an Indian tribe or tribal organization (as such
terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
5304)); or
(D) an Urban Indian organization (as such term is
defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)).
(2) Secretary.--The term ``Secretary'' means the Secretary
of Housing and Urban Development.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for fiscal year
2022, which shall remain available until expended.
SEC. 5. DEPARTMENT OF TRANSPORTATION.
(a) Report.--Not later than 1 year after the date of enactment of
this Act, the Secretary of Transportation shall submit to Congress and
make publicly available a report that contains--
(1) an assessment of transportation barriers preventing
individuals from attending prenatal and postpartum
appointments, accessing maternal health care services, or
accessing services and resources related to social determinants
of maternal health;
(2) recommendations on how to overcome the barriers
described in paragraph (1);
(3) an assessment of transportation safety risks for
pregnant individuals and recommendations on how to mitigate
those risks; and
(4) an assessment of the impact of disabilities, including
service-related disabilities, on pregnant and postpartum
women's mobility and access to appropriate care.
(b) Considerations.--In carrying out subsection (a), the Secretary
of Transportation shall give special consideration to solutions for--
(1) pregnant and postpartum individuals living in a health
professional shortage area designated under section 332 of the
Public Health Service Act (42 U.S.C. 254e);
(2) pregnant and postpartum individuals living in areas
with high maternal mortality or severe morbidity rates or
significant racial or ethnic disparities in maternal health
outcomes; and
(3) pregnant and postpartum individuals with a disability
that impacts mobility.
SEC. 6. DEPARTMENT OF AGRICULTURE.
(a) Special Supplemental Nutrition Program for Women, Infants, and
Children.--
(1) Breastfeeding women.--
(A) Definition of breastfeeding woman.--Section
17(b) of the Child Nutrition Act of 1966 (42 U.S.C.
1786(b)) is amended by striking paragraph (1) and
inserting the following:
``(1) Breastfeeding woman.--The term `breastfeeding woman'
means--
``(A) a woman who is not more than 1 year
postpartum and is breastfeeding the infant of the
woman; and
``(B) for purposes of subsection (d), a woman who
is not more than 2 years postpartum and is
breastfeeding the infant of the woman.''.
(B) Extension of breastfeeding period.--Section
17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (42
U.S.C. 1786(d)(3)(A)(ii)) is amended by striking ``1
year'' and inserting ``2 years''.
(2) Postpartum women.--
(A) Definition of postpartum women.--Section
17(b)(10) of the Child Nutrition Act of 1966 (42 U.S.C.
1786(b)(10)) is amended by striking ``six months'' and
inserting ``2 years''.
(B) Certification.--Section 17(d)(3)(A) of the
Child Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A))
is amended by adding at the end the following:
``(iv) Postpartum women.--A State may elect
to certify a postpartum woman for a period of
up to 2 years after the termination of
pregnancy of the postpartum woman.''.
(3) Report.--Not later than 2 years after the date of
enactment of this section, the Secretary of Agriculture shall
submit to Congress a report that includes an evaluation of the
effect of each of the amendments made by this subsection on--
(A) maternal and infant health outcomes, including
racial and ethnic disparities with respect to those
outcomes;
(B) breastfeeding rates among postpartum
individuals;
(C) qualitative evaluations of family experiences
under the special supplemental nutrition program for
women, infants, and children established under section
17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786);
and
(D) other relevant information as determined by the
Secretary of Agriculture.
(b) Grant Program for Healthy Food and Clean Water for Pregnant and
Postpartum Individuals.--
(1) Definitions.--In this subsection:
(A) Eligible entity.--The term ``eligible entity''
means--
(i) a community-based organization;
(ii) a State or local governmental entity,
including a State or local public health
department;
(iii) an Indian tribe or tribal
organization (as those terms are defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304)); and
(iv) an Urban Indian organization (as
defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)).
(B) Secretary.--The term ``Secretary'' means the
Secretary of Agriculture.
(2) Establishment.--The Secretary shall establish a program
to award grants, on a competitive basis, to eligible entities
to carry out the activities described in paragraph (5).
