Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696590915732.pdf (United States)
I 118TH CONGRESS 1ST SESSION H. R. 3310 To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES MAY 15, 2023 Ms. ADAMS (for herself, Ms. UNDERWOOD, Mr. AGUILAR, Mr. ALLRED, Ms. BARRAGA´N, 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. GARCI´A of Illi- nois, 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, Ms. MOORE of Wisconsin, Mr. MRVAN, Mr. MULLIN, Mrs. NAPOLITANO, Mr. NEGUSE, Ms. OCASIO-CORTEZ, Mr. PAPPAS, Mr. PAYNE, Mr. PHILLIPS, Ms. PORTER, Ms. PRESSLEY, Mr. RUPPERS- BERGER, Ms. SALINAS, Ms. SCANLON, Mr. SCHIFF, Mr. SCHNEIDER, Ms. SCHOLTEN, Mr. SCOTT of Virginia, Mr. DAVID SCOTT of Georgia, Ms. SEWELL, Mr. SMITH of Washington, 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. VELA´ZQUEZ, 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 Com- merce BILL To end preventable maternal mortality and severe maternal morbidity in the United States and close disparities in maternal health outcomes, and for other purposes.
Be it enacted by the Senate and House of Representa- tives of the United States of America in Congress assembled, SECTION 1.

SHORT TITLE.

This Act may be cited as the ‘‘Kira Johnson Act’’.

SEC.

2.

SUSTAINED FUNDING FOR COMMUNITY-BASED OR- GANIZATIONS TO ADVANCE MATERNAL HEALTH EQUITY.
(a) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Sec- retary’’) shall award grants to eligible entities to establish or expand programs to advance maternal health equity.

(b) TIMING.—Following the 1-year period described in subsection (d), the Secretary shall commence awarding the grants authorized by subsection (a).
(c) ELIGIBLE ENTITIES.—To be eligible to seek a grant under this section, an entity shall be a community- based organization offering programs and resources aligned with evidence-based practices for improving mater- nal health outcomes for demographic groups with elevated rates of maternal mortality, severe maternal morbidity, •HR 3310 IH maternal health disparities, or other adverse perinatal or childbirth outcomes.
(d) OUTREACH AND TECHNICAL ASSISTANCE PE- RIOD.—During the 1-year period beginning on the date of enactment of this Act, the Secretary shall— (1) conduct outreach to encourage eligible enti- ties to apply for grants under this section; and (2) provide technical assistance to eligible enti- ties on best practices for applying for grants under this section.
(e) SPECIAL CONSIDERATION.— (1) OUTREACH.—In conducting outreach under subsection (d), the Secretary shall give special con- sideration to eligible entities that— (A) are based in, and provide support for, communities with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes, to the extent such data are available; (B) are led by individuals from demo- graphic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; and •HR 3310 IH (C) offer programs and resources that are aligned with evidence-based practices for im- proving maternal health outcomes for individ- uals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes.
(2) AWARDS.—In awarding grants under this section, the Secretary shall give special consideration to eligible entities that— (A) are described in subparagraphs (A), (B), and (C) of paragraph (1); (B) offer programs and resources designed in consultation with and intended for individ- uals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes; (C) offer programs and resources in the communities in which the respective eligible en- tities are located that— (i) promote maternal mental health and maternal substance use disorder treat- ments and supports that are aligned with evidence-based practices for improving ma- •HR 3310 IH ternal mental and behavioral health out- comes for individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, ma- ternal health disparities, or other adverse perinatal or childbirth outcomes; (ii) address social determinants of ma- ternal health; (iii) promote evidence-based health lit- eracy and pregnancy, childbirth, and par- enting education; (iv) provide support from perinatal health workers; (v) provide culturally and linguis- tically congruent training to perinatal health workers; (vi) conduct or support research on maternal health issues disproportionately impacting individuals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, ma- ternal health disparities, or other adverse perinatal or childbirth outcomes; (vii) offer group prenatal care or group postpartum care;
00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3310.IH H3310 •HR 3310 IH (viii) coordinate mutual aid efforts during infant formula shortages, including community milk depots, donor human milk banks and exchanges, and forums for com- munity outreach and education; (ix) provide support to individuals or family members of individuals who suffered a pregnancy loss, pregnancy-associated death, or pregnancy-related death; or (x) operate midwifery practices that provide culturally and linguistically con- gruent maternal health care and support, including for the purposes of— (I) supporting additional edu- cation, training, and certification pro- grams, including support for distance learning; (II) providing financial support to current and future midwives to ad- dress education costs, debts, and other needs; (III) clinical site investments; (IV) supporting preceptor devel- opment trainings; •HR 3310 IH (V) expanding the midwifery practice; or (VI) related needs identified by the midwifery practice and described in the practice’s application; and (D) have developed other programs and re- sources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for individ- uals from demographic groups with elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes.
(f) TECHNICAL ASSISTANCE.—The Secretary shall provide to grant recipients under this section technical as- sistance on— (1) capacity building to establish or expand pro- grams to advance maternal health equity; (2) best practices in data collection, measure- ment, evaluation, and reporting; and (3) planning for sustaining programs to ad- vance maternal health equity after the period of the grant.
•HR 3310 IH (g) EVALUATION.—Not later than the end of fiscal year 2028, the Secretary shall submit to the Congress an evaluation of the grant program under this section that— (1) assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients; (2) makes recommendations for future outreach efforts to diversify the pool of grant recipients for Department of Health and Human Services grant programs and funding opportunities related to ma- ternal health; (3) assesses the effectiveness of programs fund- ed by grants under this section in improving mater- nal health outcomes for individuals from demo- graphic groups with elevated rates of maternal mor- tality, severe maternal morbidity, maternal health disparities, or other adverse perinatal or childbirth outcomes, to the extent practicable; and (4) makes recommendations for future Depart- ment of Health and Human Services grant programs and funding opportunities that deliver funding to community-based organizations that provide pro- grams and resources that are aligned with evidence- based practices for improving maternal health out- comes for individuals from demographic groups with •HR 3310 IH elevated rates of maternal mortality, severe maternal morbidity, maternal health disparities, or other ad- verse perinatal or childbirth outcomes.
(h) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there is authorized to be appropriated $100,000,000 for each of fiscal years 2024 through 2028.

