II 

116TH CONGRESS 

1ST SESSION S. 1600 

To support States in their work to end preventable morbidity and mortality 

in maternity care by using evidence-based quality improvement to protect 

the health of mothers during pregnancy, childbirth, and in the 

postpartum period and to reduce neonatal and infant mortality, to eliminate racial disparities in maternal health outcomes, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 22, 2019 

Ms. HARRIS (for herself, Ms. HIRONO, Mr. MERKLEY, Ms. BALDWIN, Mr. 

BLUMENTHAL, Mr. JONES, Mr. DURBIN, Mr. KAINE, Mr. BROWN, Mr. 

MARKEY, Ms. WARREN, Mr. BOOKER, Mr. CASEY, Mr. SANDERS, Mr. 

CARDIN, Ms. KLOBUCHAR, Mr. WYDEN, Ms. DUCKWORTH, Ms. STABENOW, and Mrs. GILLIBRAND) introduced the following bill; which was 

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

and Pensions 

A BILL 

To support States in their work to end preventable morbidity 

and mortality in maternity care by using evidence-based 

quality improvement to protect the health of mothers 

during pregnancy, childbirth, and in the postpartum period and to reduce neonatal and infant mortality, to 

eliminate racial disparities in maternal health outcomes, 

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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Maternal Care Access 

3 and Reducing Emergencies Act’’ or the ‘‘Maternal CARE 

4 Act’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) In the United States, maternal mortality 

8 rates are among the highest in the developed world 

9 and increased by 26.6 percent between 2000 and 

10 2014. 

11 (2) Of the 4,000,000 American women who give 

12 birth each year, about 700 suffer fatal complications 

13 during pregnancy, while giving birth, or during the 

14 postpartum period, and an additional 50,000 are se15 verely injured. 

16 (3) It is estimated that about 60 percent of the 

17 maternal mortalities in the United States could be 

18 prevented and half of the maternal injuries in the 

19 United States could be reduced or eliminated with 

20 better care. 

21 (4) Data from the Centers for Disease Control 

22 and Prevention show that Black women are 3 to 4 

23 times more likely to die from pregnancy-related 

24 causes than White women. There are 42.8 deaths 

25 per 100,000 live births for Black women, compared 

26 to 13 deaths per 100,000 live births for White 


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1 women and 17.2 deaths per 100,000 live births for 

2 women nationally. 

3 (5) Black women’s risk of maternal mortality 

4 has remained higher than White women’s risk for 

5 the past 6 decades. 

6 (6) Black women in the United States suffer 

7 from life-threatening pregnancy complications twice 

8 as often as their White counterparts. 

9 (7) High rates of maternal mortality among 

10 Black women span income and education levels, as 

11 well as socioeconomic status; moreover, risk factors 

12 such as a lack of access to prenatal care and phys13 ical health conditions do not fully explain the racial 

14 disparity in maternal mortality. 

15 (8) A growing body of evidence indicates that 

16 stress from racism and racial discrimination results 

17 in conditions—including hypertension and pre-ec18 lampsia—that contribute to poor maternal health 

19 outcomes among Black women. 

20 (9) Pervasive racial bias against Black women 

21 and unequal treatment of Black women exist in the 

22 health care system, often resulting in inadequate 

23 treatment for pain and dismissal of cultural norms 

24 with respect to health. A 2016 study by University 

25 of Virginia researchers found that White medical 


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1 students and residents often believed biological 

2 myths about racial differences in patients, including 

3 that Black patients have less-sensitive nerve endings 

4 and thicker skin than their White counterparts. Pro5 viders, however, are not consistently required to un6 dergo implicit bias, cultural competency, or empathy 

7 training. 

8 (10) North Carolina has established a statewide 

9 Pregnancy Medical Home (PMH) program, which 

10 aims to reduce adverse maternal health outcomes 

11 and maternal deaths by incentivizing maternal 

12 health care providers to provide integral health care 

13 services to pregnant women and new mothers. Ac14 cording to the North Carolina Department of Health 

15 and Human Services Center for Health Statistics, 

16 the pregnancy-related mortality rate for Black 

17 women was approximately 5.1 times higher than 

18 that of White women in 2004. Almost a decade 

19 later, in 2013, the pregnancy-related mortality rates 

20 for Black women and White women were 24.3 and 

21 24.2 deaths per 100,000 live births, respectively. 

