II 

117TH CONGRESS 

1ST SESSION S. 346 

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 SENATE OF THE UNITED STATES 

FEBRUARY 22, 2021 

Mr. BOOKER (for himself, Ms. DUCKWORTH, Mrs. GILLIBRAND, Mr. DURBIN, 

Mr. KAINE, Mr. CASEY, Mr. PETERS, Ms. BALDWIN, Mr. MERKLEY, Mr. 

VAN HOLLEN, Ms. STABENOW, Mr. BENNET, Ms. WARREN, Mr. MENENDEZ, Mr. MARKEY, Mr. BLUMENTHAL, Ms. SMITH, Mr. BROWN, Mr. 

WHITEHOUSE, Ms. KLOBUCHAR, and Mr. WARNOCK) introduced the following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A 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. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Black Maternal Health 

5 Momnibus Act of 2021’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents for this Act is as follows: 


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Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Definitions. 

Sec. 4. Sense of Congress. 

TITLE I—SOCIAL DETERMINANTS FOR MOMS 

Sec. 101. Task force to develop a strategy to address social determinants of 

maternal health. 

Sec. 102. Housing for Moms grant program. 

Sec. 103. Department of Transportation. 

Sec. 104. Department of Agriculture. 

Sec. 105. Environmental study through National Academies. 

Sec. 106. Child care access. 

Sec. 107. Grants to local entities addressing social determinants of maternal 

health. 

TITLE II—HONORING KIRA JOHNSON 

Sec. 201. Investments in community-based organizations to improve Black maternal health outcomes. 

Sec. 202. Investments in community-based organizations to improve maternal 

health outcomes in underserved communities. 

Sec. 203. Respectful maternity care training for all employees in maternity care 

settings. 

Sec. 204. Study on reducing and preventing bias, racism, and discrimination in 

maternity care settings. 

Sec. 205. Respectful maternity care compliance program. 

Sec. 206. GAO report. 

TITLE III—PROTECTING MOMS WHO SERVED 

Sec. 301. Codification of maternity coordination program of Department of 

Veterans Affairs. 

Sec. 302. Report on maternal mortality and severe maternal morbidity among 

pregnant and postpartum veterans. 

TITLE IV—PERINATAL WORKFORCE 

Sec. 401. HHS agency directives. 

Sec. 402. Grants to grow and diversify the perinatal workforce. 

Sec. 403. Grants to grow and diversify the nursing workforce in maternal and 

perinatal health. 

Sec. 404. GAO report. 

TITLE V—DATA TO SAVE MOMS 

Sec. 501. Funding for maternal mortality review committees to promote representative community engagement. 

Sec. 502. Data collection and review. 

Sec. 503. Review of maternal health data collection processes and quality measures. 

Sec. 504. Indian Health Service study and report on maternal mortality and severe maternal morbidity. 

Sec. 505. Grants to minority-serving institutions to study maternal mortality, 

severe maternal morbidity, and other adverse maternal health 

outcomes. 


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TITLE VI—MOMS MATTER 

Sec. 601. Maternal mental health equity grant program. 

Sec. 602. Grants to grow and diversify the maternal mental and behavioral 

health care workforce. 

TITLE VII—JUSTICE FOR INCARCERATED MOMS 

Sec. 701. Ending the shackling of pregnant individuals. 

Sec. 702. Creating model programs for the care of incarcerated individuals in 

the prenatal and postpartum periods. 

Sec. 703. Grant program to improve maternal health outcomes for individuals 

in State and local prisons and jails. 

Sec. 704. GAO report. 

Sec. 705. MACPAC report. 

TITLE VIII—TECH TO SAVE MOMS 

Sec. 801. Integrated telehealth models in maternity care services. 

Sec. 802. Grants to expand the use of technology-enabled collaborative learning 

and capacity models for pregnant and postpartum individuals. 

Sec. 803. Grants to promote equity in maternal health outcomes through digital 

tools. 

Sec. 804. Report on the use of technology in maternity care. 

TITLE IX—IMPACT TO SAVE MOMS 

Sec. 901. Perinatal Care Alternative Payment Model Demonstration Project. 

Sec. 902. MACPAC report. 

TITLE X—MATERNAL HEALTH PANDEMIC RESPONSE 

Sec. 1001. Definitions. 

Sec. 1002. Funding for data collection, surveillance, and research on maternal 

health outcomes during the COVID–19 public health emergency. 

Sec. 1003. COVID–19 maternal health data collection and disclosure. 

Sec. 1004. Inclusion of pregnant individuals and lactating individuals in vaccine 

and therapeutic development for COVID–19. 

Sec. 1005. Public health communication regarding maternal care during 

COVID–19. 

Sec. 1006. Task force on birthing experience and safe maternity care during a 

public health emergency. 

Sec. 1007. GAO report on maternal health and public health emergency preparedness. 

TITLE XI—PROTECTING MOMS AND BABIES AGAINST CLIMATE 

CHANGE 

Sec. 1101. Definitions. 

Sec. 1102. Grant program to protect vulnerable mothers and babies from climate change risks. 

Sec. 1103. Grant program for education and training at health profession 

schools. 

Sec. 1104. NIH Consortium on Birth and Climate Change Research. 

Sec. 1105. Strategy for identifying climate change risk zones for vulnerable 

mothers and babies. 


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TITLE XII—MATERNAL VACCINATIONS 

Sec. 1201. Maternal vaccination awareness and equity campaign. 

1 SEC. 3. DEFINITIONS. 

2 In this Act: 

3 (1) CULTURALLY CONGRUENT.—The term ‘‘cul4 turally congruent’’, with respect to care or maternity 

5 care, means care that is in agreement with the pre6 ferred cultural values, beliefs, worldview, language, 

7 and practices of the health care consumer and other 

8 stakeholders. 

9 (2) MATERNITY CARE PROVIDER.—The term 

10 ‘‘maternity care provider’’ means a health care pro11 vider who— 

12 (A) is a physician, physician assistant, 

13 midwife who meets at a minimum the inter14 national definition of the midwife and global 

15 standards for midwifery education as estab16 lished by the International Confederation of 

17 Midwives, nurse practitioner, or clinical nurse 

18 specialist; and 

19 (B) has a focus on maternal or perinatal 

20 health. 

21 (3) MATERNAL MORTALITY.—The term ‘‘mater22 nal mortality’’ means a death occurring during or 

23 within a one-year period after pregnancy, caused by 

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1 cluding a suicide, overdose, or other death resulting 

2 from a mental health or substance use disorder at3 tributed to or aggravated by pregnancy-related or 

4 childbirth complications. 

5 (4) 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 (5) 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 (6) PREGNANCY-ASSOCIATED DEATH.—The 

16 term ‘‘pregnancy-associated death’’ means a death of 

17 a pregnant or postpartum individual, by any cause, 

18 that occurs during, or within 1 year following, the 

19 individual’s pregnancy, regardless of the outcome, 

20 duration, or site of the pregnancy. 

21 (7) PREGNANCY-RELATED DEATH.—The term 

22 ‘‘pregnancy-related death’’ means a death of a preg23 nant or postpartum individual that occurs during, or 

24 within 1 year following, the individual’s pregnancy, 

25 from a pregnancy complication, a chain of events 


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1 initiated by pregnancy, or the aggravation of an un2 related condition by the physiologic effects of preg3 nancy. 

4 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

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

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

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

8 6(g)(1)). 

9 (9) SEVERE MATERNAL MORBIDITY.—The term 

10 ‘‘severe maternal morbidity’’ means a health condi11 tion, including mental health conditions and sub12 stance use disorders, attributed to or aggravated by 

13 pregnancy or childbirth that results in significant 

14 short-term or long-term consequences to the health 

15 of the individual who was pregnant. 

16 (10) SOCIAL DETERMINANTS OF MATERNAL

17 HEALTH.—The term ‘‘social determinants of mater18 nal health’’ means non-clinical factors that impact 

19 maternal health outcomes, including— 

20 (A) economic factors, which may include 

21 poverty, employment, food security, support for 

22 and access to lactation and other infant feeding 

23 options, housing stability, and related factors; 

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1 tation, access to child care, availability of 

2 healthy foods and nutrition counseling, avail3 ability of clean water, air and water quality, 

4 ambient temperatures, neighborhood crime and 

5 violence, access to broadband, and related fac6 tors; 

7 (C) social and community factors, which 

8 may include systemic racism, gender discrimi9 nation or discrimination based on other pro10 tected classes, workplace conditions, incarcer11 ation, and related factors; 

12 (D) household factors, which may include 

13 ability to conduct lead testing and abatement, 

14 car seat installation, indoor air temperatures, 

15 and related factors; 

16 (E) education access and quality factors, 

17 which may include educational attainment, lan18 guage and literacy, and related factors; and 

19 (F) health care access factors, including 

20 health insurance coverage, access to culturally 

21 congruent health care services, providers, and 

22 non-clinical support, access to home visiting 

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1 health and items required to receive telehealth 

2 services, and related factors. 

3 SEC. 4. SENSE OF CONGRESS. 

4 It is the sense of Congress that— 

5 (1) the respect and proper care that birthing 

6 people deserve is inclusive; and 

7 (2) regardless of race, ethnicity, gender iden8 tity, sexual orientation, religion, marital status, fa9 milial status, socioeconomic status, immigration sta10 tus, incarceration status, or disability, all deserve 

11 dignity. 

12 TITLE I—SOCIAL 

13 DETERMINANTS FOR MOMS 

14 SEC. 101. TASK FORCE TO DEVELOP A STRATEGY TO AD15 DRESS SOCIAL DETERMINANTS OF MATER16 NAL HEALTH. 

17 (a) IN GENERAL.—The Secretary of Health and 

18 Human Services shall convene a task force (in this section 

19 referred to as the ‘‘Task Force’’) to develop a strategy 

20 to coordinate efforts between Federal agencies to address 

21 social determinants of maternal health with respect to 

22 pregnant and postpartum individuals. 

23 (b) EX OFFICIO MEMBERS.—The ex officio members 

24 of the Task Force shall consist of the following: 


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1 (1) The Secretary of Health and Human Serv2 ices (or a designee thereof). 

3 (2) The Secretary of Housing and Urban Devel4 opment (or a designee thereof). 

5 (3) The Secretary of Transportation (or a des6 ignee thereof). 

7 (4) The Secretary of Agriculture (or a designee 

8 thereof). 

9 (5) The Secretary of Labor (or a designee 

10 thereof). 

11 (6) The Secretary of Defense (or a designee 

12 thereof). 

13 (7) The Secretary of Veterans Affairs (or a des14 ignee thereof). 

15 (8) The Administrator of the Environmental 

16 Protection Agency (or a designee thereof). 

17 (9) The Assistant Secretary for the Administra18 tion for Children and Families (or a designee there19 of). 

20 (10) The Administrator of the Centers for 

21 Medicare & Medicaid Services (or a designee there22 of). 

23 (11) The Director of the Indian Health Service 

24 (or a designee thereof). 


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1 (12) The Director of the National Institutes of 

2 Health (or a designee thereof). 

3 (13) The Administrator of the Health Re4 sources and Services Administration (or a designee 

5 thereof). 

6 (14) The Deputy Assistant Secretary for Minor7 ity Health of the Department of Health and Human 

8 Services (or a designee thereof). 

9 (15) The Deputy Assistant Secretary for Wom10 en’s Health of the Department of Health and 

11 Human Services (or a designee thereof). 

12 (16) The Director of the Centers for Disease 

13 Control and Prevention (or a designee thereof). 

14 (17) The Director of the Office on Violence 

15 Against Women at the Department of Justice (or a 

16 designee thereof). 

17 (c) APPOINTED MEMBERS.—In addition to the ex 

18 officio members of the Task Force, the Secretary of 

19 Health and Human Services shall appoint the following 

20 members of the Task Force: 

21 (1) At least 2 representatives of patients, to in22 clude— 

23 (A) a representative of patients who have 

24 suffered from severe maternal morbidity; or 


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1 (B) a representative of patients who is a 

2 family member of an individual who suffered a 

3 pregnancy-related death. 

4 (2) At least 2 leaders of community-based orga5 nizations that address maternal mortality and severe 

6 maternal morbidity with a specific focus on racial 

7 and ethnic disparities. In appointing such leaders 

8 under this paragraph, the Secretary of Health and 

9 Human Services shall give priority to individuals 

10 who are leaders of organizations led by individuals 

11 from racial and ethnic minority groups. 

12 (3) At least 2 perinatal health workers. 

13 (4) A professionally diverse panel of maternity 

14 care providers. 

15 (d) CHAIR.—The Secretary of Health and Human 

16 Services shall select the chair of the Task Force from 

17 among the members of the Task Force. 

18 (e) REPORT.—Not later than 2 years after the date 

19 of enactment of this Act, the Task Force shall submit to 

20 Congress a report on— 

21 (1) the strategy developed under subsection (a); 

22 (2) recommendations on funding amounts with 

23 respect to implementing such strategy; 

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1 minants of maternal health under Medicaid managed 

2 care organizations and State Medicaid programs. 

3 (f) TERMINATION.—Section 14 of the Federal Advi4 sory Committee Act (5 U.S.C. App.) shall not apply to 

5 the Task Force with respect to termination. 

6 SEC. 102. HOUSING FOR MOMS GRANT PROGRAM. 

7 (a) IN GENERAL.—The Secretary of Housing and 

8 Urban Development shall establish a Housing for Moms 

9 grant program under this section to make grants to eligi10 ble entities to increase access to safe, stable, affordable, 

11 and adequate housing for pregnant and postpartum indi12 viduals and their families. 

13 (b) APPLICATION.—To be eligible to receive a grant 

14 under this section, an eligible entity shall submit to the 

15 Secretary an application at such time, in such manner, 

16 and containing such information as the Secretary may 

17 provide. 

18 (c) PRIORITY.—In awarding grants under this sec19 tion, the Secretary shall give priority to an eligible entity 

20 that— 

21 (1) is a community-based organization or will 

22 partner with a community-based organization to im23 plement initiatives to increase access to safe, stable, 

24 affordable, and adequate housing for pregnant and 

25 postpartum individuals and their families; 


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1 (2) is operating in an area with high rates of 

2 adverse maternal health outcomes or significant ra3 cial or ethnic disparities in maternal health out4 comes, to the extent such data are available; and 

5 (3) is operating in an area with a high poverty 

6 rate or significant number of individuals who lack 

7 consistent access to safe, stable, affordable, and ade8 quate housing. 

9 (d) USE OF FUNDS.—An eligible entity that receives 

10 a grant under this section shall use funds under the grant 

11 for the purposes of— 

12 (1) identifying and conducting outreach to 

13 pregnant and postpartum individuals who are low-in14 come and lack consistent access to safe, stable, af15 fordable, and adequate housing; 

16 (2) providing safe, stable, affordable, and ade17 quate housing options to such individuals; 

18 (3) connecting such individuals with local orga19 nizations offering safe, stable, affordable, and ade20 quate housing options; 

21 (4) providing application assistance to such in22 dividuals seeking to enroll in programs offering safe, 

23 stable, affordable, and adequate housing options; 

24 (5) providing direct financial assistance to such 

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1 ble, and adequate housing for the duration of the in2 dividual’s pregnancy and postpartum periods; and 

3 (6) working with relevant stakeholders to en4 sure that local housing and homeless shelter infra5 structure is supportive to pregnant and postpartum 

6 individuals, including through— 

7 (A) health-promoting housing codes; 

8 (B) enforcement of housing codes; 

9 (C) proactive rental inspection programs; 

10 (D) code enforcement officer training; and 

11 (E) partnerships between regional offices 

12 of the Department of Housing and Urban De13 velopment and community-based organizations 

14 to ensure housing laws are understood and vio15 lations are discovered. 

16 (e) REPORTING.— 

17 (1) ELIGIBLE ENTITIES.—The Secretary shall 

18 require each eligible entity receiving a grant under 

19 this section to annually submit to the Secretary and 

20 make publicly available a report on the status of ac21 tivities conducted using the grant. 

22 (2) SECRETARY.—Not later than the end of 

23 each fiscal year in which grants are made under this 

24 section, the Secretary shall submit to Congress and 

25 make publicly available a report that— 


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1 (A) summarizes the reports received under 

2 paragraph (1); 

3 (B) evaluates the effectiveness of grants 

4 awarded under this section in increasing access 

5 to safe, stable, affordable, and adequate hous6 ing for pregnant and postpartum individuals 

7 and their families; and 

8 (C) makes recommendations with respect 

9 to ensuring activities described subsection (d) 

10 continue after grant amounts made available 

11 under this section are expended. 

12 (f) DEFINITIONS.—In this section: 

13 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti14 ty’’ means— 

15 (A) a community-based organization; 

16 (B) a State or local governmental entity, 

17 including a State or local public health depart18 ment; 

19 (C) an Indian tribe or tribal organization 

20 (as such terms are defined in section 4 of the 

21 Indian Self-Determination and Education As22 sistance Act (25 U.S.C. 5304)); or 

23 (D) an Urban Indian organization (as such 

24 term is defined in section 4 of the Indian 


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1 Health Care Improvement Act (25 U.S.C. 

2 1603)). 

3 (2) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Housing and Urban Development. 

5 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated to carry out this section 

7 $10,000,000 for fiscal year 2022, which shall remain 

8 available until expended. 

9 SEC. 103. DEPARTMENT OF TRANSPORTATION. 

10 (a) REPORT.—Not later than 1 year after the date 

11 of enactment of this Act, the Secretary of Transportation 

12 shall submit to Congress and make publicly available a 

13 report that contains— 

14 (1) an assessment of transportation barriers 

15 preventing individuals from attending prenatal and 

16 postpartum appointments, accessing maternal health 

17 care services, or accessing services and resources re18 lated to social determinants of maternal health; 

19 (2) recommendations on how to overcome the 

20 barriers described in paragraph (1); 

21 (3) an assessment of transportation safety risks 

22 for pregnant individuals and recommendations on 

23 how to mitigate those risks; and 

24 (4) an assessment of the impact of disabilities, 

25 including service-related disabilities, on pregnant 


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1 and postpartum women’s mobility and access to ap2 propriate care. 

3 (b) CONSIDERATIONS.—In carrying out subsection 

4 (a), the Secretary of Transportation shall give special con5 sideration to solutions for— 

6 (1) pregnant and postpartum individuals living 

7 in a health professional shortage area designated 

8 under section 332 of the Public Health Service Act 

9 (42 U.S.C. 254e); 

10 (2) pregnant and postpartum individuals living 

11 in areas with high maternal mortality or severe mor12 bidity rates or significant racial or ethnic disparities 

13 in maternal health outcomes; and 

14 (3) pregnant and postpartum individuals with a 

15 disability that impacts mobility. 

16 SEC. 104. DEPARTMENT OF AGRICULTURE. 

17 (a) SPECIAL SUPPLEMENTAL NUTRITION PROGRAM

18 FOR WOMEN, INFANTS, AND CHILDREN.— 

19 (1) BREASTFEEDING WOMEN.— 

20 (A) DEFINITION OF BREASTFEEDING

21 WOMAN.—Section 17(b) of the Child Nutrition 

22 Act of 1966 (42 U.S.C. 1786(b)) is amended by 

23 striking paragraph (1) and inserting the fol24 lowing: 


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1 ‘‘(1) BREASTFEEDING WOMAN.—The term 

2 ‘breastfeeding woman’ means— 

3 ‘‘(A) a woman who is not more than 1 year 

4 postpartum and is breastfeeding the infant of 

5 the woman; and 

6 ‘‘(B) for purposes of subsection (d), a 

7 woman who is not more than 2 years 

8 postpartum and is breastfeeding the infant of 

9 the woman.’’. 

10 (B) EXTENSION OF BREASTFEEDING PE11 RIOD.—Section 17(d)(3)(A)(ii) of the Child Nu12 trition Act of 1966 (42 U.S.C. 

13 1786(d)(3)(A)(ii)) is amended by striking ‘‘1 

14 year’’ and inserting ‘‘2 years’’. 

15 (2) POSTPARTUM WOMEN.— 

16 (A) DEFINITION OF POSTPARTUM

17 WOMEN.—Section 17(b)(10) of the Child Nutri18 tion Act of 1966 (42 U.S.C. 1786(b)(10)) is 

19 amended by striking ‘‘six months’’ and insert20 ing ‘‘2 years’’. 

21 (B) CERTIFICATION.—Section 17(d)(3)(A) 

22 of the Child Nutrition Act of 1966 (42 U.S.C. 

23 1786(d)(3)(A)) is amended by adding at the 

24 end the following: 


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1 ‘‘(iv) POSTPARTUM WOMEN.—A State 

2 may elect to certify a postpartum woman 

3 for a period of up to 2 years after the ter4 mination of pregnancy of the postpartum 

5 woman.’’. 

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

7 date of enactment of this section, the Secretary of 

8 Agriculture shall submit to Congress a report that 

9 includes an evaluation of the effect of each of the 

10 amendments made by this subsection on— 

11 (A) maternal and infant health outcomes, 

12 including racial and ethnic disparities with re13 spect to those outcomes; 

14 (B) breastfeeding rates among postpartum 

15 individuals; 

16 (C) qualitative evaluations of family experi17 ences under the special supplemental nutrition 

18 program for women, infants, and children es19 tablished under section 17 of the Child Nutri20 tion Act of 1966 (42 U.S.C. 1786); and 

21 (D) other relevant information as deter22 mined by the Secretary of Agriculture. 

