[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1606 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 1606
To end preventable maternal mortality, severe maternal morbidity, and
maternal health disparities in the United States, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 15, 2023
Mr. Booker (for himself, Ms. Warren, Mr. Warnock, Mr. Merkley, Mr.
Schatz, Mr. Casey, Mr. Sanders, Mr. Van Hollen, Mr. Padilla, Mr.
Menendez, Mrs. Gillibrand, Mr. Cardin, Mr. Heinrich, Ms. Klobuchar, Mr.
Welch, Mr. Bennet, Ms. Baldwin, Ms. Smith, Mr. Markey, Ms. Stabenow,
Mr. Durbin, Ms. Duckworth, Mr. Fetterman, Ms. Hirono, Mr. Kaine, Mr.
Blumenthal, Mr. Brown, and Ms. Cortez Masto) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To end preventable maternal mortality, severe maternal morbidity, and
maternal health disparities in the United States, 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 ``Black Maternal Health Momnibus
Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Definitions.
Sec. 4. Sense of Congress.
TITLE I--SOCIAL DETERMINANTS FOR MOMS
Sec. 101. Task force to address the United States maternal health
crisis.
Sec. 102. Sustained funding to address social determinants of maternal
health.
TITLE II--EXTENDING WIC FOR NEW MOMS
Sec. 201. Extending WIC eligibility for new moms.
TITLE III--HONORING KIRA JOHNSON
Sec. 301. Sustained funding for community-based organizations to
advance maternal health equity.
Sec. 302. Respectful maternity care training for all employees in
maternity care settings.
Sec. 303. Study on reducing and preventing bias, racism, and
discrimination in maternity care settings.
Sec. 304. Respectful maternity care compliance program.
Sec. 305. GAO report.
TITLE IV--MATERNAL HEALTH FOR VETERANS
Sec. 401. Support for maternity health care and coordination programs
of the Department of Veterans Affairs.
TITLE V--PERINATAL WORKFORCE
Sec. 501. HHS agency directives.
Sec. 502. Grants to grow and diversify the perinatal workforce.
Sec. 503. Grants to grow and diversify the nursing workforce in
maternal and perinatal health.
Sec. 504. GAO report.
Sec. 505. Definitions.
TITLE VI--DATA TO SAVE MOMS
Sec. 601. Funding for maternal mortality review committees to promote
representative community engagement.
Sec. 602. Data collection and review.
Sec. 603. Review of maternal health data collection processes and
quality measures.
Sec. 604. Study on maternal health among American Indian and Alaska
Native individuals.
Sec. 605. Grants to minority-serving institutions to study maternal
mortality, severe maternal morbidity, and
other adverse maternal health outcomes.
TITLE VII--MOMS MATTER
Sec. 701. Maternal mental health equity grant program.
Sec. 702. Grants to grow and diversify the maternal mental and
behavioral health care workforce.
TITLE VIII--JUSTICE FOR INCARCERATED MOMS
Sec. 801. Ending the shackling of pregnant individuals.
Sec. 802. Creating model programs for the care of incarcerated
individuals in the prenatal and postpartum
periods.
Sec. 803. Grant program to improve maternal health outcomes for
individuals in State and local prisons and
jails.
Sec. 804. GAO report.
TITLE IX--TECH TO SAVE MOMS
Sec. 901. Integrated telehealth models in maternity care services.
Sec. 902. Grants to expand the use of technology-enabled collaborative
learning and capacity models for pregnant
and postpartum individuals.
Sec. 903. Grants to promote equity in maternal health outcomes through
digital tools.
Sec. 904. Report on the use of technology in maternity care.
TITLE X--IMPACT TO SAVE MOMS
Sec. 1001. Perinatal Care Alternative Payment Model Demonstration
Project.
TITLE XI--MATERNAL HEALTH PANDEMIC RESPONSE
Sec. 1101. Definitions.
Sec. 1102. Funding for data collection, surveillance, and research on
maternal health outcomes during public
health emergencies.
Sec. 1103. Public health emergency maternal health data collection and
disclosure.
Sec. 1104. Public health communication regarding maternal care during
public health emergencies.
Sec. 1105. Task force on birthing experience and safe, respectful,
responsive, and empowering maternity care
during public health emergencies.
TITLE XII--PROTECTING MOMS AND BABIES AGAINST CLIMATE CHANGE
Sec. 1201. Definitions.
Sec. 1202. Grant program to protect vulnerable mothers and babies from
climate change risks.
Sec. 1203. Grant program for education and training at health
profession schools.
Sec. 1204. NIH Consortium on Birth and Climate Change Research.
Sec. 1205. Strategy for identifying climate change risk zones for
vulnerable mothers and babies.
TITLE XIII--MATERNAL VACCINATIONS
Sec. 1301. Maternal vaccination awareness and equity campaign.
SEC. 3. DEFINITIONS.
In this Act:
(1) Culturally and linguistically congruent.--The term
``culturally and linguistically 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) Maternal mortality.--The term ``maternal mortality''
means a death occurring during or within a 1-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) Maternity care provider.--The term ``maternity care
provider'' means a health care provider who--
(A) is a physician, a physician assistant, a
midwife who meets, at a minimum, the international
definition of a midwife and global standards for
midwifery education as established by the International
Confederation of Midwives, an advanced practice
registered nurse, or a lactation consultant certified
by the International Board of Lactation Consultant
Examiners; and
(B) has a focus on maternal or perinatal health.
(4) Perinatal health worker.--The term ``perinatal health
worker'' means a nonclinical health worker focused on maternal
or perinatal health, such as a doula, community health worker,
peer supporter, lactation educator or counselor, nutritionist
or dietitian, childbirth educator, social worker, home visitor,
patient navigator or coordinator, or language interpreter.
(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
nonclinical factors that impact maternal health outcomes.
SEC. 4. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) the respect and proper care that birthing people
deserve is inclusive; and
(2) regardless of race, ethnicity, gender identity, sexual
orientation, religion, marital status, primary language,
familial status, socioeconomic status, immigration status,
incarceration status, or disability, all deserve dignity.
TITLE I--SOCIAL DETERMINANTS FOR MOMS
SEC. 101. TASK FORCE TO ADDRESS THE UNITED STATES MATERNAL HEALTH
CRISIS.
(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 strategies and coordinate efforts between Federal
agencies and other stakeholders to eliminate preventable maternal
mortality, severe maternal morbidity, and maternal health disparities
in the United States, including actions to address clinical and
nonclinical causes of maternal mortality, severe maternal morbidity,
and maternal health disparities.
(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 Administrator of the Environmental Protection
Agency (or a designee thereof).
(7) The Assistant Secretary for the Administration for
Children and Families (or a designee thereof).
(8) The Administrator of the Centers for Medicare &
Medicaid Services (or a designee thereof).
(9) The Director of the Indian Health Service (or a
designee thereof).
(10) The Director of the National Institutes of Health (or
a designee thereof).
(11) The Director of the Eunice Kennedy Shriver National
Institute of Child Health and Human Development (or a designee
thereof).
(12) The Administrator of the Health Resources and Services
Administration (or a designee thereof).
(13) The Deputy Assistant Secretary for Minority Health of
the Department of Health and Human Services (or a designee
thereof).
(14) The Deputy Assistant Secretary for Women's Health of
the Department of Health and Human Services (or a designee
thereof).
(15) The Director of the Centers for Disease Control and
Prevention (or a designee thereof).
(16) 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 may appoint
the following members of the Task Force:
(1) 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) Leaders of community-based organizations that address
maternal mortality, severe maternal morbidity, and maternal
health 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
demographic groups with elevated rates of maternal mortality,
severe maternal morbidity, maternal health disparities, or
other adverse perinatal or childbirth outcomes.
(3) Perinatal health workers.
(4) A professionally and geographically diverse panel of
maternity care providers.
(5) Other maternal health stakeholders outside of the
Federal Government with expertise in maternal health, including
social determinants of maternal health.
(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) Topics.--In developing strategies coordinating efforts between
Federal agencies and other stakeholders to eliminate preventable
maternal mortality, severe maternal morbidity, and maternal health
disparities in the United States under this section, the Task Force may
address topics such as--
(1) addressing barriers that prevent 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) increasing access to safe, stable, affordable, and
adequate housing for pregnant and postpartum individuals and
their families;
(3) delivering healthy food, infant formula, clean water,
diapers, or other perinatal necessities to pregnant and
postpartum individuals located in areas that are food deserts;
(4) addressing the impacts of water and air quality,
exposure to extreme temperatures, environmental chemicals,
environmental risks in the workplace and the home, and
pollution levels, on maternal and infant health outcomes;
(5) offering free and accessible drop-in childcare services
during prenatal and postpartum appointments;
(6) addressing the clinical and nonclinical needs of
postpartum individuals and their families for the duration of
the postpartum period;
(7) engaging with nongovernmental entities to address
social determinants of maternal health, including through
public-private partnerships;
(8) addressing the impact of domestic or intimate partner
violence on maternal health outcomes; and
(9) other topics determined by the chair of the Task Force.
(f) Report.--Not later than 2 years after the date of enactment of
this Act, and every year thereafter, the Task Force shall submit to
Congress and make publicly available on the website of the Department
of Health and Human Services a report--
(1) describing the Task Force's efforts to develop
strategies and coordinate efforts between Federal agencies and
other stakeholders to eliminate preventable maternal mortality,
severe maternal morbidity, and maternal health disparities in
the United States;
(2) providing an overview of actions taken by each member
of the Task Force listed under subsection (b) to eliminate
preventable maternal mortality, severe maternal morbidity, and
maternal health disparities in the United States;
(3) providing recommendations on Federal funding amounts
and authorities needed to implement strategies developed by the
Task Force to eliminate preventable maternal mortality, severe
maternal morbidity, and maternal health disparities in the
United States;
(4) providing recommendations on actions that stakeholders
outside of the Federal Government can take to eliminate
preventable maternal mortality, severe maternal morbidity, and
maternal health disparities in the United States; and
(5) addressing other topics as determined by the chair of
the Task Force.
(g) Termination.--Section 1013 of title 5, United States Code,
shall not apply to the Task Force with respect to termination.
SEC. 102. SUSTAINED FUNDING TO ADDRESS 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 address social determinants of maternal health to
eliminate maternal mortality, severe maternal morbidity, and maternal
health disparities.
(b) Eligible Entities.--In this section, the term ``eligible
entity'' means--
(1) a community-based organization, Indian Tribe or Tribal
organization, or Urban Indian organization;
(2) a public health department or nonprofit organization
working with an entity listed in paragraph (1); or
(3) a consortium of entities listed in paragraph (1) or (2)
that includes at minimum one entity listed in paragraph (1).
(c) 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.
(d) Prioritization.--In awarding grants under subsection (a), the
Secretary shall give priority to an eligible entity that is operating
in an area with--
(1) high rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes; and
(2) a high poverty rate.
(e) Activities.--An eligible entity that receives a grant under
this section may use the grant to address social determinants of
maternal health such as--
(1) housing;
(2) transportation;
(3) nutrition;
(4) employment, workplace conditions, and other economic
factors;
(5) environmental conditions;
(6) intimate partner violence; and
(7) other nonclinical factors that impact maternal health
outcomes.
(f) 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
after the period of the grant.
(g) 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, primary language, geography,
socioeconomic status, and other relevant factors.
(2) Secretary.--Not later than the end of fiscal year 2028,
the Secretary shall submit to Congress a report that includes--
(A) a summary of the reports under paragraph (1);
and
(B) recommendations for future Federal grant
allocations to address social determinants of maternal
health.
(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $100,000,000 for each of fiscal
years 2024 through 2028.
TITLE II--EXTENDING WIC FOR NEW MOMS
SEC. 201. EXTENDING WIC ELIGIBILITY FOR NEW MOMS.
(a) Extension of Postpartum Period.--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 ``24 months''.
(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 ``24 months''.
(c) Report.--Not later than 2 years after the date of the enactment
of this section, the Secretary shall submit to Congress a report that
includes an evaluation of the effect of each of the amendments made by
this section on--
(1) maternal and infant health outcomes, including racial
and ethnic disparities with respect to such outcomes;
(2) breastfeeding rates among postpartum individuals;
(3) qualitative evaluations of family experiences under the
special supplemental nutrition program under section 17 of the
Child Nutrition Act of 1966 (42 U.S.C. 1786); and
(4) other relevant information as determined by the
Secretary.