SEC.

3.

RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN MATERNITY CARE SETTINGS.

Part B of title VII of the Public Health Service Act 10 (42 U.S.C.

293 et seq.)

is amended by adding at the end 11 the following new section: ‘‘SEC.

742.
742.

RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN MATERNITY CARE SET- TINGS.

‘‘(a) GRANTS.—The Secretary shall award grants for programs to reduce and prevent bias, racism, and dis- crimination in maternity care settings and to advance re- spectful, culturally and linguistically congruent, trauma- 19 informed care.
‘‘(b) SPECIAL CONSIDERATION.—In awarding grants under subsection (a), the Secretary shall give special con- sideration to applications for programs that would— ‘‘(1) apply to all maternity care providers and any employees who interact with pregnant and postpartum individuals in the provider setting, in- •HR 3310 IH 10 cluding front desk employees, sonographers, sched- ulers, health care professionals, hospital or health system administrators, security staff, and other em- ployees; ‘‘(2) emphasize periodic, as opposed to one- time, trainings for all birthing professionals and em- ployees described in paragraph (1); ‘‘(3) address implicit bias, racism, and cultural humility; ‘‘(4) be delivered in ongoing education settings for providers maintaining their licenses, with a pref- erence for trainings that provide continuing edu- cation units; ‘‘(5) include trauma-informed care best prac- tices and an emphasis on shared decision making be- tween providers and patients; ‘‘(6) include antiracism training and programs; ‘‘(7) be delivered in undergraduate programs that funnel into health professions schools; ‘‘(8) be delivered in settings that apply to pro- viders of the special supplemental nutrition program for women, infants, and children under section 17 of the Child Nutrition Act of 1966; ‘‘(9) integrate bias training in obstetric emer- gency simulation trainings or related trainings; •HR 3310 IH 11 ‘‘(10) include training for emergency depart- ment employees and emergency medical technicians on recognizing warning signs for severe pregnancy- related complications; ‘‘(11) offer training to all maternity care pro- viders on the value of racially, ethnically, and profes- sionally diverse maternity care teams to provide cul- turally and linguistically congruent care; or ‘‘(12) be based on one or more programs de- signed by a historically Black college or university or other minority-serving institution.
‘‘(c) APPLICATION.—To seek a grant under sub- section (a), an entity shall submit an application at such time, in such manner, and containing such information as the Secretary may require.
‘‘(d) REPORTING.—Each recipient of a grant under this section shall annually submit to the Secretary a report on the status of activities conducted using the grant, in- cluding, as applicable, a description of the impact of train- ing provided through the grant on patient outcomes and patient experience for pregnant and postpartum individ- uals from racial and ethnic minority groups and their fam- 23 ilies.
24 25 ‘‘(e) BEST PRACTICES.—Based on the annual reports submitted pursuant to subsection (d), the Secretary— •HR 3310 IH 12 ‘‘(1) shall produce an annual report on the find- ings resulting from programs funded through this section; ‘‘(2) shall disseminate such report to all recipi- ents of grants under this section and to the public; and ‘‘(3) may include in such report findings on best practices for improving patient outcomes and patient experience for pregnant and postpartum in- dividuals from racial and ethnic minority groups and their families in maternity care settings.
‘‘(f) DEFINITIONS.—In this section: ‘‘(1) The term ‘postpartum’ means the 1-year period beginning on the last day of an individual’s pregnancy.