23 (b) GRANT PROGRAM FOR HEALTHY FOOD AND

24 CLEAN WATER FOR PREGNANT AND POSTPARTUM INDI25 VIDUALS.— 


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1 (1) DEFINITIONS.—In this subsection: 

2 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 

3 entity’’ means— 

4 (i) a community-based organization; 

5 (ii) a State or local governmental enti6 ty, including a State or local public health 

7 department; 

8 (iii) an Indian tribe or tribal organiza9 tion (as those terms are defined in section 

10 4 of the Indian Self-Determination and 

11 Education Assistance Act (25 U.S.C. 

12 5304)); and 

13 (iv) an urban Indian organization (as 

14 defined in section 4 of the Indian Health 

15 Care Improvement Act (25 U.S.C. 1603)). 

16 (B) SECRETARY.—The term ‘‘Secretary’’ 

17 means the Secretary of Agriculture. 

18 (2) ESTABLISHMENT.—The Secretary shall es19 tablish a program to award grants, on a competitive 

20 basis, to eligible entities to carry out the activities 

21 described in paragraph (5). 

22 (3) APPLICATION.—To be eligible for a grant 

23 under this subsection, an eligible entity shall submit 

24 to the Secretary an application at such time, in such 


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1 manner, and containing such information as the Sec2 retary determines appropriate. 

3 (4) PRIORITY.—In awarding grants under this 

4 subsection, the Secretary shall give priority to an eli5 gible entity that— 

6 (A) is, or will partner with, a community7 based organization; and 

8 (B) is operating in an area with high rates 

9 of— 

10 (i) adverse maternal health outcomes; 

11 or 

12 (ii) significant racial or ethnic dispari13 ties in maternal health outcomes. 

14 (5) USE OF FUNDS.—An eligible entity shall 

15 use grant funds awarded under this subsection to 

16 deliver healthy food, infant formula, clean water, or 

17 diapers to pregnant women (as defined in section 

18 17(b) of the Child Nutrition Act of 1966 (42 U.S.C. 

19 1786(b))) and postpartum individuals located in 

20 areas that are food deserts, as determined by the 

21 Secretary using data from the Food Access Research 

22 Atlas of the Department of Agriculture. 

23 (6) REPORTS.— 

24 (A) ELIGIBLE ENTITY.—Each eligible enti25 ty that receives a grant under this subsection 


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1 shall, not later than 1 year after receiving the 

2 grant, and annually thereafter, submit to the 

3 Secretary a report on the status of activities 

4 conducted using the grant, which shall contain 

5 such information as the Secretary may require. 

6 (B) SECRETARY.— 

7 (i) IN GENERAL.—Not later than 2 

8 years after the date on which the first 

9 grant is awarded under this subsection, the 

10 Secretary shall submit to Congress a re11 port that includes— 

12 (I) a summary of the reports 

13 submitted by eligible entities under 

14 subparagraph (A); 

15 (II) an assessment of the extent 

16 to which food distributed through the 

17 grant program under this subsection 

18 was purchased from local and regional 

19 food systems; 

20 (III) an evaluation of the effect 

21 of the grant program under this sub22 section on maternal and infant health 

23 outcomes, including racial and ethnic 

24 disparities and disparities impacting 

25 other underserved mothers, such as 


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1 mothers living in rural areas, with re2 spect to those outcomes; and 

3 (IV) recommendations with re4 spect to ensuring the activities de5 scribed in paragraph (5) continue 

6 after the grant funding for those ac7 tivities expires. 

8 (ii) PUBLICATION.—The Secretary 

9 shall make the report submitted under 

10 clause (i) publicly available on the website 

11 of the Department of Agriculture. 

12 (7) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to the Sec14 retary $5,000,000 to carry out this subsection for 

15 the period of fiscal years 2022 through 2024. 

16 SEC. 105. ENVIRONMENTAL STUDY THROUGH NATIONAL 

17 ACADEMIES. 

18 (a) IN GENERAL.—Not later than 60 days after the 

19 date of enactment of this Act, the Administrator of the 

20 Environmental Protection Agency shall seek to enter into 

21 an agreement with the National Academies of Sciences, 

22 Engineering, and Medicine (referred to in this section as 

23 the ‘‘National Academies’’) under which the National 

24 Academies agree to conduct a study on the impacts of 

25 water and air quality, exposure to extreme temperatures, 


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1 exposure to environmental chemicals, environmental risks 

2 in the workplace and the home, and pollution levels on 

3 maternal and infant health outcomes. 

4 (b) STUDY REQUIREMENTS.—The agreement under 

5 subsection (a) shall direct the National Academies to make 

6 recommendations for— 

7 (1) improving the environmental conditions de8 scribed in that subsection to improve maternal and 

9 infant health outcomes; and 

10 (2) reducing or eliminating racial and ethnic 

11 disparities in those outcomes. 

12 (c) REPORT.—The agreement under subsection (a) 

13 shall require the National Academies— 

14 (1) to complete the study described in that sub15 section; and 

16 (2) not later than 1 year after the date of en17 actment of this Act, to transmit to Congress and 

18 make publicly available a report that— 

19 (A) describes the results of the study; and 

20 (B) includes the recommendations de21 scribed in subsection (b). 

22 SEC. 106. CHILD CARE ACCESS. 

23 (a) GRANT PROGRAM.—The Secretary of Health and 

24 Human Services (in this section referred to as the ‘‘Sec25 retary’’) shall award grants to eligible organizations to 


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1 provide pregnant and postpartum individuals with free 

2 and accessible drop-in child care services during prenatal 

3 and postpartum appointments, including for mental health 

4 care, prenatal and childbirth classes, and labor and deliv5 ery. The Secretary shall coordinate with the Secretary of 

6 Defense to disseminate information regarding such serv7 ices and to expand on-installation drop-in child care serv8 ices for military parents. 

9 (b) APPLICATION.—To be eligible to receive a grant 

10 under this section, an eligible entity shall submit to the 

11 Secretary an application at such time, in such manner, 

12 and containing such information as the Secretary may re13 quire. 

14 (c) ELIGIBLE ORGANIZATIONS.— 

15 (1) ELIGIBILITY.—To be eligible to receive a 

16 grant under this section, an organization shall be an 

17 organization that provides child care services and 

18 can carry out programs providing pregnant and 

19 postpartum individuals with free and accessible 

20 drop-in child care services during prenatal and 

21 postpartum appointments. 

22 (2) PRIORITIZATION.—In selecting grant recipi23 ents under this section, the Secretary shall give pri24 ority to eligible organizations that operate in an area 

25 with high rates of adverse maternal health outcomes 


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1 or significant racial or ethnic disparities in maternal 

2 health outcomes, to the extent such data are avail3 able. 

4 (d) TIMING.—The Secretary shall commence the 

5 grant program under subsection (a) not later than 1 year 

6 after the date of enactment of this Act. 

7 (e) REPORTING.— 

8 (1) GRANTEES.—Each recipient of a grant 

9 under this section shall annually submit to the Sec10 retary and make publicly available a report on the 

11 status of activities conducted using the grant. Each 

12 such report shall include— 

13 (A) an analysis of the effect of the funded 

14 program on prenatal and postpartum appoint15 ment attendance rates; 

16 (B) summaries of qualitative assessments 

17 of the funded program from— 

18 (i) pregnant and postpartum individ19 uals participating in the program; and 

20 (ii) the families of such individuals; 

21 and 

22 (C) such additional information as the Sec23 retary may require. 

24 (2) SECRETARY.—Not later than the end of fis25 cal year 2024, the Secretary shall submit to ConVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 gress and make publicly available a report con2 taining the following: 

3 (A) A summary of the reports under para4 graph (1). 

5 (B) An assessment of the effects, if any, of 

6 the funded programs on maternal health out7 comes, with a specific focus on racial and ethnic 

8 disparities in such outcomes. 

9 (C) A description of actions the Secretary 

10 can take to ensure that pregnant and 

11 postpartum individuals eligible for medical as12 sistance under a State plan under title XIX of 

13 the Social Security Act (42 U.S.C. 1936 et 

14 seq.) have access to free and accessible drop-in 

15 child care services during prenatal and 

16 postpartum appointments, including identifica17 tion of the funding necessary to carry out such 

18 actions. 

19 (f) DROP-IN CHILD CARE SERVICES DEFINED.—In 

20 this section, the term ‘‘drop-in child care services’’ means 

21 child care and early childhood education services that 

22 are— 

23 (1) delivered at a facility that meets the re24 quirements of all applicable laws and regulations of 

25 the State or local government in which it is located, 


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1 including the licensing of the facility as a child care 

2 facility; and 

3 (2) provided in single encounters without re4 quiring full-time enrollment of a person in a child 

5 care program. 

6 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

7 out this section, there is authorized to be appropriated 

8 $5,000,000 for the period of fiscal years 2022 through 

9 2024. 

10 SEC. 107. GRANTS TO LOCAL ENTITIES ADDRESSING SO11 CIAL DETERMINANTS OF MATERNAL 

12 HEALTH. 

13 (a) IN GENERAL.—The Secretary of Health and 

14 Human Services (in this section referred to as the ‘‘Sec15 retary’’) shall award grants to eligible entities to— 

16 (1) address social determinants of maternal 

17 health for pregnant and postpartum individuals; and 

18 (2) eliminate racial and ethnic disparities in 

19 maternal health outcomes. 

20 (b) APPLICATION.—To be eligible to receive a grant 

21 under this subsection an eligible entity shall submit to the 

22 Secretary an application at such time, in such manner, 

23 and containing such information as the Secretary may 

24 provide. 


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1 (c) PRIORITIZATION.—In awarding grants under sub2 section (a), the Secretary shall give priority to an eligible 

3 entity that— 

4 (1) is, or will partner with, a community-based 

5 organization to carrying out the activities under sub6 section (d); 

7 (2) is operating in an area with high rates of 

8 adverse maternal health outcomes or significant ra9 cial or ethnic disparities in maternal health out10 comes; and 

11 (3) is operating in an area with a high poverty 

12 rate. 

13 (d) ACTIVITIES.—An eligible entity that receives a 

14 grant under this section may— 

15 (1) hire and retain staff; 

16 (2) develop and distribute a culturally and lin17 guistically appropriate list of available resources 

18 with respect to social service programs in a commu19 nity, including housing supports, child care access, 

20 nutrition counseling, and resources for pregnant 

21 women facing intimate partner violence; 

22 (3) establish a culturally appropriate resource 

23 center that provides multiple social service programs 

24 in a single location; 


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1 (4) offer programs and resources in the commu2 nities in which the respective eligible entities are lo3 cated to address social determinants of health for 

4 pregnant and postpartum individuals; and 

5 (5) consult with such pregnant and postpartum 

6 individuals, including undocumented pregnant indi7 viduals, to conduct an assessment of the activities 

8 under this subsection. 

9 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

10 provide to grant recipients under this section technical as11 sistance to plan for sustaining programs to address social 

12 determinants of maternal health among pregnant and 

13 postpartum individuals after the period of the grant. 

14 (f) REPORTING.— 

15 (1) GRANTEES.—Not later than 1 year after an 

16 eligible entity first receives a grant under this sec17 tion, and annually thereafter, an eligible entity shall 

18 submit to the Secretary, and make publicly available, 

19 a report on the status of activities conducted using 

20 the grant. Each such report shall include data on 

21 the effects of such activities, disaggregated by race, 

22 ethnicity, gender, and other relevant factors. 

23 (2) SECRETARY.—Not later than the end of fis24 cal year 2026, the Secretary shall submit to Con25 gress a report that includes— 


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1 (A) a summary of the reports under para2 graph (1); and 

3 (B) recommendations for— 

4 (i) improving maternal health out5 comes; and 

6 (ii) reducing or eliminating racial and 

7 ethnic disparities in maternal health out8 comes. 

9 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

10 authorized to be appropriated to carry out this section 

11 $15,000,000 for each of fiscal years 2022 through 2026. 

12 TITLE II—HONORING KIRA 

13 JOHNSON 

14 SEC. 201. INVESTMENTS IN COMMUNITY-BASED ORGANIZA15 TIONS TO IMPROVE BLACK MATERNAL 

16 HEALTH OUTCOMES. 

17 (a) AWARDS.—Following the 1-year period beginning 

18 on the date of enactment of this Act, the Secretary of 

19 Health and Human Services (in this section referred to 

20 as the ‘‘Secretary’’) shall award grants to eligible entities 

21 to establish or expand programs to prevent maternal mor22 tality and severe maternal morbidity among Black preg23 nant and postpartum individuals. 

24 (b) ELIGIBILITY.—To be eligible to seek a grant 

25 under this section, an entity shall be a community-based 


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1 organization offering programs and resources aligned with 

2 evidence-based practices for improving maternal health 

3 outcomes for Black pregnant and postpartum individuals. 

4 (c) OUTREACH AND TECHNICAL ASSISTANCE PE5 RIOD.—During the 1-year period beginning on the date 

6 of enactment of this Act, the Secretary shall— 

7 (1) conduct outreach to encourage eligible enti8 ties to apply for grants under this section; and 

9 (2) provide technical assistance to eligible enti10 ties on best practices for applying for grants under 

11 this section. 

12 (d) SPECIAL CONSIDERATION.— 

13 (1) OUTREACH.—In conducting outreach under 

14 subsection (c), the Secretary shall give special con15 sideration to eligible entities that— 

16 (A) are based in, and provide support for, 

17 communities with high rates of adverse mater18 nal health outcomes or significant racial and 

19 ethnic disparities in maternal health outcomes, 

20 to the extent such data are available; 

21 (B) are led by Black women; and 

22 (C) offer programs and resources that are 

23 aligned with evidence-based practices for im24 proving maternal health outcomes for Black 

25 pregnant and postpartum individuals. 


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1 (2) AWARDS.—In awarding grants under this 

2 section, the Secretary shall give special consideration 

3 to eligible entities that— 

4 (A) are described in subparagraphs (A), 

5 (B), and (C) of paragraph (1); 

6 (B) offer programs and resources designed 

7 in consultation with and intended for Black 

8 pregnant and postpartum individuals; and 

9 (C) offer programs and resources in the 

10 communities in which the respective eligible en11 tities are located that— 

12 (i) promote maternal mental health 

13 and maternal substance use disorder treat14 ments and supports that are aligned with 

15 evidence-based practices for improving ma16 ternal mental and behavioral health out17 comes for Black pregnant and postpartum 

18 individuals; 

19 (ii) address social determinants of ma20 ternal health for pregnant and postpartum 

21 individuals; 

22 (iii) promote evidence-based health lit23 eracy and pregnancy, childbirth, and par24 enting education for pregnant and 

25 postpartum individuals; 


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1 (iv) provide support from perinatal 

2 health workers to pregnant and 

3 postpartum individuals; 

4 (v) provide culturally congruent train5 ing to perinatal health workers; 

6 (vi) conduct or support research on 

7 maternal health issues disproportionately 

8 impacting Black pregnant and postpartum 

9 individuals; 

10 (vii) provide support to family mem11 bers of individuals who suffered a preg12 nancy-associated death or pregnancy-re13 lated death; 

14 (viii) operate midwifery practices that 

15 provide culturally congruent maternal 

16 health care and support, including for the 

17 purposes of— 

18 (I) supporting additional edu19 cation, training, and certification pro20 grams, including support for distance 

21 learning; 

22 (II) providing financial support 

23 to current and future midwives to ad24 dress education costs, debts, and 

25 other needs; 


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1 (III) clinical site investments; 

2 (IV) supporting preceptor devel3 opment trainings; 

4 (V) expanding the midwifery 

5 practice; or 

6 (VI) related needs identified by 

7 the midwifery practice and described 

8 in the practice’s application; or 

9 (ix) have developed other programs 

10 and resources that address community-spe11 cific needs for pregnant and postpartum 

12 individuals and are aligned with evidence13 based practices for improving maternal 

14 health outcomes for Black pregnant and 

15 postpartum individuals. 

16 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

17 provide to grant recipients under this section technical as18 sistance on— 

19 (1) capacity building to establish or expand pro20 grams to prevent adverse maternal health outcomes 

21 among Black pregnant and postpartum individuals; 

22 (2) best practices in data collection, measure23 ment, evaluation, and reporting; and 

24 (3) planning for sustaining programs to prevent 

25 maternal mortality and severe maternal morbidity 


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1 among Black pregnant and postpartum individuals 

2 after the period of the grant. 

3 (f) EVALUATION.—Not later than the end of fiscal 

4 year 2026, the Secretary shall submit to Congress an eval5 uation of the grant program under this section that— 

6 (1) assesses the effectiveness of outreach efforts 

7 during the application process in diversifying the 

8 pool of grant recipients; 

9 (2) makes recommendations for future outreach 

10 efforts to diversify the pool of grant recipients for 

11 Department of Health and Human Services grant 

12 programs and funding opportunities related to ma13 ternal health; 

14 (3) assesses the effectiveness of programs fund15 ed by grants under this section in improving mater16 nal health outcomes for Black pregnant and 

17 postpartum individuals, to the extent practicable; 

18 and 

19 (4) makes recommendations for future Depart20 ment of Health and Human Services grant programs 

21 and funding opportunities that deliver funding to 

22 community-based organizations that provide pro23 grams and resources that are aligned with evidence24 based practices for improving maternal health outVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 comes for Black pregnant and postpartum individ2 uals. 

3 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there is authorized to be appropriated 

5 $10,000,000 for each of fiscal years 2022 through 2026. 

6 SEC. 202. INVESTMENTS IN COMMUNITY-BASED ORGANIZA7 TIONS TO IMPROVE MATERNAL HEALTH OUT8 COMES IN UNDERSERVED COMMUNITIES. 

9 (a) AWARDS.—Following the 1-year period beginning 

10 on the date of enactment of this Act, the Secretary of 

11 Health and Human Services (in this section referred to 

12 as the ‘‘Secretary’’) shall award grants to eligible entities 

13 to establish or expand programs to prevent maternal mor14 tality and severe maternal morbidity among underserved 

15 groups. 

16 (b) ELIGIBILITY.—To be eligible to seek a grant 

17 under this section, an entity shall be a community-based 

18 organization offering programs and resources aligned with 

19 evidence-based practices for improving maternal health 

20 outcomes for pregnant and postpartum individuals. 

21 (c) OUTREACH AND TECHNICAL ASSISTANCE PE22 RIOD.—During the 1-year period beginning on the date 

23 of enactment of this Act, the Secretary shall— 

24 (1) conduct outreach to encourage eligible enti25 ties to apply for grants under this section; and 


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1 (2) provide technical assistance to eligible enti2 ties on best practices for applying for grants under 

3 this section. 

4 (d) SPECIAL CONSIDERATION.— 

5 (1) OUTREACH.—In conducting outreach under 

6 subsection (c), the Secretary shall give special con7 sideration to eligible entities that— 

8 (A) are based in, and provide support for, 

9 communities with high rates of adverse mater10 nal health outcomes or significant racial and 

11 ethnic disparities in maternal health outcomes, 

12 to the extent such data are available; 

13 (B) are led by individuals from racially, 

14 ethnically, and geographically diverse back15 grounds; and 

16 (C) offer programs and resources that are 

17 aligned with evidence-based practices for im18 proving maternal health outcomes for pregnant 

19 and postpartum individuals. 

20 (2) AWARDS.—In awarding grants under this 

21 section, the Secretary shall give special consideration 

22 to eligible entities that— 

23 (A) are described in subparagraphs (A), 

24 (B), and (C) of paragraph (1); 


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1 (B) offer programs and resources designed 

2 in consultation with and intended for pregnant 

3 and postpartum individuals from underserved 

4 groups; and 

5 (C) offer programs and resources in the 

6 communities in which the respective eligible en7 tities are located that— 

8 (i) promote maternal mental health 

9 and maternal substance use disorder treat10 ments and support that are aligned with 

11 evidence-based practices for improving ma12 ternal mental and behavioral health out13 comes for pregnant and postpartum indi14 viduals; 

15 (ii) address social determinants of ma16 ternal health for pregnant and postpartum 

17 individuals; 

18 (iii) promote evidence-based health lit19 eracy and pregnancy, childbirth, and par20 enting education for pregnant and 

21 postpartum individuals; 

22 (iv) provide support from perinatal 

23 health workers to pregnant and 

24 postpartum individuals; 


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1 (v) provide culturally congruent train2 ing to perinatal health workers; 

3 (vi) conduct or support research on 

4 maternal health outcomes and disparities; 

5 (vii) provide support to family mem6 bers of individuals who suffered a preg7 nancy-associated death or pregnancy-re8 lated death; 

9 (viii) operate midwifery practices that 

10 provide culturally congruent maternal 

11 health care and support, including for the 

12 purposes of— 

13 (I) supporting additional edu14 cation, training, and certification pro15 grams, including support for distance 

16 learning; 

17 (II) providing financial support 

18 to current and future midwives to ad19 dress education costs, debts, and 

20 other needs; 

21 (III) clinical site investments; 

22 (IV) supporting preceptor devel23 opment trainings; 

24 (V) expanding the midwifery 

25 practice; or 


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1 (VI) related needs identified by 

2 the midwifery practice and described 

3 in the practice’s application; or 

4 (ix) have developed other programs 

5 and resources that address community-spe6 cific needs for pregnant and postpartum 

7 individuals and are aligned with evidence8 based practices for improving maternal 

9 health outcomes for pregnant and 

10 postpartum individuals. 

