[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 943 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 943

   To address social determinants of maternal health with respect to 
      pregnant and postpartum individuals, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 8, 2021

  Mrs. McBath (for herself, Ms. Underwood, Ms. Adams, Mr. Khanna, Ms. 
Velazquez, Mr. Smith of Washington, Ms. Scanlon, Mr. Lawson of Florida, 
 Mrs. Hayes, Mr. Butterfield, Ms. Moore of Wisconsin, Ms. Strickland, 
    Mr. Ryan, Mr. Schiff, Mr. Johnson of Georgia, Mr. Horsford, Ms. 
Wasserman Schultz, Ms. Barragan, Mr. Deutch, Mr. Payne, Mr. Blumenauer, 
 Mr. Moulton, Mr. Soto, Mr. Nadler, Mr. Trone, Ms. Clarke of New York, 
Ms. Schakowsky, Ms. Bass, Ms. Pressley, Mr. Evans, Ms. Blunt Rochester, 
    Ms. Castor of Florida, Ms. Sewell, and Ms. Williams of Georgia) 
 introduced the following bill; which was referred to the Committee on 
  Energy and Commerce, and in addition to the Committees on Financial 
Services, Transportation and Infrastructure, Agriculture, and Education 
 and Labor, for a period to be subsequently determined by the Speaker, 
 in each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To address social determinants of maternal health with respect to 
      pregnant and postpartum individuals, 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 ``Social Determinants for Moms Act''.

SEC. 2. TASK FORCE TO DEVELOP A STRATEGY TO ADDRESS SOCIAL DETERMINANTS 
              OF MATERNAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services shall 
convene a task force (in this section referred to as the ``Task 
Force'') to develop a strategy to coordinate efforts between Federal 
agencies to address social determinants of maternal health with respect 
to pregnant and postpartum individuals.
    (b) Ex Officio Members.--The ex officio members of the Task Force 
shall consist of the following:
            (1) The Secretary of Health and Human Services (or a 
        designee thereof).
            (2) The Secretary of Housing and Urban Development (or a 
        designee thereof).
            (3) The Secretary of Transportation (or a designee 
        thereof).
            (4) The Secretary of Agriculture (or a designee thereof).
            (5) The Secretary of Labor (or a designee thereof).
            (6) The 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 Administrator of the Health Resources and Services 
        Administration (or a designee thereof).
            (12) The Deputy Assistant Secretary for Minority Health of 
        the Department of Health and Human Services (or a designee 
        thereof).
            (13) The Deputy Assistant Secretary for Women's Health of 
        the Department of Health and Human Services (or a designee 
        thereof).
            (14) The Director of the Centers for Disease Control and 
        Prevention (or a designee thereof).
            (15) The Director of the Office on Violence Against Women 
        at the Department of Justice (or a designee thereof).
    (c) Appointed Members.--In addition to the ex officio members of 
the Task Force, the Secretary of Health and Human Services shall 
appoint the following members of the Task Force:
            (1) At least two representatives of patients, to include--
                    (A) a representative of patients who have suffered 
                from severe maternal morbidity; or
                    (B) a representative of patients who is a family 
                member of an individual who suffered a pregnancy-
                related death.
            (2) At least two leaders of community-based organizations 
        that address maternal mortality and severe maternal morbidity 
        with a specific focus on racial and ethnic disparities. In 
        appointing such leaders under this paragraph, the Secretary of 
        Health and Human Services shall give priority to individuals 
        who are leaders of organizations led by individuals from racial 
        and ethnic minority groups.
            (3) At least two perinatal health workers.
            (4) A professionally diverse panel of maternity care 
        providers.
    (d) Chair.--The Secretary of Health and Human Services shall select 
the chair of the Task Force from among the members of the Task Force.
    (e) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Task Force shall submit to Congress a report on--
            (1) the strategy developed under subsection (a);
            (2) recommendations on funding amounts with respect to 
        implementing such strategy;
            (3) recommendations for how to expand coverage of social 
        services to address social determinants of maternal health 
        under Medicaid managed care organizations and State Medicaid 
        programs.
    (f) Termination.--Section 14 of the Federal Advisory Committee Act 
(5 U.S.C. App.) shall not apply to the Task Force with respect to 
termination.

SEC. 3. HOUSING FOR MOMS GRANT PROGRAM.