‘‘(2) The term ‘culturally and linguistically con- gruent’ means in agreement with the preferred cul- tural values, beliefs, worldview, language, and prac- tices of the health care consumer and other stake- holders.

‘‘(3) The term ‘racial and ethnic minority group’ has the meaning given such term in section 1707(g)(1).
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there is authorized to be appro- •HR 3310 IH priated $5,000,000 for each of fiscal years 2024 through 13 2028.’’.

SEC.

4.
SEC.

4.

STUDY ON REDUCING AND PREVENTING BIAS, RAC- ISM, AND DISCRIMINATION IN MATERNITY CARE SETTINGS.
(a) IN GENERAL.—The Secretary of Health and Human Services shall seek to enter into an agreement, not later than 90 days after the date of enactment of this Act, with the National Academies of Sciences, Engineer- ing, and Medicine (referred to in this section as the ‘‘Na- tional Academies’’) under which the National Academies agree to— (1) conduct a study on the design and imple- mentation of programs to reduce and prevent bias, racism, and discrimination in maternity care settings and to advance respectful, culturally and linguis- tically congruent, trauma-informed care; and (2) not later than 24 months after the date of enactment of this Act— (A) complete the study; and (B) transmit a report on the results of the study to the Congress.
(b) POSSIBLE TOPICS.—The agreement entered into pursuant to subsection (a) may provide for the study of 25 any of the following: •HR 3310 IH 14 (1) The development of a scorecard or other evaluation standards for programs designed to re- duce and prevent bias, racism, and discrimination in maternity care settings to assess the effectiveness of such programs in improving patient outcomes and patient experience for pregnant and postpartum in- dividuals from racial and ethnic minority groups and their families.
(2) Determination of the types and frequency of training to reduce and prevent bias, racism, and dis- crimination in maternity care settings that are dem- onstrated to improve patient outcomes or patient ex- perience for pregnant and postpartum individuals from racial and ethnic minority groups and their families.

SEC.

5.

RESPECTFUL MATERNITY CARE COMPLIANCE PRO- GRAM.


(a) IN GENERAL.—The Secretary of Health and Human Services (referred to in this section as the ‘‘Sec- retary’’) shall award grants to accredited hospitals, health systems, and other maternity care settings to establish as an integral part of quality implementation initiatives with- in one or more hospitals or other birth settings a respect- ful maternity care compliance program.
•HR 3310 IH 15 (b) PROGRAM REQUIREMENTS.—A respectful mater- nity care compliance program funded through a grant under this section shall— (1) institutionalize mechanisms to allow pa- tients receiving maternity care services, the families of such patients, or perinatal health workers sup- porting such patients to report instances of racism or evidence of bias on the basis of race, ethnicity, or another protected class; (2) institutionalize response mechanisms through which representatives of the program can directly follow up with the patient, if possible, and the patient’s family in a timely manner; (3) prepare and make publicly available a hospital- or health system-wide strategy to reduce bias on the basis of race, ethnicity, or another pro- tected class in the delivery of maternity care that in- cludes— (A) information on the training programs to reduce and prevent bias, racism, and dis- crimination on the basis of race, ethnicity, or another protected class for all employees in ma- ternity care settings; (B) information on the number of cases re- ported to the compliance program; and •HR 3310 IH 16 (C) the development of methods to rou- tinely assess the extent to which bias, racism, or discrimination on the basis of race, ethnicity, or another protected class is present in the de- livery of maternity care to patients from racial and ethnic minority groups; (4) develop mechanisms to routinely collect and publicly report hospital-level data related to patient- reported experience of care; and (5) provide annual reports to the
 Secretary with information about each case reported to the compli- ance program over the course of the year containing such information as the Secretary may require, such as— (A) deidentified demographic information on the patient in the case, such as race, eth- nicity, gender identity, and primary language; (B) the content of the report from the pa- tient or the family of the patient to the compli- ance program; (C) the response from the compliance pro- gram; and (D) to the extent applicable, institutional changes made as a result of the case.
(c) SECRETARY REQUIREMENTS.— •HR 3310 IH 17 (1) PROCESSES.—Not later than 180 days after the date of enactment of this Act, the Secretary shall establish processes for— (A) disseminating best practices for estab- lishing and implementing a respectful maternity care compliance program within a hospital or other birth setting; (B) promoting coordination and collabora- tion between hospitals, health systems, and other maternity care delivery settings on the es- tablishment and implementation of respectful maternity care compliance programs; and (C) evaluating the effectiveness of respect- ful maternity care compliance programs on ma- ternal health outcomes and patient and family experiences, especially for patients from racial and ethnic minority groups and their families.
(2) STUDY.— (A) IN GENERAL.—Not later than 2 years after the date of enactment of this Act, the Sec- retary shall, through a contract with an inde- pendent research organization, conduct a study on strategies to address— •HR 3310 IH (i) racism or bias on the basis of race, ethnicity, or another protected class in the delivery of maternity care services; and (ii) successful implementation of re- spectful care initiatives.
(B) COMPONENTS OF STUDY.—The study shall include the following: (i) An assessment of the reports sub- mitted to the Secretary from the respectful maternity care compliance programs pur- suant to subsection (b)(5).