11 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

12 provide to grant recipients under this section technical as13 sistance on— 

14 (1) capacity building to establish or expand pro15 grams to prevent adverse maternal health outcomes 

16 among pregnant and postpartum individuals from 

17 underserved groups; 

18 (2) best practices in data collection, measure19 ment, evaluation, and reporting; and 

20 (3) planning for sustaining programs to prevent 

21 maternal mortality and severe maternal morbidity 

22 among pregnant and postpartum individuals from 

23 underserved groups after the period of the grant. 


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1 (f) EVALUATION.—Not later than the end of fiscal 

2 year 2026, the Secretary shall submit to Congress an eval3 uation of the grant program under this section that— 

4 (1) assesses the effectiveness of outreach efforts 

5 during the application process in diversifying the 

6 pool of grant recipients; 

7 (2) makes recommendations for future outreach 

8 efforts to diversify the pool of grant recipients for 

9 Department of Health and Human Services grant 

10 programs and funding opportunities related to ma11 ternal health; 

12 (3) assesses the effectiveness of programs fund13 ed by grants under this section in improving mater14 nal health outcomes for pregnant and postpartum 

15 individuals from underserved groups, to the extent 

16 practicable; and 

17 (4) makes recommendations for future Depart18 ment of Health and Human Services grant programs 

19 and funding opportunities that deliver funding to 

20 community-based organizations that provide pro21 grams and resources that are aligned with evidence22 based practices for improving maternal health out23 comes for pregnant and postpartum individuals. 


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1 (g) DEFINITION.—In this section, the term ‘‘under2 served groups’’ means to pregnant and postpartum indi3 viduals— 

4 (1) from racial and ethnic minority groups (as 

5 such term is defined in section 1707(g)(1) of the 

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

7 6(g)(1))); 

8 (2) whose household income is equal to or less 

9 than 150 percent of the Federal poverty line; 

10 (3) who live in health professional shortage 

11 areas (as such term is defined in section 332 of the 

12 Public Health Service Act (42 U.S.C. 254e(a)(1))); 

13 (4) who live in counties with no hospital offer14 ing obstetric care, no birth center, and no obstetric 

15 provider; or 

16 (5) who live in counties with a level of vulner17 ability of moderate-to-high or higher, according to 

18 the Social Vulnerability Index of the Centers for 

19 Disease Control and Prevention. 

20 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there is authorized to be appropriated 

22 $10,000,000 for each of fiscal years 2022 through 2026. 


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1 SEC. 203. RESPECTFUL MATERNITY CARE TRAINING FOR 

2 ALL EMPLOYEES IN MATERNITY CARE SET3 TINGS. 

4 Part B of title VII of the Public Health Service Act 

5 (42 U.S.C. 293 et seq.) is amended by adding at the end 

6 the following new section: 

7 ‘‘SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR 

8 ALL EMPLOYEES IN MATERNITY CARE SET9 TINGS. 

10 ‘‘(a) GRANTS.—The Secretary shall award grants for 

11 programs to reduce and prevent bias, racism, and dis12 crimination in maternity care settings and to advance re13 spectful, culturally congruent, trauma-informed care. 

14 ‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 

15 under subsection (a), the Secretary shall give special con16 sideration to applications for programs that would— 

17 ‘‘(1) apply to all maternity care providers and 

18 any employees who interact with pregnant and 

19 postpartum individuals in the provider setting, in20 cluding front desk employees, sonographers, sched21 ulers, health care professionals, hospital or health 

22 system administrators, security staff, and other em23 ployees; 

24 ‘‘(2) emphasize periodic, as opposed to one25 time, trainings for all birthing professionals and em26 ployees described in paragraph (1); 


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1 ‘‘(3) address implicit bias, racism, and cultural 

2 humility; 

3 ‘‘(4) be delivered in ongoing education settings 

4 for providers maintaining their licenses, with a pref5 erence for trainings that provide continuing edu6 cation units; 

7 ‘‘(5) include trauma-informed care best prac8 tices and an emphasis on shared decision making be9 tween providers and patients; 

10 ‘‘(6) include antiracism training and programs; 

11 ‘‘(7) be delivered in undergraduate programs 

12 that funnel into health professions schools; 

13 ‘‘(8) be delivered in settings that apply to pro14 viders of the special supplemental nutrition program 

15 for women, infants, and children under section 17 of 

16 the Child Nutrition Act of 1966; 

17 ‘‘(9) integrate bias training in obstetric emer18 gency simulation trainings or related trainings; 

19 ‘‘(10) include training for emergency depart20 ment employees and emergency medical technicians 

21 on recognizing warning signs for severe pregnancy22 related complications; 

23 ‘‘(11) offer training to all maternity care pro24 viders on the value of racially, ethnically, and profesVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 sionally diverse maternity care teams to provide cul2 turally congruent care; or 

3 ‘‘(12) be based on one or more programs de4 signed by a historically Black college or university or 

5 other minority-serving institution. 

6 ‘‘(c) APPLICATION.—An entity desiring a grant under 

7 subsection (a), shall submit an application at such time, 

8 in such manner, and containing such information as the 

9 Secretary may require. 

10 ‘‘(d) REPORTING.—Each recipient of a grant under 

11 this section shall annually submit to the Secretary a report 

12 on the status of activities conducted using the grant, in13 cluding, as applicable, a description of the impact of train14 ing provided through the grant on patient outcomes and 

15 patient experience for pregnant and postpartum individ16 uals from racial and ethnic minority groups and their fam17 ilies. 

18 ‘‘(e) BEST PRACTICES.—Based on the annual reports 

19 submitted pursuant to subsection (d), the Secretary— 

20 ‘‘(1) shall produce an annual report on the find21 ings resulting from programs funded through this 

22 section; 

23 ‘‘(2) shall disseminate such report to all recipi24 ents of grants under this section and to the public; 

25 and 


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1 ‘‘(3) may include in such report findings on 

2 best practices for improving patient outcomes and 

3 patient experience for pregnant and postpartum in4 dividuals from racial and ethnic minority groups and 

5 their families in maternity care settings. 

6 ‘‘(f) DEFINITIONS.—In this section: 

7 ‘‘(1) The term ‘postpartum’ means the one-year 

8 period beginning on the last day of an individual’s 

9 pregnancy. 

10 ‘‘(2) The term ‘culturally congruent’ means in 

11 agreement with the preferred cultural values, beliefs, 

12 world view, language, and practices of the health 

13 care consumer and other stakeholders. 

14 ‘‘(3) The term ‘racial and ethnic minority 

15 group’ has the meaning given such term in section 

16 1707(g)(1). 

17 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

18 carry out this section, there is authorized to be appro19 priated $5,000,000 for each of fiscal years 2022 through 

20 2026.’’. 

21 SEC. 204. STUDY ON REDUCING AND PREVENTING BIAS, 

22 RACISM, AND DISCRIMINATION IN MATER23 NITY CARE SETTINGS. 

24 (a) IN GENERAL.—The Secretary of Health and 

25 Human Services shall seek to enter into an agreement, 


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1 not later than 90 days after the date of enactment of this 

2 Act, with the National Academies of Sciences, Engineer3 ing, and Medicine (referred to in this section as the ‘‘Na4 tional Academies’’) under which the National Academies 

5 agree to— 

6 (1) conduct a study on the design and imple7 mentation of programs to reduce and prevent bias, 

8 racism, and discrimination in maternity care settings 

9 and to advance respectful, culturally congruent, 

10 trauma-informed care; and 

11 (2) not later than 2 years after the date of en12 actment of this Act— 

13 (A) complete the study; and 

14 (B) transmit a report on the results of the 

15 study to Congress. 

16 (b) POSSIBLE TOPICS.—The agreement entered into 

17 pursuant to subsection (a) may provide for the study of 

18 any of the following: 

19 (1) The development of a scorecard or other 

20 evaluation standards for programs designed to re21 duce and prevent bias, racism, and discrimination in 

22 maternity care settings to assess the effectiveness of 

23 such programs in improving patient outcomes and 

24 patient experience for pregnant and postpartum inVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 dividuals from racial and ethnic minority groups and 

2 their families. 

3 (2) Determination of the types and frequency of 

4 training to reduce and prevent bias, racism, and dis5 crimination in maternity care settings that are dem6 onstrated to improve patient outcomes or patient ex7 perience for pregnant and postpartum individuals 

8 from racial and ethnic minority groups and their 

9 families. 

10 SEC. 205. RESPECTFUL MATERNITY CARE COMPLIANCE 

11 PROGRAM. 

12 (a) IN GENERAL.—The Secretary of Health and 

13 Human Services (referred to in this section as the ‘‘Sec14 retary’’) shall award grants to accredited hospitals, health 

15 systems, and other maternity care settings to establish as 

16 an integral part of quality implementation initiatives with17 in one or more hospitals or other birth settings a respect18 ful maternity care compliance program. 

19 (b) PROGRAM REQUIREMENTS.—A respectful mater20 nity care compliance program funded through a grant 

21 under this section shall— 

22 (1) institutionalize mechanisms to allow pa23 tients receiving maternity care services, the families 

24 of such patients, or perinatal health workers sup25 porting such patients to report instances of racism 


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1 or evidence of bias on the basis of race, ethnicity, or 

2 another protected class; 

3 (2) institutionalize response mechanisms 

4 through which representatives of the program can 

5 directly follow up with the patient, if possible, and 

6 the patient’s family in a timely manner; 

7 (3) prepare and make publicly available a 

8 hospital- or health system-wide strategy to reduce 

9 bias on the basis of race, ethnicity, or another pro10 tected class in the delivery of maternity care that in11 cludes— 

12 (A) information on the training programs 

13 to reduce and prevent bias, racism, and dis14 crimination on the basis of race, ethnicity, or 

15 another protected class for all employees in ma16 ternity care settings; 

17 (B) information on the number of cases re18 ported to the compliance program; and 

19 (C) the development of methods to rou20 tinely assess the extent to which bias, racism, 

21 or discrimination on the basis of race, ethnicity, 

22 or another protected class are present in the de23 livery of maternity care to patients from racial 

24 and ethnic minority groups; 


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1 (4) develop mechanisms to routinely collect and 

2 publicly report hospital-level data related to patient3 reported experience of care; and 

4 (5) provide annual reports to the Secretary with 

5 information about each case reported to the compli6 ance program over the course of the year containing 

7 such information as the Secretary may require, such 

8 as— 

9 (A) de-identified demographic information 

10 on the patient in the case, such as race, eth11 nicity, gender identity, and primary language; 

12 (B) the content of the report from the pa13 tient or the family of the patient to the compli14 ance program; 

15 (C) the response from the compliance pro16 gram; and 

17 (D) to the extent applicable, institutional 

18 changes made as a result of the case. 

19 (c) SECRETARY REQUIREMENTS.— 

20 (1) PROCESSES.—Not later than 180 days after 

21 the date of enactment of this Act, the Secretary 

22 shall establish processes for— 

23 (A) disseminating best practices for estab24 lishing and implementing a respectful maternity 


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1 care compliance program within a hospital or 

2 other birth setting; 

3 (B) promoting coordination and collabora4 tion between hospitals, health systems, and 

5 other maternity care delivery settings on the es6 tablishment and implementation of respectful 

7 maternity care compliance programs; and 

8 (C) evaluating the effectiveness of respect9 ful maternity care compliance programs on ma10 ternal health outcomes and patient and family 

11 experiences, especially for patients from racial 

12 and ethnic minority groups and their families. 

13 (2) STUDY.— 

14 (A) IN GENERAL.—Not later than 2 years 

15 after the date of enactment of this Act, the Sec16 retary shall, through a contract with an inde17 pendent research organization, conduct a study 

18 on strategies to address— 

19 (i) racism or bias on the basis of race, 

20 ethnicity, or another protected class in the 

21 delivery of maternity care services; and 

22 (ii) successful implementation of re23 spectful care initiatives. 


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1 (B) COMPONENTS OF STUDY.—The study 

2 under this paragraph shall include the fol3 lowing: 

4 (i) An assessment of the reports sub5 mitted to the Secretary from the respectful 

6 maternity care compliance programs pur7 suant to subsection (b)(5). 

8 (ii) Based on the assessment under 

9 clause (i), recommendations for potential 

10 accountability mechanisms related to cases 

11 of racism or bias on the basis of race, eth12 nicity, or another protected class in the de13 livery of maternity care services at hos14 pitals and other birth settings. Such rec15 ommendations shall take into consideration 

16 medical and non-medical factors that con17 tribute to adverse patient experiences and 

18 maternal health outcomes. 

19 (C) REPORT.—The Secretary shall submit 

20 to Congress and make publicly available a re21 port on the results of the study under this 

22 paragraph. 

23 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

24 out this section, there is authorized to be appropriated 


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1 such sums as may be necessary for fiscal years 2022 

2 through 2027. 

3 SEC. 206. GAO REPORT. 

4 (a) IN GENERAL.—Not later than 2 years after the 

5 date of enactment of this Act and annually thereafter, the 

6 Comptroller General of the United States shall submit to 

7 Congress and make publicly available a report on the es8 tablishment of respectful maternity care compliance pro9 grams within hospitals, health systems, and other mater10 nity care settings. 

11 (b) MATTERS INCLUDED.—The report under para12 graph (1) shall include the following: 

13 (1) Information regarding the extent to which 

14 hospitals, health systems, and other maternity care 

15 settings have elected to establish respectful mater16 nity care compliance programs, including— 

17 (A) which hospitals and other birth set18 tings elect to establish compliance programs 

19 and when such programs are established; 

20 (B) to the extent practicable, impacts of 

21 the establishment of such programs on mater22 nal health outcomes and patient and family ex23 periences in the hospitals and other birth set24 tings that have established such programs, esVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 pecially for patients from racial and ethnic mi2 nority groups and their families; 

3 (C) information on geographic areas, and 

4 types of hospitals or other birth settings, where 

5 respectful maternity care compliance programs 

6 are not being established and information on 

7 factors contributing to decisions to not establish 

8 such programs; and 

9 (D) recommendations for establishing re10 spectful maternity care compliance programs in 

11 geographic areas, and types of hospitals or 

12 other birth settings, where such programs are 

13 not being established. 

14 (2) Whether the funding made available to 

15 carry out this section has been sufficient and, if ap16 plicable, recommendations for additional appropria17 tions to carry out this section. 

18 (3) Such other information as the Comptroller 

19 General determines appropriate. 


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1 TITLE III—PROTECTING MOMS 

2 WHO SERVED 

3 SEC. 301. CODIFICATION OF MATERNITY COORDINATION 

4 PROGRAM OF DEPARTMENT OF VETERANS 

5 AFFAIRS. 

6 (a) PROGRAM ON MATERNITY CARE COORDINA7 TION.— 

8 (1) IN GENERAL.—The Secretary of Veterans 

9 Affairs shall carry out the maternity care coordina10 tion program described in Veterans Health Adminis11 tration Handbook 1330.03, or successor handbook. 

12 (2) TRAINING AND SUPPORT.—In carrying out 

13 the program under paragraph (1), the Secretary 

14 shall provide to community maternity care providers 

15 training and support with respect to the unique 

16 needs of pregnant and postpartum veterans, particu17 larly regarding mental and behavioral health condi18 tions relating to the service of the veterans in the 

19 Armed Forces. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.— 

21 (1) IN GENERAL.—There is authorized to be 

22 appropriated to the Secretary $15,000,000 for fiscal 

23 year 2022 for the program under subsection (a)(1). 

24 (2) SUPPLEMENT NOT SUPPLANT.—Amounts 

25 authorized under paragraph (1) are authorized in 


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1 addition to any other amounts authorized for mater2 nity health care and coordination for the Depart3 ment of Veterans Affairs. 

4 (c) DEFINITIONS.—In this section: 

5 (1) COMMUNITY MATERNITY CARE PRO6 VIDERS.—The term ‘‘community maternity care pro7 viders’’ means maternity care providers located at 

8 non-Department facilities who provide maternity 

9 care to veterans under section 1703 of title 38, 

10 United States Code, or any other law administered 

11 by the Secretary of Veterans Affairs. 

12 (2) NON-DEPARTMENT FACILITIES.—The term 

13 ‘‘non-Department facilities’’ has the meaning given 

14 that term in section 1701 of title 38, United States 

15 Code. 

16 SEC. 302. REPORT ON MATERNAL MORTALITY AND SEVERE 

17 MATERNAL MORBIDITY AMONG PREGNANT 

18 AND POSTPARTUM VETERANS. 

19 (a) GAO REPORT.—Not later than two years after 

20 the date of the enactment of this Act, the Comptroller 

21 General of the United States shall submit to the Com22 mittee on Veterans’ Affairs of the Senate and the Com23 mittee on Veterans’ Affairs of the House of Representa24 tives, and make publicly available, a report on maternal 

25 mortality and severe maternal morbidity among pregnant 


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1 and postpartum veterans, with a particular focus on racial 

2 and ethnic disparities in maternal health outcomes for vet3 erans. 

4 (b) MATTERS INCLUDED.—The report under sub5 section (a) shall include the following: 

6 (1) To the extent practicable— 

7 (A) the number of pregnant and 

8 postpartum veterans who have experienced a 

9 pregnancy-related death or pregnancy-associ10 ated death in the most recent 10 years of avail11 able data; 

12 (B) the rate of pregnancy-related deaths 

13 per 100,000 live births for pregnant and 

14 postpartum veterans; 

15 (C) the number of cases of severe maternal 

16 morbidity among pregnant and postpartum vet17 erans in the most recent year of available data; 

18 (D) the racial and ethnic disparities in ma19 ternal mortality and severe maternal morbidity 

20 rates among pregnant and postpartum veterans; 

21 (E) identification of the causes of maternal 

22 mortality and severe maternal morbidity that 

23 are unique to veterans, including post-traumatic 

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1 fertility or miscarriages that may be caused by 

2 service in the Armed Forces; 

3 (F) identification of the causes of maternal 

4 mortality and severe maternal morbidity that 

5 are unique to veterans from racial and ethnic 

6 minority groups; 

7 (G) identification of any correlations be8 tween the former rank of veterans and their 

9 maternal health outcomes; 

10 (H) the number of veterans who have been 

11 diagnosed with infertility by a health care pro12 vider of the Veterans Health Administration 

13 each year in the most recent five years, 

14 disaggregated by age, race, ethnicity, sex, mar15 ital status, sexual orientation, gender identity, 

16 and geographical location; 

17 (I) the number of veterans who have re18 ceived a clinical diagnosis of unexplained infer19 tility by a health care provider of the Veterans 

20 Health Administration each year in the most 

21 recent five years; and 

22 (J) the extent to which the rate of inci23 dence of clinically diagnosed infertility among 

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1 dence of clinically diagnosed infertility among 

2 the civilian population. 

3 (2) An assessment of the barriers to deter4 mining the information required under paragraph 

5 (1) and recommendations for improvements in track6 ing maternal health outcomes among pregnant and 

7 postpartum veterans— 

8 (A) who have health care coverage through 

9 the Department; 

10 (B) enrolled in the TRICARE program; 

11 (C) with employer-based or private insur12 ance; 

13 (D) enrolled in the Medicaid program; and 

14 (E) who are uninsured. 

15 (3) Recommendations for legislative and admin16 istrative actions to increase access to mental and be17 havioral health care for pregnant and postpartum 

18 veterans who screen positively for maternal mental 

19 or behavioral health conditions. 

20 (4) Recommendations to address homelessness, 

21 food insecurity, poverty, and related issues among 

22 pregnant and postpartum veterans. 

23 (5) Recommendations on how to effectively edu24 cate maternity care providers on best practices for 

25 providing maternity care services to veterans that 


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1 addresses the unique maternal health care needs of 

2 veteran populations. 

3 (6) Recommendations to reduce maternal mor4 tality and severe maternal morbidity among preg5 nant and postpartum veterans and to address racial 

6 and ethnic disparities in maternal health outcomes 

7 for each of the groups described in subparagraphs 

8 (A) through (E) of paragraph (2). 

9 (7) Recommendations to improve coordination 

10 of care between the Department and non-Depart11 ment facilities for pregnant and postpartum vet12 erans, including recommendations to improve— 

13 (A) health record interoperability; and 

14 (B) training for the directors of the Vet15 erans Integrated Service Networks, directors of 

16 medical facilities of the Department, chiefs of 

17 staff of such facilities, maternity care coordina18 tors, and staff of relevant non-Department fa19 cilities. 

20 (8) An assessment of the authority of the Sec21 retary of Veterans Affairs to access maternal health 

22 data collected by the Department of Health and 

23 Human Services and, if applicable, recommendations 

24 to increase such authority. 


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1 (9) Any other information the Comptroller Gen2 eral determines appropriate with respect to the re3 duction of maternal mortality and severe maternal 

4 morbidity among pregnant and postpartum veterans 

5 and to address racial and ethnic disparities in ma6 ternal health outcomes for veterans. 