(3) Application.--To be eligible for a grant under this
subsection, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary determines appropriate.
(4) Priority.--In awarding grants under this subsection,
the Secretary shall give priority to an eligible entity that--
(A) is, or will partner with, a community-based
organization; and
(B) is operating in an area with high rates of--
(i) adverse maternal health outcomes; or
(ii) significant racial or ethnic
disparities in maternal health outcomes.
(5) Use of funds.--An eligible entity shall use grant funds
awarded under this subsection to deliver healthy food, infant
formula, clean water, or diapers to pregnant women (as defined
in section 17(b) of the Child Nutrition Act of 1966 (42 U.S.C.
1786(b))) and postpartum individuals located in areas that are
food deserts, as determined by the Secretary using data from
the Food Access Research Atlas of the Department of
Agriculture.
(6) Reports.--
(A) Eligible entity.--Each eligible entity that
receives a grant under this subsection shall, not later
than 1 year after receiving the grant, and annually
thereafter, submit to the Secretary a report on the
status of activities conducted using the grant, which
shall contain such information as the Secretary may
require.
(B) Secretary.--
(i) In general.--Not later than 2 years
after the date on which the first grant is
awarded under this subsection, the Secretary
shall submit to Congress a report that
includes--
(I) a summary of the reports
submitted by eligible entities under
subparagraph (A);
(II) an assessment of the extent to
which food distributed through the
grant program under this subsection was
purchased from local and regional food
systems;
(III) an evaluation of the effect
of the grant program under this
subsection on maternal and infant
health outcomes, including racial and
ethnic disparities and disparities
impacting other underserved mothers,
such as mothers living in rural areas,
with respect to those outcomes; and
(IV) recommendations with respect
to ensuring the activities described in
paragraph (5) continue after the grant
funding for those activities expires.
(ii) Publication.--The Secretary shall make
the report submitted under clause (i) publicly
available on the website of the Department of
Agriculture.
(7) Authorization of appropriations.--There is authorized
to be appropriated to the Secretary $5,000,000 to carry out
this subsection for the period of fiscal years 2022 through
2024.
SEC. 7. ENVIRONMENTAL STUDY THROUGH NATIONAL ACADEMIES.
(a) In General.--Not later than 60 days after the date of enactment
of this Act, the Administrator of the Environmental Protection Agency
shall seek to enter into an agreement 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
conduct a study on the impacts of water and air quality, exposure to
extreme temperatures, exposure to environmental chemicals,
environmental risks in the workplace and the home, and pollution levels
on maternal and infant health outcomes.
(b) Study Requirements.--The agreement under subsection (a) shall
direct the National Academies to make recommendations for--
(1) improving the environmental conditions described in
that subsection to improve maternal and infant health outcomes;
and
(2) reducing or eliminating racial and ethnic disparities
in those outcomes.
(c) Report.--The agreement under subsection (a) shall require the
National Academies--
(1) to complete the study described in that subsection; and
(2) not later than 1 year after the date of enactment of
this Act, to transmit to Congress and make publicly available a
report that--
(A) describes the results of the study; and
(B) includes the recommendations described in
subsection (b).
SEC. 8. CHILD CARE ACCESS.
(a) Grant Program.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall award grants to
eligible organizations to provide pregnant and postpartum individuals
with free and accessible drop-in child care services during prenatal
and postpartum appointments, including for mental health care, prenatal
and childbirth classes, and labor and delivery. The Secretary shall
coordinate with the Secretary of Defense to disseminate information
regarding such services and to expand on-installation drop-in child
care services for military parents.
(b) Application.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
(c) Eligible Organizations.--
(1) Eligibility.--To be eligible to receive a grant under
this section, an organization shall be an organization that
provides child care services and can carry out programs
providing pregnant and postpartum individuals with free and
accessible drop-in child care services during prenatal and
postpartum appointments.
(2) Prioritization.--In selecting grant recipients under
this section, the Secretary shall give priority to eligible
organizations that operate in an area with high rates of
adverse maternal health outcomes or significant racial or
ethnic disparities in maternal health outcomes, to the extent
such data are available.
