II 

117TH CONGRESS 

1ST SESSION S. 287 

To direct the Secretary of Health and Human Services to issue 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, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 8, 2021 

Ms. BALDWIN (for herself and Mr. MERKLEY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To direct the Secretary of Health and Human Services to 

issue 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, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. HHS AGENCY DIRECTIVES. 

4 (a) GUIDANCE TO STATES.— 


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1 (1) IN GENERAL.—Not later than 2 years after 

2 the date of enactment of this Act, the Secretary of 

3 Health and Human Services shall issue and dissemi4 nate guidance to States to educate providers, man5 aged care entities, and other insurers about the 

6 value and process of delivering respectful maternal 

7 health care through diverse and multidisciplinary 

8 care provider models. 

9 (2) CONTENTS.—The guidance required by 

10 paragraph (1) shall address how States can encour11 age and incentivize hospitals, health systems, mid12 wifery practices, freestanding birth centers, other 

13 maternity care provider groups, managed care enti14 ties, and other insurers— 

15 (A) to recruit and retain maternity care 

16 providers, mental and behavioral health care 

17 providers acting in accordance with State law, 

18 registered dietitians or nutrition professionals 

19 (as such term is defined in section 1861(vv)(2) 

20 of the Social Security Act (42 U.S.C. 

21 1395x(vv)(2))), and lactation consultants cer22 tified by the International Board of Lactation 

23 Consultants Examiners— 

24 (i) from racially, ethnically, and lin25 guistically diverse backgrounds; 


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1 (ii) with experience practicing in ra2 cially and ethnically diverse communities; 

3 and 

4 (iii) who have undergone training on 

5 implicit bias and racism; 

6 (B) to incorporate into maternity care 

7 teams— 

8 (i) midwives who meet at a minimum 

9 the international definition of the midwife 

10 and global standards for midwifery edu11 cation as established by the International 

12 Confederation of Midwives; and 

13 (ii) perinatal health workers; 

14 (C) to provide collaborative, culturally con15 gruent care; and 

16 (D) to provide opportunities for individuals 

17 enrolled in accredited midwifery education pro18 grams to participate in job shadowing with ma19 ternity care teams in hospitals, health systems, 

20 midwifery practices, and freestanding birth cen21 ters. 

22 (b) STUDY ON RESPECTFUL AND CULTURALLY CON23 GRUENT MATERNITY CARE.— 

24 (1) STUDY.—The Secretary of Health and 

25 Human Services acting through the Director of the 


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1 National Institutes of Health (in this subsection re2 ferred to as the ‘‘Secretary’’) shall conduct a study 

3 on best practices in respectful and culturally con4 gruent maternity care. 

5 (2) REPORT.—Not later than 2 years after the 

6 date of enactment of this Act, the Secretary shall— 

7 (A) complete the study required by para8 graph (1); 

9 (B) submit to the Congress and make pub10 licly available a report on the results of such 

11 study; and 

12 (C) include in such report— 

13 (i) a compendium of examples of hos14 pitals, health systems, midwifery practices, 

15 freestanding birth centers, other maternity 

16 care provider groups, managed care enti17 ties, and other insurers that are delivering 

18 respectful and culturally congruent mater19 nal health care; 

20 (ii) a compendium of examples of hos21 pitals, health systems, midwifery practices, 

22 freestanding birth centers, other maternity 

23 care provider groups, managed care enti24 ties, and other insurers that have made 

25 progress in reducing disparities in materVerDate Sep 11 2014 23:29 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S287.IS S287

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1 nal health outcomes and improving birth2 ing experiences for pregnant and 

3 postpartum individuals from racial and 

4 ethnic minority groups; and 

5 (iii) recommendations to hospitals, 

6 health systems, midwifery practices, free7 standing birth centers, other maternity 

8 care provider groups, managed care enti9 ties, and other insurers, for best practices 

10 in respectful and culturally congruent ma11 ternity care. 

12 SEC. 2. GRANTS TO GROW AND DIVERSIFY THE PERINATAL 

13 WORKFORCE. 

14 Title VII of the Public Health Service Act is amended 

15 by inserting after section 757 (42 U.S.C. 294f) the fol16 lowing new section: 

17 ‘‘SEC. 758. PERINATAL WORKFORCE GRANTS. 