7 TITLE IV—PERINATAL 

8 WORKFORCE 

9 SEC. 401. HHS AGENCY DIRECTIVES. 

10 (a) GUIDANCE TO STATES.— 

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

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

13 Health and Human Services (referred to in this sec14 tion as the ‘‘Secretary’’) shall issue and disseminate 

15 guidance to States to educate providers, managed 

16 care entities, and other insurers about the value and 

17 process of delivering respectful maternal health care 

18 through diverse and multidisciplinary care provider 

19 models. 

20 (2) CONTENTS.—The guidance required by 

21 paragraph (1) shall address how States can encour22 age and incentivize hospitals, health systems, mid23 wifery practices, freestanding birth centers, other 

24 maternity care provider groups, managed care enti25 ties, and other insurers— 


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1 (A) to recruit and retain maternity care 

2 providers, mental and behavioral health care 

3 providers acting in accordance with State law, 

4 registered dietitians or nutrition professionals 

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

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

7 1395x(vv)(2))), and lactation consultants cer8 tified by the International Board of Lactation 

9 Consultants Examiners— 

10 (i) from racially, ethnically, and lin11 guistically diverse backgrounds; 

12 (ii) with experience practicing in ra13 cially and ethnically diverse communities; 

14 and 

15 (iii) who have undergone training on 

16 implicit bias and racism; 

17 (B) to incorporate into maternity care 

18 teams— 

19 (i) midwives who meet at a minimum 

20 the international definition of the midwife 

21 and global standards for midwifery edu22 cation as established by the International 

23 Confederation of Midwives; and 

24 (ii) perinatal health workers; 


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1 (C) to provide collaborative, culturally con2 gruent care; and 

3 (D) to provide opportunities for individuals 

4 enrolled in accredited midwifery education pro5 grams to participate in job shadowing with ma6 ternity care teams in hospitals, health systems, 

7 midwifery practices, and freestanding birth cen8 ters. 

9 (b) STUDY ON RESPECTFUL AND CULTURALLY CON10 GRUENT MATERNITY CARE.— 

11 (1) STUDY.—The Secretary, acting through the 

12 Director of the National Institutes of Health, shall 

13 conduct a study on best practices in respectful and 

14 culturally congruent maternity care. 

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

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

17 (A) complete the study required by para18 graph (1); 

19 (B) submit to Congress and make publicly 

20 available a report on the results of such study; 

21 and 

22 (C) include in such report— 

23 (i) a compendium of examples of hos24 pitals, health systems, midwifery practices, 

25 freestanding birth centers, other maternity 


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1 care provider groups, managed care enti2 ties, and other insurers that are delivering 

3 respectful and culturally congruent mater4 nal health care; 

5 (ii) a compendium of examples of hos6 pitals, health systems, midwifery practices, 

7 freestanding birth centers, other maternity 

8 care provider groups, managed care enti9 ties, and other insurers that have made 

10 progress in reducing disparities in mater11 nal health outcomes and improving birth12 ing experiences for pregnant and 

13 postpartum individuals from racial and 

14 ethnic minority groups; and 

15 (iii) recommendations to hospitals, 

16 health systems, midwifery practices, free17 standing birth centers, other maternity 

18 care provider groups, managed care enti19 ties, and other insurers, for best practices 

20 in respectful and culturally congruent ma21 ternity care. 


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1 SEC. 402. GRANTS TO GROW AND DIVERSIFY THE 

2 PERINATAL WORKFORCE. 

3 Title VII of the Public Health Service Act is amended 

4 by inserting after section 757 (42 U.S.C. 294f) the fol5 lowing new section: 

6 ‘‘SEC. 758. PERINATAL WORKFORCE GRANTS. 

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

8 grants to entities to establish or expand programs de9 scribed in subsection (b) to grow and diversify the 

10 perinatal workforce. 

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

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

13 perinatal workforce by— 

14 ‘‘(1) establishing schools or programs that pro15 vide education and training to individuals seeking 

16 appropriate licensing or certification as— 

17 ‘‘(A) physician assistants who will complete 

18 clinical training in the field of maternal and 

19 perinatal health; or 

20 ‘‘(B) perinatal health workers; and 

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

22 or programs described in paragraph (1), for the pur23 poses of increasing the number of students enrolled 

24 in such schools or programs, including by awarding 

25 scholarships for students. 


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

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

3 that— 

4 ‘‘(1) has demonstrated a commitment to re5 cruiting and retaining students and faculty from ra6 cial and ethnic minority groups; 

7 ‘‘(2) has developed a strategy to recruit and re8 tain a diverse pool of students into the perinatal 

9 workforce program or school supported by funds re10 ceived through the grant, particularly from racial 

11 and ethnic minority groups and other underserved 

12 populations; 

13 ‘‘(3) has developed a strategy to recruit and re14 tain students who plan to practice in a health pro15 fessional shortage area designated under section 

16 332; 

17 ‘‘(4) has developed a strategy to recruit and re18 tain students who plan to practice in an area with 

19 significant racial and ethnic disparities in maternal 

20 health outcomes, to the extent practicable; and 

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

22 students within the perinatal workforce program or 

23 school a bias, racism, or discrimination training pro24 gram that includes training on implicit bias and rac25 ism. 


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

2 grant under this section for a perinatal workforce program 

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

4 an annual report on the activities conducted through the 

5 grant, including— 

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

7 participating in the program or school; 

8 ‘‘(2) the extent to which students in the pro9 gram or school are entering careers in— 

10 ‘‘(A) health professional shortage areas 

11 designated under section 332; and 

12 ‘‘(B) areas with significant racial and eth13 nic disparities in maternal health outcomes, to 

14 the extent such data are available; and 

15 ‘‘(3) whether the program or school has in16 cluded in the standard curriculum for all students a 

17 bias, racism, or discrimination training program that 

18 includes explicit and implicit bias, and if so the ef19 fectiveness of such training program. 

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

21 under this section shall be up to 5 years. 

22 ‘‘(f) APPLICATION.—To seek a grant under this sec23 tion, an entity shall submit to the Secretary an application 

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1 mation as the Secretary may require, including any infor2 mation necessary for prioritization under subsection (c). 

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

4 provide, directly or by contract, technical assistance to en5 tities seeking or receiving a grant under this section on 

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

7 sustainability of the perinatal workforce programs or 

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

9 through the grant. 

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

11 4 years after the date of enactment of this section, the 

12 Secretary shall prepare and submit to Congress, and post 

13 on the internet website of the Department of Health and 

14 Human Services, a report on the effectiveness of the grant 

15 program under this section at— 

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

17 minority groups; 

18 ‘‘(2) increasing the number of physician assist19 ants who will complete clinical training in the field 

20 of maternal and perinatal health, and perinatal 

21 health workers, from racial and ethnic minority 

22 groups and other underserved populations; 

23 ‘‘(3) increasing the number of physician assist24 ants who will complete clinical training in the field 

25 of maternal and perinatal health, and perinatal 


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1 health workers, working in health professional short2 age areas designated under section 332; and 

3 ‘‘(4) increasing the number of physician assist4 ants who will complete clinical training in the field 

5 of maternal and perinatal health, and perinatal 

6 health workers, working in areas with significant ra7 cial and ethnic disparities in maternal health out8 comes, to the extent such data are available. 

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

10 and ethnic minority group’ has the meaning given such 

11 term in section 1707(g). 

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

13 carry out this section, there is authorized to be appro14 priated $15,000,000 for each of fiscal years 2022 through 

15 2026.’’. 

16 SEC. 403. GRANTS TO GROW AND DIVERSIFY THE NURSING 

17 WORKFORCE IN MATERNAL AND PERINATAL 

18 HEALTH. 

19 Title VIII of the Public Health Service Act is amend20 ed by inserting after section 811 of that Act (42 U.S.C. 

21 296j) the following: 

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

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

24 grants to schools of nursing to grow and diversify the 

25 perinatal nursing workforce. 


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

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

3 perinatal nursing workforce by providing scholarships to 

4 students seeking to become— 

5 ‘‘(1) nurse practitioners whose education in6 cludes a focus on maternal and perinatal health; or 

7 ‘‘(2) clinical nurse specialists whose education 

8 includes a focus on maternal and perinatal health. 

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

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

11 of nursing that— 

12 ‘‘(1) has developed a strategy to recruit and re13 tain a diverse pool of students seeking to enter ca14 reers focused on maternal and perinatal health, par15 ticularly students from racial and ethnic minority 

16 groups and other underserved populations; 

17 ‘‘(2) has developed a partnership with a prac18 tice setting in a health professional shortage area 

19 designated under section 332 for the clinical place20 ments of the school’s students; 

21 ‘‘(3) has developed a strategy to recruit and re22 tain students who plan to practice in an area with 

23 significant racial and ethnic disparities in maternal 

24 health outcomes, to the extent practicable; and 


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

2 students seeking to enter careers focused on mater3 nal and perinatal health a bias, racism, or discrimi4 nation training program that includes education on 

5 implicit bias and racism. 

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

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

8 to submit to the Secretary an annual report on the activi9 ties conducted through the grant, including, to the extent 

10 practicable— 

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

12 in the school of nursing seeking to enter careers fo13 cused on maternal and perinatal health; 

14 ‘‘(2) the extent to which such students are pre15 paring to enter careers in— 

16 ‘‘(A) health professional shortage areas 

17 designated under section 332; and 

18 ‘‘(B) areas with significant racial and eth19 nic disparities in maternal health outcomes, to 

20 the extent such data are available; and 

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

22 students seeking to enter careers focused on mater23 nal and perinatal health includes a bias, racism, or 

24 discrimination training program that includes edu25 cation on implicit bias and racism. 


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

2 under this section shall be up to 5 years. 

3 ‘‘(f) APPLICATION.—To seek a grant under this sec4 tion, an entity shall submit to the Secretary an applica5 tion, at such time, in such manner, and containing such 

6 information as the Secretary may require, including any 

7 information necessary for prioritization under subsection 

8 (c). 

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

10 provide, directly or by contract, technical assistance to 

11 schools of nursing seeking or receiving a grant under this 

12 section on the processes of awarding and evaluating schol13 arships through the grant. 

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

15 4 years after the date of enactment of this section, the 

16 Secretary shall prepare and submit to Congress, and post 

17 on the internet website of the Department of Health and 

18 Human Services, a report on the effectiveness of the grant 

19 program under this section at— 

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

21 minority groups and other underserved populations; 

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

24 focused on maternal and perinatal health from racial 


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1 and ethnic minority groups and other underserved 

2 populations; 

3 ‘‘(3) increasing the number of nurse practi4 tioners and clinical nurse specialists entering careers 

5 focused on maternal and perinatal health working in 

6 health professional shortage areas designated under 

7 section 332; and 

8 ‘‘(4) increasing the number of nurse practi9 tioners and clinical nurse specialists entering careers 

10 focused on maternal and perinatal health working in 

11 areas with significant racial and ethnic disparities in 

12 maternal health outcomes, to the extent such data 

13 are available. 

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

15 carry out this section, there is authorized to be appro16 priated $15,000,000 for each of fiscal years 2022 through 

17 2026.’’. 

18 SEC. 404. GAO REPORT. 

19 (a) IN GENERAL.—Not later than 2 years after the 

20 date of enactment of this Act and every 5 years thereafter, 

21 the Comptroller General of the United States shall submit 

22 to Congress a report on barriers to maternal health edu23 cation and access to care in the United States. Such report 

24 shall include the information and recommendations de25 scribed in subsection (b). 


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1 (b) CONTENT OF REPORT.—The report under sub2 section (a) shall include— 

3 (1) an assessment of current barriers to enter4 ing accredited midwifery education programs, and 

5 recommendations for addressing such barriers, par6 ticularly for low-income women and women from ra7 cial and ethnic minority groups; 

8 (2) an assessment of current barriers to enter9 ing and successfully completing accredited education 

10 programs for other health professional careers re11 lated to maternity care, including maternity care 

12 providers, mental and behavioral health care pro13 viders acting in accordance with State law, reg14 istered dietitians or nutrition professionals (as such 

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

16 Security Act (42 U.S.C. 1395x(vv)(2))), and lacta17 tion consultants certified by the International Board 

18 of Lactation Consultants Examiners, particularly for 

19 low-income women and women from racial and eth20 nic minority groups; 

21 (3) an assessment of current barriers that pre22 vent midwives from meeting the international defini23 tion of the midwife and global standards for mid24 wifery education as established by the International 

25 Confederation of Midwives, and recommendations 


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1 for addressing such barriers, particularly for low-in2 come women and women from racial and ethnic mi3 nority groups; 

4 (4) an assessment of disparities in access to 

5 maternity care providers, mental or behavioral 

6 health care providers acting in accordance with 

7 State law, registered dietitians or nutrition profes8 sionals (as such term is defined in section 

9 1861(vv)(2) of the Social Security Act (42 U.S.C. 

10 1395x(vv)(2))), lactation consultants certified by the 

11 International Board of Lactation Consultants Exam12 iners, and perinatal health workers, stratified by 

13 race, ethnicity, gender identity, geographic location, 

14 and insurance type and recommendations to promote 

15 greater access equity; and 

16 (5) recommendations to promote greater equity 

17 in compensation for perinatal health workers under 

18 public and private insurers, particularly for such in19 dividuals from racially and ethnically diverse back20 grounds. 


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1 TITLE V—DATA TO SAVE MOMS 

2 SEC. 501. FUNDING FOR MATERNAL MORTALITY REVIEW 

3 COMMITTEES TO PROMOTE REPRESENTA4 TIVE COMMUNITY ENGAGEMENT. 

5 (a) IN GENERAL.—Section 317K(d) of the Public 

6 Health Service Act (42 U.S.C. 247b–12(d)) is amended 

7 by adding at the end the following: 

8 ‘‘(9) GRANTS TO PROMOTE REPRESENTATIVE

9 COMMUNITY ENGAGEMENT IN MATERNAL MOR10 TALITY REVIEW COMMITTEES.— 

11 ‘‘(A) IN GENERAL.—The Secretary may, 

12 using funds made available pursuant to sub13 paragraph (C), provide assistance to an applica14 ble maternal mortality review committee of a 

15 State, Indian tribe, tribal organization, or 

16 urban Indian organization— 

17 ‘‘(i) to select for inclusion in the mem18 bership of such a committee community 

19 members from the State, Indian tribe, trib20 al organization, or urban Indian organiza21 tion by— 

22 ‘‘(I) prioritizing community mem23 bers who can increase the diversity of 

24 the committee’s membership with re25 spect to race and ethnicity, location, 


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1 and professional background, includ2 ing members with non-clinical experi3 ences; and 

4 ‘‘(II) to the extent applicable, 

5 using funds reserved under subsection 

6 (f), to address barriers to maternal 

7 mortality review committee participa8 tion for community members, includ9 ing required training, transportation 

10 barriers, compensation, and other sup11 ports as may be necessary; 

12 ‘‘(ii) to establish initiatives to conduct 

13 outreach and community engagement ef14 forts within communities throughout the 

15 State or Tribe to seek input from commu16 nity members on the work of such mater17 nal mortality review committee, with a par18 ticular focus on outreach to minority 

19 women; and 

20 ‘‘(iii) to release public reports assess21 ing— 

22 ‘‘(I) the pregnancy-related death 

23 and pregnancy-associated death review 

24 processes of the maternal mortality 

25 review committee, with a particular 


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1 focus on the maternal mortality re2 view committee’s sensitivity to the 

3 unique circumstances of pregnant and 

4 postpartum individuals from racial 

5 and ethnic minority groups (as such 

6 term is defined in section 1707(g)(1)) 

7 who have suffered pregnancy-related 

8 deaths; and 

9 ‘‘(II) the impact of the use of 

10 funds made available pursuant to sub11 paragraph (C) on increasing the diver12 sity of the maternal mortality review 

13 committee membership and promoting 

14 community engagement efforts 

15 throughout the State or Tribe. 

16 ‘‘(B) TECHNICAL ASSISTANCE.—The Sec17 retary shall provide (either directly through the 

18 Department of Health and Human Services or 

19 by contract) technical assistance to any mater20 nal mortality review committee receiving a 

21 grant under this paragraph on best practices 

22 for increasing the diversity of the maternal 

23 mortality review committee’s membership and 

24 for conducting effective community engagement 

25 throughout the State or Tribe. 


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1 ‘‘(C) AUTHORIZATION OF APPROPRIA2 TIONS.—In addition to any funds made avail3 able under subsection (f), there are authorized 

4 to be appropriated to carry out this paragraph 

5 $10,000,000 for each of fiscal years 2022 

6 through 2026.’’. 

7 (b) DEFINITIONS.—Section 317K(e) of the Public 

8 Health Service Act (42 U.S.C. 247b–12(e)) is amended— 

9 (1) in paragraph (2), by striking ‘‘and’’ at the 

10 end; 

11 (2) in paragraph (3)(B), by striking the period 

12 and inserting ‘‘; and’’; and 

13 (3) by adding at the end the following: 

14 ‘‘(4) the term ‘urban Indian organization’ has 

15 the meaning given such term in section 4 of the In16 dian Health Care Improvement Act.’’. 

17 (c) RESERVATION OF FUNDS.—Section 317K(f) of 

18 the Public Health Service Act (42 U.S.C. 247b–12(f)) is 

19 amended by adding at the end the following: ‘‘Of the 

20 amount made available under the preceding sentence for 

21 a fiscal year, not less than $1,500,000 shall be reserved 

22 for grants to Indian tribes, tribal organizations, or urban 

23 Indian organizations.’’. 


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1 SEC. 502. DATA COLLECTION AND REVIEW. 

2 Section 317K(d)(3)(A)(i) of the Public Health Serv3 ice Act (42 U.S.C. 247b–12(d)(3)(A)(i)) is amended— 

4 (1) by redesignating subclauses (II) and (III) 

5 as subclauses (V) and (VI), respectively; and 

6 (2) by inserting after subclause (I) the fol7 lowing: 

8 ‘‘(II) to the extent practicable, 

9 reviewing cases of severe maternal 

10 morbidity, according to the most up11 to-date indicators; 

12 ‘‘(III) to the extent practicable, 

13 reviewing deaths during pregnancy or 

14 up to 1 year after the end of a preg15 nancy from suicide, overdose, or other 

16 death from a mental health condition 

17 or substance use disorder attributed 

18 to or aggravated by pregnancy or 

19 childbirth complications; 

20 ‘‘(IV) to the extent practicable, 

21 consulting with local community-based 

22 organizations representing pregnant 

23 and postpartum individuals from de24 mographic groups disproportionately 

25 impacted by poor maternal health out26 comes to ensure that, in addition to 


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1 clinical factors, non-clinical factors 

2 that might have contributed to a preg3 nancy-related death are appropriately 

4 considered;’’. 

5 SEC. 503. REVIEW OF MATERNAL HEALTH DATA COLLEC6 TION PROCESSES AND QUALITY MEASURES. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services, acting through the Administrator for 

9 Centers for Medicare & Medicaid Services and the Direc10 tor of the Agency for Healthcare Research and Quality, 

11 shall consult with relevant stakeholders— 

12 (1) to review existing maternal health data col13 lection processes and quality measures; and 

14 (2) make recommendations to improve such 

15 processes and measures, including topics described 

16 in subsection (c). 

17 (b) COLLABORATION.—In carrying out this section, 

18 the Secretary shall consult with a diverse group of mater19 nal health stakeholders, which may include— 

20 (1) pregnant and postpartum individuals and 

21 their family members, and nonprofit organizations 

22 representing such individuals, with a particular focus 

23 on patients from racial and ethnic minority groups; 

24 (2) community-based organizations that provide 

25 support for pregnant and postpartum individuals, 


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1 with a particular focus on patients from racial and 

2 ethnic minority groups; 

3 (3) membership organizations for maternity 

4 care providers; 

5 (4) organizations representing perinatal health 

6 workers; 

7 (5) organizations that focus on maternal mental 

8 or behavioral health; 

9 (6) organizations that focus on intimate partner 

10 violence; 

11 (7) institutions of higher education, with a par12 ticular focus on minority-serving institutions; 

13 (8) licensed and accredited hospitals, birth cen14 ters, midwifery practices, or other medical practices 

15 that provide maternal health care services to preg16 nant and postpartum patients; 

17 (9) relevant State and local public agencies, in18 cluding State maternal mortality review committees; 

19 and 

20 (10) the National Quality Forum, or such other 

21 standard-setting organizations specified by the Sec22 retary. 

