[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4269 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4269

 To amend the Public Health Service Act to improve maternal health and 
                        promote safe motherhood.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 22, 2020

  Mr. Kaine (for himself and Ms. Murkowski) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to improve maternal health and 
                        promote safe motherhood.

    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 ``Mothers and Newborns Success Act''.

SEC. 2. FINDINGS AND SENSE OF THE SENATE.

    (a) Findings.--Congress finds the following:
            (1) Among developed nations, the United States has 
        disturbingly high rates of maternal and infant mortality.
            (2) The United States published an official maternal 
        mortality rate from vital statistics for the first time since 
        2007 in 2018. The United States maternal mortality rate of 17.4 
        per 100,000 live births, is significantly higher than the 
        Organisation for Economic Co-operation and Development 
        (referred to in this section as the ``OECD'') average of 14.0 
        in 2017, according to modeling by the World Bank.
            (3) The United States infant mortality rate in 2017 was 5.8 
        per 1,000 live births, while the OECD average was 3.8 per 1,000 
        live births.
            (4) In the United States, there are significant maternal 
        mortality and infant mortality inequities.
            (5) The maternal mortality rate for non-Hispanic Black 
        women in 2018 was 37.1 per 100,000 live births. This rate is 
        more than 2.5 times higher than the maternal mortality rate of 
        14.7 for non-Hispanic White women and more than 3.1 times 
        higher than the maternal mortality rate of 11.8 for Hispanic 
        women of any race.
            (6) The Centers for Disease Control and Prevention data 
        from 2007 through 2016 shows that American Indian/Alaska Native 
        women also have significantly higher rates of pregnancy-related 
        deaths than White, Hispanic, and Asian/Pacific Islander women. 
        American Indian/Alaska Native women had a rate of 29.7 
        pregnancy-related deaths per 100,000 live births from 2007 
        through 2016, which is 2.3 times higher than the rate of 12.7 
        deaths per 100,000 live births for White women during the same 
        time period.
            (7) The mortality rate for infants of non-Hispanic Black 
        women is 11.0 per 1,000 live births and 9.2 per 1,000 live 
        births for infants of American Indian or Alaska Native women. 
        This rate is more than 2.3 times higher than the infant 
        mortality rate of non-Hispanic White infants at 4.7 and more 
        than 2.1 times higher than the infant mortality rate of 
        Hispanic infants of any race at 5.1 per 1,000 live births.
    (b) Sense of the Senate.--It is the sense of the Senate that the 
following should apply:
            (1) The United States should dramatically reduce maternal 
        and infant mortality, ensure that all infants can grow up 
        healthy and safe, and protect women's health before, during, 
        and after pregnancy.
            (2) Any pregnant woman choosing to have a child should be 
        able to do so safely without regard to income, race, ethnicity, 
        employment status, geographic location, ability, or any other 
        socio-economic factor. United States policy should support 
        women's health so that women thrive and newborns have the 
        maximum chance for a healthy life.
            (3) The evidence of serious racial inequities in maternal 
        and infant mortality, especially between Black women and White 
        women demonstrates the persistence of racism and racial bias in 
        our society and health care system. A 2015 study funded by the 
        National Institute for Biomedical and Bioengineering of the 
        National Institutes of Health found that most health care 
        providers appear to harbor negative implicit biases towards 
        people of color. These biases were found to impact patient-
        provider interactions, treatment decisions, treatment 
        adherence, and patient health outcomes. Therefore, the programs 
        authorized by this Act should be specifically deployed in ways 
        to counter such inequities.
            (4) In the next 5 years, the United States should aim to 
        reduce its overall maternal and infant mortality rates such 
        that they are no higher than the OECD average. The United 
        States should dramatically reduce the maternal mortality and 
        infant mortality inequities between Black and American Indian/
        Alaskan Native women and White women.
            (5) By advancing evidence-based policies to improve 
        maternal and infant health outcomes, the United States can work 
        to reduce and eliminate preventable maternal and infant 
        mortality and severe maternal morbidity.

SEC. 3. STATE MATERNAL HEALTH INNOVATION.