22 The PMH program has been credited with the con23 vergence in pregnancy-related mortality rates be24 cause the program partners each high-risk pregnant 


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1 and postpartum woman that is covered under Med2 icaid with a pregnancy care manager. 

3 SEC. 3. DEFINITIONS. 

4 In this Act: 

5 (1) SECRETARY.—The term ‘‘Secretary’’ means 

6 the Secretary of Health and Human Services. 

7 (2) STATE.—The term ‘‘State’’ has the mean8 ing given that term in section 1101 of the Social Se9 curity Act (42 U.S.C. 1301) for purposes of title 

10 XIX of that Act (42 U.S.C. 1396 et seq.). 

11 SEC. 4. IMPLICIT BIAS TRAINING FOR HEALTH CARE PRO12 VIDERS. 

13 (a) GRANT PROGRAM.—The Secretary shall establish 

14 a grant program under which such Secretary awards 

15 grants to accredited schools of allopathic medicine, accred16 ited schools of osteopathic medicine, accredited nursing 

17 schools, other health professional training programs, and 

18 other entities for the purpose of supporting implicit bias 

19 training, with priority given to such training with respect 

20 to obstetrics and gynecology. 

21 (b) COLLABORATION REQUIRED.—In developing re22 quirements for implicit bias training carried out with 

23 grant funds awarded under this section, the Secretary 

24 shall collaborate with relevant stakeholders that specialize 

25 in addressing health equity, including— 


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1 (1) health care providers who serve pregnant 

2 women, including doctors, nurses, and midwives; 

3 (2) academic institutions, including schools and 

4 training programs described in subsection (a); 

5 (3) community-based health workers, including 

6 perinatal health workers, doulas, and home visitors; 

7 and 

8 (4) community-based organizations. 

9 (c) IMPLICIT BIAS TRAINING DEFINED.—In this sec10 tion, the term ‘‘implicit bias training’’ means evidence11 based, on-going professional development and support, 

12 with respect to— 

13 (1) bias in judgment or behavior that results 

14 from subtle cognitive processes, including implicit at15 titudes and implicit stereotypes, that often operate 

16 at a level below conscious awareness and without in17 tentional control; or 

18 (2) implicit attitudes and stereotypes that result 

19 in beliefs or simple associations that a person makes 

20 between an object and its evaluation that are auto21 matically activated by the mere presence (actual or 

22 symbolic) of the attitude object. 

23 (d) PRIORITIZATION.—In awarding grants under this 

24 section, the Secretary shall give priority to awarding 

25 grants to schools, programs, or entities located in or servVerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600

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1 ing areas with the greatest needs, based such factors as 

2 the Secretary may consider, including racial disparities in 

3 maternal mortality and the incidence of severe maternal 

4 morbidity rates. 

5 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated for purposes of carrying 

7 out the grant program under subsection (a), $5,000,000 

8 for each of fiscal years 2020 through 2024. 

9 SEC. 5. PREGNANCY MEDICAL HOME DEMONSTRATION 

10 PROJECT. 

11 (a) AUTHORITY TO AWARD GRANTS.—The Secretary 

12 shall award grants to States for the purpose of estab13 lishing or operating State pregnancy medical home pro14 grams that meet the requirements of subsection (b) to de15 liver integrated health care services to pregnant women 

16 and new mothers and reduce adverse maternal health out17 comes, maternal deaths, and racial health disparities in 

18 maternal mortality and morbidity. 