18 ‘‘(a) IN GENERAL.—The Secretary shall award 

19 grants to entities to establish or expand programs de20 scribed in subsection (b) to grow and diversify the 

21 perinatal workforce. 

22 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

23 this section shall use the grants to grow and diversify the 

24 perinatal workforce by— 


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1 ‘‘(1) establishing schools or programs that pro2 vide education and training to individuals seeking 

3 appropriate licensing or certification as— 

4 ‘‘(A) physician assistants who will complete 

5 clinical training in the field of maternal and 

6 perinatal health; or 

7 ‘‘(B) perinatal health workers; and 

8 ‘‘(2) expanding the capacity of existing schools 

9 or programs described in paragraph (1), for the pur10 poses of increasing the number of students enrolled 

11 in such schools or programs, including by awarding 

12 scholarships for students. 

13 ‘‘(c) PRIORITIZATION.—In awarding grants under 

14 this section, the Secretary shall give priority to any entity 

15 that— 

16 ‘‘(1) has demonstrated a commitment to re17 cruiting and retaining students and faculty from ra18 cial and ethnic minority groups; 

19 ‘‘(2) has developed a strategy to recruit and re20 tain a diverse pool of students into the perinatal 

21 workforce program or school supported by funds re22 ceived through the grant, particularly from racial 

23 and ethnic minority groups and other underserved 

24 populations; 


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1 ‘‘(3) has developed a strategy to recruit and re2 tain students who plan to practice in a health pro3 fessional shortage area designated under section 

4 332; 

5 ‘‘(4) has developed a strategy to recruit and re6 tain students who plan to practice in an area with 

7 significant racial and ethnic disparities in maternal 

8 health outcomes, to the extent practicable; and 

9 ‘‘(5) includes in the standard curriculum for all 

10 students within the perinatal workforce program or 

11 school a bias, racism, or discrimination training pro12 gram that includes training on implicit bias and rac13 ism. 

14 ‘‘(d) REPORTING.—As a condition on receipt of a 

15 grant under this section for a perinatal workforce program 

16 or school, an entity shall agree to submit to the Secretary 

17 an annual report on the activities conducted through the 

18 grant, including— 

19 ‘‘(1) the number and demographics of students 

20 participating in the program or school; 

21 ‘‘(2) the extent to which students in the pro22 gram or school are entering careers in— 

23 ‘‘(A) health professional shortage areas 

24 designated under section 332; and 


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1 ‘‘(B) areas with significant racial and eth2 nic disparities in maternal health outcomes, to 

3 the extent such data are available; and 

4 ‘‘(3) whether the program or school has in5 cluded in the standard curriculum for all students a 

6 bias, racism, or discrimination training program that 

7 includes explicit and implicit bias, and if so the ef8 fectiveness of such training program. 

9 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

10 under this section shall be up to 5 years. 

11 ‘‘(f) APPLICATION.—To seek a grant under this sec12 tion, an entity shall submit to the Secretary an application 

13 at such time, in such manner, and containing such infor14 mation as the Secretary may require, including any infor15 mation necessary for prioritization under subsection (c). 

16 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

17 provide, directly or by contract, technical assistance to en18 tities seeking or receiving a grant under this section on 

19 the development, use, evaluation, and post-grant period 

20 sustainability of the perinatal workforce programs or 

21 schools proposed to be, or being, established or expanded 

22 through the grant. 

23 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

24 4 years after the date of enactment of this section, the 

25 Secretary shall prepare and submit to the Congress, and 


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1 post on the internet website of the Department of Health 

2 and Human Services, a report on the effectiveness of the 

3 grant program under this section at— 

4 ‘‘(1) recruiting students from racial and ethnic 

5 minority groups; 

6 ‘‘(2) increasing the number of physician assist7 ants who will complete clinical training in the field 

8 of maternal and perinatal health, and perinatal 

9 health workers, from racial and ethnic minority 

10 groups and other underserved populations; 

11 ‘‘(3) increasing the number of physician assist12 ants who will complete clinical training in the field 

13 of maternal and perinatal health, and perinatal 

14 health workers, working in health professional short15 age areas designated under section 332; and 

16 ‘‘(4) increasing the number of physician assist17 ants who will complete clinical training in the field 

18 of maternal and perinatal health, and perinatal 

19 health workers, working in areas with significant ra20 cial and ethnic disparities in maternal health out21 comes, to the extent such data are available. 