TITLE III--HONORING KIRA JOHNSON
SEC. 301. SUSTAINED FUNDING FOR COMMUNITY-BASED ORGANIZATIONS TO
ADVANCE MATERNAL HEALTH EQUITY.
(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 establish or expand programs to advance maternal
health equity.
(b) Timing.--Following the 1-year period described in subsection
(d), the Secretary shall commence awarding the grants authorized by
subsection (a).
(c) Eligible Entities.--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 demographic groups with elevated
rates of maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes.
(d) 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.
(e) Special Consideration.--
(1) Outreach.--In conducting outreach under subsection (d),
the Secretary shall give special consideration to eligible
entities that--
(A) are based in, and provide support for,
communities with elevated rates of maternal mortality,
severe maternal morbidity, maternal health disparities,
or other adverse perinatal or childbirth outcomes, to
the extent such data are available;
(B) are led by individuals from demographic groups
with elevated rates of maternal mortality, severe
maternal morbidity, maternal health disparities, or
other adverse perinatal or childbirth outcomes; and
(C) offer programs and resources that are aligned
with evidence-based practices for improving maternal
health outcomes for individuals from demographic groups
with elevated rates of maternal mortality, severe
maternal morbidity, maternal health disparities, or
other adverse perinatal or childbirth outcomes.
(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 individuals from
demographic groups with elevated rates of maternal
mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth
outcomes;
(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 individuals from
demographic groups with elevated rates of
maternal mortality, severe maternal morbidity,
maternal health disparities, or other adverse
perinatal or childbirth outcomes;
(ii) address social determinants of
maternal health;
(iii) promote evidence-based health
literacy and pregnancy, childbirth, and
parenting education;
(iv) provide support from perinatal health
workers;
(v) provide culturally and linguistically
congruent training to perinatal health workers;
(vi) conduct or support research on
maternal health issues disproportionately
impacting individuals from demographic groups
with elevated rates of maternal mortality,
severe maternal morbidity, maternal health
disparities, or other adverse perinatal or
childbirth outcomes;
(vii) offer group prenatal care or group
postpartum care;
(viii) coordinate mutual aid efforts during
infant formula shortages, including community
milk depots, donor human milk banks and
exchanges, and forums for community outreach
and education;
(ix) provide support to individuals or
family members of individuals who suffered a
pregnancy loss, pregnancy-associated death, or
pregnancy-related death; or
(x) operate midwifery practices that
provide culturally and linguistically 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; and
(D) 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 individuals from demographic groups with elevated
rates of maternal mortality, severe maternal morbidity,
maternal health disparities, or other adverse perinatal
or childbirth outcomes.
(f) Technical Assistance.--The Secretary shall provide to grant
recipients under this section technical assistance on--
(1) capacity building to establish or expand programs to
advance maternal health equity;
(2) best practices in data collection, measurement,
evaluation, and reporting; and
(3) planning for sustaining programs to advance maternal
health equity after the period of the grant.
(g) Evaluation.--Not later than the end of fiscal year 2028, 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
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes,
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
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes.
(h) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $100,000,000 for each of fiscal
years 2024 through 2028.
SEC. 302. 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 and linguistically
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 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 and linguistically
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 1-year period
beginning on the last day of an individual's pregnancy.
``(2) The term `culturally and linguistically congruent'
means in agreement with the preferred cultural values, beliefs,
worldview, 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 2024 through 2028.''.
SEC. 303. 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 and linguistically 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. 304. 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 is present in the delivery of maternity care to
patients from racial and ethnic minority groups;
(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) deidentified 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 nonmedical 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 are authorized to be appropriated such sums as may be necessary
for fiscal years 2024 through 2029.
SEC. 305. 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 subsection (a) 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.
TITLE IV--MATERNAL HEALTH FOR VETERANS
SEC. 401. SUPPORT FOR MATERNITY HEALTH CARE AND COORDINATION PROGRAMS
OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Report to Congress.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter until September 30,
2028, the Secretary of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives,
and make publicly available, a report that contains the following:
(1) A summary of the activities carried out under the
programs of the Department of Veterans Affairs relating to
maternity health care or coordination.
(2) Data on maternal health outcomes of veterans who
receive care furnished by the Secretary of Veterans Affairs,
including pursuant to such programs.
(3) Recommendations by the Secretary of Veterans Affairs to
improve the maternal health outcomes of veterans, with a
particular focus on veterans from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes.
(b) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
the Secretary of Veterans Affairs $15,000,000 for each of
fiscal years 2024, 2025, 2026, 2027, and 2028, for the programs
of the Department of Veterans Affairs relating to maternity
care coordination and related programs, including the maternity
care coordination program described in Veterans Health
Administration Directive 1330.03.
(2) Supplement not supplant.--Amounts authorized under
paragraph (1) are authorized in addition to any other amounts
authorized for maternity health care and coordination for the
Department of Veterans Affairs.
TITLE V--PERINATAL WORKFORCE
SEC. 501. 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, and 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)))--
(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 a midwife and
global standards for midwifery education as
established by the International Confederation
of Midwives;
(ii) perinatal health workers;
(iii) physician assistants;
(iv) advanced practice registered nurses;
and
(v) lactation consultants certified by the
International Board of Lactation Consultant
Examiners;
(C) to provide collaborative, culturally and
linguistically 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 and Linguistically 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 and linguistically 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 and linguistically
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 and linguistically congruent
maternity care.
SEC. 502. 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 accredited schools or programs that
provide education and training to individuals seeking
appropriate licensing and certification as--
``(A) physician assistants who will complete
clinical training in the field of maternal and
perinatal health;
``(B) perinatal health workers; or
``(C) midwives who meet, at a minimum, the
international definition of a midwife and global
standards for midwifery education as established by the
International Confederation of Midwives; and
``(2) expanding the capacity of existing accredited schools
or programs described in paragraph (1), for the purposes of
increasing the number of students enrolled in such accredited
schools or programs, such as by awarding scholarships for
students (including students from racially, ethnically, and
linguistically diverse backgrounds).
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to a school or program described in
subsection (b) 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 school or program described
in subsection (b) that is 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 school or program described in subsection (b) 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 school or program described in subsection (b), 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 school or program;
``(2) the extent to which students in the school or program
are entering careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with elevated rates of maternal
mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth
outcomes, to the extent such data are available; and
``(3) whether the school or program 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
postgrant period sustainability of the school or program described in
subsection (b) that is proposed to be, or is 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 health professionals
described in subparagraphs (A), (B), and (C) of subsection
(b)(1) from racial and ethnic minority groups and other
underserved populations;
``(3) increasing the number of such health professionals
working in health professional shortage areas designated under
section 332; and
``(4) increasing the number of such health professionals
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)(1).
``(j) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2024 through 2028.''.
SEC. 503. 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;
``(2) certified nurse-midwives; or
``(3) 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 elevated rates of maternal
mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth
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 advanced practice registered
nurses entering careers focused on maternal and perinatal
health from racial and ethnic minority groups and other
underserved populations;
``(3) increasing the number of advanced practice registered
nurses entering careers focused on maternal and perinatal
health working in health professional shortage areas designated
under section 332; and
``(4) increasing the number of advanced practice registered
nurses 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 2024 through 2028.''.
SEC. 504. GAO REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act and every 5 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 and
successfully completing 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, and
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)), 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 a 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, and 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 perinatal health workers, stratified by
race, ethnicity, gender identity, primary language, 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. 505. DEFINITIONS.
In this title:
(1) Culturally and linguistically congruent.--The term
``culturally and linguistically 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
a midwife and global standards for midwifery education
as established by the International Confederation of
Midwives, advanced practice registered nurse, or a
lactation consultant certified by the International
Board of Lactation Consultant Examiners; and
(B) has a focus on maternal or perinatal health.
(3) Perinatal health worker.--The term ``perinatal health
worker'' means a nonclinical health worker focused on maternal
or perinatal health, such as a doula, community health worker,
peer supporter, lactation educator or counselor, nutritionist
or dietitian, childbirth educator, social worker, home visitor,
patient navigator or coordinator, or language interpreter.
(4) Postpartum.--The term ``postpartum'' refers 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)).
TITLE VI--DATA TO SAVE MOMS
SEC. 601. 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 (as such
term is defined in section 4 of the Indian Health Care
Improvement Act)--
``(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, personal or family
experiences of maternal mortality or
severe maternal morbidity, and
professional background, including
members with nonclinical 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
Indian tribe to seek input from community
members on the work of such maternal mortality
review committee, with a particular focus on
outreach to women from racial and ethnic
minority groups (as such term is defined in
section 1707(g)(1)); 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 Indian 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 Indian tribe.
``(C) Authorization of appropriations.--In addition
to any funds made available under subsection (f), there
is authorized to be appropriated to carry out this
paragraph $10,000,000 for each of fiscal years 2024
through 2028.''.
(b) 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 (as such term is defined in section 4 of the Indian
Health Care Improvement Act)''.
SEC. 602. 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 with elevated rates of maternal
mortality, severe maternal morbidity,
maternal health disparities, or other
adverse perinatal or childbirth
outcomes to ensure that, in addition to
clinical factors, nonclinical factors
that might have contributed to a
pregnancy-related death are
appropriately considered;''.
SEC. 603. REVIEW OF MATERNAL HEALTH DATA COLLECTION PROCESSES AND
QUALITY MEASURES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Centers for Medicare & Medicaid
Services and the Director of the Agency for Healthcare Research and
Quality (referred to in this section as the ``Secretary''), shall
consult with relevant stakeholders--
(1) to review existing maternal health data collection
processes and quality measures; and
(2) to make recommendations to improve such processes and
measures, including topics described under 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 demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
(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 facilities that provide maternal
health care services;
(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, primary
language, socioeconomic status, geography, 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 data on race, ethnicity, and
other demographic characteristics;
(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 demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other
adverse perinatal or childbirth outcomes, 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; and
(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 and making
publicly available, to the extent practicable,
stratified data on race, ethnicity, and other
demographic characteristics of pregnant and postpartum
individuals in hospitals, health systems, midwifery
practices, and birth centers, and for incorporating
such demographically 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
maternal health disparities.
(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 the 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) Definition.--In this section, 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)).
(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal years 2024 through 2027.
SEC. 604. STUDY ON MATERNAL HEALTH AMONG AMERICAN INDIAN AND ALASKA
NATIVE INDIVIDUALS.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') shall, in
coordination with entities described in subsection (b)--
(1) not later than 90 days after the date of enactment of
this Act, enter into a contract with an independent research
organization or Tribal Epidemiology Center to conduct a
comprehensive study on maternal mortality, severe maternal
morbidity, and other adverse perinatal or childbirth outcomes
in the populations of American Indian and Alaska Native
individuals; and
(2) not later than 3 years after the date of enactment of
this Act, submit to Congress a report on such study that
contains recommendations for policies and practices that can be
adopted to improve maternal health outcomes for American Indian
and Alaska Native individuals.
(b) Participating Entities.--The entities described in this
subsection shall consist of 12 members, selected by the Secretary from
among individuals nominated by Indian Tribes and Tribal organizations
(as such terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304)), and Urban
Indian organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)). In selecting such
members, the Secretary shall ensure that each of the 12 service areas
of the Indian Health Service is represented.