    (a) In General.--The Secretary of Housing and Urban Development 
shall establish a Housing for Moms grant program under this section to 
make grants to eligible entities to increase access to safe, stable, 
affordable, and adequate housing for pregnant and postpartum 
individuals and their families.
    (b) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may provide.
    (c) Priority.--In awarding grants under this section, the Secretary 
shall give priority to an eligible entity that--
            (1) is a community-based organization or will partner with 
        a community-based organization to implement initiatives to 
        increase access to safe, stable, affordable, and adequate 
        housing for pregnant and postpartum individuals and their 
        families;
            (2) is operating in an area with high rates of adverse 
        maternal health outcomes or significant racial or ethnic 
        disparities in maternal health outcomes, to the extent such 
        data are available; and
            (3) is operating in an area with a high poverty rate or 
        significant number of individuals who lack consistent access to 
        safe, stable, affordable, and adequate housing.
    (d) Use of Funds.--An eligible entity that receives a grant under 
this section shall use funds under the grant for the purposes of--
            (1) identifying and conducting outreach to pregnant and 
        postpartum individuals who are low-income and lack consistent 
        access to safe, stable, affordable, and adequate housing;
            (2) providing safe, stable, affordable, and adequate 
        housing options to such individuals;
            (3) connecting such individuals with local organizations 
        offering safe, stable, affordable, and adequate housing 
        options;
            (4) providing application assistance to such individuals 
        seeking to enroll in programs offering safe, stable, 
        affordable, and adequate housing options;
            (5) providing direct financial assistance to such 
        individuals for the purposes of maintaining safe, stable, and 
        adequate housing for the duration of the individual's pregnancy 
        and postpartum periods; and
            (6) working with relevant stakeholders to ensure that local 
        housing and homeless shelter infrastructure is supportive to 
        pregnant and postpartum individuals, including through--
                    (A) health-promoting housing codes;
                    (B) enforcement of housing codes;
                    (C) proactive rental inspection programs;
                    (D) code enforcement officer training; and
                    (E) partnerships between regional offices of the 
                Department of Housing and Urban Development and 
                community-based organizations to ensure housing laws 
                are understood and violations are discovered.
    (e) Reporting.--
            (1) Eligible entities.--The Secretary shall require each 
        eligible entity receiving a grant under this section to 
        annually submit to the Secretary and make publicly available a 
        report on the status of activities conducted using the grant.
            (2) Secretary.--Not later than the end of each fiscal year 
        in which grants are made under this section, the Secretary 
        shall submit to the Congress and make publicly available a 
        report that--
                    (A) summarizes the reports received under paragraph 
                (1);
                    (B) evaluates the effectiveness of grants awarded 
                under this section in increasing access to safe, 
                stable, affordable, and adequate housing for pregnant 
                and postpartum individuals and their families; and
                    (C) makes recommendations with respect to ensuring 
                activities described subsection (d) continue after 
                grant amounts made available under this section are 
                expended.
    (f) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) a community-based organization;
                    (B) a State or local governmental entity, including 
                a State or local public health department;
                    (C) an Indian tribe or tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304)); or
                    (D) an Urban Indian organization (as such term is 
                defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Housing and Urban Development.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 
2022, which shall remain available until expended.

SEC. 4. DEPARTMENT OF TRANSPORTATION.

    (a) Report.--Not later than one year after the date of enactment of 
this Act, the Secretary of Transportation shall submit to Congress and 
make publicly available a report containing--
            (1) an assessment of transportation barriers preventing 
        individuals from attending prenatal and postpartum 
        appointments, accessing maternal health care services, or 
        accessing services and resources related to social determinants 
        maternal of health;
            (2) recommendations on how to overcome the barriers 
        assessed under paragraph (1); and
            (3) an assessment of transportation safety risks for 
        pregnant individuals and recommendations on how to mitigate 
        such risks.
    (b) Considerations.--In carrying out subsection (a), the Secretary 
shall give special consideration to solutions for--
            (1) pregnant and postpartum individuals living in a health 
        professional shortage area designated under section 332 of the 
        Public Health Service Act (42 U.S.C. 254e);
            (2) pregnant and postpartum individuals living in areas 
        with high maternal mortality or severe morbidity rates or 
        significant racial or ethnic disparities in maternal health 
        outcomes; or
            (3) pregnant and postpartum individuals with a disability 
        that impacts mobility.

SEC. 5. DEPARTMENT OF AGRICULTURE.