23 (c) TOPICS.—The review of maternal health data col24 lection processes and recommendations to improve such 

25 processes and measures required under subsection (a) 


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1 shall assess all available relevant information, including 

2 information from State-level sources, and shall consider at 

3 least the following: 

4 (1) Current State and Tribal practices for ma5 ternal health, maternal mortality, and severe mater6 nal morbidity data collection and dissemination, in7 cluding consideration of— 

8 (A) the timeliness of processes for amend9 ing a death certificate when new information 

10 pertaining to the death becomes available to re11 flect whether the death was a pregnancy-related 

12 death; 

13 (B) relevant data collected with electronic 

14 health records, including data on race, eth15 nicity, socioeconomic status, insurance type, 

16 and other relevant demographic information; 

17 (C) maternal health data collected and 

18 publicly reported by hospitals, health systems, 

19 midwifery practices, and birth centers; 

20 (D) the barriers preventing States from 

21 correlating maternal outcome data with race 

22 and ethnicity data; 

23 (E) processes for determining the cause of 

24 a pregnancy-associated death in States that do 


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1 not have a maternal mortality review com2 mittee; 

3 (F) whether maternal mortality review 

4 committees include multidisciplinary and di5 verse membership (as described in section 

6 317K(d)(1)(A) of the Public Health Service Act 

7 (42 U.S.C. 247b–12(d)(1)(A))); 

8 (G) whether members of maternal mor9 tality review committees participate in trainings 

10 on bias, racism, or discrimination, and the qual11 ity of such trainings; 

12 (H) the extent to which States have imple13 mented systematic processes of listening to the 

14 stories of pregnant and postpartum individuals 

15 and their family members, with a particular 

16 focus on pregnant and postpartum individuals 

17 from racial and ethnic minority groups (as such 

18 term is defined in section 1707(g)(1) of the 

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

20 6(g)(1))) and their family members, to fully un21 derstand the causes of, and inform potential so22 lutions to, the maternal mortality and severe 

23 maternal morbidity crisis within their respective 

24 States; 


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1 (I) the extent to which maternal mortality 

2 review committees are considering social deter3 minants of maternal health when examining the 

4 causes of pregnancy-associated and pregnancy5 related deaths; 

6 (J) the extent to which maternal mortality 

7 review committees are making actionable rec8 ommendations based on their reviews of adverse 

9 maternal health outcomes and the extent to 

10 which such recommendations are being imple11 mented by appropriate stakeholders; 

12 (K) the legal and administrative barriers 

13 preventing the collection, collation, and dissemi14 nation of State maternity care data; 

15 (L) the effectiveness of data collection and 

16 reporting processes in separating pregnancy-as17 sociated deaths from pregnancy-related deaths; 

18 and 

19 (M) the current Federal, State, local, and 

20 Tribal funding support for the activities re21 ferred to in subparagraphs (A) through (L). 

22 (2) Whether the funding support referred to in 

23 paragraph (1)(M) is adequate for States to carry out 

24 optimal data collection and dissemination processes 


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1 with respect to maternal health, maternal mortality, 

2 and severe maternal morbidity. 

3 (3) Current quality measures for maternity 

4 care, including prenatal measures, labor and delivery 

5 measures, and postpartum measures, including top6 ics such as— 

7 (A) effective quality measures for mater8 nity care used by hospitals, health systems, 

9 midwifery practices, birth centers, health plans, 

10 and other relevant entities; 

11 (B) the sufficiency of current outcome 

12 measures used to evaluate maternity care for 

13 driving improved care, experiences, and out14 comes in maternity care payment and delivery 

15 system models; 

16 (C) maternal health quality measures that 

17 other countries effectively use; 

18 (D) validated measures that have been 

19 used for research purposes that could be tested, 

20 refined, and submitted for national endorse21 ment; 

22 (E) barriers preventing maternity care pro23 viders and insurers from implementing quality 

24 measures that are aligned with best practices; 


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1 (F) the frequency with which maternity 

2 care quality measures are reviewed and revised; 

3 (G) the strengths and weaknesses of the 

4 Prenatal and Postpartum Care measures of the 

5 Health Plan Employer Data and Information 

6 Set measures established by the National Com7 mittee for Quality Assurance; 

8 (H) the strengths and weaknesses of ma9 ternity care quality measures under the Med10 icaid program under title XIX of the Social Se11 curity Act (42 U.S.C. 1396 et seq.) and the 

12 Children’s Health Insurance Program under 

13 title XXI of such Act (42 U.S.C. 1397 et seq.), 

14 including the extent to which States voluntarily 

15 report relevant measures; 

16 (I) the extent to which maternity care 

17 quality measures are informed by patient expe18 riences that include measures of patient-re19 ported experience of care; 

20 (J) the current processes for collecting 

21 stratified data on the race and ethnicity of 

22 pregnant and postpartum individuals in hos23 pitals, health systems, midwifery practices, and 

24 birth centers, and for incorporating such raVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 cially and ethnically stratified data in maternity 

2 care quality measures; 

3 (K) the extent to which maternity care 

4 quality measures account for the unique experi5 ences of pregnant and postpartum individuals 

6 from racial and ethnic minority groups (as such 

7 term is defined in section 1707(g)(1) of the 

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

9 6(g)(1))); and 

10 (L) the extent to which hospitals, health 

11 systems, midwifery practices, and birth centers 

12 are implementing existing maternity care qual13 ity measures. 

14 (4) Recommendations on authorizing additional 

15 funds and providing additional technical assistance 

16 to improve maternal mortality review committees 

17 and State and Tribal maternal health data collection 

18 and reporting processes. 

19 (5) Recommendations for new authorities that 

20 may be granted to maternal mortality review com21 mittees to be able to— 

22 (A) access records from other Federal and 

23 State agencies and departments that may be 

24 necessary to identify causes of pregnancy-asso25 ciated and pregnancy-related deaths that are 


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1 unique to pregnant and postpartum individuals 

2 from specific populations, such as veterans and 

3 individuals who are incarcerated; and 

4 (B) work with relevant experts who are not 

5 members of the maternal mortality review com6 mittee to assist in the review of pregnancy-asso7 ciated deaths of pregnant and postpartum indi8 viduals from specific populations, such as vet9 erans and individuals who are incarcerated. 

10 (6) Recommendations to improve and stand11 ardize current quality measures for maternity care, 

12 with a particular focus on racial and ethnic dispari13 ties in maternal health outcomes. 

14 (7) Recommendations to improve the coordina15 tion by the Department of Health and Human Serv16 ices of the efforts undertaken by the agencies and 

17 organizations within the Department related to ma18 ternal health data and quality measures. 

19 (d) REPORT.—Not later than 1 year after the date 

20 of enactment of this Act, the Secretary shall submit to 

21 Congress and make publicly available a report on the re22 sults of the review of maternal health data collection proc23 esses and quality measures and recommendations to im24 prove such processes and measures required under sub25 section (a). 


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1 (e) DEFINITIONS.—In this section: 

2 (1) MATERNAL MORTALITY REVIEW COM3 MITTEE.—The term ‘‘maternal mortality review 

4 committee’’ means a maternal mortality review com5 mittee duly authorized by a State and receiving 

6 funding under section 317K(a)(2)(D) of the Public 

7 Health Service Act (42 U.S.C. 247b–12(a)(2)(D)). 

8 (2) PREGNANCY-ASSOCIATED DEATH.—The 

9 term ‘‘pregnancy-associated’’, with respect to a 

10 death, means a death of a pregnant or postpartum 

11 individual, by any cause, that occurs during, or with12 in 1 year following, the individual’s pregnancy, re13 gardless of the outcome, duration, or site of the 

14 pregnancy. 

15 (3) PREGNANCY-RELATED DEATH.—The term 

16 ‘‘pregnancy-related’’, with respect to a death, means 

17 a death of a pregnant or postpartum individual that 

18 occurs during, or within 1 year following, the indi19 vidual’s pregnancy, from a pregnancy complication, 

20 a chain of events initiated by pregnancy, or the ag21 gravation of an unrelated condition by the physio22 logic effects of pregnancy. 

23 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated such sums as may be 


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1 necessary to carry out this section for fiscal years 2022 

2 through 2025. 

3 SEC. 504. INDIAN HEALTH SERVICE STUDY AND REPORT ON 

4 MATERNAL MORTALITY AND SEVERE MATER5 NAL MORBIDITY. 

6 (a) DEFINITIONS.—In this section: 

7 (1) DIRECTOR.—The term ‘‘Director’’ means 

8 the Director of the Indian Health Service. 

9 (2) INDIAN TRIBE.—The term ‘‘Indian Tribe’’ 

10 has the meaning given the term in section 4 of the 

11 Indian Self-Determination and Education Assistance 

12 Act (25 U.S.C. 5304). 

13 (3) MATERNAL MORTALITY REVIEW COM14 MITTEE.—The term ‘‘maternal mortality review 

15 committee’’ means a maternal mortality review com16 mittee duly authorized by a State and receiving 

17 funding under section 317k(a)(2)(D) of the Public 

18 Health Service Act (42 U.S.C. 247b–12(a)(2)(D)). 

19 (4) TRIBAL EPIDEMIOLOGY CENTER.—The term 

20 ‘‘Tribal epidemiology center’’ means a Tribal epide21 miology center established under section 214 of the 

22 Indian Health Care Improvement Act (25 U.S.C. 

23 1621m). 

24 (5) TRIBAL ORGANIZATION.—The term ‘‘tribal 

25 organization’’ has the meaning given the term in 


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1 section 4 of the Indian Self-Determination and Edu2 cation Assistance Act (25 U.S.C. 5304). 

3 (6) URBAN INDIAN ORGANIZATION.—The term 

4 ‘‘urban Indian organization’’ has the meaning given 

5 the term in section 4 of the Indian Health Care Im6 provement Act (25 U.S.C. 1603). 

7 (b) STUDY AND REPORT.— 

8 (1) STUDY.— 

9 (A) IN GENERAL.—Not later than 90 days 

10 after the date of enactment of this Act, the Di11 rector, in coordination with the individuals se12 lected under subsection (c), shall enter into an 

13 agreement with an independent research organi14 zation or a Tribal epidemiology center to con15 duct a comprehensive study on maternal mor16 tality and severe maternal morbidity in Indian 

17 and Alaska Native populations. 

18 (B) REPORT.—The agreement entered into 

19 under subparagraph (A) shall require that the 

20 independent research organization or Tribal ep21 idemiology center submit to the Director a re22 port describing the results of the study con23 ducted pursuant to that agreement by not later 

24 than 2 years after the date of enactment of this 

25 Act. 


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1 (2) CONTENTS OF STUDY.—The study con2 ducted under paragraph (1) shall— 

3 (A) examine the causes of maternal mor4 tality and severe maternal morbidity that are 

5 unique to Indians and Alaska Natives; 

6 (B) include a systematic process of listen7 ing to the stories of pregnant and postpartum 

8 Indians and Alaska Natives to fully understand 

9 the causes of, and inform potential solutions to, 

10 the maternal mortality and severe maternal 

11 morbidity crisis within the Indian and Alaska 

12 Native communities; 

13 (C) identify the different settings in which 

14 pregnant and postpartum Indians and Alaska 

15 Natives receive maternity care, such as— 

16 (i) facilities operated by the Indian 

17 Health Service; 

18 (ii) an Indian health program oper19 ated by an Indian Tribe or tribal organiza20 tion pursuant to a grant from, or contract, 

21 cooperative agreement, or compact with, 

22 the Indian Health Service pursuant to the 

23 Indian Self-Determination and Education 

24 Assistance Act (25 U.S.C. 5301 et seq.); 

25 and 


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1 (iii) an urban Indian health program 

2 operated by an urban Indian organization 

3 pursuant to a grant from or contract with 

4 the Indian Health Service pursuant to title 

5 V of the Indian Health Care Improvement 

6 Act (25 U.S.C. 1651 et seq.); 

7 (D) determine the different landscapes of 

8 maternity care received by pregnant and 

9 postpartum Indians and Alaska Natives at the 

10 different settings identified under subparagraph 

11 (C); 

12 (E) review processes for coordinating pro13 grams of the Indian Health Service with social 

14 services provided through other programs ad15 ministered by the Secretary of Health and 

16 Human Services (other than the Medicare pro17 gram under title XVIII of the Social Security 

18 Act (42 U.S.C. 1395 et seq.), the Medicaid pro19 gram under title XIX of that Act (42 U.S.C. 

20 1396 et seq.), and the State Children’s Health 

21 Insurance Program established under title XXI 

22 of that Act (42 U.S.C. 1397aa et seq.)); 

23 (F) review current data collection and 

24 quality measurement processes and practices 


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1 with respect to pregnant and postpartum Indi2 ans and Alaska Natives; 

3 (G) assess causes and frequency of mater4 nal mental health conditions and substance use 

5 disorders with respect to Indians and Alaska 

6 Natives; 

7 (H) consider social determinants of health, 

8 including poverty, lack of health insurance, un9 employment, sexual violence, and environmental 

10 conditions in Tribal areas; 

11 (I) consider the role that historical mis12 treatment of Indian and Alaska Native women 

13 has played in causing currently high rates of 

14 maternal mortality and severe maternal mor15 bidity; 

16 (J) consider how current funding of the 

17 Indian Health Service affects the ability of the 

18 Indian Health Service to deliver quality mater19 nity care; and 

20 (K) consider the extent to which the deliv21 ery of maternity care services is culturally ap22 propriate for pregnant and postpartum Indians 

23 and Alaska Natives. 

24 (3) REPORT.—Not later than 3 years after the 

25 date of enactment of this Act, the Director shall 


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1 submit to Congress a report describing the results of 

2 the study conducted under paragraph (1), including 

3 recommendations for policies and practices that can 

4 be adopted to improve maternal health outcomes for 

5 pregnant and postpartum Indians and Alaska Na6 tives, including recommendations— 

7 (A) on how to improve maternal health 

8 outcomes for Indians and Alaska Natives re9 ceiving care at the different settings identified 

10 under paragraph (2)(C); 

11 (B) on how to reduce misclassification of 

12 pregnant and postpartum Indians and Alaska 

13 Natives, including consideration of best prac14 tices in training for members of maternal mor15 tality review committees to be able to correctly 

16 classify Indians and Alaska Natives; and 

17 (C) informed by the stories shared by preg18 nant and postpartum Indians and Alaska Na19 tives under paragraph (2)(B) to improve mater20 nal health outcomes for those individuals. 

21 (c) PARTICIPATING INDIVIDUALS.— 

22 (1) IN GENERAL.—The Director shall select 

23 from among individuals nominated by Indian Tribes, 

24 tribal organizations, and urban Indian organizations 


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1 12 individuals for participation in the study con2 ducted under subsection (b)(1). 

3 (2) REQUIREMENT.—In selecting members 

4 under paragraph (1), the Director shall ensure that 

5 each of the 12 service areas of the Indian Health 

6 Service is represented. 

7 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

8 authorized to be appropriated to carry out this section 

9 $2,000,000 for each of fiscal years 2022 through 2024. 

10 SEC. 505. GRANTS TO MINORITY-SERVING INSTITUTIONS TO 

11 STUDY MATERNAL MORTALITY, SEVERE MA12 TERNAL MORBIDITY, AND OTHER ADVERSE 

13 MATERNAL HEALTH OUTCOMES. 

14 (a) IN GENERAL.—The Secretary of Health and 

15 Human Services shall establish a program under which 

16 the Secretary shall award grants to research centers, 

17 health professions schools and programs, and other enti18 ties at minority-serving institutions to study specific as19 pects of the maternal health crisis among pregnant and 

20 postpartum individuals from racial and ethnic minority 

21 groups. Such research may— 

22 (1) include the development and implementation 

23 of systematic processes of listening to the stories of 

24 pregnant and postpartum individuals from racial 

25 and ethnic minority groups, and perinatal health 


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1 workers supporting such individuals, to fully under2 stand the causes of, and inform potential solutions 

3 to, the maternal mortality and severe maternal mor4 bidity crisis within their respective communities; 

5 (2) assess the potential causes of relatively low 

6 rates of maternal mortality among Hispanic individ7 uals, including potential racial misclassification and 

8 other data collection and reporting issues that might 

9 be misrepresenting maternal mortality rates among 

10 Hispanic individuals in the United States; and 

11 (3) assess differences in rates of adverse mater12 nal health outcomes among subgroups identifying as 

13 Hispanic. 

14 (b) APPLICATION.—To be eligible to receive a grant 

15 under subsection (a), an entity described in such sub16 section shall submit to the Secretary an application at 

17 such time, in such manner, and containing such informa18 tion as the Secretary may require. 

19 (c) TECHNICAL ASSISTANCE.—The Secretary may 

20 use not more than 10 percent of the funds made available 

21 under subsection (g)— 

22 (1) to conduct outreach to minority-serving in23 stitutions to raise awareness of the availability of 

24 grants under this subsection (a); 


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1 (2) to provide technical assistance in the appli2 cation process for such a grant; and 

3 (3) to promote capacity building as needed to 

4 enable entities described in such subsection to sub5 mit such an application. 

6 (d) REPORTING REQUIREMENT.—Each entity award7 ed a grant under this section shall periodically submit to 

8 the Secretary a report on the status of activities conducted 

9 using the grant. 

10 (e) EVALUATION.—Beginning one year after the date 

11 on which the first grant is awarded under this section, 

12 the Secretary shall submit to Congress an annual report 

13 summarizing the findings of research conducted using 

14 funds made available under this section. 

15 (f) MINORITY-SERVING INSTITUTIONS DEFINED.—In 

16 this section, the term ‘‘minority-serving institution’’ has 

17 the meaning given the term in section 371(a) of the High18 er Education Act of 1965 (20 U.S.C. 1067q(a)). 

19 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

21 $10,000,000 for each of fiscal years 2022 through 2026. 


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1 TITLE VI—MOMS MATTER 

2 SEC. 601. MATERNAL MENTAL HEALTH EQUITY GRANT 

3 PROGRAM. 

4 (a) IN GENERAL.—The Secretary, acting through the 

5 Assistant Secretary for Mental Health and Substance Use, 

6 shall establish a program to award grants to eligible enti7 ties to address maternal mental health conditions and sub8 stance use disorders with respect to pregnant and 

9 postpartum individuals, with a focus on racial and ethnic 

10 minority groups. 

11 (b) APPLICATION.—To be eligible to receive a grant 

12 under this section an eligible entity shall submit to the 

13 Secretary an application at such time, in such manner, 

14 and containing such information as the Secretary may 

15 provide, including how such entity will use funds for activi16 ties described in subsection (d) that are culturally con17 gruent. 

18 (c) PRIORITY.—In awarding grants under this sec19 tion, the Secretary shall give priority to an eligible entity 

20 that— 

21 (1) is, or will partner with, a community-based 

22 organization to address maternal mental health con23 ditions and substance use disorders described in sub24 section (a); 

25 (2) is operating in an area with high rates of— 


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1 (A) adverse maternal health outcomes; or 

2 (B) significant racial or ethnic disparities 

3 in maternal health outcomes; and 

4 (3) is operating in a health professional short5 age area designated under section 332 of the Public 

6 Health Service Act (42 U.S.C. 254e). 

7 (d) USE OF FUNDS.—An eligible entity that receives 

8 a grant under this section shall use funds for the fol9 lowing: 

10 (1) Establishing or expanding maternity care 

11 programs to improve the integration of maternal 

12 health and behavioral health care services into pri13 mary care settings where pregnant individuals regu14 larly receive health care services. 

15 (2) Establishing or expanding group prenatal 

16 care programs or postpartum care programs. 

17 (3) Expanding existing programs that improve 

18 maternal mental and behavioral health during the 

19 prenatal and postpartum periods, with a focus on in20 dividuals from racial and ethnic minority groups. 

21 (4) Providing services and support for pregnant 

22 and postpartum individuals with maternal mental 

23 health conditions and substance use disorders, in24 cluding referrals to addiction treatment centers that 

25 offer evidence-based treatment options. 


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1 (5) Addressing stigma associated with maternal 

2 mental health conditions and substance use dis3 orders, with a focus on racial and ethnic minority 

4 groups. 

5 (6) Raising awareness of warning signs of ma6 ternal mental health conditions and substance use 

7 disorders, with a focus on pregnant and postpartum 

8 individuals from racial and ethnic minority groups. 

9 (7) Establishing or expanding programs to pre10 vent suicide or self-harm among pregnant and 

11 postpartum individuals. 

12 (8) Offering evidence-aligned programs at free13 standing birth centers that provide maternal mental 

14 and behavioral health care education, treatments, 

15 and services, and other services for individuals 

16 throughout the prenatal and postpartum period. 

17 (9) Establishing or expanding programs to pro18 vide education and training to maternity care pro19 viders with respect to— 

20 (A) identifying potential warning signs for 

21 maternal mental health conditions or substance 

22 use disorders in pregnant and postpartum indi23 viduals, with a focus on individuals from racial 

24 and ethnic minority groups; and 


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1 (B) in the case where such providers iden2 tify such warning signs, offering referrals to 

3 mental and behavioral health care professionals. 

4 (10) Developing a website, or other source, that 

5 includes information on health care providers who 

6 treat maternal mental health conditions and sub7 stance use disorders. 

8 (11) Establishing or expanding programs in 

9 communities to improve coordination between mater10 nity care providers and mental and behavioral health 

11 care providers who treat maternal mental health 

12 conditions and substance use disorders, including 

13 through the use of toll-free hotlines. 

14 (12) Carrying out other programs aligned with 

15 evidence-based practices for addressing maternal 

16 mental health conditions and substance use dis17 orders for pregnant and postpartum individuals from 

18 racial and ethnic minority groups. 

19 (e) REPORTING.— 

20 (1) ELIGIBLE ENTITIES.—An eligible entity 

21 that receives a grant under subsection (a) shall sub22 mit annually to the Secretary, and make publicly 

23 available, a report on the activities conducted using 

24 funds received through a grant under this section. 

25 Such reports shall include quantitative and qualiVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 tative evaluations of such activities, including the ex2 perience of individuals who received health care 

3 through such grant. 