22 ‘‘(i) DEFINITION.—In this section, the term ‘racial 

23 and ethnic minority group’ has the meaning given such 

24 term in section 1707(g). 


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1 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there is authorized to be appro3 priated $15,000,000 for each of fiscal years 2022 through 

4 2026.’’. 

5 SEC. 3. GRANTS TO GROW AND DIVERSIFY THE NURSING 

6 WORKFORCE IN MATERNAL AND PERINATAL 

7 HEALTH. 

8 Title VIII of the Public Health Service Act is amend9 ed by inserting after section 811 of that Act (42 U.S.C. 

10 296j) the following: 

11 ‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 

12 ‘‘(a) IN GENERAL.—The Secretary shall award 

13 grants to schools of nursing to grow and diversify the 

14 perinatal nursing workforce. 

15 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

16 this section shall use the grants to grow and diversify the 

17 perinatal nursing workforce by providing scholarships to 

18 students seeking to become— 

19 ‘‘(1) nurse practitioners whose education in20 cludes a focus on maternal and perinatal health; or 

21 ‘‘(2) clinical nurse specialists whose education 

22 includes a focus on maternal and perinatal health. 

23 ‘‘(c) PRIORITIZATION.—In awarding grants under 

24 this section, the Secretary shall give priority to any school 

25 of nursing that— 


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1 ‘‘(1) has developed a strategy to recruit and re2 tain a diverse pool of students seeking to enter ca3 reers focused on maternal and perinatal health, par4 ticularly students from racial and ethnic minority 

5 groups and other underserved populations; 

6 ‘‘(2) has developed a partnership with a prac7 tice setting in a health professional shortage area 

8 designated under section 332 for the clinical place9 ments of the school’s students; 

10 ‘‘(3) has developed a strategy to recruit and re11 tain students who plan to practice in an area with 

12 significant racial and ethnic disparities in maternal 

13 health outcomes, to the extent practicable; and 

14 ‘‘(4) includes in the standard curriculum for all 

15 students seeking to enter careers focused on mater16 nal and perinatal health a bias, racism, or discrimi17 nation training program that includes education on 

18 implicit bias and racism. 

19 ‘‘(d) REPORTING.—As a condition on receipt of a 

20 grant under this section, a school of nursing shall agree 

21 to submit to the Secretary an annual report on the activi22 ties conducted through the grant, including, to the extent 

23 practicable— 


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1 ‘‘(1) the number and demographics of students 

2 in the school of nursing seeking to enter careers fo3 cused on maternal and perinatal health; 

4 ‘‘(2) the extent to which such students are pre5 paring to enter careers in— 

6 ‘‘(A) health professional shortage areas 

7 designated under section 332; and 

8 ‘‘(B) areas with significant racial and eth9 nic disparities in maternal health outcomes, to 

10 the extent such data are available; and 

11 ‘‘(3) whether the standard curriculum for all 

12 students seeking to enter careers focused on mater13 nal and perinatal health includes a bias, racism, or 

14 discrimination training program that includes edu15 cation on implicit bias and racism. 

16 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

17 under this section shall be up to 5 years. 

18 ‘‘(f) APPLICATION.—To seek a grant under this sec19 tion, an entity shall submit to the Secretary an applica20 tion, at such time, in such manner, and containing such 

21 information as the Secretary may require, including any 

22 information necessary for prioritization under subsection 

23 (c). 

24 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

25 provide, directly or by contract, technical assistance to 


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1 schools of nursing seeking or receiving a grant under this 

2 section on the processes of awarding and evaluating schol3 arships through the grant. 

4 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

5 4 years after the date of enactment of this section, the 

6 Secretary shall prepare and submit to the Congress, and 

7 post on the internet website of the Department of Health 

8 and Human Services, a report on the effectiveness of the 

9 grant program under this section at— 

10 ‘‘(1) recruiting students from racial and ethnic 

11 minority groups and other underserved populations; 

12 ‘‘(2) increasing the number of nurse practi13 tioners and clinical nurse specialists entering careers 

14 focused on maternal and perinatal health from racial 

15 and ethnic minority groups and other underserved 

16 populations; 

17 ‘‘(3) increasing the number of nurse practi18 tioners and clinical nurse specialists entering careers 

19 focused on maternal and perinatal health working in 

20 health professional shortage areas designated under 

21 section 332; and 

22 ‘‘(4) increasing the number of nurse practi23 tioners and clinical nurse specialists entering careers 

24 focused on maternal and perinatal health working in 

25 areas with significant racial and ethnic disparities in 


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1 maternal health outcomes, to the extent such data 

2 are available. 