    (a) Special Supplemental Nutrition Program.--
            (1) 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''.
            (2) Extension of breastfeeding period.--Section 
        17(d)(3)(A)(ii) of the Child Nutrition Act of 1966 (7 U.S.C. 
        1431(d)(3)(A)(ii)) is amended by striking ``1 year'' and 
        inserting ``24 months''.
            (3) 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 subsection on--
                    (A) maternal and infant health outcomes, including 
                racial and ethnic disparities with respect to such 
                outcomes;
                    (B) breastfeeding rates among postpartum 
                individuals;
                    (C) 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
                    (D) other relevant information as determined by the 
                Secretary.
    (b) Grant Program for Healthy Food and Clean Water for Pregnant and 
Postpartum Individuals.--
            (1) In general.--The Secretary shall establish a program to 
        award grants, on a competitive basis, to eligible entities to 
        carry out the activities described in paragraph (4).
            (2) Application.--To be eligible for a grant under this 
        subsection, an eligible entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary determines appropriate.
            (3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to an eligible entity that--
                    (A) is, or will partner with, a community-based 
                organization; and
                    (B) is operating in an area with high rates of--
                            (i) adverse maternal health outcomes; or
                            (ii) significant racial or ethnic 
                        disparities in maternal health outcomes.
            (4) Use of funds.--An eligible entity shall use grant funds 
        awarded under this subsection to deliver healthy food, infant 
        formula, clean water, or diapers to pregnant and postpartum 
        individuals located in areas that are food deserts, as 
        determined by the Secretary using data from the Food Access 
        Research Atlas of the Department of Agriculture.
            (5) Reports.--
                    (A) Eligible entity.--Not later than 1 year after 
                an eligible entity first receives a grant under this 
                subsection, and annually thereafter, an eligible entity 
                shall submit to the Secretary a report on the status of 
                activities conducted using the grant, which shall 
                contain such information as the Secretary may require.
                    (B) Secretary.--
                            (i) In general.--Not later than 2 years 
                        after the date on which the first grant is 
                        awarded under this subsection, the Secretary 
                        shall submit to Congress a report that 
                        includes--
                                    (I) a summary of the reports 
                                submitted under subparagraph (A);
                                    (II) an assessment of the extent to 
                                which food distributed through the 
                                grant program was purchased from local 
                                and regional food systems;
                                    (III) an evaluation of the effect 
                                of the grant program under this 
                                subsection on maternal and infant 
                                health outcomes, including racial and 
                                ethnic disparities with respect to such 
                                outcomes; and
                                    (IV) recommendations with respect 
                                to ensuring the activities described in 
                                paragraph (4) continue after the grant 
                                period funding such activities expires.
                            (ii) Publication.--The Secretary shall make 
                        the report submitted under clause (i) publicly 
                        available on the website of the Department of 
                        Agriculture.
            (6) Authorization of appropriations.--There are authorized 
        to be appropriated $5,000,000 to carry out this subsection for 
        fiscal years 2022 through 2024.
    (c) Definitions.--In this section:
            (1) Eligible entity.--The term ``eligible entity'' means--
                    (A) a community-based organization;
                    (B) a State or local governmental entity, including 
                a State or local public health department;
                    (C) an Indian tribe or tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304)); or
                    (D) an Urban Indian organization (as such term is 
                defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Agriculture.

SEC. 6. ENVIRONMENTAL STUDY THROUGH NATIONAL ACADEMIES.

    (a) In General.--The Administrator of the Environmental Protection 
Agency shall seek to enter an agreement, not later than 60 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 
conduct a study on 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.
    (b) Study Requirements.--The agreement under subsection (a) shall 
direct the National Academies to make recommendations for--
            (1) improving environmental conditions to improve maternal 
        and infant health outcomes; and
            (2) reducing or eliminating racial and ethnic disparities 
        in such outcomes.
    (c) Report.--The agreement under subsection (a) shall direct the 
National Academies to complete the study under this section, and 
transmit to the Congress and make publicly available a report on the 
results of the study, not later than 12 months after the date of 
enactment of this Act.

SEC. 7. CHILD CARE ACCESS.