4 (2) SECRETARY.—Not later than the end of fis5 cal year 2024, the Secretary shall submit to Con6 gress a report that includes— 

7 (A) a summary of the reports received 

8 under paragraph (1); 

9 (B) an evaluation of the effectiveness of 

10 grants awarded under this section; 

11 (C) recommendations with respect to ex12 panding coverage of evidence-based screenings 

13 and treatments for maternal mental health con14 ditions and substance use disorders; and 

15 (D) recommendations with respect to en16 suring activities described under subsection (d) 

17 continue after the end of a grant period. 

18 (f) DEFINITIONS.—In this section: 

19 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti20 ty’’ means— 

21 (A) a community-based organization serv22 ing pregnant and postpartum individuals, in23 cluding such organizations serving individuals 

24 from racial and ethnic minority groups and 

25 other underserved populations; 


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1 (B) a nonprofit or patient advocacy organi2 zation with expertise in maternal mental and 

3 behavioral health; 

4 (C) a maternity care provider; 

5 (D) a mental or behavioral health care pro6 vider who treats maternal mental health condi7 tions or substance use disorders; 

8 (E) a State or local governmental entity, 

9 including a State or local public health depart10 ment; 

11 (F) an Indian Tribe or Tribal organization 

12 (as such terms are defined in section 4 of the 

13 Indian Self-Determination and Education As14 sistance Act (25 U.S.C. 5304)); and 

15 (G) an Urban Indian organization (as such 

16 term is defined in section 4 of the Indian 

17 Health Care Improvement Act (25 U.S.C. 

18 1603)). 

19 (2) FREESTANDING BIRTH CENTER.—The term 

20 ‘‘freestanding birth center’’ has the meaning given 

21 that term under section 1905(l) of the Social Secu22 rity Act (42 U.S.C. 1396d(1)). 

23 (3) SECRETARY.—The term ‘‘Secretary’’ means 

24 the Secretary of Health and Human Services. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there is authorized to be appropriated 

3 $25,000,000 for each of fiscal years 2022 through 2025. 

4 SEC. 602. GRANTS TO GROW AND DIVERSIFY THE MATER5 NAL MENTAL AND BEHAVIORAL HEALTH 

6 CARE WORKFORCE. 

7 Title VII of the Public Health Service Act (42 U.S.C. 

8 292 et seq.) is amended by inserting after section 758 of 

9 such Act, as added by section 402 of this Act, the fol10 lowing new section: 

11 ‘‘SEC. 758A. MATERNAL MENTAL AND BEHAVIORAL HEALTH 

12 CARE WORKFORCE GRANTS. 

13 ‘‘(a) IN GENERAL.—The Secretary may award grants 

14 to entities to establish or expand programs described in 

15 subsection (b) to grow and diversify the maternal mental 

16 and behavioral health care workforce. 

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

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

19 maternal mental and behavioral health care workforce 

20 by— 

21 ‘‘(1) establishing schools or programs that pro22 vide education and training to individuals seeking 

23 appropriate licensing or certification as mental or 

24 behavioral health care providers who will specialize 


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1 in maternal mental health conditions or substance 

2 use disorders; or 

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

4 or programs described in paragraph (1), for the pur5 poses of increasing the number of students enrolled 

6 in such schools or programs, including by awarding 

7 scholarships for students. 

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

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

10 that— 

11 ‘‘(1) has demonstrated a commitment to re12 cruiting and retaining students and faculty from ra13 cial and ethnic minority groups; 

14 ‘‘(2) has developed a strategy to recruit and re15 tain a diverse pool of students into the maternal 

16 mental or behavioral health care workforce program 

17 or school supported by funds received through the 

18 grant, particularly from racial and ethnic minority 

19 groups and other underserved populations; 

20 ‘‘(3) has developed a strategy to recruit and re21 tain students who plan to practice in a health pro22 fessional shortage area designated under section 

23 332; 

24 ‘‘(4) has developed a strategy to recruit and re25 tain students who plan to practice in an area with 


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1 significant racial and ethnic disparities in maternal 

2 health outcomes, to the extent practicable; and 

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

4 students within the maternal mental or behavioral 

5 health care workforce program or school a bias, rac6 ism, or discrimination training program that in7 cludes training on implicit bias and racism. 

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

9 grant under this section for a maternal mental or behav10 ioral health care workforce program or school, an entity 

11 shall agree to submit to the Secretary an annual report 

12 on the activities conducted through the grant, including— 

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

14 participating in the program or school; 

15 ‘‘(2) the extent to which students in the pro16 gram or school are entering careers in— 

17 ‘‘(A) health professional shortage areas 

18 designated under section 332; and 

19 ‘‘(B) areas with significant racial and eth20 nic disparities in maternal health outcomes, to 

21 the extent such data are available; and 

22 ‘‘(3) whether the program or school has in23 cluded in the standard curriculum for all students a 

24 bias, racism, or discrimination training program that 


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1 includes training on implicit bias and racism, and if 

2 so the effectiveness of such training program. 

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

4 under this section shall be up to 5 years. 

5 ‘‘(f) APPLICATION.—To seek a grant under this sec6 tion, an entity shall submit to the Secretary an application 

7 at such time, in such manner, and containing such infor8 mation as the Secretary may require, including any infor9 mation necessary for prioritization under subsection (c). 

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

11 provide, directly or by contract, technical assistance to en12 tities seeking or receiving a grant under this section on 

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

14 sustainability of the maternal mental or behavioral health 

15 care workforce programs or schools proposed to be, or 

16 being, established or expanded through the grant. 

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

18 4 years after the date of enactment of this section, the 

19 Secretary shall prepare and submit to Congress, and post 

20 on the internet website of the Department of Health and 

21 Human Services, a report on the effectiveness of the grant 

22 program under this section at— 

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

24 minority groups and other underserved populations; 


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1 ‘‘(2) increasing the number of mental or behav2 ioral health care providers specializing in maternal 

3 mental health conditions or substance use disorders 

4 from racial and ethnic minority groups and other 

5 underserved populations; 

6 ‘‘(3) increasing the number of mental or behav7 ioral health care providers specializing in maternal 

8 mental health conditions or substance use disorders 

9 working in health professional shortage areas des10 ignated under section 332; and 

11 ‘‘(4) increasing the number of mental or behav12 ioral health care providers specializing in maternal 

13 mental health conditions or substance use disorders 

14 working in areas with significant racial and ethnic 

15 disparities in maternal health outcomes, to the ex16 tent such data are available. 

17 ‘‘(i) DEFINITIONS.—In this section: 

18 ‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.— 

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

20 meaning given such term in section 1707(g)(1). 

21 ‘‘(2) MENTAL OR BEHAVIORAL HEALTH CARE

22 PROVIDER.—The term ‘mental or behavioral health 

23 care provider’ refers to a health care provider in the 

24 field of mental and behavioral health, including subVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 stance use disorders, acting in accordance with State 

2 law. 

3 ‘‘(j) 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 TITLE VII—JUSTICE FOR 

8 INCARCERATED MOMS 

9 SEC. 701. ENDING THE SHACKLING OF PREGNANT INDIVID10 UALS. 

11 (a) IN GENERAL.—Beginning on the date that is 6 

12 months after the date of enactment of this Act, and annu13 ally thereafter, in each State that receives a grant under 

14 subpart 1 of part E of title I of the Omnibus Crime Con15 trol and Safe Streets Act of 1968 (34 U.S.C. 10151 et 

16 seq.) (commonly referred to as the ‘‘Edward Byrne Memo17 rial Justice Grant Program’’) and that does not have in 

18 effect throughout the State for such fiscal year laws re19 stricting the use of restraints on pregnant individuals in 

20 prison that are substantially similar to the rights, proce21 dures, requirements, effects, and penalties set forth in sec22 tion 4322 of title 18, United States Code, the amount of 

23 such grant that would otherwise be allocated to such State 

24 under such subpart for the fiscal year shall be decreased 

25 by 25 percent. 


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1 (b) REALLOCATION.—Amounts not allocated to a 

2 State for failure to comply with subsection (a) shall be 

3 reallocated in accordance with subpart 1 of part E of title 

4 I of the Omnibus Crime Control and Safe Streets Act of 

5 1968 (34 U.S.C. 10151 et seq.) to States that have com6 plied with such subsection. 

7 SEC. 702. CREATING MODEL PROGRAMS FOR THE CARE OF 

8 INCARCERATED INDIVIDUALS IN THE PRE9 NATAL AND POSTPARTUM PERIODS. 

10 (a) ESTABLISHMENT.— 

11 (1) IN GENERAL.—Not later than 1 year after 

12 the date of enactment of this Act, the Attorney Gen13 eral, acting through the Director of the Bureau of 

14 Prisons, shall establish, in not fewer than 6 Bureau 

15 of Prisons facilities, programs to optimize maternal 

16 health outcomes for pregnant and postpartum indi17 viduals incarcerated in such facilities. 

18 (2) REQUIRED CONSULTATION.—The Attorney 

19 General shall establish the programs authorized 

20 under paragraph (1) in consultation with stake21 holders such as— 

22 (A) relevant community-based organiza23 tions, particularly organizations that represent 

24 incarcerated and formerly incarcerated individ25 uals and organizations that seek to improve maVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 ternal health outcomes for pregnant and 

2 postpartum individuals from racial and ethnic 

3 minority groups; 

4 (B) relevant organizations representing pa5 tients, with a particular focus on patients from 

6 racial and ethnic minority groups; 

7 (C) organizations representing maternity 

8 care providers and maternal health care edu9 cation programs; 

10 (D) perinatal health workers; and 

11 (E) researchers and policy experts in fields 

12 related to maternal health care for incarcerated 

13 individuals. 

14 (b) START DATE.—Each facility selected under sub15 section (a) shall begin facility programs not later than 18 

16 months after the date of enactment of this Act. 

17 (c) FACILITY PRIORITY.—In carrying out subsection 

18 (a), the Director shall give priority to a facility based on— 

19 (1) the number of pregnant and postpartum in20 dividuals incarcerated in such facility and, among 

21 such individuals, the number of pregnant and 

22 postpartum individuals from racial and ethnic mi23 nority groups; and 

24 (2) the extent to which the leaders of such facil25 ity have demonstrated a commitment to developing 


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1 exemplary programs for pregnant and postpartum 

2 individuals incarcerated in such facility. 

3 (d) PROGRAM DURATION.—The programs established 

4 under this section shall be for a 5-year period. 

5 (e) PROGRAMS.—Bureau of Prisons facilities selected 

6 by the Director shall establish programs for pregnant and 

7 postpartum incarcerated individuals, and such pro8 grams— 

9 (1) may— 

10 (A) provide access to perinatal health 

11 workers from pregnancy through the 

12 postpartum period; 

13 (B) provide access to healthy foods and 

14 counseling on nutrition, recommended activity 

15 levels, and safety measures throughout preg16 nancy; 

17 (C) train correctional officers to ensure 

18 that pregnant incarcerated individuals receive 

19 safe and respectful treatment; 

20 (D) train medical personnel to ensure that 

21 pregnant incarcerated individuals receive trau22 ma-informed, culturally congruent care that 

23 promotes the health and safety of the pregnant 

24 individuals; 


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1 (E) provide counseling and treatment for 

2 individuals who have suffered from— 

3 (i) diagnosed mental or behavioral 

4 health conditions, including trauma and 

5 substance use disorders; 

6 (ii) trauma or violence, including do7 mestic violence; 

8 (iii) human immunodeficiency virus; 

9 (iv) sexual abuse; 

10 (v) pregnancy or infant loss; or 

11 (vi) chronic conditions; 

12 (F) provide evidence-based pregnancy and 

13 childbirth education, parenting support, and 

14 other relevant forms of health literacy; 

15 (G) provide clinical education opportunities 

16 to maternity care providers in training to ex17 pand pathways into maternal health care ca18 reers serving incarcerated individuals; 

19 (H) offer opportunities for postpartum in20 dividuals to maintain contact with the individ21 ual’s newborn child to promote bonding, includ22 ing enhanced visitation policies, access to prison 

23 nursery programs, or breastfeeding support; 

24 (I) provide reentry assistance, particularly 

25 to— 


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1 (i) ensure access to health insurance 

2 coverage and transfer of health records to 

3 community providers if an incarcerated in4 dividual exits the criminal justice system 

5 during such individual’s pregnancy or in 

6 the postpartum period; and 

7 (ii) connect individuals exiting the 

8 criminal justice system during pregnancy 

9 or in the postpartum period to community10 based resources, such as referrals to health 

11 care providers, substance use disorder 

12 treatments, and social services that ad13 dress social determinants maternal of 

14 health; or 

15 (J) establish partnerships with local public 

16 entities, private community entities, community17 based organizations, Indian Tribes and tribal 

18 organizations (as such terms are defined in sec19 tion 4 of the Indian Self-Determination and 

20 Education Assistance Act (25 U.S.C. 5304)), 

21 and urban Indian organizations (as such term 

22 is defined in section 4 of the Indian Health 

23 Care Improvement Act (25 U.S.C. 1603)) to es24 tablish or expand pretrial diversion programs as 


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1 an alternative to incarceration for pregnant and 

2 postpartum individuals; and 

3 (2) may include— 

4 (A) evidence-based childbirth education or 

5 parenting classes; 

6 (B) prenatal health coordination; 

7 (C) family and individual counseling; 

8 (D) evidence-based screenings, education, 

9 and, as needed, treatment for mental and be10 havioral health conditions, including drug and 

11 alcohol treatments; 

12 (E) family case management services; 

13 (F) domestic violence education and pre14 vention; 

15 (G) physical and sexual abuse counseling; 

16 and 

17 (H) programs to address social deter18 minants of health such as employment, housing, 

19 education, transportation, and nutrition. 

20 (f) IMPLEMENTATION AND REPORTING.—A selected 

21 facility shall be responsible for— 

22 (1) implementing programs, which may include 

23 the programs described in subsection (e); and 

24 (2) not later than 3 years after the date of en25 actment of this Act, and 6 years after the date of 


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1 enactment of this Act, reporting results of the pro2 grams to the Director, including information de3 scribing— 

4 (A) relevant quantitative indicators of suc5 cess in improving the standard of care and 

6 health outcomes for pregnant and postpartum 

7 incarcerated individuals in the facility, including 

8 data stratified by race, ethnicity, sex, gender, 

9 age, geography, disability status, the category 

10 of the criminal charge against such individual, 

11 rates of pregnancy-related deaths, pregnancy12 associated deaths, cases of infant mortality and 

13 morbidity, rates of preterm births and low14 birthweight births, cases of severe maternal 

15 morbidity, cases of violence against pregnant or 

16 postpartum individuals, diagnoses of maternal 

17 mental or behavioral health conditions, and 

18 other such information as appropriate; 

19 (B) relevant qualitative and quantitative 

20 evaluations from pregnant and postpartum in21 carcerated individuals who participated in such 

22 programs, including measures of patient-re23 ported experience of care; and 


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1 (C) strategies to sustain such programs 

2 after fiscal year 2026 and expand such pro3 grams to other facilities. 

4 (g) REPORT.—Not later than 6 years after the date 

5 of enactment of this Act, the Director shall submit to the 

6 Attorney General and to the Congress a report describing 

7 the results of the programs funded under this section. 

8 (h) OVERSIGHT.—Not later than 1 year after the 

9 date of enactment of this Act, the Attorney General shall 

10 award a contract to an independent organization or inde11 pendent organizations to conduct oversight of the pro12 grams described in subsection (e). 

13 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 $10,000,000 for each of fiscal years 2022 through 2026. 

16 SEC. 703. GRANT PROGRAM TO IMPROVE MATERNAL 

17 HEALTH OUTCOMES FOR INDIVIDUALS IN 

18 STATE AND LOCAL PRISONS AND JAILS. 

19 (a) ESTABLISHMENT.— 

20 (1) IN GENERAL.—Not later than 1 year after 

21 the date of enactment of this Act, the Attorney Gen22 eral, acting through the Director of the Bureau of 

23 Justice Assistance, shall award Justice for Incarcer24 ated Moms grants to States to establish or expand 


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1 programs in State and local prisons and jails for 

2 pregnant and postpartum incarcerated individuals. 

3 (2) REQUIRED CONSULTATION.—The Attorney 

4 General shall award the grants authorized under 

5 paragraph (1) in consultation with stakeholders such 

6 as— 

7 (A) relevant community-based organiza8 tions, particularly organizations that represent 

9 incarcerated and formerly incarcerated individ10 uals and organizations that seek to improve ma11 ternal health outcomes for pregnant and 

12 postpartum individuals from racial and ethnic 

13 minority groups; 

14 (B) relevant organizations representing pa15 tients, with a particular focus on patients from 

16 racial and ethnic minority groups; 

17 (C) organizations representing maternity 

18 care providers and maternal health care edu19 cation programs; 

20 (D) perinatal health workers; and 

21 (E) researchers and policy experts in fields 

22 related to maternal health care for incarcerated 

23 individuals. 

24 (b) APPLICATIONS.—Each applicant for a grant 

25 under this section shall submit to the Director of the BuVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 reau of Justice Assistance an application at such time, in 

2 such manner, and containing such information as the Di3 rector may require. 

4 (c) USE OF FUNDS.—A State that is awarded a grant 

5 under this section shall use such grant to establish or ex6 pand programs for pregnant and postpartum incarcerated 

7 individuals, and such programs— 

8 (1) may— 

9 (A) provide access to perinatal health 

10 workers from pregnancy through the post11 partum period; 

12 (B) provide access to healthy foods and 

13 counseling on nutrition, recommended activity 

14 levels, and safety measures throughout preg15 nancy; 

16 (C) train correctional officers to ensure 

17 that pregnant incarcerated individuals receive 

18 safe and respectful treatment; 

19 (D) train medical personnel to ensure that 

20 pregnant incarcerated individuals receive trau21 ma-informed, culturally congruent care that 

22 promotes the health and safety of the pregnant 

23 individuals; 

24 (E) provide counseling and treatment for 

25 individuals who have suffered from— 


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1 (i) diagnosed mental or behavioral 

2 health conditions, including trauma and 

3 substance use disorders; 

4 (ii) trauma or violence, including do5 mestic violence; 

6 (iii) human immunodeficiency virus; 

7 (iv) sexual abuse; 

8 (v) pregnancy or infant loss; or 

9 (vi) chronic conditions; 

10 (F) provide evidence-based pregnancy and 

11 childbirth education, parenting support, and 

12 other relevant forms of health literacy; 

13 (G) provide clinical education opportunities 

14 to maternity care providers in training to ex15 pand pathways into maternal health care ca16 reers serving incarcerated individuals; 

17 (H) offer opportunities for postpartum in18 dividuals to maintain contact with the individ19 ual’s newborn child to promote bonding, includ20 ing enhanced visitation policies, access to prison 

21 nursery programs, or breastfeeding support; 

22 (I) provide reentry assistance, particularly 

23 to— 

24 (i) ensure access to health insurance 

25 coverage and transfer of health records to 


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1 community providers if an incarcerated in2 dividual exits the criminal justice system 

3 during such individual’s pregnancy or in 

4 the postpartum period; and 

5 (ii) connect individuals exiting the 

6 criminal justice system during pregnancy 

7 or in the postpartum period to community8 based resources, such as referrals to health 

9 care providers, substance use disorder 

10 treatments, and social services that ad11 dress social determinants of maternal 

12 health; or 

13 (J) establish partnerships with local public 

14 entities, private community entities, community15 based organizations, Indian Tribes and tribal 

16 organizations (as such terms are defined in sec17 tion 4 of the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 5304)), 

19 and urban Indian organizations (as such term 

20 is defined in section 4 of the Indian Health 

21 Care Improvement Act (25 U.S.C. 1603)) to es22 tablish or expand pretrial diversion programs as 

23 an alternative to incarceration for pregnant and 

24 postpartum individuals; and 

25 (2) may include— 


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1 (A) evidence-based childbirth education or 

2 parenting classes; 

3 (B) prenatal health coordination; 

4 (C) family and individual counseling; 

5 (D) evidence-based screenings, education, 

6 and, as needed, treatment for mental and be7 havioral health conditions, including drug and 

8 alcohol treatments; 

9 (E) family case management services; 

10 (F) domestic violence education and pre11 vention; 

12 (G) physical and sexual abuse counseling; 

13 and 

14 (H) programs to address social deter15 minants of health such as employment, housing, 

16 education, transportation, and nutrition. 

17 (d) PRIORITY.—In awarding grants under this sec18 tion, the Director of the Bureau of Justice Assistance 

19 shall give priority to applicants based on— 

20 (1) the number of pregnant and postpartum in21 dividuals incarcerated in the State and, among such 

22 individuals, the number of pregnant and postpartum 

23 individuals from racial and ethnic minority groups; 

24 and 


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1 (2) the extent to which the State has dem2 onstrated a commitment to developing exemplary 

3 programs for pregnant and postpartum individuals 

4 incarcerated in the prisons and jails in the State. 

5 (e) GRANT DURATION.—A grant awarded under this 

6 section shall be for a 5-year period. 

