[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3523 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 3523

 To grow and diversify the perinatal workforce, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 18, 2023

  Ms. Moore of Wisconsin (for herself, Ms. Underwood, Ms. Adams, Mr. 
     Allred, Ms. Barragan, Mrs. Beatty, Mr. Bishop of Georgia, Mr. 
Blumenauer, Ms. Blunt Rochester, Ms. Brownley, Ms. Budzinski, Ms. Bush, 
 Ms. Caraveo, Mr. Carbajal, Mr. Carson, Mr. Carter of Louisiana, Mrs. 
 Cherfilus-McCormick, Ms. Clarke of New York, Mr. Cleaver, Mr. Cohen, 
      Ms. Craig, Ms. Crockett, Mr. Davis of Illinois, Ms. Dean of 
Pennsylvania, Ms. Escobar, Mr. Espaillat, Mr. Evans, Mrs. Foushee, Mr. 
 Garamendi, Ms. Garcia of Texas, Mr. Garcia of Illinois, Mr. Green of 
Texas, Mrs. Hayes, Mr. Horsford, Mr. Huffman, Mr. Ivey, Mr. Jackson of 
  Illinois, Ms. Jackson Lee, Ms. Jacobs, Ms. Jayapal, Mr. Johnson of 
Georgia, Ms. Kamlager-Dove, Mr. Krishnamoorthi, Ms. Kuster, Ms. Lee of 
  California, Mr. Lieu, Ms. Lofgren, Mrs. McBath, Mrs. McClellan, Ms. 
 McCollum, Mr. McGovern, Mr. Meeks, Ms. Meng, Mr. Mfume, Mr. Morelle, 
 Mr. Moulton, Mr. Mrvan, Mr. Mullin, Mrs. Napolitano, Mr. Neguse, Ms. 
  Ocasio-Cortez, Mr. Pappas, Mr. Payne, Mr. Phillips, Ms. Porter, Ms. 
Pressley, Mr. Ruppersberger, Ms. Salinas, Ms. Scanlon, Mr. Schiff, Mr. 
 Schneider, Ms. Scholten, Mr. David Scott of Georgia, Ms. Sewell, Mr. 
 Soto, Ms. Spanberger, Ms. Stansbury, Ms. Strickland, Mrs. Sykes, Mr. 
 Takano, Ms. Tlaib, Ms. Tokuda, Mr. Tonko, Mrs. Torres of California, 
  Mrs. Trahan, Mr. Trone, Mr. Vargas, Mr. Veasey, Ms. Velazquez, Ms. 
  Wasserman Schultz, Mrs. Watson Coleman, Ms. Wexton, Ms. Williams of 
   Georgia, Mr. Pascrell, Ms. DelBene, and Mr. Lynch) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
 To grow and diversify the perinatal workforce, 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 ``Perinatal Workforce Act''.

SEC. 2. 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. 3. 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. 4. 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. 5. 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. 6. 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, 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.
            (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.--The term ``postpartum'' refers 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)).
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