(c) Contents of Study.--The study conducted pursuant to subsection
(a) shall--
(1) examine the causes of maternal mortality and severe
maternal morbidity that are unique to American Indian and
Alaska Native individuals;
(2) include a systematic process of listening to the
stories of American Indian and Alaska Native individuals to
fully understand the causes of, and inform potential solutions
to, the maternal health crisis within their respective
communities;
(3) distinguish between the causes of, landscape of
maternity care at, and recommendations to improve maternal
health outcomes within, the different settings in which
American Indian and Alaska Native individuals receive maternity
care, such as--
(A) facilities operated by the Indian Health
Service;
(B) an Indian health program operated by an Indian
Tribe or Tribal organization pursuant to a contract,
grant, cooperative agreement, or compact with the
Indian Health Service pursuant to the Indian Self-
Determination Act;
(C) an urban Indian health program operated by an
Urban Indian organization pursuant to a grant or
contract with the Indian Health Service pursuant to
title V of the Indian Health Care Improvement Act; and
(D) facilities outside of the Indian Health Service
in which American Indian and Alaska Native individuals
receive maternity care services;
(4) review processes for coordinating programs of the
Indian Health Service with social services provided through
other programs administered by the Secretary (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 such 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.);
(5) review current data collection and quality measurement
processes and practices;
(6) assess causes and frequency of maternal mental health
conditions and substance use disorders;
(7) consider social determinants of health, including
poverty, lack of health insurance, unemployment, sexual and
domestic violence, and environmental conditions in Tribal
areas;
(8) consider the role that historical mistreatment of
American Indian and Alaska Native women has played in causing
currently elevated rates of maternal mortality, severe maternal
morbidity, and other adverse perinatal or childbirth outcomes;
(9) consider how current funding of the Indian Health
Service affects the ability of the Service to deliver quality
maternity care;
(10) consider the extent to which the delivery of maternity
care services is culturally appropriate for American Indian and
Alaska Native individuals;
(11) make recommendations to reduce misclassification of
American Indian and Alaska Native individuals, including
consideration of best practices in training for maternal
mortality review committee members to be able to correctly
classify American Indian and Alaska Native individuals; and
(12) make recommendations informed by the stories shared by
American Indian and Alaska Native individuals referred to in
paragraph (2) to improve maternal health outcomes for such
individuals.
(d) Report.--The agreement entered into under subsection (a) with
an independent research organization or Tribal Epidemiology Center
shall require that the organization or Center transmit to Congress a
report on the results of the study conducted pursuant to that agreement
not later than 36 months after the date of enactment of this Act.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2024 through 2026.
SEC. 605. 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
(referred to in this section as the ``Secretary'') 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;
(3) assess differences in rates of adverse maternal health
outcomes among subgroups identifying as Hispanic, including
disparities in access to early prenatal care; and
(4) include lactation education to promote racial and
ethnic diversity within the workforce of health care
professionals with breastfeeding and lactation expertise.
(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 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 1 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'' means an institution described in
section 371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)).
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2024 through 2028.
TITLE VII--MOMS MATTER
SEC. 701. MATERNAL MENTAL HEALTH EQUITY GRANT PROGRAM.
(a) In General.--The Secretary of Health and Human Services, acting
through the Assistant Secretary for Mental Health and Substance Use,
shall establish a program to award grants to eligible entities to
address maternal mental health conditions and substance use disorders,
with a focus on demographic groups with elevated rates of maternal
mortality, severe maternal morbidity, maternal health disparities, or
other adverse perinatal or childbirth outcomes.
(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) Priority.--In awarding grants under this section, the Secretary
shall give priority to an eligible entity that--
(1) is, or will partner with, a community-based
organization to address maternal mental health conditions and
substance use disorders described in subsection (a);
(2) is operating in an area with elevated rates of maternal
mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
and
(3) is operating in a health professional shortage area
designated under section 332 of the Public Health Service Act
(42 U.S.C. 254e).
(d) Use of Funds.--An eligible entity that receives a grant under
this section shall use the grant for the following:
(1) Establishing or expanding maternity care programs to
improve the integration of maternal mental health and
behavioral health care services into primary care settings
where pregnant individuals regularly receive health care
services.
(2) Establishing or expanding group prenatal care programs
or postpartum care programs.
(3) Expanding existing programs that improve maternal
mental and behavioral health during the prenatal and postpartum
periods, with a focus on individuals from demographic groups
with elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes.
(4) Providing services and support for pregnant and
postpartum individuals with maternal mental health conditions
and substance use disorders, including referrals to addiction
treatment centers that offer evidence-based treatment options.
(5) Addressing stigma associated with maternal mental
health conditions and substance use disorders, with a focus on
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes.
(6) Raising awareness of warning signs of maternal mental
health conditions and substance use disorders, with a focus on
pregnant and postpartum individuals from demographic groups
with elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes.
(7) Establishing or expanding programs to prevent suicide
or self-harm among pregnant and postpartum individuals.
(8) Offering evidence-aligned programs at freestanding
birth centers that provide maternal mental and behavioral
health care education, treatments, and services, and other
services for individuals throughout the prenatal and postpartum
period.
(9) Establishing or expanding programs to provide education
and training to maternity care providers with respect to--
(A) identifying potential warning signs for
maternal mental health conditions or substance use
disorders in pregnant and postpartum individuals, with
a focus on individuals from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other
adverse perinatal or childbirth outcomes; and
(B) in the case where such providers identify such
warning signs, offering referrals to mental and
behavioral health care professionals.
(10) Developing a website, or other source, that includes
information on health care providers who treat maternal mental
health conditions and substance use disorders.
(11) Establishing or expanding programs in communities to
improve coordination between maternity care providers and
mental and behavioral health care providers who treat maternal
mental health conditions and substance use disorders, including
through the use of toll-free hotlines.
(12) Carrying out other programs aligned with evidence-
based practices for addressing maternal mental health
conditions and substance use disorders for pregnant and
postpartum individuals from demographic groups with elevated
rates of maternal mortality, severe maternal morbidity,
maternal health disparities, or other adverse perinatal or
childbirth outcomes.
(e) Reporting.--
(1) Eligible entities.--An eligible entity that receives a
grant under subsection (a) shall submit annually to the
Secretary, and make publicly available, a report on the
activities conducted using funds received through a grant under
this section. Such reports shall include quantitative and
qualitative evaluations of such activities, including the
experience of individuals who received health care through such
grant.
(2) Secretary.--Not later than the end of fiscal year 2027,
the Secretary shall submit to Congress a report that includes--
(A) a summary of the reports received under
paragraph (1);
(B) an evaluation of the effectiveness of grants
awarded under this section;
(C) recommendations with respect to expanding
coverage of evidence-based screenings and treatments
for maternal mental health conditions and substance use
disorders; and
(D) recommendations with respect to ensuring
activities described under subsection (d) continue
after the end of a grant period.
(f) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means--
(A) a community-based organization serving pregnant
and postpartum individuals, including such
organizations serving individuals from demographic
groups with elevated rates of maternal mortality,
severe maternal morbidity, maternal health disparities,
or other adverse perinatal or childbirth outcomes;
(B) a nonprofit or patient advocacy organization
with expertise in maternal mental and behavioral
health;
(C) a maternity care provider;
(D) a mental or behavioral health care provider who
treats maternal mental health conditions or substance
use disorders;
(E) a State or local governmental entity, including
a State or local public health department;
(F) 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)); and
(G) 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) Freestanding birth center.--The term ``freestanding
birth center'' has the meaning given that term under section
1905(l) of the Social Security Act (42 U.S.C. 1396d(l)).
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(g) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $25,000,000 for each of fiscal
years 2024 through 2027.
SEC. 702. GRANTS TO GROW AND DIVERSIFY THE MATERNAL MENTAL AND
BEHAVIORAL HEALTH CARE WORKFORCE.
Title VII of the Public Health Service Act is amended by inserting
after section 758 of such Act, as added by section 502 of this Act, the
following new section:
``SEC. 758A. MATERNAL MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE
GRANTS.
``(a) In General.--The Secretary may award grants to entities to
establish or expand programs described in subsection (b) to grow and
diversify the maternal mental and behavioral health care workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the maternal mental and behavioral
health care workforce by--
``(1) establishing schools or programs that provide
education and training to individuals seeking appropriate
licensing or certification as mental or behavioral health care
providers who will specialize in maternal mental health
conditions or substance use disorders; or
``(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 maternal mental or behavioral
health care 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
maternal health disparities, to the extent practicable; and
``(5) includes in the standard curriculum for all students
within the maternal mental or behavioral health care 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 maternal mental or behavioral health care 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 maternal health
disparities, 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 training on
implicit bias and racism, 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
postgrant period sustainability of the maternal mental or behavioral
health care 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 and other underserved populations;
``(2) increasing the number of mental or behavioral health
care providers specializing in maternal mental health
conditions or substance use disorders from racial and ethnic
minority groups and other underserved populations;
``(3) increasing the number of mental or behavioral health
care providers specializing in maternal mental health
conditions or substance use disorders working in health
professional shortage areas designated under section 332; and
``(4) increasing the number of mental or behavioral health
care providers specializing in maternal mental health
conditions or substance use disorders working in areas with
significant maternal health disparities, to the extent such
data are available.
``(i) Definitions.--In this section:
``(1) Racial and ethnic minority group.--The term `racial
and ethnic minority group' has the meaning given such term in
section 1707(g)(1).
``(2) Mental or behavioral health care provider.--The term
`mental or behavioral health care provider' refers to a health
care provider in the field of mental and behavioral health,
including substance use disorders, acting in accordance with
State law.
``(j) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2024 through 2028.''.
TITLE VIII--JUSTICE FOR INCARCERATED MOMS
SEC. 801. ENDING THE SHACKLING OF PREGNANT INDIVIDUALS.
(a) In General.--Beginning on the date that is 6 months after the
date of enactment of this Act, and annually thereafter, in each State
that receives a grant under subpart 1 of part E of title I of the
Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et
seq.) (commonly referred to as the ``Edward Byrne Memorial Justice
Assistance Grant Program'') and that does not have in effect throughout
the State for such fiscal year laws restricting the use of restraints
on pregnant individuals in prison that are substantially similar to the
rights, procedures, requirements, effects, and penalties set forth in
section 4322 of title 18, United States Code, the amount of such grant
that would otherwise be allocated to such State under such subpart for
the fiscal year shall be decreased by 25 percent.
(b) Reallocation.--Amounts not allocated to a State for failure to
comply with subsection (a) shall be reallocated in accordance with
subpart 1 of part E of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (34 U.S.C. 10151 et seq.) to States that have
complied with such subsection.
SEC. 802. CREATING MODEL PROGRAMS FOR THE CARE OF INCARCERATED
INDIVIDUALS IN THE PRENATAL AND POSTPARTUM PERIODS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Attorney General, acting through the Director of the
Bureau of Prisons, shall establish, in not fewer than 6 Bureau of
Prisons facilities, programs to optimize maternal health outcomes for
pregnant and postpartum individuals incarcerated in such facilities.
The Attorney General shall establish such programs in consultation with
stakeholders such as--
(1) relevant community-based organizations, particularly
organizations that represent incarcerated and formerly
incarcerated individuals and organizations that seek to improve
maternal health outcomes for pregnant and postpartum
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
(2) relevant organizations representing patients, with a
particular focus on patients from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes;
(3) organizations representing maternity care providers and
maternal health care education programs;
(4) perinatal health workers; and
(5) researchers and policy experts in fields related to
maternal health care for incarcerated individuals.
(b) Start Date.--Each selected facility shall begin facility
programs not later than 18 months after the date of enactment of this
Act.
(c) Facility Priority.--In carrying out subsection (a), the
Director shall give priority to a facility based on--
(1) the number of pregnant and postpartum individuals
incarcerated in such facility and, among such individuals, the
number of pregnant and postpartum individuals from demographic
groups with elevated rates of maternal mortality, severe
maternal morbidity, maternal health disparities, or other
adverse perinatal or childbirth outcomes; and
(2) the extent to which the leaders of such facility have
demonstrated a commitment to developing exemplary programs for
pregnant and postpartum individuals incarcerated in such
facility.
(d) Program Duration.--The programs established under this section
shall be for a 5-year period.