    Title III of the Public Health Service Act is amended by inserting 
after section 330M (42 U.S.C. 254c-19) the following:

``SEC. 330N. STATE MATERNAL HEALTH INNOVATION.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall continue in 
effect the State Maternal Health Innovation Program and the Supporting 
Maternal Health Innovation Program to award competitive grants to 
eligible entities for the purpose of assisting States to implement 
State-specific actions that address racial, ethnic and geographic 
inequities in maternal health and improve maternal health outcomes, 
including the prevention and reduction of maternal mortality and severe 
maternal morbidity.
    ``(b) Use of Funds.--An entity receiving a grant under this section 
may use such funds--
            ``(1) to translate recommendations on addressing maternal 
        mortality and severe maternal morbidity into action through 
        activities which may include--
                    ``(A) establishing a State- or regional multi-
                State-focused Maternal Health Task Force to create and 
                implement a strategic plan;
                    ``(B) improving the collection, analysis, and 
                application of State- or regional multi-State-level 
                data on maternal mortality and severe maternal 
                morbidity; and
                    ``(C) promoting and executing innovation in 
                maternal health service delivery, such as improving 
                access to maternal health care services, identifying 
                and addressing workforce needs, including maternal 
                health provider shortages; identifying and addressing 
                implicit and explicit bias based on race or ethnicity; 
                or supporting postpartum and inter-pregnancy care 
                services; or
            ``(2) to provide support to entities receiving assistance 
        under paragraph (1), and other initiatives of the Department of 
        Health and Human Services to improve maternal health outcomes 
        as the Secretary determines appropriate, States, multi-State 
        regions and other stakeholders working to reduce and prevent 
        maternal mortality and severe maternal morbidity through 
        activities which may include--
                    ``(A) providing capacity-building assistance to 
                such entities to implement innovative and evidence-
                informed strategies; and
                    ``(B) establishing or continuing the operation of a 
                resource center to provide national guidance to such 
                entities, States, and key stakeholders to improve 
                maternal health.
    ``(c) Alignment of Activities.--An entity carrying out activities 
under subsection (b)(1) shall coordinate and align such activities with 
the activities to improve maternal health outcomes carried out by such 
entities under title V of the Social Security Act.
    ``(d) Eligible Entities.--To be eligible for a grant under 
subsection (a), a domestic public or non-profit private entity, Indian 
Tribe, or Tribal serving organization, such as a Tribal health 
department or other organization fulfilling similar functions for the 
Tribe, shall submit to the Secretary an application at such time, in 
such manner, and containing such information as the Secretary may 
require. In the case of applicants intending to carry out activities 
described in subsection (b)(1), such applicants shall demonstrate in 
such application that the entity has a commitment from a State or group 
of States to collaborate as part of the project on strengthening State-
level capacity in achieving the program aims.
    ``(e) Report to Congress.--Not later than January 1, 2024, the 
Secretary shall submit to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on Energy and Commerce of 
the House of Representatives, and make publicly available, a report 
concerning the impact of the programs continued under this section on 
addressing inequities in maternal health and improving maternal health 
outcomes, including the prevention and reduction of maternal mortality 
and severe maternal morbidity, together with recommendations on whether 
to expand such programs to additional recipients and the estimated 
amount of funds needed to expand such programs.
    ``(f) Authorization of Appropriations.--To carry out this section, 
including carrying out the programs referred to in subsection (a) on a 
national basis (subject to the availability of appropriations), there 
is authorized to be appropriated $53,000,000 for each of fiscal years 
2021 through 2024.''.

SEC. 4. SAFE MOTHERHOOD.