(d) Timing.--The Secretary shall commence the grant program under
subsection (a) not later than 1 year after the date of enactment of
this Act.
(e) Reporting.--
(1) Grantees.--Each recipient of a grant under this section
shall annually submit to the Secretary and make publicly
available a report on the status of activities conducted using
the grant. Each such report shall include--
(A) an analysis of the effect of the funded program
on prenatal and postpartum appointment attendance
rates;
(B) summaries of qualitative assessments of the
funded program from--
(i) pregnant and postpartum individuals
participating in the program; and
(ii) the families of such individuals; and
(C) such additional information as the Secretary
may require.
(2) Secretary.--Not later than the end of fiscal year 2024,
the Secretary shall submit to Congress and make publicly
available a report containing the following:
(A) A summary of the reports under paragraph (1).
(B) An assessment of the effects, if any, of the
funded programs on maternal health outcomes, with a
specific focus on racial and ethnic disparities in such
outcomes.
(C) A description of actions the Secretary can take
to ensure that pregnant and postpartum individuals
eligible for medical assistance under a State plan
under title XIX of the Social Security Act (42 U.S.C.
1936 et seq.) have access to free and accessible drop-
in child care services during prenatal and postpartum
appointments, including identification of the funding
necessary to carry out such actions.
(f) Drop-In Child Care Services Defined.--In this section, the term
``drop-in child care services'' means child care and early childhood
education services that are--
(1) delivered at a facility that meets the requirements of
all applicable laws and regulations of the State or local
government in which it is located, including the licensing of
the facility as a child care facility; and
(2) provided in single encounters without requiring full-
time enrollment of a person in a child care program.
(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $5,000,000 for the period of
fiscal years 2022 through 2024.
SEC. 9. GRANTS TO LOCAL ENTITIES ADDRESSING SOCIAL DETERMINANTS OF
MATERNAL HEALTH.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall award grants to
eligible entities to--
(1) address social determinants of maternal health for
pregnant and postpartum individuals; and
(2) eliminate racial and ethnic disparities in maternal
health outcomes.
(b) Application.--To be eligible to receive a grant under this
subsection an eligible entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may provide.
(c) Prioritization.--In awarding grants under subsection (a), the
Secretary shall give priority to an eligible entity that--
(1) is, or will partner with, a community-based
organization to carrying out the activities under subsection
(d);
(2) is operating in an area with high rates of adverse
maternal health outcomes or significant racial or ethnic
disparities in maternal health outcomes; and
(3) is operating in an area with a high poverty rate.
(d) Activities.--An eligible entity that receives a grant under
this section may--
(1) hire and retain staff;
(2) develop and distribute a culturally and linguistically
appropriate list of available resources with respect to social
service programs in a community, including housing supports,
child care access, nutrition counseling, and resources for
pregnant women facing intimate partner violence;
(3) establish a culturally appropriate resource center that
provides multiple social service programs in a single location;
(4) offer programs and resources in the communities in
which the respective eligible entities are located to address
social determinants of health for pregnant and postpartum
individuals; and
(5) consult with such pregnant and postpartum individuals,
pregnant women who are unauthorized aliens, to conduct an
assessment of the activities under this subsection.
(e) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance to plan for
sustaining programs to address social determinants of maternal health
among pregnant and postpartum individuals after the period of the
grant.
(f) Reporting.--
(1) Grantees.--Not later than 1 year after an eligible
entity first receives a grant under this section, and annually
thereafter, an eligible entity shall submit to the Secretary,
and make publicly available, a report on the status of
activities conducted using the grant. Each such report shall
include data on the effects of such activities, disaggregated
by race, ethnicity, gender, and other relevant factors.
(2) Secretary.--Not later than the end of fiscal year 2026,
the Secretary shall submit to Congress a report that includes--
(A) a summary of the reports under paragraph (1);
and
(B) recommendations for--
(i) improving maternal health outcomes; and
(ii) reducing or eliminating racial and
ethnic disparities in maternal health outcomes.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $15,000,000 for each of fiscal
years 2022 through 2026.
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