(e) Programs.--Bureau of Prisons facilities selected by the
Director shall establish programs for pregnant and postpartum
incarcerated individuals, and such programs may--
(1) provide access to perinatal health workers from
pregnancy through the postpartum period;
(2) provide access to healthy foods and counseling on
nutrition, recommended activity levels, and safety measures
throughout pregnancy;
(3) train correctional officers to ensure that pregnant
incarcerated individuals receive safe and respectful treatment;
(4) train medical personnel to ensure that pregnant
incarcerated individuals receive trauma-informed, culturally
and linguistically congruent care that promotes the health and
safety of the pregnant individuals;
(5) provide counseling and treatment for individuals who
have suffered from--
(A) diagnosed mental or behavioral health
conditions, including trauma and substance use
disorders;
(B) trauma or violence, including domestic
violence;
(C) human immunodeficiency virus;
(D) sexual abuse;
(E) pregnancy or infant loss; or
(F) chronic conditions;
(6) provide evidence-based pregnancy and childbirth
education, parenting support, and other relevant forms of
health literacy;
(7) provide clinical education opportunities to maternity
care providers in training to expand pathways into maternal
health care careers serving incarcerated individuals;
(8) offer opportunities for postpartum individuals to
maintain contact with the individual's newborn child to promote
bonding, including enhanced visitation policies, access to
prison nursery programs, or breastfeeding support;
(9) provide reentry assistance, particularly to--
(A) ensure access to health insurance coverage and
transfer of health records to community providers if an
incarcerated individual exits the criminal justice
system during such individual's pregnancy or in the
postpartum period; and
(B) connect individuals exiting the criminal
justice system during pregnancy or in the postpartum
period to community-based resources, such as referrals
to health care providers, substance use disorder
treatments, and social services that address social
determinants maternal of health; or
(10) establish partnerships with local public entities,
private community entities, community-based organizations,
Indian Tribes and Tribal organizations (as such terms are
defined in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304)), and Urban Indian
organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)) to
establish or expand pretrial diversion programs as an
alternative to incarceration for pregnant and postpartum
individuals. Such programs may include--
(A) evidence-based childbirth education or
parenting classes;
(B) prenatal health coordination;
(C) family and individual counseling;
(D) evidence-based screenings, education, and, as
needed, treatment for mental and behavioral health
conditions, including drug and alcohol treatments;
(E) family case management services;
(F) domestic violence education and prevention;
(G) physical and sexual abuse counseling; and
(H) programs to address social determinants of
health such as employment, housing, education,
transportation, and nutrition.
(f) Implementation and Reporting.--A selected facility shall be
responsible for--
(1) implementing programs, which may include the programs
described in subsection (e); and
(2) not later than 3 years after the date of enactment of
this Act, and 6 years after the date of enactment of this Act,
reporting results of the programs to the Director, including
information describing--
(A) relevant quantitative indicators of success in
improving the standard of care and health outcomes for
pregnant and postpartum incarcerated individuals in the
facility, including data stratified by race, ethnicity,
sex, gender, primary language, age, geography,
disability status, the category of the criminal charge
against such individual, rates of pregnancy-related
deaths, pregnancy-associated deaths, cases of infant
mortality and morbidity, rates of preterm births and
low-birthweight births, cases of severe maternal
morbidity, cases of violence against pregnant or
postpartum individuals, diagnoses of maternal mental or
behavioral health conditions, and other such
information as appropriate;
(B) relevant qualitative and quantitative
evaluations from pregnant and postpartum incarcerated
individuals who participated in such programs,
including measures of patient-reported experience of
care; and
(C) strategies to sustain such programs after
fiscal year 2028 and expand such programs to other
facilities.
(g) Report.--Not later than 6 years after the date of enactment of
this Act, the Director shall submit to the Attorney General and to the
Congress a report describing the results of the programs funded under
this section.
(h) Oversight.--Not later than 1 year after the date of enactment
of this Act, the Attorney General shall award a contract to an
independent organization or independent organizations to conduct
oversight of the programs described in subsection (e).
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2024 through 2028.
SEC. 803. GRANT PROGRAM TO IMPROVE MATERNAL HEALTH OUTCOMES FOR
INDIVIDUALS IN STATE AND LOCAL PRISONS AND JAILS.
(a) Establishment.--Not later than 1 year after the date of
enactment of this Act, the Attorney General, acting through the
Director of the Bureau of Justice Assistance, shall award Justice for
Incarcerated Moms grants to States to establish or expand programs in
State and local prisons and jails for pregnant and postpartum
incarcerated individuals. The Attorney General shall award such grants
in consultation with stakeholders such as--
(1) relevant community-based organizations, particularly
organizations that represent incarcerated and formerly
incarcerated individuals and organizations that seek to improve
maternal health outcomes for pregnant and postpartum
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
(2) relevant organizations representing patients, with a
particular focus on patients from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes;
(3) organizations representing maternity care providers and
maternal health care education programs;
(4) perinatal health workers; and
(5) researchers and policy experts in fields related to
maternal health care for incarcerated individuals.
(b) Applications.--Each applicant for a grant under this section
shall submit to the Director of the Bureau of Justice Assistance an
application at such time, in such manner, and containing such
information as the Director may require.
(c) Use of Funds.--A State that is awarded a grant under this
section shall use such grant to establish or expand programs for
pregnant and postpartum incarcerated individuals, and such programs
may--
(1) provide access to perinatal health workers from
pregnancy through the postpartum period;
(2) provide access to healthy foods and counseling on
nutrition, recommended activity levels, and safety measures
throughout pregnancy;
(3) train correctional officers to ensure that pregnant
incarcerated individuals receive safe and respectful treatment;
(4) train medical personnel to ensure that pregnant
incarcerated individuals receive trauma-informed, culturally
and linguistically congruent care that promotes the health and
safety of the pregnant individuals;
(5) provide counseling and treatment for individuals who
have suffered from--
(A) diagnosed mental or behavioral health
conditions, including trauma and substance use
disorders;
(B) trauma or violence, including domestic
violence;
(C) human immunodeficiency virus;
(D) sexual abuse;
(E) pregnancy or infant loss; or
(F) chronic conditions;
(6) provide evidence-based pregnancy and childbirth
education, parenting support, and other relevant forms of
health literacy;
(7) provide clinical education opportunities to maternity
care providers in training to expand pathways into maternal
health care careers serving incarcerated individuals;
(8) offer opportunities for postpartum individuals to
maintain contact with the individual's newborn child to promote
bonding, including enhanced visitation policies, access to
prison nursery programs, or breastfeeding support;
(9) provide reentry assistance, particularly to--
(A) ensure access to health insurance coverage and
transfer of health records to community providers if an
incarcerated individual exits the criminal justice
system during such individual's pregnancy or in the
postpartum period; and
(B) connect individuals exiting the criminal
justice system during pregnancy or in the postpartum
period to community-based resources, such as referrals
to health care providers, substance use disorder
treatments, and social services that address social
determinants of maternal health; or
(10) establish partnerships with local public entities,
private community entities, community-based organizations,
Indian Tribes and Tribal organizations (as such terms are
defined in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304)), and Urban Indian
organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)) to
establish or expand pretrial diversion programs as an
alternative to incarceration for pregnant and postpartum
individuals. Such programs may include--
(A) evidence-based childbirth education or
parenting classes;
(B) prenatal health coordination;
(C) family and individual counseling;
(D) evidence-based screenings, education, and, as
needed, treatment for mental and behavioral health
conditions, including drug and alcohol treatments;
(E) family case management services;
(F) domestic violence education and prevention;
(G) physical and sexual abuse counseling; and
(H) programs to address social determinants of
health such as employment, housing, education,
transportation, and nutrition.
(d) Priority.--In awarding grants under this section, the Director
of the Bureau of Justice Assistance shall give priority to applicants
based on--
(1) the number of pregnant and postpartum individuals
incarcerated in the State and, among such individuals, the
number of pregnant and postpartum individuals from demographic
groups with elevated rates of maternal mortality, severe
maternal morbidity, maternal health disparities, or other
adverse perinatal or childbirth outcomes; and
(2) the extent to which the State has demonstrated a
commitment to developing exemplary programs for pregnant and
postpartum individuals incarcerated in the prisons and jails in
the State.
(e) Grant Duration.--A grant awarded under this section shall be
for a 5-year period.
(f) Implementing and Reporting.--A State that receives a grant
under this section shall be responsible for--
(1) implementing the program funded by the grant; and
(2) not later than 3 years after the date of enactment of
this Act, and 6 years after the date of enactment of this Act,
reporting results of such program to the Attorney General,
including information describing--
(A) relevant quantitative indicators of the
program's success in improving the standard of care and
health outcomes for pregnant and postpartum
incarcerated individuals in the facility, including
data stratified by race, ethnicity, sex, gender,
primary language, age, geography, disability status,
category of the criminal charge against such
individual, incidence rates of pregnancy-related
deaths, pregnancy-associated deaths, cases of infant
mortality and morbidity, rates of preterm births and
low-birthweight births, cases of severe maternal
morbidity, cases of violence against pregnant or
postpartum individuals, diagnoses of maternal mental or
behavioral health conditions, and other such
information as appropriate;
(B) relevant qualitative and quantitative
evaluations from pregnant and postpartum incarcerated
individuals who participated in such programs,
including measures of patient-reported experience of
care; and
(C) strategies to sustain such programs beyond the
duration of the grant and expand such programs to other
facilities.
(g) Report.--Not later than 6 years after the date of enactment of
this Act, the Attorney General shall submit to the Congress a report
describing the results of such grant programs.
(h) Oversight.--Not later than 1 year after the date of enactment
of this Act, the Attorney General shall award a contract to an
independent organization or independent organizations to conduct
oversight of the programs described in subsection (c).
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2024 through 2028.
SEC. 804. GAO REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act, the Comptroller General of the United States shall submit
to Congress a report on adverse maternal and infant health outcomes
among incarcerated individuals and infants born to such individuals,
with a particular focus on racial and ethnic disparities in maternal
and infant health outcomes for incarcerated individuals.
(b) Contents of Report.--The report described in this section shall
include--
(1) to the extent practicable--
(A) the number of pregnant individuals who are
incarcerated in Bureau of Prisons facilities;
(B) the number of incarcerated individuals,
including those incarcerated in Federal, State, and
local correctional facilities, who have experienced a
pregnancy-related death, pregnancy-associated death, or
the death of an infant in the most recent 10 years of
available data;
(C) the number of cases of severe maternal
morbidity among incarcerated individuals, including
those incarcerated in Federal, State, and local
detention facilities, in the most recent 10 years of
available data;
(D) the number of preterm and low-birthweight
births of infants born to incarcerated individuals,
including those incarcerated in Federal, State, and
local correctional facilities, in the most recent 10
years of available data; and
(E) statistics on the racial and ethnic disparities
in maternal and infant health outcomes and severe
maternal morbidity rates among incarcerated
individuals, including those incarcerated in Federal,
State, and local detention facilities;
(2) in the case that the Comptroller General of the United
States is unable determine the information required in
subparagraphs (A) through (C) of paragraph (1), an assessment
of the barriers to determining such information and
recommendations for improvements in tracking maternal health
outcomes among incarcerated individuals, including those
incarcerated in Federal, State, and local detention facilities;
(3) the implications of pregnant and postpartum
incarcerated individuals being ineligible for medical
assistance under a State plan under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) including information
about--
(A) the effects of such ineligibility on maternal
health outcomes for pregnant and postpartum
incarcerated individuals, with emphasis given to such
effects for pregnant and postpartum individuals from
racial and ethnic minority groups; and
(B) potential implications on maternal health
outcomes resulting from temporarily suspending, rather
than permanently terminating, such eligibility when a
pregnant or postpartum individual is incarcerated;
(4) the extent to which Federal, State, and local
correctional facilities are holding pregnant and postpartum
individuals who test positive for illicit drug use in detention
with special conditions, such as additional bond requirements,
due to the individual's drug use, and the effect of such
detention policies on maternal and infant health outcomes;
(5) causes of adverse maternal health outcomes that are
unique to incarcerated individuals, including those
incarcerated in Federal, State, and local detention facilities;
(6) causes of adverse maternal health outcomes and severe
maternal morbidity that are unique to incarcerated individuals
from racial and ethnic minority groups;
(7) recommendations to reduce maternal mortality and severe
maternal morbidity among incarcerated individuals and to
address racial and ethnic disparities in maternal health
outcomes for incarcerated individuals in Bureau of Prisons
facilities and State and local prisons and jails; and
(8) such other information as may be appropriate to reduce
the occurrence of adverse maternal health outcomes among
incarcerated individuals and to address racial and ethnic
disparities in maternal health outcomes for such individuals.
TITLE IX--TECH TO SAVE MOMS
SEC. 901. INTEGRATED TELEHEALTH MODELS IN MATERNITY CARE SERVICES.