    Section 317K of the Public Health Service Act (42 U.S.C. 247b-12) 
is amended--
            (1) by redesignating subsections (e) and (f) as subsections 
        (h) and (i), respectively;
            (2) by inserting after subsection (d) the following:
    ``(e) Levels of Maternal and Neonatal Care.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall establish or continue in effect a program to award 
        competitive grants to eligible entities to assist with the 
        classification of birthing facilities based on the level of 
        risk-appropriate maternal and neonatal care such entities can 
        provide in order to strategically improve maternal and infant 
        care delivery and health outcomes.
            ``(2) Use of funds.--An eligible entity receiving a grant 
        under this subsection shall use such funds to--
                    ``(A) coordinate an assessment of the risk-
                appropriate maternal and neonatal care of a State, 
                jurisdiction, or region, based on the most recent 
                guidelines and policy statements issued by the 
                professional associations representing relevant 
                clinical specialties, including obstetrics and 
                gynecology and pediatrics; and
                    ``(B) work with relevant stakeholders, such as 
                hospitals, hospital associations, perinatal quality 
                collaboratives, members of the communities most 
                affected by racial, ethnic, and geographic maternal 
                health inequities, maternal mortality review 
                committees, and maternal and neonatal health care 
                providers and community-based birth workers to review 
                the findings of the assessment made of activities 
                carried out under paragraph (1) and implement changes, 
                as appropriate, based on identified gaps in perinatal 
                services and differences in maternal and neonatal 
                outcomes in the State, jurisdiction, or region for 
                which such an assessment was conducted to support the 
                provision of risk-appropriate care.
            ``(3) Eligible entities.--To be eligible for a grant under 
        this subsection, a State health department, Indian Tribe or 
        other Tribal serving organization, such as a Tribal health 
        department or other organization fulfilling similar functions 
        for the Tribe, shall submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            ``(4) Period.--A grant awarded under this subsection shall 
        be made for a period of 3 years. Any supplemental award made to 
        a grantee under this subsection may be made for a period of 
        less than 3 years.
            ``(5) Report to congress.--Not later than January 1, 2023, 
        the Secretary shall submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives, and 
        make publicly available, a report concerning the impact of the 
        programs established or continued under this subsection.
    ``(f) Pregnancy Checkbox Quality Assurance.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        establish or continue a program to award competitive grants and 
        provide technical assistance to eligible entities to implement 
        a quality assurance process to improve the validity of the 
        pregnancy checkbox data from death certificates.
            ``(2) Use of funds.--Eligible entities receiving a grant 
        under this subsection shall use grant funds to implement a 
        quality assurance process to improve the validity of the 
        pregnancy checkbox data from death certificates in the State or 
        within the Indian Tribe. Activities funded under the grant may 
        include the following:
                    ``(A) Reviewing death certificates for women of 
                reproductive age and individuals with a pregnancy 
                checkbox marked.
                    ``(B) Attempting to confirm the pregnancy of a 
                decedent by searching for a matching birth or fetal 
                death record (or other matching state administrative 
                data source), contacting the death certifier, or 
                reviewing the medical record.
                    ``(C) Amending death certificates or death record 
                files, as appropriate, and sending the updated file to 
                the National Center for Health Statistics.
                    ``(D) Providing training to death certifiers about 
                completing the death certificate.
                    ``(E) Building awareness among death certifiers and 
                health department staff about the pregnancy checkbox.
                    ``(F) Coordinating quality assurance activities 
                among State maternal and child health programs, State 
                vital records offices, and maternal mortality review 
                committee members and abstractors.
            ``(3) Eligible entities.--To be eligible for a grant under 
        this subsection, a State health department, Indian Tribe, or 
        other Tribal serving organization, such as a Tribal health 
        department or other organization fulfilling similar functions 
        for the Tribe, shall submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            ``(4) Report to congress.--Not later than January 1, 2023, 
        the Secretary shall submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives, and 
        make publicly available, a report concerning the impact of the 
        programs established or continued under this subsection.''; and
            (3) in subsection (i) (as so redesignated), by striking 
        ``$58,000,000 for each of fiscal years 2019 through 2023'' and 
        inserting ``$81,000,000 for each of fiscal years 2021 through 
        2023''.

SEC. 5. PREGNANCY RISK ASSESSMENT MONITORING SYSTEM.

    Section 317K of the Public Health Service Act (42 U.S.C. 247b-12) 
is amended by inserting after subsection (f) (as added by section 4) 
the following:
    ``(h) Pregnancy Risk Assessment Monitoring System.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        establish or continue activities to collect data on maternal 
        attitudes and experiences during the prepregnancy, pregnancy, 
        labor and delivery, and postpartum periods. The Secretary may 
        expand data collection to all States, Indian Tribes, and 
        territories, and to the extent practicable, compile and publish 
        population-based findings on the health and well-being of 
        women, mothers and infants.
            ``(2) Enhanced surveillance activities and technical 
        assistance.--The Secretary, acting through the Director of the 
        Centers for Disease Control and Prevention may support enhanced 
        surveillance activities and provide technical assistance to 
        States and Indian Tribes to improve data collection and ensure 
        an adequate representation of racial, ethnic and other 
        communities of color in related datasets.''.

SEC. 6. POSTPARTUM CARE COORDINATION PILOT PROGRAM.