19 (b) STATE PREGNANCY MEDICAL HOME PROGRAM

20 REQUIREMENTS.—A State pregnancy medical home pro21 gram meets the requirements of this subsection if— 

22 (1) the State works with relevant stakeholders 

23 to develop and carry out the program, including— 

24 (A) State and local agencies responsible for 

25 Medicaid, public health, social services, mental 


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1 health, and substance abuse treatment and sup2 port; 

3 (B) health care providers who serve preg4 nant women, including doctors, nurses, and 

5 midwives; 

6 (C) community-based health workers, in7 cluding perinatal health workers, doulas, and 

8 home visitors; and 

9 (D) community-based organizations and 

10 individuals representing the communities 

11 with— 

12 (i) the highest overall rates of mater13 nal mortality and morbidity; and 

14 (ii) the greatest racial disparities in 

15 rates of maternal mortality and morbidity; 

16 (2) the State selects health care providers who 

17 serve pregnant women, including doctors, nurses, 

18 and midwives, to participate in the program as preg19 nancy medical homes, and requires that any provider 

20 that wishes to participate in the program as a preg21 nancy medical home— 

22 (A) commits to following evidence-based 

23 practices for maternity care, as developed by 

24 the State in consultation with relevant stake25 holders; and 


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1 (B) completes training to provide culturally 

2 and linguistically competent care; 

3 (3) under the program, each pregnancy medical 

4 home is required to conduct a standardized medical, 

5 obstetric, and psychosocial risk assessment for every 

6 patient of the medical home who is pregnant at the 

7 patient’s first prenatal appointment with the medical 

8 home; 

9 (4) under the program, a care manager— 

10 (A) is assigned to each pregnancy medical 

11 home; and 

12 (B) coordinates care (including coordi13 nating resources and referrals for health care 

14 and social services that are not available from 

15 the pregnancy medical home) for each patient 

16 of a pregnancy medical home who is eligible for 

17 services under the program; and 

18 (5) the program prioritizes pregnant and 

19 postpartum women who are uninsured or enrolled in 

20 the State Medicaid plan under title XIX of the So21 cial Security Act (42 U.S.C. 1396 et seq.), or a 

22 waiver of such plan. 

23 (c) GRANTS.— 

24 (1) LIMITATION.—The Secretary may award a 

25 grant under this section to up to 10 States. 


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1 (2) PERIOD.—Grants under this section shall 

2 be for a 5-year period. 

3 (3) PRIORITIZATION.—In awarding grants 

4 under this section, the Secretary shall give priority 

5 to the States with the greatest racial disparities in 

6 maternal mortality and severe morbidity rates. 

7 (d) REPORT ON GRANT IMPACT AND DISSEMINATION

8 OF BEST PRACTICES.—Not later than 1 year after all the 

9 grant periods awarded under this section have ended, the 

10 Secretary shall— 

11 (1) submit a report to Congress that de12 scribes— 

13 (A) the impact of the grants awarded 

14 under this section on maternal and child health; 

15 (B) best practices and models of care used 

16 by recipients of grants under this section; and 

17 (C) obstacles faced by recipients of grants 

18 under this section in delivering care, improving 

19 maternal and child health, and reducing racial 

20 disparities in rates of maternal and infant mor21 tality and morbidity; and 

22 (2) disseminate information on best practices 

23 and models of care used by recipients of grants 

24 under this section (including best practices and mod25 els of care relating to the reduction of racial dispariVerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600

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1 ties in rates of maternal and infant mortality and 

2 morbidity) to interested parties, including health 

3 providers, medical schools, relevant State and local 

4 agencies, and the general public. 

5 (e) AUTHORIZATION.—There are authorized to be ap6 propriated to carry out this section, $25,000,000 for each 

7 of fiscal years 2020 through 2024, to remain available 

8 until expended. 

9 SEC. 6. NATIONAL ACADEMY OF MEDICINE STUDY. 

10 (a) IN GENERAL.—The Secretary shall enter into an 

11 arrangement with the National Academy of Medicine 

12 under which the National Academy agrees to study and 

13 make recommendations for incorporating bias recognition 

14 in clinical skills testing for accredited schools of allopathic 

15 medicine and accredited schools of osteopathic medicine. 

16 (b) REPORT.—The arrangement under subsection (a) 

17 shall provide for submission by the National Academy of 

18 Medicine to the Secretary and Congress, not later than 

19 3 years after the date of enactment of this Act, of a report 

20 on the results of the study that includes such rec21 ommendations. 

Æ 


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