(a) In General.--Section 1115A(b)(2)(B) of the Social Security Act
(42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the
following:
``(xxviii) Focusing on title XIX, providing
for the adoption of and use of telehealth tools
that allow for screening, monitoring, and
management of common health complications with
respect to an individual receiving medical
assistance during such individual's pregnancy
and for not more than a 1-year period beginning
on the last day of the pregnancy.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect 1 year after the date of the enactment of this Act.
SEC. 902. GRANTS TO EXPAND THE USE OF TECHNOLOGY-ENABLED COLLABORATIVE
LEARNING AND CAPACITY MODELS FOR PREGNANT AND POSTPARTUM
INDIVIDUALS.
Title III of the Public Health Service Act is amended by inserting
after section 330P (42 U.S.C. 254c-22) the following:
``SEC. 330Q. EXPANDING CAPACITY FOR MATERNAL HEALTH OUTCOMES.
``(a) Establishment.--Beginning not later than 1 year after the
date of enactment of this Act, the Secretary shall award grants to
eligible entities to evaluate, develop, and expand the use of
technology-enabled collaborative learning and capacity building models
and improve maternal health outcomes--
``(1) in health professional shortage areas;
``(2) in areas with high rates of maternal mortality and
severe maternal morbidity;
``(3) in rural and underserved areas;
``(4) in areas with significant maternal health
disparities; and
``(5) for medically underserved populations and American
Indians and Alaska Natives, including Indian Tribes, Tribal
organizations, and Urban Indian organizations.
``(b) Use of Funds.--
``(1) Required uses.--Recipients of grants under this
section shall use the grants to--
``(A) train maternal health care providers,
students, and other similar professionals through
models that include--
``(i) methods to increase safety and health
care quality;
``(ii) implicit bias, racism, and
discrimination;
``(iii) best practices in screening for
and, as needed, evaluating and treating
maternal mental health conditions and substance
use disorders;
``(iv) training on best practices in
maternity care for pregnant and postpartum
individuals during public health emergencies;
``(v) methods to screen for social
determinants of maternal health risks in the
prenatal and postpartum; and
``(vi) the use of remote patient monitoring
tools for pregnancy-related complications
described in section 1115A(b)(2)(B)(xxviii) of
the Social Security Act;
``(B) evaluate and collect information on the
effect of such models on--
``(i) access to and quality of care;
``(ii) outcomes with respect to the health
of an individual; and
``(iii) the experience of individuals who
receive pregnancy-related health care;
``(C) develop qualitative and quantitative measures
to identify best practices for the expansion and use of
such models;
``(D) study the effect of such models on patient
outcomes and maternity care providers; and
``(E) conduct any other activity determined by the
Secretary.
``(2) Permissible uses.--Recipients of grants under this
section may use grants to support--
``(A) the use and expansion of technology-enabled
collaborative learning and capacity building models,
including hardware and software that--
``(i) enables distance learning and
technical support; and
``(ii) supports the secure exchange of
electronic health information; and
``(B) maternity care providers, students, and other
similar professionals in the provision of maternity
care through such models.
``(c) Application.--
``(1) In general.--An eligible entity seeking a grant under
subsection (a) shall submit to the Secretary an application, at
such time, in such manner, and containing such information as
the Secretary may require.
``(2) Assurance.--An application under paragraph (1) shall
include an assurance that such entity shall collect information
on and assess the effect of the use of technology-enabled
collaborative learning and capacity building models, including
with respect to--
``(A) maternal health outcomes;
``(B) access to maternal health care services;
``(C) quality of maternal health care; and
``(D) retention of maternity care providers serving
areas and populations described in subsection (a).
``(d) Limitations.--
``(1) Number.--The Secretary may not award more than 1
grant under this section.
``(2) Duration.--A grant awarded under this section shall
be for a 5-year period.
``(e) Access to Broadband.--In administering grants under this
section, the Secretary may coordinate with other agencies to ensure
that funding opportunities are available to support access to reliable,
high-speed internet for grantees.
``(f) Technical Assistance.--The Secretary shall provide (either
directly or by contract) technical assistance to eligible entities,
including recipients of grants under subsection (a), on the
development, use, and sustainability of technology-enabled
collaborative learning and capacity building models to expand access to
maternal health care services provided by such entities, including--
``(1) in health professional shortage areas;
``(2) in areas with high rates of maternal mortality and
severe maternal morbidity or significant maternal health
disparities;
``(3) in rural and underserved areas; and
``(4) for medically underserved populations or American
Indians and Alaska Natives.
``(g) Research and Evaluation.--The Secretary, in consultation with
experts, shall develop a strategic plan to research and evaluate the
evidence for technology-enabled collaborative learning and capacity
building models.
``(h) Reporting.--
``(1) Eligible entities.--An eligible entity that receives
a grant under subsection (a) shall submit to the Secretary a
report, at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Secretary.--Not later than 4 years after the date of
enactment of this section, the Secretary shall submit to the
Congress, and make available on the website of the Department
of Health and Human Services, a report that includes--
``(A) a description of grants awarded under
subsection (a) and the purpose and amounts of such
grants;
``(B) a summary of--
``(i) the evaluations conducted under
subsection (b)(1)(B);
``(ii) any technical assistance provided
under subsection (f); and
``(iii) the activities conducted under
subsection (a); and
``(C) a description of any significant findings
with respect to--
``(i) patient outcomes; and
``(ii) best practices for expanding, using,
or evaluating technology-enabled collaborative
learning and capacity building models.
``(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $6,000,000 for each of fiscal
years 2024 through 2028.
``(j) Definitions.--In this section:
``(1) Eligible entity.--
``(A) In general.--The term `eligible entity' means
an entity that provides, or supports the provision of,
maternal health care services or other evidence-based
services for pregnant and postpartum individuals--
``(i) in health professional shortage
areas;
``(ii) in rural or underserved areas;
``(iii) in areas with high rates of adverse
maternal health outcomes or significant racial
and ethnic disparities in maternal health
outcomes; and
``(iv) who are--
``(I) members of medically
underserved populations; or
``(II) American Indians and Alaska
Natives, including Indian Tribes,
Tribal organizations, and Urban Indian
organizations.
``(B) Inclusions.--An eligible entity may include
entities that lead, or are capable of leading a
technology-enabled collaborative learning and capacity
building model.
``(2) Health professional shortage area.--The term `health
professional shortage area' means a health professional
shortage area designated under section 332.
``(3) Indian tribe.--The term `Indian Tribe' has the
meaning given such term in section 4 of the Indian Self-
Determination and Education Assistance Act.
``(4) Maternal mortality.--The term `maternal mortality'
means a death occurring during or within 1-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 or childbirth
complications.
``(5) Medically underserved population.--The term
`medically underserved population' has the meaning given such
term in section 330(b)(3).
``(6) Postpartum.--The term `postpartum' means the 1-year
period beginning on the last date of an individual's pregnancy.
``(7) Severe maternal morbidity.--The term `severe maternal
morbidity' means a health condition, including a mental health
or substance use disorder, 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) Technology-enabled collaborative learning and
capacity building model.--The term `technology-enabled
collaborative learning and capacity building model' means a
distance health education model that connects health care
professionals, and other specialists, through simultaneous
interactive video conferencing for the purpose of facilitating
case-based learning, disseminating best practices, and
evaluating outcomes in the context of maternal health care.
``(9) Tribal organization.--The term `Tribal organization'
has the meaning given such term in section 4 of the Indian
Self-Determination and Education Assistance Act.
``(10) Urban indian organization.--The term `Urban Indian
organization' has the meaning given such term in section 4 of
the Indian Health Care Improvement Act.''.
SEC. 903. GRANTS TO PROMOTE EQUITY IN MATERNAL HEALTH OUTCOMES THROUGH
DIGITAL TOOLS.
(a) In General.--Beginning not later than 1 year after the date of
the enactment of this Act, the Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall make grants to
eligible entities to reduce maternal health disparities by increasing
access to digital tools related to maternal health care, including
provider-facing technologies, such as early warning systems and
clinical decision support mechanisms.
(b) Applications.--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) Prioritization.--In awarding grants under this section, the
Secretary shall prioritize an eligible entity--
(1) in an area with elevated rates of maternal mortality,
severe maternal morbidity, maternal health disparities, or
other adverse perinatal or childbirth outcomes;
(2) in a health professional shortage area designated under
section 332 of the Public Health Service Act (42 U.S.C. 254e)
or a rural or underserved area; and
(3) that promotes technology that addresses maternal health
disparities.
(d) Limitations.--
(1) Number.--The Secretary may award not more than 1 grant
under this section.
(2) Duration.--A grant awarded under this section shall be
for a 5-year period.
(e) Technical Assistance.--The Secretary shall provide technical
assistance to an eligible entity on the development, use, evaluation,
and postgrant sustainability of digital tools for purposes of promoting
equity in maternal health outcomes.
(f) Reporting.--
(1) Eligible entities.--An eligible entity that receives a
grant under subsection (a) shall submit to the Secretary a
report, at such time, in such manner, and containing such
information as the Secretary may require.
(2) Secretary.--Not later than 4 years after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report that includes--
(A) an evaluation on the effectiveness of grants
awarded under this section to improve maternal health
outcomes, particularly for pregnant and postpartum
individuals from racial and ethnic minority groups;
(B) recommendations on new grant programs that
promote the use of technology to improve such maternal
health outcomes; and
(C) recommendations with respect to--
(i) technology-based privacy and security
safeguards in maternal health care;
(ii) reimbursement rates for maternal
telehealth services;
(iii) the use of digital tools to analyze
large data sets to identify potential
pregnancy-related complications;
(iv) barriers that prevent maternity care
providers from providing telehealth services
across States;
(v) the use of consumer digital tools such
as mobile phone applications, patient portals,
and wearable technologies to improve maternal
health outcomes;
(vi) barriers that prevent access to
telehealth services, including a lack of access
to reliable, high-speed internet or electronic
devices;
(vii) barriers to data sharing between the
Special Supplemental Nutrition Program for
Women, Infants, and Children program and
maternity care providers, and recommendations
for addressing such barriers; and
(viii) lessons learned from expanded access
to telehealth related to maternity care during
the COVID-19 public health emergency.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $6,000,000 for each of fiscal
years 2024 through 2028.
SEC. 904. REPORT ON THE USE OF TECHNOLOGY IN MATERNITY CARE.
(a) In General.--Not later than 60 days after the date of enactment
of this Act, the Secretary of Health and Human Services shall seek to
enter an agreement with the National Academies of Sciences,
Engineering, and Medicine (referred to in this Act as the ``National
Academies'') under which the National Academies shall conduct a study
on the use of technology and patient monitoring devices in maternity
care.
(b) Content.--The agreement entered into pursuant to subsection (a)
shall provide for the study of the following:
(1) The use of innovative technology (including artificial
intelligence) in maternal health care, including the extent to
which such technology has affected racial or ethnic biases in
maternal health care.
(2) The use of patient monitoring devices (including pulse
oximeter devices) in maternal health care, including the extent
to which such devices have affected racial or ethnic biases in
maternal health care.
(3) Best practices for reducing and preventing racial or
ethnic biases in the use of innovative technology and patient
monitoring devices in maternity care.
(4) Best practices in the use of innovative technology and
patient monitoring devices for pregnant and postpartum
individuals from racial and ethnic minority groups.
(5) Best practices with respect to privacy and security
safeguards in such use.
(c) Report.--The agreement under subsection (a) shall direct the
National Academies to complete the study under this section, and
transmit to Congress a report on the results of the study, not later
than 24 months after the date of enactment of this Act.
TITLE X--IMPACT TO SAVE MOMS
SEC. 1001. PERINATAL CARE ALTERNATIVE PAYMENT MODEL DEMONSTRATION
PROJECT.
(a) In General.--For the period of fiscal years 2024 through 2028,
the Secretary of Health and Human Services (referred to in this section
as the ``Secretary''), acting through the Administrator of the Centers
for Medicare & Medicaid Services, shall establish and implement, in
accordance with the requirements of this section, a demonstration
project, to be known as the Perinatal Care Alternative Payment Model
Demonstration Project (referred to in this section as the
``Demonstration Project''), for purposes of allowing States to test
payment models under their State plans under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) and State child health plans
under title XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to
maternity care provided to pregnant and postpartum individuals enrolled
in such State plans and State child health plans.