    Title III of the Public Health Service Act is amended by inserting 
after section 330N (as added by section 3) the following:

``SEC. 330O. POSTPARTUM CARE COORDINATION PILOT PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, and in 
consultation with experts representing a variety of clinical 
specialties, including obstetrics and gynecology, State, Tribal, or 
local public health officials, , and in coordination with existing 
efforts to address postpartum care, including activities conducted 
under section 330H, shall establish a program to award competitive 
grants to not more than 10 eligible entities for the purpose of--
            ``(1) identifying and disseminating best practices to 
        improve care and outcomes for women, including women with 
        chronic health conditions prepregnancy and those with ongoing 
        pregnancy-related conditions, in the postpartum period of at 
        least one year following birth, which may include--
                    ``(A) information on evidence-based and evidence-
                informed practices to improve the quality of care;
                    ``(B) best practices for connecting women to 
                primary or specialized care, including behavioral 
                health services, in the postpartum period;
                    ``(C) information on addressing social and clinical 
                determinants of health that impact women in the 
                postpartum period; and
                    ``(D) information on the most appropriate course of 
                care during the postpartum period, including continued 
                access to maternity care providers and ways to 
                strengthen capabilities of primary care providers and 
                specialists, including cardiologists and 
                endocrinologists to recognize and treat conditions that 
                may result from or be exacerbated by pregnancy;
            ``(2) collaborating with State-based maternal mortality 
        review committees, State-based perinatal quality care 
        collaboratives and other relevant initiatives to--
                    ``(A) identify risk factors and systems issues for 
                the development of best practices; and
                    ``(B) disseminate best practices;
            ``(3) providing technical assistance and supporting the 
        implementation of best practices identified in paragraph (1) to 
        entities and providers providing health care and social support 
        services to postpartum women;
            ``(4) identifying, developing, and evaluating new models of 
        care that improve maternal health outcomes, which may include 
        the integration of community-based services, behavioral health, 
        and clinical care, including interprofessional education for 
        team-based care; and
            ``(5) developing condition-specific consumer materials 
        directed toward women to help them better manage their physical 
        and behavioral health in the postpartum period.
    ``(b) Eligible Entities.--To be eligible for a grant under 
subsection (a), an entity shall--
            ``(1) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require; and
            ``(2) demonstrate in such application that the entity is 
        capable of carrying out data-driven maternal safety and quality 
        improvement initiatives in the areas of obstetrics and 
        gynecology or maternal health.
    ``(c) Report to Congress.--Not later than January 1, 2025, the 
Secretary shall submit to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on Energy and Commerce of 
the House of Representatives, and make publicly available, a report 
concerning the impact of the programs established or continued under 
this section.
    ``(d) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2021 through 2025.''.

SEC. 7. MATERNAL HEALTH RESEARCH NETWORK.

    Subpart 7 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285g et seq.) is amended by adding at the end the following:

``SEC. 452H. MATERNAL HEALTH RESEARCH NETWORK.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the National Institutes of Health, shall establish a National Maternal 
Health Research Network (referred to in this section as the `Network'), 
to more effectively support innovative research to reduce maternal 
mortality and promote maternal health.
    ``(b) Activities.--The Secretary, acting through the Network, may 
carry out activities to support mechanistic, translational, clinical, 
behavioral, or epidemiologic research, as well as community-informed 
research on structural risk factors to address unmet maternal health 
research needs specific to the underlying causes of maternal mortality 
and severe maternal morbidity and their treatment. Such activities 
should be focused on optimizing improved diagnostics and clinical 
treatments, improving health outcomes, and reducing inequities.
    ``(c) Existing Networks.--In carrying out this section, the 
Secretary may utilize or coordinate with the Maternal Fetal Medicine 
Units Network and the Obstetric-Fetal Pharmacology Research Centers 
Network.
    ``(d) Use of Funds.--Amounts appropriated to carry out this section 
may be used to support the Network for activities related to maternal 
mortality or severe maternal morbidity that lead to potential therapies 
or clinical practices that will improve maternal health outcomes and 
reduce inequities. Amounts provided to such Network shall be used to 
supplement, and not supplant, other funding provided to such Network 
for such activities.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $50,000,000 for each of fiscal 
years 2021 through 2025.''.

SEC. 8. TELEHEALTH DEMONSTRATION PROGRAM.