(ii) Based on such assessment, rec- ommendations for potential accountability mechanisms related to cases of racism or bias on the basis of race, ethnicity, or an- other protected class in the delivery of ma- ternity care services at hospitals and other birth settings.
Such recommendations shall take into consideration medical and non- medical factors that contribute to adverse patient experiences and maternal health outcomes.

(C) REPORT.—The Secretary shall submit to the Congress and make publicly available a •HR 3310 IH 19 report on the results of the study under this paragraph.
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2024 through 2029.

SEC.

6.

GAO REPORT.


(a) IN GENERAL.—Not later than 2 years after the date of enactment of this Act and annually thereafter, the Comptroller General of the United States shall submit to the Congress and make publicly available a report on the establishment of respectful maternity care compliance pro- grams within hospitals, health systems, and other mater- nity care settings.
(b) MATTERS INCLUDED.—The report under sub- section (a) shall include the following: (1) Information regarding the extent to which hospitals, health systems, and other maternity care settings have elected to establish respectful mater- nity care compliance programs, including— (A) which hospitals and other birth set- tings elect to establish compliance programs and when such programs are established; (B) to the extent practicable, impacts of the establishment of such programs on mater- •HR 3310 IH 20 nal health outcomes and patient and family ex- periences in the hospitals and other birth set- tings that have established such programs, es- pecially for patients from racial and ethnic mi- nority groups and their families; (C) information on geographic areas, and types of hospitals or other birth settings, where respectful maternity care compliance programs are not being established and information on factors contributing to decisions to not establish such programs; and (D) recommendations for establishing re- spectful maternity care compliance programs in geographic areas, and types of hospitals or other birth settings, where such programs are not being established.
(2) Whether the funding made available to carry out this section has been sufficient and, if ap- plicable, recommendations for additional appropria- tions to carry out this section.

(3) Such other information as the Comptroller General determines appropriate.

SEC.

7.

DEFINITIONS.
In this Act: •HR 3310 IH 21 (1) CULTURALLY AND LINGUISTICALLY CON- GRUENT.—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 ‘‘mater- nal mortality’’ means a death occurring during or within a 1-year period after pregnancy, caused by pregnancy-related or childbirth complications, in- cluding a suicide, overdose, or other death resulting from a mental health or substance use disorder at- tributed to or aggravated by pregnancy-related or childbirth complications.
(3) PERINATAL HEALTH WORKER.—The term ‘‘perinatal health worker’’ means a nonclinical health worker focused on maternal or perinatal health, such as a doula, community health worker, peer sup- porter, lactation educator or counselor, nutritionist or dietitian, childbirth educator, social worker, home visitor, patient navigator or coordinator, or language interpreter.
•HR 3310 IH 22 (4) POSTPARTUM.—The term ‘‘postpartum’’ re- fers to the 1-year period beginning on the last day of the pregnancy of an individual.
(5) PREGNANCY-ASSOCIATED DEATH.—The term ‘‘pregnancy-associated death’’ means a death of a pregnant or postpartum individual, by any cause, that occurs during, or within 1 year following, the individual’s pregnancy, regardless of the outcome, duration, or site of the pregnancy.
(6) PREGNANCY-RELATED DEATH.—The term ‘‘pregnancy-related death’’ means a death of a preg- nant or postpartum individual that occurs during, or within 1 year following, the individual’s pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an un- related condition by the physiologic effects of preg- nancy.
(7) 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)).
(8) SEVERE MATERNAL MORBIDITY.—The term ‘‘severe maternal morbidity’’ means a health condi- tion, including mental health conditions and sub- •HR 3310 IH 23 stance 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.
(9) SOCIAL DETERMINANTS OF MATERNAL HEALTH.—The term ‘‘social determinants of mater- nal health’’ means nonclinical factors that impact maternal health outcomes •HR 3310 IH