3 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there is authorized to be appro5 priated $15,000,000 for each of fiscal years 2022 through 

6 2026.’’. 

7 SEC. 4. GAO REPORT. 

8 (a) IN GENERAL.—Not later than two years after the 

9 date of enactment of this Act and every five years there10 after, the Comptroller General of the United States shall 

11 submit to Congress a report on barriers to maternal health 

12 education and access to care in the United States. Such 

13 report shall include the information and recommendations 

14 described in subsection (b). 

15 (b) CONTENT OF REPORT.—The report under sub16 section (a) shall include— 

17 (1) an assessment of current barriers to enter18 ing accredited midwifery education programs, and 

19 recommendations for addressing such barriers, par20 ticularly for low-income women and women from ra21 cial and ethnic minority groups; 

22 (2) an assessment of current barriers to enter23 ing and successfully completing accredited education 

24 programs for other health professional careers re25 lated to maternity care, including maternity care 


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1 providers, mental and behavioral health care pro2 viders acting in accordance with State law, reg3 istered dietitians or nutrition professionals (as such 

4 term is defined in section 1861(vv)(2) of the Social 

5 Security Act (42 U.S.C. 1395x(vv)(2))), and lacta6 tion consultants certified by the International Board 

7 of Lactation Consultants Examiners, particularly for 

8 low-income women and women from racial and eth9 nic minority groups; 

10 (3) an assessment of current barriers that pre11 vent midwives from meeting the international defini12 tion of the midwife and global standards for mid13 wifery education as established by the International 

14 Confederation of Midwives, and recommendations 

15 for addressing such barriers, particularly for low-in16 come women and women from racial and ethnic mi17 nority groups; 

18 (4) an assessment of disparities in access to 

19 maternity care providers, mental or behavioral 

20 health care providers acting in accordance with 

21 State law, registered dietitians or nutrition profes22 sionals (as such term is defined in section 

23 1861(vv)(2) of the Social Security Act (42 U.S.C. 

24 1395x(vv)(2))), lactation consultants certified by the 

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1 iners, and perinatal health workers, stratified by 

2 race, ethnicity, gender identity, geographic location, 

3 and insurance type and recommendations to promote 

4 greater access equity; and 

5 (5) recommendations to promote greater equity 

6 in compensation for perinatal health workers under 

7 public and private insurers, particularly for such in8 dividuals from racially and ethnically diverse back9 grounds. 

10 SEC. 5. DEFINITIONS. 

11 In this Act: 

12 (1) CULTURALLY CONGRUENT.—The term ‘‘cul13 turally congruent’’, with respect to care or maternity 

14 care, means care that is in agreement with the pre15 ferred cultural values, beliefs, worldview, language, 

16 and practices of the health care consumer and other 

17 stakeholders. 

18 (2) MATERNITY CARE PROVIDER.—The term 

19 ‘‘maternity care provider’’ means a health care pro20 vider who— 

21 (A) is a physician, physician assistant, 

22 midwife who meets at a minimum the inter23 national definition of the midwife and global 

24 standards for midwifery education as estab25 lished by the International Confederation of 


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1 Midwives, nurse practitioner, or clinical nurse 

2 specialist; and 

3 (B) has a focus on maternal or perinatal 

4 health. 

5 (3) PERINATAL HEALTH WORKER.—The term 

6 ‘‘perinatal health worker’’ means a doula, commu7 nity health worker, peer supporter, breastfeeding 

8 and lactation educator or counselor, nutritionist or 

9 dietitian, childbirth educator, social worker, home 

10 visitor, language interpreter, or navigator. 

11 (4) POSTPARTUM AND POSTPARTUM PERIOD.— 

12 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

13 refer to the 1-year period beginning on the last day 

14 of the pregnancy of an individual. 

15 (5) RACIAL AND ETHNIC MINORITY GROUP.— 

16 The term ‘‘racial and ethnic minority group’’ has the 

17 meaning given such term in section 1707(g)(1) of 

18 the Public Health Service Act (42 U.S.C. 300u– 

19 6(g)(1)). 

Æ 


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