(b) Coordination.--In establishing the Demonstration Project, the
Secretary shall coordinate with stakeholders such as--
(1) State Medicaid programs;
(2) maternity care providers and organizations representing
maternity care providers;
(3) relevant organizations representing patients, with a
particular focus on patients from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes;
(4) relevant community-based organizations, particularly
organizations that seek to improve maternal health outcomes for
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
(5) perinatal health workers;
(6) relevant health insurance issuers;
(7) hospitals, health systems, midwifery practices,
freestanding birth centers (as such term is defined in
paragraph (3)(B) of section 1905(l) of the Social Security Act
(42 U.S.C. 1396d(l))), Federally-qualified health centers (as
such term is defined in paragraph (2)(B) of such section), and
rural health clinics (as such term is defined in section
1861(aa) of such Act (42 U.S.C. 1395x(aa)));
(8) researchers and policy experts in fields related to
maternity care payment models; and
(9) any other stakeholders as the Secretary determines
appropriate, with a particular focus on stakeholders from
demographic groups with elevated rates of maternal mortality,
severe maternal morbidity, maternal health disparities, or
other adverse perinatal or childbirth outcomes.
(c) Considerations.--In establishing the Demonstration Project, the
Secretary shall consider any alternative payment model that--
(1) is designed to improve maternal health outcomes for
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
(2) includes methods for stratifying patients by pregnancy
risk level and, as appropriate, adjusting payments under such
model to take into account pregnancy risk level, including
consideration of the appropriate transfer of patients by
pregnancy risk level;
(3) establishes evidence-based quality metrics for such
payments;
(4) includes consideration of nonhospital birth settings
such as freestanding birth centers (as so defined);
(5) includes consideration of social determinants of
maternal health;
(6) includes diverse maternity care teams that include--
(A) maternity care providers, mental and behavioral
health care providers acting in accordance with State
law, and 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)))--
(i) from racially, ethnically, and
professionally diverse backgrounds;
(ii) with experience practicing in racially
and ethnically diverse communities; or
(iii) who have undergone training on
implicit bias and racism; and
(B) perinatal health workers; or
(7) includes consideration of maternal mental health
conditions and substance use disorders.
(d) Eligibility.--To be eligible to participate in the
Demonstration Project, a State shall submit an application to the
Secretary at such time, in such manner, and containing such information
as the Secretary may require.
(e) Evaluation.--The Secretary shall conduct an evaluation of the
Demonstration Project to determine the impact of the Demonstration
Project on--
(1) maternal health outcomes, with data stratified by race,
ethnicity, primary language, socioeconomic status, geography,
insurance type, and other factors as the Secretary determines
appropriate;
(2) spending on maternity care by States participating in
the Demonstration Project;
(3) to the extent practicable, qualitative and quantitative
measures of patient experience; and
(4) any other areas of assessment that the Secretary
determines relevant.
(f) Report.--Not later than one year after the completion or
termination date of the Demonstration Project, the Secretary shall
submit to the Congress, and make publicly available, a report
containing--
(1) the results of any evaluation conducted under
subsection (e); and
(2) a recommendation regarding whether the Demonstration
Project should be continued after fiscal year 2028 and expanded
on a national basis.
(g) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary to carry out this section.
(h) Definitions.--In this section:
(1) Alternative payment model.--The term ``alternative
payment model'' has the meaning given such term in section
1833(z)(3)(C) of the Social Security Act (42 U.S.C.
1395l(z)(3)(C)).
(2) Perinatal.--The term ``perinatal'' means the period
beginning on the day an individual becomes pregnant and ending
on the last day of the 1-year period beginning on the last day
of such individual's pregnancy.
TITLE XI--MATERNAL HEALTH PANDEMIC RESPONSE
SEC. 1101. DEFINITIONS.
In this title:
(1) Respectful maternity care.--The term ``respectful
maternity care'' refers to care organized for, and provided to,
pregnant and postpartum individuals in a manner that--
(A) is culturally and linguistically congruent;
(B) maintains their dignity, privacy, and
confidentiality;
(C) ensures freedom from harm and mistreatment; and
(D) enables informed choice and continuous support.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
SEC. 1102. FUNDING FOR DATA COLLECTION, SURVEILLANCE, AND RESEARCH ON
MATERNAL HEALTH OUTCOMES DURING PUBLIC HEALTH
EMERGENCIES.
To conduct or support data collection, surveillance, and research
on maternal health as a result of public health emergencies and
infectious diseases that pose a risk to maternal and infant health,
including support to assist in the capacity building for State, Tribal,
territorial, and local public health departments to collect and
transmit racial, ethnic, and other demographic data related to maternal
health, there are authorized to be appropriated--
(1) $100,000,000 for the Surveillance for Emerging Threats
to Mothers and Babies program of the Centers for Disease
Control and Prevention, to support the Centers for Disease
Control and Prevention in its efforts to--
(A) work with public health, clinical, and
community-based organizations to provide timely,
continually updated guidance to families and health
care providers on ways to reduce risk to pregnant and
postpartum individuals and their newborns and tailor
interventions to improve their long-term health;
(B) partner with more State, Tribal, territorial,
and local public health programs in the collection and
analysis of clinical data on the impact of public
health emergencies and infectious diseases that pose a
risk to maternal and infant health on pregnant and
postpartum patients and their newborns, particularly
among patients from racial and ethnic minority groups;
and
(C) establish regionally based centers of
excellence to offer medical, public health, and other
knowledge to ensure communities can help pregnant and
postpartum individuals and newborns get the care and
support they need, particularly in areas with large
populations of individuals from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other
adverse perinatal or childbirth outcomes;
(2) $30,000,000 for the Enhancing Reviews and Surveillance
to Eliminate Maternal Mortality program (commonly known as the
``ERASE MM program'') of the Centers for Disease Control and
Prevention, to support the Centers for Disease Control and
Prevention in expanding its partnerships with States and Indian
Tribes and provide technical assistance to existing Maternal
Mortality Review Committees;
(3) $45,000,000 for the Pregnancy Risk Assessment
Monitoring System (commonly known as the ``PRAMS'') of the
Centers for Disease Control and Prevention, to support the
Centers for Disease Control and Prevention in its efforts to--
(A) create a supplement to its PRAMS survey related
to public health emergencies and infectious diseases
that pose a risk to maternal and infant health;
(B) add questions around experiences of respectful
maternity care in prenatal, intrapartum, and postpartum
care; and
(C) work to transition such PRAMS survey to an
electronic platform and expand such PRAMS survey to a
larger population, with a special focus on reaching
underrepresented communities, and other program
improvements; and
(4) $15,000,000 for the National Institute of Child Health
and Human Development, to conduct or support research for
interventions to mitigate the effects of public health
emergencies and infectious diseases that pose a risk to
maternal and infant health, with a particular focus on
individuals from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes.
SEC. 1103. PUBLIC HEALTH EMERGENCY MATERNAL HEALTH DATA COLLECTION AND
DISCLOSURE.
(a) Availability of Collected Data.--The Secretary, acting through
the Director of the Centers for Disease Control and Prevention and the
Administrator of the Centers for Medicare & Medicaid Services, shall
make publicly available on the website of the Centers for Disease
Control and Prevention data described in subsection (b).
(b) Data Described.--The data described in this subsection are data
collected through Federal surveillance systems under the Centers for
Disease Control and Prevention with respect to public health
emergencies and individuals who are pregnant or in a postpartum period.
Such data shall include the following:
(1) Diagnostic testing, confirmed cases, hospitalizations,
deaths, and other health outcomes related to an infectious
disease outbreak among pregnant and postpartum individuals.
(2) Maternal and infant health outcomes among individuals
who test positive for an infectious disease during or after
pregnancy.
(c) American Indian and Alaska Native Health Outcomes.--In carrying
out subsection (a), the Secretary shall consult with Indian Tribes and
confer with Urban Indian organizations.
(d) Disaggregated Information.--In carrying out subsection (a), the
Secretary shall disaggregate data by race, ethnicity, gender, primary
language, geography, socioeconomic status, and other relevant factors.
(e) Update.--During public health emergencies, the Secretary shall
update the data made available under this section--
(1) at least on a monthly basis; and
(2) not less than one month after the end of such public
health emergency.
(f) Privacy.--In carrying out subsection (a), the Secretary shall
take steps to protect the privacy of individuals pursuant to
regulations promulgated under section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note).
(g) Guidance.--
(1) In general.--Not later than 30 days after the
declaration of a public health emergency under section 319 of
the Public Health Service Act (42 U.S.C. 247d), the Secretary
shall issue guidance to States and local public health
departments to ensure that--
(A) laboratories that test specimens for an
infectious disease receive all relevant demographic
data on race, ethnicity, pregnancy status, and other
demographic data as determined by the Secretary; and
(B) data described in subsection (b) are
disaggregated by race, ethnicity, gender, primary
language, geography, socioeconomic status, and other
relevant factors.
(2) Consultation.--In carrying out paragraph (1), the
Secretary shall consult with Indian Tribes--
(A) to ensure that such guidance includes tribally
developed best practices; and
(B) to reduce misclassification of American Indians
and Alaska Natives.
SEC. 1104. PUBLIC HEALTH COMMUNICATION REGARDING MATERNAL CARE DURING
PUBLIC HEALTH EMERGENCIES.
The Director of the Centers for Disease Control and Prevention
shall conduct public health education campaigns during public health
emergencies to ensure that pregnant and postpartum individuals, their
employers, and their health care providers have accurate, evidence-
based information on maternal and infant health risks during the public
health emergency, with a particular focus on reaching pregnant and
postpartum individuals in underserved communities.
SEC. 1105. TASK FORCE ON BIRTHING EXPERIENCE AND SAFE, RESPECTFUL,
RESPONSIVE, AND EMPOWERING MATERNITY CARE DURING PUBLIC
HEALTH EMERGENCIES.
(a) Establishment.--The Secretary, in consultation with the
Director of the Centers for Disease Control and Prevention and the
Administrator of the Health Resources and Services Administration,
shall convene a task force (in this subsection referred to as the
``Task Force'') to develop Federal recommendations regarding
respectful, responsive, and empowering maternity care, including safe
birth care and postpartum care, during public health emergencies.
(b) Duties.--The Task Force shall develop, publicly post, and
update Federal recommendations in multiple languages to ensure high-
quality, nondiscriminatory maternity care, promote positive birthing
experiences, and improve maternal health outcomes during public health
emergencies, with a particular focus on outcomes for individuals from
demographic groups with elevated rates of maternal mortality, severe
maternal morbidity, maternal health disparities, or other adverse
perinatal or childbirth outcomes. Such recommendations shall--
(1) address, with particular attention to ensuring
equitable treatment on the basis of race and ethnicity--
(A) measures to facilitate respectful, responsive,
and empowering maternity care;
(B) measures to facilitate telehealth maternity
care for pregnant people who cannot regularly access
in-person care;
(C) strategies to increase access to specialized
care for those with high-risk pregnancies or pregnant
individuals with elevated risk factors;
(D) diagnostic testing for pregnant and laboring
patients;
(E) birthing without one's chosen companions, with
one's chosen companions, and with smartphone or other
telehealth connection to one's chosen companions;
(F) newborn separation after birth in relation to
maternal infection status;
(G) breast milk feeding in relation to maternal
infection status;
(H) licensure, training, scope of practice, and
Medicaid and other insurance reimbursement for
certified midwives, certified nurse-midwives, and
certified professional midwives, in a manner that
facilitates inclusion of midwives of color and midwives
from underserved communities;
(I) financial support and training for perinatal
health workers who provide nonclinical support to
people from pregnancy through the postpartum period in
a manner that facilitates inclusion from underserved
communities;
(J) strategies to ensure and expand doula coverage
under State Medicaid programs;
(K) how to identify, address, and treat prenatal
and postpartum mental and behavioral health conditions,
such as anxiety, substance use disorder, and
depression, during public health emergencies;
(L) how to identify and address instances of
intimate partner violence during pregnancy which may
arise or intensify during public health emergencies;
(M) strategies to address hospital capacity
concerns in communities with a surge in infectious
disease cases and to provide childbearing people with
options that reduce the potential for cross-
contamination and increase the ability to implement
their care preferences while maintaining safety and
quality, such as the use of auxiliary maternity units
and freestanding birth centers;
(N) provision of child care services during
prenatal and postpartum appointments for mothers whose
children are unable to attend as a result of
restrictions relating to the public health emergencies;
(O) how to identify and address racism, bias, and
discrimination in the delivery of maternity care
services to pregnant and postpartum people, including
evaluating the value of training for hospital staff on
implicit bias and racism, respectful, responsive, and
empowering maternity care, and demographic data
collection;
(P) how to address the needs of undocumented
pregnant individuals and new mothers who may be afraid
or unable to seek needed care during the COVID-19
public health emergency;
(Q) how to address the needs of uninsured pregnant
individuals who have historically relied on emergency
departments for care;
(R) how to identify pregnant and postpartum
individuals at risk for depression, anxiety disorder,
psychosis, obsessive-compulsive disorder, and other
maternal mood disorders before, during, and after
pregnancy, and how to treat those diagnosed with a
postpartum mood disorder;
(S) how to effectively and compassionately screen
for substance use disorder during pregnancy and
postpartum and help pregnant and postpartum individuals
find support and effective treatment;
(T) how to ensure access to infant nutrition during
public health emergencies; and
(U) such other matters as the Task Force determines
appropriate;
(2) identify barriers to the implementation of the
recommendations;
(3) take into consideration existing State and other
programs that have demonstrated effectiveness in addressing
pregnancy, birth, and postpartum care during public health
emergencies; and
(4) identify policies specific to COVID-19 that should be
discontinued when safely possible and those that should be
continued as the public health emergency abates.
