[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 964 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 964
To amend the Public Health Service Act to improve maternal health and
promote safe motherhood.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 23, 2023
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 maternal mortality rate in 2020 was
23.8 deaths per 100,000 live births, which is significantly
higher than the Organisation for Economic Co-operation and
Development (referred to in this section as the ``OECD'')
average of 9.8, according to the Commonwealth Fund.
(3) The United States infant mortality rate in 2020 was 5.4
deaths per 1,000 live births, while the OECD average was 4.1
deaths 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 2020 was 55.3 deaths per 100,000 live births. This
rate is 2.89 times higher than the maternal mortality rate of
19.1 deaths per 100,000 live births for non-Hispanic white
women and more than 3 times higher than the maternal mortality
rate of 18.2 deaths per 100,000 live births for Hispanic women
of any race.
(6) The Centers for Disease Control and Prevention data
from 2016 through 2018 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 26.5
pregnancy-related deaths per 100,000 live births from 2016
through 2018, which is 1.9 times higher than the rate of 13.7
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 10.6 deaths per 1,000 live births and for infants of
American Indian or Alaska Native women it is 7.9 deaths per
1,000 live births. These rates are significantly higher than
the infant mortality rate of non-Hispanic white infants at 4.5
deaths per 1,000 live births and the infant mortality rate of
Hispanic infants of any race at 5 deaths 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 2017 systemic review of
implicit bias in health care professionals found that 35
studies found evidence of negative implicit biases towards
people of color among health care professionals. Those biases
were correlated with ``lower quality of care''. 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 330P (42 U.S.C. 254c-22) the following:
``SEC. 330Q. 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, 2027, 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
2024 through 2027.''.
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, 2026,
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, 2026,
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 2024 through
2026''.
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:
``(g) 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 330Q (as added by section 3) the following:
``SEC. 330R. 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, 2028, 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 2024 through 2028.''.
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 2024 through 2028.''.
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, 2026,
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 2024 through 2026.''.
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, 2027, 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 2024 through 2028.
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