    Section 330A of the Public Health Service Act (42 U.S.C. 254c) is 
amended--
            (1) by redesignating subsections (h) through (j) as 
        subsections (i) through (k), respectively; and
            (2) by inserting after subsection (g), the following:
    ``(h) Telehealth Demonstration Program.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall continue in effect the Rural Maternity 
        and Obstetrics Management Strategies (RMOMS) Program to award 
        competitive grants to eligible entities for the purpose of 
        improving access to, and continuity of, maternal and obstetrics 
        care in rural communities.
            ``(2) Use of funds.--An entity receiving a grant under this 
        subsection shall use grant funds to develop a sustainable 
        consortium approach to coordinate maternal and obstetrics care 
        within a rural region--
                    ``(A) through a focus on--
                            ``(i) rural regional approaches to risk 
                        appropriate care;
                            ``(ii) an approach to coordinating a 
                        continuum of care for prepregnancy, pregnancy, 
                        labor and delivery, postpartum, and 
                        interpregnancy services;
                            ``(iii) leveraging telehealth and specialty 
                        care to enhance case management of higher-risk 
                        expectant mothers living in geographically 
                        isolated areas; and
                            ``(iv) demonstrating financial 
                        sustainability through improved maternal and 
                        neonatal outcomes and potential cost savings; 
                        and
                    ``(B) by testing and improving upon strategies to 
                improve access to, and continuity of, obstetrics care 
                in rural communities and reduce geographic inequities 
                in maternal health through the use of data and outcome 
                measures spanning the continuum of care from 
                prepregnancy through pregnancy, labor, delivery, and 
                the postpartum period.
            ``(3) Eligible entities.--To be eligible for a grant under 
        paragraph (1), a domestic public or non-profit private entity, 
        including Indian Tribes, and Tribal serving organizations such 
        as a Tribal health department or other organization fulfilling 
        similar functions for the Tribe, shall--
                    ``(A) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require;
                    ``(B) propose to carry out activities that 
                exclusively target populations residing in rural 
                counties or rural census tracts in urban counties as 
                designated by the Health Resources and Services 
                Administration; and
                    ``(C) demonstrate a formal arrangement among a 
                consortium of three or more entities, including the 
                applicant, to build a rural based system of perinatal 
                and maternal care.
            ``(4) Report to congress.--Not later than January 1, 2023, 
        the Secretary shall submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives, and 
        make publicly available, a report concerning the impact of the 
        programs continued under this subsection together with 
        recommendations on whether to expand such programs and the 
        estimated amount of funds needed to expand such programs.
            ``(5) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $12,000,000 
        for each of fiscal years 2021 through 2023.''.

SEC. 9. PUBLIC AND PROVIDER AWARENESS CAMPAIGN PROMOTING MATERNAL AND 
              CHILD HEALTH.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
and in coordination with State, local, territorial, health departments, 
Indian Tribes, Tribal serving organizations, public health experts and 
associations, the medical and allied professional community, and 
minority health organizations, shall award competitive grants to 
eligible entities to establish a national evidence-based public and 
provider awareness campaign on the importance of maternal and child 
health, including identifying and responding to maternal health warning 
signs and vaccinations for the health of pregnant women and their 
children, with the goal of increasing vaccination rates among pregnant 
women and children, reducing racism and racial, ethnic, and geographic 
inequities in maternal and child health, and reducing maternal 
mortality and severe maternal morbidity.
    (b) Use of Funds.--An entity receiving a grant under this section 
shall use grant funds to supplement, not supplant, any Federal, State, 
or local funds supporting the establishment of a national evidence-
based public and provider awareness campaign with all resources in an 
accessible format that--
            (1) increases awareness and knowledge of maternal health 
        warning signs and how to respond to those signs as well as the 
        safety and effectiveness of vaccines for pregnant women and 
        their children;
            (2) provides targeted evidence-based, culturally and 
        linguistically appropriate resources to pregnant women, 
        particularly in communities with low rates of vaccination and 
        in rural and underserved areas; and
            (3) provides evidence-based information and resources on 
        the importance of maternal and child health, including maternal 
        health warning signs and the safety of vaccinations for 
        pregnant women and their children to public health departments 
        and health care providers that care for pregnant women.
    (c) Eligible Entities.--To be eligible for a grant under this 
section, a public or private entity shall submit to the Secretary of 
Health and Human Services an application at such time, in such manner, 
and containing such information as the Secretary may require.
    (d) Collaboration.--The Secretary of Health and Human Services 
shall ensure that the information and resources developed for the 
campaign under this section are disseminated to other divisions of the 
Department of Health and Human Services working to improve maternal and 
child health outcomes.
    (e) Evaluation.--Not later than January 1, 2025, the Secretary of 
Health and Human Services shall establish quantitative and qualitative 
metrics to evaluate the campaign under this section and shall submit a 
report detailing the campaign's impact to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives.
    (f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $2,000,000 for each of fiscal 
years 2021 through 2025.
                                 <all>