7 (f) IMPLEMENTING AND REPORTING.—A State that 

8 receives a grant under this section shall be responsible 

9 for— 

10 (1) implementing the program funded by the 

11 grant; and 

12 (2) not later than 3 years after the date of en13 actment of this Act, and 6 years after the date of 

14 enactment of this Act, reporting results of such pro15 gram to the Attorney General, including information 

16 describing— 

17 (A) relevant quantitative indicators of the 

18 program’s success in improving the standard of 

19 care and health outcomes for pregnant and 

20 postpartum incarcerated individuals in the facil21 ity, including data stratified by race, ethnicity, 

22 sex, gender, age, geography, disability status, 

23 category of the criminal charge against such in24 dividual, incidence rates of pregnancy-related 

25 deaths, pregnancy-associated deaths, cases of 


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1 infant mortality and morbidity, rates of preterm 

2 births and low-birthweight births, cases of se3 vere maternal morbidity, cases of violence 

4 against pregnant or postpartum individuals, di5 agnoses of maternal mental or behavioral health 

6 conditions, and other such information as ap7 propriate; 

8 (B) relevant qualitative and quantitative 

9 evaluations from pregnant and postpartum in10 carcerated individuals who participated in such 

11 programs, including measures of patient-re12 ported experience of care; and 

13 (C) strategies to sustain such programs be14 yond the duration of the grant and expand such 

15 programs to other facilities. 

16 (g) REPORT.—Not later than 6 years after the date 

17 of enactment of this Act, the Attorney General shall sub18 mit to the Congress a report describing the results of such 

19 grant programs. 

20 (h) OVERSIGHT.—Not later than 1 year after the 

21 date of enactment of this Act, the Attorney General shall 

22 award a contract to an independent organization or inde23 pendent organizations to conduct oversight of the pro24 grams described in subsection (c). 


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1 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $10,000,000 for each of fiscal years 2022 through 2026. 

4 SEC. 704. GAO REPORT. 

5 (a) IN GENERAL.—Not later than 2 years after the 

6 date of enactment of this Act, the Comptroller General 

7 of the United States shall submit to Congress a report 

8 on adverse maternal and infant health outcomes among 

9 incarcerated individuals and infants born to such individ10 uals, with a particular focus on racial and ethnic dispari11 ties in maternal and infant health outcomes for incarcer12 ated individuals. 

13 (b) CONTENTS OF REPORT.—The report described in 

14 this section shall include— 

15 (1) to the extent practicable— 

16 (A) the number of pregnant individuals 

17 who are incarcerated in Bureau of Prisons fa18 cilities; 

19 (B) the number of incarcerated individuals, 

20 including those incarcerated in Federal, State, 

21 and local correctional facilities, who have expe22 rienced a pregnancy-related death, pregnancy23 associated death, or the death of an infant in 

24 the most recent 10 years of available data; 


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1 (C) the number of cases of severe maternal 

2 morbidity among incarcerated individuals, in3 cluding those incarcerated in Federal, State, 

4 and local detention facilities, in the most recent 

5 10 years of available data; 

6 (D) the number of preterm and low-birth7 weight births of infants born to incarcerated in8 dividuals, including those incarcerated in Fed9 eral, State, and local correctional facilities, in 

10 the most recent 10 years of available data; and 

11 (E) statistics on the racial and ethnic dis12 parities in maternal and infant health outcomes 

13 and severe maternal morbidity rates among in14 carcerated individuals, including those incarcer15 ated in Federal, State, and local detention fa16 cilities; 

17 (2) in the case that the Comptroller General of 

18 the United States is unable determine the informa19 tion required in subparagraphs (A) through (C) of 

20 paragraph (1), an assessment of the barriers to de21 termining such information and recommendations 

22 for improvements in tracking maternal health out23 comes among incarcerated individuals, including 

24 those incarcerated in Federal, State, and local deten25 tion facilities; 


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1 (3) causes of adverse maternal health outcomes 

2 that are unique to incarcerated individuals, including 

3 those incarcerated in Federal, State, and local deten4 tion facilities; 

5 (4) causes of adverse maternal health outcomes 

6 and severe maternal morbidity that are unique to in7 carcerated individuals from racial and ethnic minor8 ity groups; 

9 (5) recommendations to reduce maternal mor10 tality and severe maternal morbidity among incar11 cerated individuals and to address racial and ethnic 

12 disparities in maternal health outcomes for incarcer13 ated individuals in Bureau of Prisons facilities and 

14 State and local prisons and jails; and 

15 (6) such other information as may be appro16 priate to reduce the occurrence of adverse maternal 

17 health outcomes among incarcerated individuals and 

18 to address racial and ethnic disparities in maternal 

19 health outcomes for such individuals. 

20 SEC. 705. MACPAC REPORT. 

21 (a) IN GENERAL.—Not later than 2 years after the 

22 date of enactment of this Act, the Medicaid and CHIP 

23 Payment and Access Commission (referred to in this sec24 tion as ‘‘MACPAC’’) shall publish a report on the implica25 tions of pregnant and postpartum incarcerated individuals 


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1 being ineligible for medical assistance under a State plan 

2 under title XIX of the Social Security Act (42 U.S.C. 

3 1396 et seq.) that contains the information described in 

4 subsection (b). 

5 (b) INFORMATION DESCRIBED.—The information de6 scribed in this subsection includes— 

7 (1) information on the effect of ineligibility for 

8 medical assistance under a State plan under title 

9 XIX of the Social Security Act (42 U.S.C. 1396 et 

10 seq.) on maternal health outcomes for pregnant and 

11 postpartum incarcerated individuals, concentrating 

12 on the effects of such ineligibility for pregnant and 

13 postpartum individuals from racial and ethnic mi14 nority groups; and 

15 (2) the potential implications on maternal 

16 health outcomes resulting from suspending eligibility 

17 for medical assistance under a State plan under 

18 such title when a pregnant or postpartum individual 

19 is incarcerated. 


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1 TITLE VIII—TECH TO SAVE 

2 MOMS 

3 SEC. 801. INTEGRATED TELEHEALTH MODELS IN MATER4 NITY CARE SERVICES. 

5 (a) IN GENERAL.—Section 1115A(b)(2)(B) of the 

6 Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amend7 ed by adding at the end the following: 

8 ‘‘(xxviii) Focusing on title XIX, pro9 viding for the adoption of and use of tele10 health tools that allow for screening, moni11 toring, and management of common health 

12 complications with respect to an individual 

13 receiving medical assistance during such 

14 individual’s pregnancy and for not more 

15 than a 1-year period beginning on the last 

16 day of the pregnancy.’’. 

17 (b) EFFECTIVE DATE.—The amendment made by 

18 subsection (a) shall take effect 1 year after the date of 

19 enactment of this Act. 


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1 SEC. 802. GRANTS TO EXPAND THE USE OF TECHNOLOGY2 ENABLED COLLABORATIVE LEARNING AND 

3 CAPACITY MODELS FOR PREGNANT AND 

4 POSTPARTUM INDIVIDUALS. 

5 Title III of the Public Health Service Act is amended 

6 by inserting after section 330N (42 U.S.C. 254c–19) the 

7 following: 

8 ‘‘SEC. 330O. EXPANDING CAPACITY FOR MATERNAL 

9 HEALTH OUTCOMES. 

10 ‘‘(a) ESTABLISHMENT.—Beginning not later than 1 

11 year after the date of enactment of this section, the Sec12 retary shall award grants to eligible entities to evaluate, 

13 develop, and expand the use of technology-enabled collabo14 rative learning and capacity building models and improve 

15 maternal health outcomes— 

16 ‘‘(1) in health professional shortage areas; 

17 ‘‘(2) in areas with high rates of maternal mor18 tality and severe maternal morbidity; 

19 ‘‘(3) in areas with significant racial and ethnic 

20 disparities in maternal health outcomes; and 

21 ‘‘(4) for medically underserved populations and 

22 American Indians and Alaska Natives, including In23 dian Tribes, Tribal organizations, and Urban Indian 

24 organizations. 

25 ‘‘(b) USE OF FUNDS.— 


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1 ‘‘(1) REQUIRED USES.—Recipients of grants 

2 under this section shall use the grants to— 

3 ‘‘(A) train maternal health care providers, 

4 students, and other similar professionals 

5 through models that include— 

6 ‘‘(i) methods to increase safety and 

7 health care quality; 

8 ‘‘(ii) methods to address implicit bias, 

9 racism, and discrimination; 

10 ‘‘(iii) best practices in screening for 

11 maternal mental health conditions and 

12 substance use disorders and, as needed, 

13 evaluating and treating such conditions 

14 and disorders; 

15 ‘‘(iv) training on best practices in ma16 ternity care for pregnant and postpartum 

17 individuals during the COVID–19 public 

18 health emergency or future public health 

19 emergencies; 

20 ‘‘(v) methods to screen for social de21 terminants of maternal health risks in the 

22 prenatal and postpartum; and 

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1 plications described in section 

2 1115A(b)(2)(B)(xxviii); 

3 ‘‘(B) evaluate and collect information on 

4 the affect of such models on— 

5 ‘‘(i) access to and quality of care; 

6 ‘‘(ii) outcomes with respect to the 

7 health of an individual; and 

8 ‘‘(iii) the experience of individuals who 

9 receive pregnancy-related health care; 

10 ‘‘(C) develop qualitative and quantitative 

11 measures to identify best practices for the ex12 pansion and use of such models; 

13 ‘‘(D) study the effect of such models on 

14 patient outcomes and maternity care providers; 

15 and 

16 ‘‘(E) conduct any other activity, as deter17 mined by the Secretary. 

18 ‘‘(2) PERMISSIBLE USES.—Recipients of grants 

19 under this section may use grants to support— 

20 ‘‘(A) the use and expansion of technology21 enabled collaborative learning and capacity 

22 building models, including hardware and soft23 ware that— 

24 ‘‘(i) enables distance learning and 

25 technical support; and 


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1 ‘‘(ii) supports the secure exchange of 

2 electronic health information; and 

3 ‘‘(B) maternity care providers, students, 

4 and other similar professionals in the provision 

5 of maternity care through such models. 

6 ‘‘(c) APPLICATION.— 

7 ‘‘(1) IN GENERAL.—An eligible entity seeking a 

8 grant under subsection (a) shall submit to the Sec9 retary an application, at such time, in such manner, 

10 and containing such information as the Secretary 

11 may require. 

12 ‘‘(2) ASSURANCE.—An application under para13 graph (1) shall include an assurance that such entity 

14 shall collect information on, and assess the affect of, 

15 the use of technology-enabled collaborative learning 

16 and capacity building models, including with respect 

17 to— 

18 ‘‘(A) maternal health outcomes; 

19 ‘‘(B) access to maternal health care serv20 ices; 

21 ‘‘(C) quality of maternal health care; and 

22 ‘‘(D) retention of maternity care providers 

23 serving areas and populations described in sub24 section (a). 

25 ‘‘(d) LIMITATIONS.— 


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1 ‘‘(1) NUMBER.—Each entity receiving a grant 

2 under this section may receive not more than 1 such 

3 grant. 

4 ‘‘(2) DURATION.—A grant awarded under this 

5 section shall be for a 5-year period. 

6 ‘‘(e) ACCESS TO BROADBAND.—In administering 

7 grants under this section, the Secretary may coordinate 

8 with other agencies to ensure that funding opportunities 

9 are available to support access to reliable, high-speed 

10 internet for grantees. 

11 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary shall 

12 provide (either directly or by contract) technical assistance 

13 to eligible entities, including recipients of grants under 

14 subsection (a), on the development, use, and sustainability 

15 of technology-enabled collaborative learning and capacity 

16 building models to expand access to maternal health care 

17 services provided by such entities, including— 

18 ‘‘(1) in health professional shortage areas; 

19 ‘‘(2) in areas with high rates of maternal mor20 tality and severe maternal morbidity or significant 

21 racial and ethnic disparities in maternal health out22 comes; and 

23 ‘‘(3) for medically underserved populations or 

24 American Indians and Alaska Natives. 


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1 ‘‘(g) RESEARCH AND EVALUATION.—The Secretary, 

2 in consultation with experts, shall develop a strategic plan 

3 to research and evaluate the evidence for such models. 

4 ‘‘(h) REPORTING.— 

5 ‘‘(1) ELIGIBLE ENTITIES.—An eligible entity 

6 that receives a grant under subsection (a) shall sub7 mit to the Secretary a report, at such time, in such 

8 manner, and containing such information as the Sec9 retary may require. 

10 ‘‘(2) SECRETARY.—Not later than 4 years after 

11 the date of enactment of this section, the Secretary 

12 shall submit to Congress, and make available on the 

13 website of the Department of Health and Human 

14 Services, a report that includes— 

15 ‘‘(A) a description of grants awarded 

16 under subsection (a) and the purpose and 

17 amounts of such grants; 

18 ‘‘(B) a summary of— 

19 ‘‘(i) the evaluations conducted under 

20 subsection (b)(1)(B); 

21 ‘‘(ii) any technical assistance provided 

22 under subsection (f); and 

23 ‘‘(iii) the activities conducted under a 

24 grant awarded under subsection (a); and 


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1 ‘‘(C) a description of any significant find2 ings with respect to— 

3 ‘‘(i) patient outcomes; and 

4 ‘‘(ii) best practices for expanding, 

5 using, or evaluating technology-enabled col6 laborative learning and capacity building 

7 models. 

8 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to carry out this section, 

10 $6,000,000 for each of fiscal years 2022 through 2026. 

11 ‘‘(j) DEFINITIONS.—In this section: 

12 ‘‘(1) ELIGIBLE ENTITY.— 

13 ‘‘(A) IN GENERAL.—The term ‘eligible en14 tity’ means an entity that provides, or supports 

15 the provision of, maternal health care services 

16 or other evidence-based services for pregnant 

17 and postpartum individuals— 

18 ‘‘(i) in health professional shortage 

19 areas; 

20 ‘‘(ii) in areas with high rates of ad21 verse maternal health outcomes or signifi22 cant racial and ethnic disparities in mater23 nal health outcomes; and 

24 ‘‘(iii) who are— 


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1 ‘‘(I) members of medically under2 served populations; or 

3 ‘‘(II) American Indians and Alas4 ka Natives, including Indian Tribes, 

5 Tribal organizations, and urban In6 dian organizations. 

7 ‘‘(B) INCLUSIONS.—An eligible entity may 

8 include entities that lead, or are capable of 

9 leading, a technology-enabled collaborative 

10 learning and capacity building model. 

11 ‘‘(2) HEALTH PROFESSIONAL SHORTAGE

12 AREA.—The term ‘health professional shortage area’ 

13 means a health professional shortage area des14 ignated under section 332. 

15 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 

16 has the meaning given such term in section 4 of the 

17 Indian Self-Determination and Education Assistance 

18 Act. 

19 ‘‘(4) MATERNAL MORTALITY.—The term ‘ma20 ternal mortality’ means a death occurring during or 

21 within 1-year period after pregnancy caused by preg22 nancy-related or childbirth complications, including a 

23 suicide, overdose, or other death resulting from a 

24 mental health or substance use disorder attributed 


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1 to or aggravated by pregnancy or childbirth com2 plications. 

3 ‘‘(5) MEDICALLY UNDERSERVED POPU4 LATION.—The term ‘medically underserved popu5 lation’ has the meaning given such term in section 

6 330(b)(3). 

7 ‘‘(6) POSTPARTUM.—The term ‘postpartum’ 

8 means the 1-year period beginning on the last date 

9 of an individual’s pregnancy. 

10 ‘‘(7) SEVERE MATERNAL MORBIDITY.—The 

11 term ‘severe maternal morbidity’ means a health 

12 condition, including a mental health or substance 

13 use disorder, attributed to or aggravated by preg14 nancy or childbirth that results in significant short15 term or long-term consequences to the health of the 

16 individual who was pregnant. 

17 ‘‘(8) TECHNOLOGY-ENABLED COLLABORATIVE

18 LEARNING AND CAPACITY BUILDING MODEL.—The 

19 term ‘technology-enabled collaborative learning and 

20 capacity building model’ means a distance health 

21 education model that connects health care profes22 sionals, and other specialists, through simultaneous 

23 interactive videoconferencing for the purpose of fa24 cilitating case-based learning, disseminating best 


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1 practices, and evaluating outcomes in the context of 

2 maternal health care. 

3 ‘‘(9) TRIBAL ORGANIZATION.—The term ‘Tribal 

4 organization’ has the meaning given such term in 

5 section 4 of the Indian Self-Determination and Edu6 cation Assistance Act. 

7 ‘‘(10) URBAN INDIAN ORGANIZATION.—The 

8 term ‘urban Indian organization’ has the meaning 

9 given such term in section 4 of the Indian Health 

10 Care Improvement Act.’’. 

11 SEC. 803. GRANTS TO PROMOTE EQUITY IN MATERNAL 

12 HEALTH OUTCOMES THROUGH DIGITAL 

13 TOOLS. 

14 (a) IN GENERAL.—Beginning not later than 1 year 

15 after the date of the enactment of this Act, the Secretary 

16 of Health and Human Services shall award grants to eligi17 ble entities to reduce racial and ethnic disparities in ma18 ternal health outcomes by increasing access to digital tools 

19 related to maternal health care. 

20 (b) APPLICATIONS.—To be eligible to receive a grant 

21 under this section, an eligible entity shall submit to the 

22 Secretary an application at such time, in such manner, 

23 and containing such information as the Secretary may re24 quire. 


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1 (c) PRIORITIZATION.—In awarding grants under this 

2 section, the Secretary shall prioritize an eligible entity— 

3 (1) in an area with high rates of adverse mater4 nal health outcomes or significant racial and ethnic 

5 disparities in maternal health outcomes; 

6 (2) in a health professional shortage area des7 ignated under section 332 of the Public Health Serv8 ice Act (42 U.S.C. 254e); and 

9 (3) that promotes technology that addresses ra10 cial and ethnic disparities in maternal health out11 comes. 

12 (d) LIMITATIONS.— 

13 (1) NUMBER.—Each entity receiving a grant 

14 under this section may receive not more than 1 such 

15 grant. 

16 (2) DURATION.—A grant awarded under this 

17 section shall be for a 5-year period. 

18 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

19 provide technical assistance to an eligible entity on the de20 velopment, use, evaluation, and post-grant sustainability 

21 of digital tools for purposes of promoting equity in mater22 nal health outcomes. 

23 (f) REPORTING.— 

24 (1) ELIGIBLE ENTITIES.—An eligible entity 

25 that receives a grant under subsection (a) shall subVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 mit to the Secretary a report, at such time, in such 

2 manner, and containing such information as the Sec3 retary may require. 

4 (2) SECRETARY.—Not later than 4 years after 

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

6 shall submit to Congress a report that includes— 

7 (A) an evaluation on the effectiveness of 

8 grants awarded under this section to improve 

9 health outcomes for pregnant and postpartum 

10 individuals from racial and ethnic minority 

11 groups; 

12 (B) recommendations on new grant pro13 grams that promote the use of technology to 

14 improve such maternal health outcomes; and 

15 (C) recommendations with respect to— 

16 (i) technology-based privacy and secu17 rity safeguards in maternal health care; 

18 (ii) reimbursement rates for maternal 

19 telehealth services; 

20 (iii) the use of digital tools to analyze 

21 large data sets to identify potential preg22 nancy-related complications; 

23 (iv) barriers that prevent maternity 

24 care providers from providing telehealth 

25 services across States; 


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1 (v) the use of consumer digital tools 

2 such as mobile phone applications, patient 

3 portals, and wearable technologies to im4 prove maternal health outcomes; 

5 (vi) barriers that prevent access to 

6 telehealth services, including a lack of ac7 cess to reliable, high-speed internet or elec8 tronic devices; 

9 (vii) barriers to data sharing between 

10 the Special Supplemental Nutrition Pro11 gram for Women, Infants, and Children 

12 program and maternity care providers, and 

13 recommendations for addressing such bar14 riers; and 

15 (viii) lessons learned from expanded 

16 access to telehealth related to maternity 

17 care during the COVID–19 public health 

18 emergency. 

19 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section 

21 $6,000,000 for each of fiscal years 2022 through 2026. 

22 SEC. 804. REPORT ON THE USE OF TECHNOLOGY IN MATER23 NITY CARE. 

24 (a) IN GENERAL.—Not later than 60 days after the 

25 date of enactment of this Act, the Secretary of Health and 


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1 Human Services shall seek to enter an agreement with the 

2 National Academies of Sciences, Engineering, and Medi3 cine (referred to in this Act as the ‘‘National Academies’’) 

4 under which the National Academies shall conduct a study 

5 on the use of technology and patient monitoring devices 

6 in maternity care. 

7 (b) CONTENT.—The agreement entered into pursu8 ant to subsection (a) shall provide for the study of the 

9 following: 

10 (1) The use of innovative technology (including 

11 artificial intelligence) in maternal health care, in12 cluding the extent to which such technology has af13 fected racial or ethnic biases in maternal health 

14 care. 

15 (2) The use of patient monitoring devices (in16 cluding pulse oximeter devices) in maternal health 

17 care, including the extent to which such devices have 

18 affected racial or ethnic biases in maternal health 

19 care. 

20 (3) Best practices for reducing and preventing 

21 racial or ethnic biases in the use of innovative tech22 nology and patient monitoring devices in maternity 

23 care. 

24 (4) Best practices in the use of innovative tech25 nology and patient monitoring devices for pregnant 


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1 and postpartum individuals from racial and ethnic 

2 minority groups. 

3 (5) Best practices with respect to privacy and 

4 security safeguards in such use. 