(c) Membership.--The Secretary shall appoint the members of the
Task Force. Such members shall be comprised of--
(1) representatives of the Department of Health and Human
Services, including representatives of--
(A) the Secretary;
(B) the Director of the Centers for Disease Control
and Prevention;
(C) the Administrator of the Health Resources and
Services Administration;
(D) the Administrator of the Centers for Medicare &
Medicaid Services;
(E) the Director of the Agency for Healthcare
Research and Quality;
(F) the Commissioner of Food and Drugs;
(G) the Assistant Secretary for Mental Health and
Substance Use; and
(H) the Director of the Indian Health Service;
(2) at least 3 State, local, or territorial public health
officials representing departments of public health, who shall
represent jurisdictions from different regions of the United
States with relatively high concentrations of historically
marginalized populations;
(3) at least 1 Tribal public health official representing
departments of public health;
(4) 1 or more representatives of community-based
organizations that address adverse maternal health outcomes
with a specific focus on racial and ethnic inequities in
maternal health outcomes, with special consideration given to
representatives of such organizations that are led by a person
of color or from communities with significant minority
populations;
(5) a professionally diverse panel of maternity care
providers and perinatal health workers;
(6) 1 or more patients who were pregnant or gave birth
during the COVID-19 public health emergency;
(7) 1 or more patients who contracted COVID-19 and later
gave birth;
(8) 1 or more patients who have received support from a
perinatal health worker; and
(9) racially and ethnically diverse representation from at
least 3 independent experts with knowledge or field experience
with racial and ethnic disparities in public health, women's
health, or maternal mortality and severe maternal morbidity.
TITLE XII--PROTECTING MOMS AND BABIES AGAINST CLIMATE CHANGE
SEC. 1201. DEFINITIONS.
In this title, the following definitions apply:
(1) Adverse maternal and infant health outcomes.--The term
``adverse maternal and infant health outcomes'' includes the
outcomes of preterm birth, low birth weight, stillbirth, infant
or maternal mortality, and severe maternal morbidity.
(2) Institution of higher education.--The term
``institution of higher education'' has the meaning given such
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(3) Minority-serving institution.--The term ``minority-
serving institution'' means an institution described in section
371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)).
(4) 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)).
(5) Risks associated with climate change.--The term ``risks
associated with climate change'' includes risks associated with
extreme heat, air pollution, extreme weather events, and other
environmental issues associated with climate change that can
result in adverse maternal and infant health outcomes.
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) Stakeholder organization.--The term ``stakeholder
organization'' means--
(A) a community-based organization with expertise
in providing assistance to vulnerable individuals;
(B) a nonprofit organization with expertise in--
(i) maternal or infant health; or
(ii) environmental or climate justice; and
(C) a patient advocacy organization representing
vulnerable individuals.
(8) Vulnerable individual.--The term ``vulnerable
individual'' means--
(A) an individual who is pregnant;
(B) an individual who was pregnant during any
portion of the preceding 1-year period; and
(C) an individual under 3 years of age.
SEC. 1202. GRANT PROGRAM TO PROTECT VULNERABLE MOTHERS AND BABIES FROM
CLIMATE CHANGE RISKS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall establish a grant program to
protect vulnerable individuals from risks associated with climate
change.
(b) Grant Authority.--In carrying out the Program, the Secretary
may award, on a competitive basis, grants to 10 covered entities.
(c) Applications.--To be eligible for a grant under the Program, a
covered entity shall submit to the Secretary an application at such
time, in such form, and containing such information as the Secretary
may require, which shall include, at a minimum, a description of the
following:
(1) Plans for the use of grant funds awarded under the
Program and how patients and stakeholder organizations were
involved in the development of such plans.
(2) How such grant funds will be targeted to geographic
areas that have disproportionately high levels of risks
associated with climate change for vulnerable individuals.
(3) How such grant funds will be used to address racial and
ethnic disparities in--
(A) adverse maternal and infant health outcomes;
and
(B) exposure to risks associated with climate
change for vulnerable individuals.
(4) Strategies to prevent an initiative assisted with such
grant funds from causing--
(A) adverse environmental impacts;
(B) displacement of residents and businesses;
(C) rent and housing price increases; or
(D) disproportionate adverse impacts on racial and
ethnic minority groups and other underserved
populations.
(d) Selection of Grant Recipients.--
(1) Timing.--Not later than 270 days after the date of
enactment of this Act, the Secretary shall select the
recipients of grants under the Program.
(2) Consultation.--In selecting covered entities for grants
under the Program, the Secretary shall consult with--
(A) representatives of stakeholder organizations;
(B) the Administrator of the Environmental
Protection Agency;
(C) the Administrator of the National Oceanic and
Atmospheric Administration; and
(D) from the Department of Health and Human
Services--
(i) the Deputy Assistant Secretary for
Minority Health;
(ii) the Administrator of the Centers for
Medicare & Medicaid Services;
(iii) the Administrator of the Health
Resources and Services Administration;
(iv) the Director of the National
Institutes of Health; and
(v) the Director of the Centers for Disease
Control and Prevention.
(3) Priority.--In selecting grantees under the Program, the
Secretary shall give priority to covered entities that serve a
county or locality--
(A) designated, or located in an area designated,
as a nonattainment area pursuant to section 107 of the
Clean Air Act (42 U.S.C. 7407) for any air pollutant
for which air quality criteria have been issued under
section 108(a) of such Act (42 U.S.C. 7408(a));
(B) 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, or a similar rating of social vulnerability
according to related Federal mapping tools;
(C) with temperatures that pose a risk to human
health, as determined by the Secretary, in consultation
with the Administrator of the National Oceanic and
Atmospheric Administration and the Chair of the United
States Global Change Research Program, based on the
best available science;
(D) with elevated rates of maternal mortality,
severe maternal morbidity, maternal health disparities,
or other adverse perinatal or childbirth outcomes;
(E) with a rating of very high or relatively high
risk according to the National Risk Index for Natural
Hazards of the Federal Emergency Management Agency; or
(F) with other climate-sensitive hazards with
associations to adverse maternal or infant health
outcomes, as determined by the Secretary.
(4) Limitation.--A recipient of grant funds under the
Program may not use such grant funds to serve a county or
locality that is served by any other recipient of a grant under
the Program.
(e) Use of Funds.--A covered entity awarded grant funds under the
Program may only use such grant funds for the following:
(1) Initiatives to identify risks associated with climate
change for vulnerable individuals and to provide services and
support to such individuals that address such risks, which may
include--
(A) training for health care providers, perinatal
health workers, and other employees in hospitals, birth
centers, midwifery practices, and other health care
practices that provide prenatal or labor and delivery
services to vulnerable individuals on the
identification of, and patient counseling relating to,
risks associated with climate change for vulnerable
individuals;
(B) hiring, training, or providing resources to
perinatal health workers who can help identify risks
associated with climate change for vulnerable
individuals, provide patient counseling about such
risks, and carry out the distribution of relevant
services and support;
(C) enhancing the monitoring of risks associated
with climate change for vulnerable individuals,
including by--
(i) collecting data on such risks in
specific census tracts, neighborhoods, or other
geographic areas; and
(ii) sharing such data with local health
care providers, perinatal health workers, and
other employees in hospitals, birth centers,
midwifery practices, and other health care
practices that provide prenatal or labor and
delivery services to local vulnerable
individuals; and
(D) providing vulnerable individuals--
(i) air conditioning units, residential
weatherization support, filtration systems,
household appliances, or related items;
(ii) direct financial assistance; and
(iii) services and support, including
housing assistance, evacuation assistance,
transportation assistance, access to cooling
shelters, and mental health counseling, to
prepare for or recover from extreme weather
events, which may include floods, hurricanes,
wildfires, droughts, and related events.
(2) Initiatives to mitigate levels of and exposure to risks
associated with climate change for vulnerable individuals,
which shall be based on the best available science and which
may include initiatives to--
(A) develop, maintain, or expand urban or community
forestry initiatives and tree canopy coverage
initiatives;
(B) improve infrastructure, such as buildings and
paved surfaces;
(C) develop or improve community outreach networks
to provide culturally and linguistically appropriate
information and notifications about risks associated
with climate change for vulnerable individuals; and
(D) provide enhanced services to racial and ethnic
minority groups and other underserved populations.
(f) Length of Award.--A grant under this section shall be disbursed
over 4 fiscal years.
(g) Technical Assistance.--The Secretary shall provide technical
assistance to a covered entity awarded a grant under the Program to
support the development, implementation, and evaluation of activities
funded with such grant.
(h) Reports to Secretary.--
(1) Annual report.--For each fiscal year during which a
covered entity is disbursed grant funds under the Program, such
covered entity shall submit to the Secretary a report that
summarizes the activities carried out by such covered entity
with such grant funds during such fiscal year, which shall
include a description of the following:
(A) The involvement of stakeholder organizations in
the implementation of initiatives assisted with such
grant funds.
(B) Relevant health and environmental data,
disaggregated, to the extent practicable, by race,
ethnicity, primary language, socioeconomic status,
geography, insurance type, pregnancy status, and other
relevant demographic information.
(C) Qualitative feedback received from vulnerable
individuals with respect to initiatives assisted with
such grant funds.
(D) Criteria used in selecting the geographic areas
assisted with such grant funds.
(E) Efforts to address racial and ethnic
disparities in adverse maternal and infant health
outcomes and in exposure to risks associated with
climate change for vulnerable individuals.
(F) Any negative and unintended impacts of
initiatives assisted with such grant funds, including--
(i) adverse environmental impacts;
(ii) displacement of residents and
businesses;
(iii) rent and housing price increases; and
(iv) disproportionate adverse impacts on
racial and ethnic minority groups and other
underserved populations.
(G) How the covered entity will address and prevent
any impacts described in subparagraph (F).
(2) Publication.--Not later than 30 days after the date on
which a report is submitted under paragraph (1), the Secretary
shall publish such report on a public website of the Department
of Health and Human Services.
(i) Report to Congress.--Not later than the date that is 5 years
after the date on which the Program is established, the Secretary shall
submit to Congress and publish on a public website of the Department of
Health and Human Services a report on the results of the Program,
including the following:
(1) Summaries of the annual reports submitted under
subsection (h).
(2) Evaluations of the initiatives assisted with grant
funds under the Program.
(3) An assessment of the effectiveness of the Program in--
(A) identifying risks associated with climate
change for vulnerable individuals;
(B) providing services and support to such
individuals;
(C) mitigating levels of and exposure to such
risks; and
(D) addressing racial and ethnic disparities in
adverse maternal and infant health outcomes and in
exposure to such risks.
(4) A description of how the Program could be expanded,
including--
(A) monitoring efforts or data collection that
would be required to identify areas with high levels of
risks associated with climate change for vulnerable
individuals;
(B) how such areas could be identified using the
strategy developed under section 1205; and
(C) recommendations for additional funding.