    (a) Grant Program.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall award grants to 
eligible organizations to provide pregnant and postpartum individuals 
with free and accessible drop-in child care services during prenatal 
and postpartum appointments.
    (b) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require.
    (c) Eligible Organizations.--
            (1) Eligibility.--To be eligible to receive a grant under 
        this section, an organization shall be an organization that 
        provides child care services and can carry out programs 
        providing pregnant and postpartum individuals with free and 
        accessible drop-in child care services during prenatal and 
        postpartum appointments.
            (2) Prioritization.--In selecting grant recipients under 
        this section, the Secretary shall give priority to eligible 
        organizations that operate in an area with high rates of 
        adverse maternal health outcomes or significant racial or 
        ethnic disparities in maternal health outcomes, to the extent 
        such data are available.
    (d) Timing.--The Secretary shall commence the grant program under 
subsection (a) not later than 1 year after the date of enactment of 
this Act.
    (e) Reporting.--
            (1) Grantees.--Each recipient of a grant under this section 
        shall annually submit to the Secretary and make publicly 
        available a report on the status of activities conducted using 
        the grant. Each such report shall include--
                    (A) an analysis of the effect of the funded program 
                on prenatal and postpartum appointment attendance 
                rates;
                    (B) summaries of qualitative assessments of the 
                funded program from--
                            (i) pregnant and postpartum individuals 
                        participating in the program; and
                            (ii) the families of such individuals; and
                    (C) such additional information as the Secretary 
                may require.
            (2) Secretary.--Not later than the end of fiscal year 2024, 
        the Secretary shall submit to the Congress and make publicly 
        available a report containing the following:
                    (A) A summary of the reports under paragraph (1).
                    (B) An assessment of the effects, if any, of the 
                funded programs on maternal health outcomes, with a 
                specific focus on racial and ethnic disparities in such 
                outcomes.
                    (C) A description of actions the Secretary can take 
                to ensure that pregnant and postpartum individuals 
                eligible for medical assistance under a State plan 
                under title XIX of the Social Security Act (42 U.S.C. 
                1936 et seq.) have access to free and accessible drop-
                in child care services during prenatal and postpartum 
                appointments, including identification of the funding 
                necessary to carry out such actions.
    (f) Drop-In Child Care Services Defined.--In this section, the term 
``drop-in child care services'' means child care and early childhood 
education services that are--
            (1) delivered at a facility that meets the requirements of 
        all applicable laws and regulations of the State or local 
        government in which it is located, including the licensing of 
        the facility as a child care facility; and
            (2) provided in single encounters without requiring full-
        time enrollment of a person in a child care program.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for the period of 
fiscal years 2022 through 2024.

SEC. 8. GRANTS TO LOCAL ENTITIES ADDRESSING SOCIAL DETERMINANTS OF 
              MATERNAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall award grants to 
eligible entities to--
            (1) address social determinants of maternal health for 
        pregnant and postpartum individuals; and
            (2) eliminate racial and ethnic disparities in maternal 
        health outcomes.
    (b) Application.--To be eligible to receive a grant under this 
subsection an eligible entity shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may provide.
    (c) Prioritization.--In awarding grants under subsection (a), the 
Secretary shall give priority to an eligible entity that--
            (1) is, or will partner with, a community-based 
        organization to carrying out the activities under subsection 
        (d);
            (2) is operating in an area with high rates of adverse 
        maternal health outcomes or significant racial or ethnic 
        disparities in maternal health outcomes; and
            (3) is operating in an area with a high poverty rate.
    (d) Activities.--An eligible entity that receives a grant under 
this section may--
            (1) hire and retain staff;
            (2) develop and distribute a list of available resources 
        with respect to social service programs in a community;
            (3) establish a resource center that provides multiple 
        social service programs in a single location; and
            (4) offer programs and resources in the communities in 
        which the respective eligible entities are located to address 
        social determinants of health for pregnant and postpartum 
        individuals; and
            (5) consult with such pregnant and postpartum individuals 
        to conduct an assessment of the activities under this 
        subsection.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance to plan for 
sustaining programs to address social determinants of maternal health 
among pregnant and postpartum individuals after the period of the 
grant.
    (f) Reporting.--
            (1) Grantees.--Not later than 1 year after an eligible 
        entity first receives a grant under this section, and annually 
        thereafter, an eligible entity shall submit to the Secretary, 
        and make publicly available, a report on the status of 
        activities conducted using the grant. Each such report shall 
        include data on the effects of such activities, disaggregated 
        by race, ethnicity, gender, and other relevant factors.
            (2) Secretary.--Not later than the end of fiscal year 2026, 
        the Secretary shall submit to Congress a report that includes--
                    (A) a summary of the reports under paragraph (1); 
                and
                    (B) recommendations for--
                            (i) improving maternal health outcomes; and
                            (ii) reducing or eliminating racial and 
                        ethnic disparities in maternal health outcomes.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $15,000,000 for each of fiscal 
years 2022 through 2026.

SEC. 9. DEFINITIONS.

    In this Act:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (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) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (7) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (8) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.
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