(j) Definitions.--In this section:
(1) The term ``covered entity'' means a consortium of
organizations serving a county that--
(A) shall include a community-based organization;
and
(B) may include--
(i) another stakeholder organization;
(ii) the government of such county;
(iii) the governments of one or more
municipalities within such county;
(iv) a State or local public health
department or emergency management agency;
(v) a local health care practice, which may
include a licensed and accredited hospital,
birth center, midwifery practice, or other
health care practice that provides prenatal or
labor and delivery services to vulnerable
individuals;
(vi) 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));
(vii) an Urban Indian organization (as
defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603)); and
(viii) an institution of higher education.
(2) The term ``Program'' means the grant program under this
section.
(k) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $100,000,000 for the period of
fiscal years 2024 through 2027.
SEC. 1203. GRANT PROGRAM FOR EDUCATION AND TRAINING AT HEALTH
PROFESSION SCHOOLS.
(a) In General.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
establish a grant program to provide funds to health profession schools
to support the development and integration of education and training
programs for identifying and addressing risks associated with climate
change for vulnerable individuals.
(b) Grant Authority.--In carrying out the Program, the Secretary
may award, on a competitive basis, grants to health profession schools.
(c) Application.--To be eligible for a grant under the Program, a
health profession school shall submit to the Secretary an application
at such time, in such form, and containing such information as the
Secretary may require, which shall include, at a minimum, a description
of the following:
(1) How such health profession school will engage with
vulnerable individuals, and stakeholder organizations
representing such individuals, in developing and implementing
the education and training programs supported by grant funds
awarded under the Program.
(2) How such health profession school will ensure that such
education and training programs will address racial and ethnic
disparities in exposure to, and the effects of, risks
associated with climate change for vulnerable individuals.
(d) Use of Funds.--A health profession school awarded a grant under
the Program shall use the grant funds to develop, and integrate into
the curriculum and continuing education of such health profession
school, education and training on each of the following:
(1) Identifying risks associated with climate change for
vulnerable individuals and individuals with the intent to
become pregnant.
(2) How risks associated with climate change affect
vulnerable individuals and individuals with the intent to
become pregnant.
(3) Racial and ethnic disparities in exposure to, and the
effects of, risks associated with climate change for vulnerable
individuals and individuals with the intent to become pregnant.
(4) Patient counseling and mitigation strategies relating
to risks associated with climate change for vulnerable
individuals.
(5) Relevant services and support for vulnerable
individuals relating to risks associated with climate change
and strategies for ensuring vulnerable individuals have access
to such services and support.
(6) Implicit and explicit bias, racism, and discrimination.
(7) Related topics identified by such health profession
school based on the engagement of such health profession school
with vulnerable individuals and stakeholder organizations
representing such individuals.
(e) Partnerships.--In carrying out activities with grant funds, a
health profession school awarded a grant under the Program may partner
with one or more of the following:
(1) A State or local public health department.
(2) A health care professional membership organization.
(3) A stakeholder organization.
(4) A health profession school.
(5) An institution of higher education.
(f) Reports to Secretary.--
(1) Annual report.--For each fiscal year during which a
health profession school is disbursed grant funds under the
Program, such health profession school shall submit to the
Secretary a report that describes the activities carried out
with such grant funds during such fiscal year.
(2) Final report.--Not later than the date that is 1 year
after the end of the last fiscal year during which a health
profession school is disbursed grant funds under the Program,
the health profession school shall submit to the Secretary a
final report that summarizes the activities carried out with
such grant funds.
(g) Report to Congress.--Not later than the date that is 6 years
after the date on which the Program is established, the Secretary shall
submit to Congress and publish on a public website of the Department of
Health and Human Services a report that includes the following:
(1) A summary of the reports submitted under subsection
(f).
(2) Recommendations to improve education and training
programs at health profession schools with respect to
identifying and addressing risks associated with climate change
for vulnerable individuals.
(h) Definitions.--In this section:
(1) The term ``health profession school'' means an
accredited--
(A) medical school;
(B) school of nursing;
(C) midwifery program;
(D) physician assistant education program;
(E) teaching hospital;
(F) residency or fellowship program; or
(G) other school or program determined appropriate
by the Secretary.
(2) The term ``Program'' means the grant program under this
section.
(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $5,000,000 for the period of
fiscal years 2024 through 2027.
SEC. 1204. NIH CONSORTIUM ON BIRTH AND CLIMATE CHANGE RESEARCH.
(a) Establishment.--Not later than one year after the date of the
enactment of this Act, the Director of the National Institutes of
Health shall establish the Consortium on Birth and Climate Change
Research (in this section referred to as the ``Consortium'').
(b) Duties.--
(1) In general.--The Consortium shall coordinate, across
the institutes, centers, and offices of the National Institutes
of Health, research on the risks associated with climate change
for vulnerable individuals.
(2) Required activities.--In carrying out paragraph (1),
the Consortium shall--
(A) establish research priorities, including by
prioritizing research that--
(i) identifies the risks associated with
climate change for vulnerable individuals with
a particular focus on disparities in such risks
among racial and ethnic minority groups and
other underserved populations; and
(ii) identifies strategies to reduce levels
of, and exposure to, such risks, with a
particular focus on risks among racial and
ethnic minority groups and other underserved
populations;
(B) identify gaps in available data related to such
risks;
(C) identify gaps in, and opportunities for,
research collaborations;
(D) identify funding opportunities for community-
based organizations and researchers from racially,
ethnically, and geographically diverse backgrounds;
(E) identify opportunities to increase public
awareness related to risks associated with climate
change for vulnerable individuals; and
(F) publish annual reports on the work and findings
of the Consortium on a public website of the National
Institutes of Health.
(c) Membership.--The Director shall appoint to the Consortium
representatives of such institutes, centers, and offices of the
National Institutes of Health as the Director considers appropriate,
including, at a minimum, representatives of--
(1) the National Institute of Environmental Health
Sciences;
(2) the National Institute on Minority Health and Health
Disparities;
(3) the Eunice Kennedy Shriver National Institute of Child
Health and Human Development;
(4) the National Institute of Mental Health;
(5) the National Institute of Nursing Research; and
(6) the Office of Research on Women's Health.
(d) Chairperson.--The Chairperson of the Consortium shall be
designated by the Director and selected from among the representatives
appointed under subsection (c).
(e) Consultation.--In carrying out the duties described in
subsection (b), the Consortium shall consult with--
(1) the heads of relevant Federal agencies, including--
(A) the Environmental Protection Agency;
(B) the National Oceanic and Atmospheric
Administration;
(C) the Occupational Safety and Health
Administration; and
(D) from the Department of Health and Human
Services--
(i) the Office of Minority Health in the
Office of the Secretary;
(ii) the Centers for Medicare & Medicaid
Services;
(iii) the Health Resources and Services
Administration;
(iv) the Centers for Disease Control and
Prevention;
(v) the Indian Health Service; and
(vi) the Administration for Children and
Families; and
(2) representatives of--
(A) stakeholder organizations;
(B) health care providers and professional
membership organizations with expertise in maternal
health or environmental justice;
(C) State and local public health departments;
(D) licensed and accredited hospitals, birth
centers, midwifery practices, or other health care
practices that provide prenatal or labor and delivery
services to vulnerable individuals; and
(E) institutions of higher education, including
such institutions that are minority-serving
institutions or have expertise in maternal health or
environmental justice.
SEC. 1205. STRATEGY FOR IDENTIFYING CLIMATE CHANGE RISK ZONES FOR
VULNERABLE MOTHERS AND BABIES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
shall develop a strategy (in this section referred to as the
``Strategy'') for designating areas that the Secretary determines to
have a high risk of adverse maternal and infant health outcomes among
vulnerable individuals as a result of risks associated with climate
change.
(b) Strategy Requirements.--
(1) In general.--In developing the Strategy, the Secretary
shall establish a process to identify areas where vulnerable
individuals are exposed to a high risk of adverse maternal and
infant health outcomes as a result of risks associated with
climate change in conjunction with other factors that can
impact such health outcomes, including--
(A) the incidence of diseases associated with air
pollution, extreme heat, and other environmental
factors;
(B) the availability and accessibility of maternal
and infant health care providers;
(C) English-language proficiency among women of
reproductive age;
(D) the health insurance status of women of
reproductive age;
(E) the number of women of reproductive age who are
members of racial or ethnic groups with
disproportionately high rates of adverse maternal and
infant health outcomes;
(F) the socioeconomic status of women of
reproductive age, including with respect to--
(i) poverty;
(ii) unemployment;
(iii) household income; and
(iv) educational attainment; and
(G) access to quality housing, transportation, and
nutrition.
(2) Resources.--In developing the Strategy, the Secretary
shall identify, and incorporate a description of, the
following:
(A) Existing mapping tools or Federal programs that
identify--
(i) risks associated with climate change
for vulnerable individuals; and
(ii) other factors that can influence
maternal and infant health outcomes, including
the factors described in paragraph (1).
(B) Environmental, health, socioeconomic, and
demographic data relevant to identifying risks
associated with climate change for vulnerable
individuals.
(C) Existing monitoring networks that collect data
described in subparagraph (B), and any gaps in such
networks.
(D) Federal, State, and local stakeholders involved
in maintaining monitoring networks identified under
subparagraph (C), and how such stakeholders are
coordinating their monitoring efforts.
(E) Additional monitoring networks, and
enhancements to existing monitoring networks, that
would be required to address gaps identified under
subparagraph (C), including at the subcounty and census
tract level.
(F) Funding amounts required to establish the
monitoring networks identified under subparagraph (E)
and recommendations for Federal, State, and local
coordination with respect to such networks.
(G) Potential uses for data collected and generated
as a result of the Strategy, including how such data
may be used in determining recipients of grants under
the program established by section 2 or other similar
programs.
(H) Other information the Secretary considers
relevant for the development of the Strategy.
(c) Coordination and Consultation.--In developing the Strategy, the
Secretary shall--
(1) coordinate with the Administrator of the Environmental
Protection Agency and the Administrator of the National Oceanic
and Atmospheric Administration; and
(2) consult with--
(A) stakeholder organizations;
(B) health care providers and professional
membership organizations with expertise in maternal
health or environmental justice;
(C) State and local public health departments;
(D) licensed and accredited hospitals, birth
centers, midwifery practices, or other health care
providers that provide prenatal or labor and delivery
services to vulnerable individuals; and
(E) institutions of higher education, including
such institutions that are minority-serving
institutions or have expertise in maternal health or
environmental justice.
(d) Notice and Comment.--At least 240 days before the date on which
the Strategy is published in accordance with subsection (e), the
Secretary shall provide--
(1) notice of the Strategy on a public website of the
Department of Health and Human Services; and
(2) an opportunity for public comment of at least 90 days.
(e) Publication.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall publish on a public website
of the Department of Health and Human Services--
(1) the Strategy;
(2) the public comments received under subsection (d); and
(3) the responses of the Secretary to such public comments.
TITLE XIII--MATERNAL VACCINATIONS
SEC. 1301. MATERNAL VACCINATION AWARENESS AND EQUITY CAMPAIGN.
(a) Campaign.--Section 313 of the Public Health Service Act (42
U.S.C. 245) is amended--
(1) in subsection (a), by inserting ``and among pregnant
and postpartum individuals,'' after ``low rates of
vaccination,'';
(2) in subsection (c)(3), by striking ``prenatal and
pediatric'' and inserting ``prenatal, obstetric, and
pediatric'';
(3) in subsection (d)(4)(B), by inserting ``pregnant and
postpartum individuals and'' after ``including''; and
(4) in subsection (g), by striking ``$15,000,000 for each
of fiscal years 2021 through 2025'' and inserting ``$17,000,000
for each of fiscal years 2024 through 2028''.
(b) Additional Activities.--Section 317(k)(1)(E) of the Public
Health Service Act (42 U.S.C. 247b(k)(1)(E)) is amended--
(1) in clause (v), by striking ``and'' at the end; and
(2) by adding at the end the following:
``(vii) increase vaccination rates of
pregnant and postpartum individuals, including
individuals from racial and ethnic minority
groups, and their children; and''.
<all>