5 (c) REPORT.—The agreement under subsection (a) 

6 shall direct the National Academies to complete the study 

7 under this section, and transmit to Congress a report on 

8 the results of the study, not later than 2 years after the 

9 date of enactment of this Act. 

10 TITLE IX—IMPACT TO SAVE 

11 MOMS 

12 SEC. 901. PERINATAL CARE ALTERNATIVE PAYMENT 

13 MODEL DEMONSTRATION PROJECT. 

14 (a) IN GENERAL.—For the period of fiscal years 

15 2022 through 2026, the Secretary of Health and Human 

16 Services (referred to in this section as the ‘‘Secretary’’), 

17 acting through the Administrator of the Centers for Medi18 care & Medicaid Services, shall establish and implement, 

19 in accordance with the requirements of this section, a 

20 demonstration project, to be known as the Perinatal Care 

21 Alternative Payment Model Demonstration Project (re22 ferred to in this section as the ‘‘Demonstration Project’’), 

23 for purposes of allowing States to test payment models 

24 under their State plans under title XIX of the Social Secu25 rity Act (42 U.S.C. 1396 et seq.) and State child health 


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1 plans under title XXI of such Act (42 U.S.C. 1397aa et 

2 seq.) with respect to maternity care provided to pregnant 

3 and postpartum individuals enrolled in such State plans 

4 and State child health plans. 

5 (b) COORDINATION.—In establishing the Demonstra6 tion Project, the Secretary shall coordinate with stake7 holders such as— 

8 (1) State Medicaid programs; 

9 (2) maternity care providers and organizations 

10 representing maternity care providers; 

11 (3) relevant organizations representing patients, 

12 with a particular focus on patients from racial and 

13 ethnic minority groups; 

14 (4) relevant community-based organizations, 

15 particularly organizations that seek to improve ma16 ternal health outcomes for pregnant and postpartum 

17 individuals from racial and ethnic minority groups; 

18 (5) perinatal health workers; 

19 (6) relevant health insurance issuers; 

20 (7) hospitals, health systems, midwifery prac21 tices, freestanding birth centers (as such term is de22 fined in paragraph (3)(B) of section 1905(l) of the 

23 Social Security Act (42 U.S.C. 1396d(l))), Feder24 ally-qualified health centers (as such term is defined 

25 in paragraph (2)(B) of such section), and rural 


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1 health clinics (as such term is defined in section 

2 1861(aa) of such Act (42 U.S.C. 1395x(aa))); 

3 (8) researchers and policy experts in fields re4 lated to maternity care payment models; and 

5 (9) any other stakeholders as the Secretary de6 termines appropriate, with a particular focus on 

7 stakeholders from racial and ethnic minority groups. 

8 (c) CONSIDERATIONS.—In establishing the Dem9 onstration Project, the Secretary shall consider any alter10 native payment model that— 

11 (1) is designed to improve maternal health out12 comes for racial and ethnic groups with dispropor13 tionate rates of adverse maternal health outcomes; 

14 (2) includes methods for stratifying patients by 

15 pregnancy risk level and, as appropriate, adjusting 

16 payments under such model to take into account 

17 pregnancy risk level; 

18 (3) establishes evidence-based quality metrics 

19 for such payments; 

20 (4) includes consideration of non-hospital birth 

21 settings such as freestanding birth centers (as so de22 fined); 

23 (5) includes consideration of social deter24 minants of maternal health; or 


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1 (6) includes diverse maternity care teams that 

2 include— 

3 (A) maternity care providers, mental and 

4 behavioral health care providers acting in ac5 cordance with State law, registered dietitians or 

6 nutrition professionals (as such term is defined 

7 in section 1861(vv)(2) of the Social Security 

8 Act (42 U.S.C. 1395x(vv)(2))), and Inter9 national Board Certified Lactation Consult10 ants— 

11 (i) from racially, ethnically, and pro12 fessionally diverse backgrounds; 

13 (ii) with experience practicing in ra14 cially and ethnically diverse communities; 

15 or 

16 (iii) who have undergone training on 

17 implicit bias and racism; and 

18 (B) perinatal health workers. 

19 (d) ELIGIBILITY.—To be eligible to participate in the 

20 Demonstration Project, a State shall submit an applica21 tion to the Secretary at such time, in such manner, and 

22 containing such information as the Secretary may require. 

23 (e) EVALUATION.—The Secretary shall conduct an 

24 evaluation of the Demonstration Project to determine the 

25 impact of the Demonstration Project on— 


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1 (1) maternal health outcomes, with data strati2 fied by race, ethnicity, socioeconomic indicators, and 

3 any other factors as the Secretary determines appro4 priate; 

5 (2) spending on maternity care by States par6 ticipating in the Demonstration Project; 

7 (3) to the extent practicable, qualitative and 

8 quantitative measures of patient experience; and 

9 (4) any other areas of assessment that the Sec10 retary determines relevant. 

11 (f) REPORT.—Not later than 1 year after the comple12 tion or termination date of the Demonstration Project, the 

13 Secretary shall submit to the Congress, and make publicly 

14 available, a report containing— 

15 (1) the results of any evaluation conducted 

16 under subsection (e); and 

17 (2) a recommendation regarding whether the 

18 Demonstration Project should be continued after fis19 cal year 2026 and expanded on a national basis. 

20 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated such sums as are nec22 essary to carry out this section. 

23 (h) DEFINITIONS.—In this section: 

24 (1) ALTERNATIVE PAYMENT MODEL.—The 

25 term ‘‘alternative payment model’’ has the meaning 


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1 given such term in section 1833(z)(3)(C) of the So2 cial Security Act (42 U.S.C. 1395l(z)(3)(C)). 

3 (2) PERINATAL.—The term ‘‘perinatal’’ means 

4 the period beginning on the day an individual be5 comes pregnant and ending on the last day of the 

6 1-year period beginning on the last day of such indi7 vidual’s pregnancy. 

8 (3) RACIAL AND ETHNIC MINORITY GROUP.— 

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

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

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

12 6(g)(1)). 

13 SEC. 902. MACPAC REPORT. 

14 Not later than 2 years after the date of the enact15 ment of this Act, the Medicaid and CHIP Payment and 

16 Access Commission shall publish a report on issues relat17 ing to the continuity of coverage under State plans under 

18 title XIX of the Social Security Act (42 U.S.C. 1396 et 

19 seq.) and State child health plans under title XXI of such 

20 Act (42 U.S.C. 1397aa et seq.) for pregnant and 

21 postpartum individuals. Such report shall, at a minimum, 

22 include the following: 

23 (1) An assessment of any existing policies 

24 under such State plans and such State child health 

25 plans regarding presumptive eligibility for pregnant 


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1 individuals while their application for enrollment in 

2 such a State plan or such a State child health plan 

3 is being processed. 

4 (2) An assessment of any existing policies 

5 under such State plans and such State child health 

6 plans regarding measures to ensure continuity of 

7 coverage under such a State plan or such a State 

8 child health plan for pregnant and postpartum indi9 viduals, including such individuals who need to 

10 change their health insurance coverage during their 

11 pregnancy or the postpartum period following their 

12 pregnancy. 

13 (3) An assessment of any existing policies 

14 under such State plans and such State child health 

15 plans regarding measures to automatically reenroll 

16 individuals who are eligible to enroll under such a 

17 State plan or such a State child health plan as a 

18 parent. 

19 (4) If determined appropriate by the Commis20 sion, any recommendations for the Department of 

21 Health and Human Services, or such State plans 

22 and such State child health plans, to ensure con23 tinuity of coverage under such a State plan or such 

24 a State child health plan for pregnant and 

25 postpartum individuals. 


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1 TITLE X—MATERNAL HEALTH 

2 PANDEMIC RESPONSE 

3 SEC. 1001. DEFINITIONS. 

4 In this title: 

5 (1) COVID–19 PUBLIC HEALTH EMERGENCY.— 

6 The term ‘‘COVID–19 public health emergency’’ 

7 means the period— 

8 (A) beginning on the date that the Sec9 retary of Health and Human Services declared 

10 a public health emergency under section 319 of 

11 the Public Health Service Act (42 U.S.C. 

12 247d), with respect to COVID–19; and 

13 (B) ending on the later of the end of such 

14 public health emergency, or January 1, 2023. 

15 (2) RESPECTFUL MATERNITY CARE.—The term 

16 ‘‘respectful maternity care’’ refers to care organized 

17 for, and provided to, pregnant and postpartum indi18 viduals in a manner that— 

19 (A) is culturally congruent; 

20 (B) maintains their dignity, privacy, and 

21 confidentiality; 

22 (C) ensures freedom from harm and mis23 treatment; and 

24 (D) enables informed choice and contin25 uous support. 


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

2 the Secretary of Health and Human Services. 

3 SEC. 1002. FUNDING FOR DATA COLLECTION, SURVEIL4 LANCE, AND RESEARCH ON MATERNAL 

5 HEALTH OUTCOMES DURING THE COVID–19 

6 PUBLIC HEALTH EMERGENCY. 

7 To conduct or support data collection, surveillance, 

8 and research on maternal health as a result of the 

9 COVID–19 public health emergency, including support to 

10 assist in the capacity building for State, Tribal, territorial, 

11 and local public health departments to collect and trans12 mit racial, ethnic, and other demographic data related to 

13 maternal health, there are authorized to be appro14 priated— 

15 (1) $100,000,000 for the Surveillance for 

16 Emerging Threats to Mothers and Babies program 

17 of the Centers for Disease Control and Prevention, 

18 to support the Centers for Disease Control and Pre19 vention in its efforts to— 

20 (A) work with public health, clinical, and 

21 community-based organizations to provide time22 ly, continually updated guidance to families and 

23 health care providers on ways to reduce risk to 

24 pregnant and postpartum individuals and their 


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1 newborns and tailor interventions to improve 

2 their long-term health; 

3 (B) partner with more State, Tribal, terri4 torial, and local public health programs in the 

5 collection and analysis of clinical data on the 

6 impact of COVID–19 on pregnant and 

7 postpartum patients and their newborns, par8 ticularly among patients from racial and ethnic 

9 minority groups; and 

10 (C) establish regionally based centers of 

11 excellence to offer medical, public health, and 

12 other knowledge to ensure communities, espe13 cially communities with large populations of in14 dividuals from racial and ethnic minority 

15 groups, can help pregnant and postpartum indi16 viduals and newborns get the care and support 

17 they need; 

18 (2) $30,000,000 for the Enhancing Reviews 

19 and Surveillance to Eliminate Maternal Mortality 

20 program (commonly known as the ‘‘ERASE MM 

21 program’’) of the Centers for Disease Control and 

22 Prevention, to support the Centers for Disease Con23 trol and Prevention in expanding its partnerships 

24 with States and Indian Tribes and provide technical 


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1 assistance to existing Maternal Mortality Review 

2 Committees; 

3 (3) $45,000,000 for the Pregnancy Risk As4 sessment Monitoring System (commonly known as 

5 the ‘‘PRAMS’’) of the Centers for Disease Control 

6 and Prevention, to support the Centers for Disease 

7 Control and Prevention in its efforts to— 

8 (A) create a COVID–19 supplement to its 

9 PRAMS questionnaire; 

10 (B) add questions around experiences of 

11 respectful maternity care in prenatal, 

12 intrapartum, and postpartum care; 

13 (C) conduct a rapid assessment of 

14 COVID–19 awareness, impact on care and ex15 periences, and use of preventive measures 

16 among pregnant, laboring and birthing, and 

17 postpartum individuals during the COVID–19 

18 public health emergency; and 

19 (D) work to transition the survey to an 

20 electronic platform and expand the survey to a 

21 larger population, with a special focus on reach22 ing underrepresented communities; and 

23 (4) $15,000,000 for the National Institute of 

24 Child Health and Human Development, to conduct 

25 or support research for interventions to mitigate the 


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1 effects of the COVID–19 public health emergency on 

2 pregnant and postpartum individuals, with a par3 ticular focus on individuals from racial and ethnic 

4 minority groups. 

5 SEC. 1003. COVID–19 MATERNAL HEALTH DATA COLLEC6 TION AND DISCLOSURE. 

7 (a) AVAILABILITY OF COLLECTED DATA.—The Sec8 retary, acting through the Director of the Centers for Dis9 ease Control and Prevention and the Administrator of the 

10 Centers for Medicare & Medicaid Services, shall make pub11 licly available on the website of the Centers for Disease 

12 Control and Prevention data described in subsection (b). 

13 (b) DATA DESCRIBED.—The data under subsection 

14 (a) means data collected through Federal surveillance sys15 tems under the Centers for Disease Control and Preven16 tion with respect to COVID–19 and individuals who are 

17 pregnant or in a postpartum period. Such data shall in18 clude the following: 

19 (1) Diagnostic testing, including the number of 

20 pregnant and postpartum individuals who are tested 

21 for COVID–19 and the number of positive cases. 

22 (2) Suspected cases of COVID–19 in pregnant 

23 and birthing individuals and individuals in a 

24 postpartum period. 


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1 (3) Serologic testing, including the number of 

2 pregnant and postpartum individuals tested and the 

3 number of such serologic tests that were positive. 

4 (4) Health care treatment for individuals who 

5 were infected with the virus, including hospitaliza6 tions, emergency room visits, and intensive care unit 

7 admissions. 

8 (5) Health outcomes for pregnant individuals 

9 and infants confirmed or suspected of being infected 

10 with the virus, including— 

11 (A) the number of fatalities and case fa12 talities (expressed as the proportion of individ13 uals who were infected with the virus to individ14 uals who died from the virus); and 

15 (B) the number of stillbirths, infant mor16 tality, pre-term births, infants born with a low17 birth weight, and cesarean section births. 

18 (c) INDIAN HEALTH SERVICE.—In carrying out sub19 section (a), the Secretary shall consult with Indian Tribes 

20 and confer with urban Indian organizations. 

21 (d) DISAGGREGATED INFORMATION.—In carrying 

22 out subsection (a), the Secretary shall disaggregate data 

23 by race, ethnicity, and location. 


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1 (e) UPDATE.—During the COVID–19 public health 

2 emergency, the Secretary shall update the data made 

3 available under this section— 

4 (1) at least on a monthly basis; and 

5 (2) not less than one month after the end of 

6 such public health emergency. 

7 (f) PRIVACY.—In carrying out subsection (a), the 

8 Secretary shall take steps to protect the privacy of individ9 uals pursuant to regulations promulgated under section 

10 264(c) of the Health Insurance Portability and Account11 ability Act of 1996 (42 U.S.C. 1320d–2 note). 

12 (g) GUIDANCE.— 

13 (1) IN GENERAL.—Not later than 30 days after 

14 the date of enactment of this Act, the Secretary 

15 shall issue guidance to States and local public health 

16 departments to ensure that— 

17 (A) laboratories that test specimens for 

18 COVID–19 receive all relevant demographic 

19 data on race, ethnicity, pregnancy status, and 

20 other demographic data as determined by the 

21 Secretary; and 

22 (B) data described in subsection (b) is 

23 disaggregated by race, ethnicity, and location. 


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1 (2) CONSULTATION.—In carrying out para2 graph (1), the Secretary shall consult with Indian 

3 Tribes— 

4 (A) to ensure that such guidance includes 

5 Tribally developed best practices; and 

6 (B) to reduce misclassification of American 

7 Indians and Alaska Natives. 

8 SEC. 1004. INCLUSION OF PREGNANT INDIVIDUALS AND 

9 LACTATING INDIVIDUALS IN VACCINE AND 

10 THERAPEUTIC DEVELOPMENT FOR COVID–19. 

11 The Director of the National Institutes of Health 

12 shall, when safe and appropriate, support and advance the 

13 inclusion of pregnant and lactating individuals in thera14 peutic and vaccine clinical trials with respect to the treat15 ment or prevention of COVID–19, including prioritizing 

16 recommendations made by the Task Force on Research 

17 Specific to Pregnant Women and Lactating Women estab18 lished under section 2041 of the 21st Century Cures Act 

19 (42 U.S.C. 289a–2 note) with respect to including such 

20 individuals in such clinical trials. 

21 SEC. 1005. PUBLIC HEALTH COMMUNICATION REGARDING 

22 MATERNAL CARE DURING COVID–19. 

23 The Director of the Centers for Disease Control and 

24 Prevention shall conduct a public health education cam25 paign to increase access by pregnant individuals, their emVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 ployers, and their health care providers to accurate, evi2 dence-based information on COVID–19 and pregnancy 

3 risks, with a particular focus pregnant individuals in un4 derserved communities. 

5 SEC. 1006. TASK FORCE ON BIRTHING EXPERIENCE AND 

6 SAFE MATERNITY CARE DURING A PUBLIC 

7 HEALTH EMERGENCY. 

8 (a) ESTABLISHMENT.—The Secretary, in consulta9 tion with the Director of the Centers for Disease Control 

10 and Prevention and the Administrator of the Health Re11 sources and Services Administration, shall convene a task 

12 force (in this subsection referred to as the ‘‘Task Force’’) 

13 to develop recommendations, and make such recommenda14 tions publicly available in multiple languages, on respect15 ful maternity care during the COVID–19 public health 

16 emergency and other public health emergencies, with a 

17 particular focus on outcomes for individuals from racial 

18 and ethnic minority groups and other underserved commu19 nities. 

20 (b) CONTENT.—In developing recommendations 

21 under paragraph (1), the Task Force shall address the 

22 following: 

23 (1) Measures to facilitate respectful maternity 

24 care. 


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1 (2) Strategies to increase access to specialized 

2 care for individuals with high-risk pregnancies. 

3 (3) COVID–19 diagnostic testing for pregnant 

4 individuals and individuals in labor. 

5 (4) The designation of a companion during 

6 birthing. 

7 (5) The ability to communicate using an elec8 tronic mobile device during birthing. 

9 (6) With respect to an individual who has the 

10 virus that causes COVID–19— 

11 (A) separation from a newborn after birth; 

12 and 

13 (B) ensuring safety while breastfeeding. 

14 (7) Licensing, training, and reimbursement for 

15 midwives from racial and ethnic minority groups and 

16 underserved communities. 

17 (8) Financial support for perinatal health work18 ers who provide nonclinical support to pregnant indi19 viduals and postpartum individuals from under20 served communities. 

21 (9) The identification and treatment of prenatal 

22 and postpartum mental and behavioral health condi23 tions that may have developed during, or worsened 

24 because of, the COVID–19 public health emergency 


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1 or future public health emergencies, including anx2 iety, substance use disorder, and depression. 

3 (10) Strategies to address hospital capacity 

4 issues in communities with an increase in COVID– 

5 19 cases, or cases of other infectious diseases. 

6 (11) Options for maternal care that reduce 

7 cross-contamination and maintain safety and quality 

8 of care, including auxiliary maternity units and free9 standing birth centers. 

10 (12) Methods to identify and address racism, 

11 bias, and discrimination in treatment, and to provide 

12 support to pregnant and postpartum individuals, in13 cluding— 

14 (A) evaluating the training of hospital staff 

15 on implicit bias and racism and respectful ma16 ternity care; and 

17 (B) the collection of demographic data. 

18 (13) Other matters the Task Force determines 

19 appropriate. 

20 (c) MEMBERSHIP.— 

21 (1) CHAIR.—The Secretary shall select the 

22 chair of the Task Force from among the members 

23 of the Task Force. 

24 (2) COMPOSITION.—The Task Force shall be 

25 composed of— 


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1 (A) representatives of Federal agencies, in2 cluding the agencies listed in paragraph (3); 

3 (B) 3 or more representatives of State, 

4 local, or territorial public health departments 

5 from different areas in the United States that 

6 have a large historically marginalized popu7 lation; 

8 (C) one or more representatives of Tribal 

9 public health departments; 

10 (D) one or more obstetrician-gynecologists 

11 or other physicians who provide obstetric care, 

12 with consideration for physicians who are from, 

13 or work in, communities experiencing a high 

14 rate of mortality and morbidity from COVID– 

15 19; 

16 (E) one or more nurses who provide ob17 stetric care, with consideration for physicians 

18 who are from, or work in, communities experi19 encing a high rate of mortality and morbidity 

20 from COVID–19; 

21 (F) one or more perinatal health workers; 

22 (G) one or more individuals who were 

23 pregnant or gave birth during the COVID–19 

24 public health emergency; 


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1 (H) one or more individuals who had the 

2 virus that causes COVID–19 and later gave 

3 birth; 

4 (I) one or more individuals who have re5 ceived support from a perinatal health; and 

6 (J) 3 or more independent experts who are 

7 racially and ethnically diverse with knowledge 

8 on racial and ethnic disparities in— 

9 (i) public health; 

10 (ii) maternal health; or 

11 (iii) maternal mortality and severe 

12 maternal morbidity. 

13 (3) FEDERAL AGENCIES.—The agencies rep14 resented under paragraph (2)(A) shall include the 

15 following: 

16 (A) The Department of Health and 

17 Human Services. 

18 (B) The Centers for Disease Control and 

19 Prevention. 

20 (C) The Centers for Medicare & Medicaid 

21 Services. 

22 (D) The Health Resources and Services 

23 Administration. 

24 (E) The Indian Health Service. 

25 (F) The National Institutes of Health. 


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1 SEC. 1007. GAO REPORT ON MATERNAL HEALTH AND PUB2 LIC HEALTH EMERGENCY PREPAREDNESS. 

3 (a) IN GENERAL.—Not later than one year after the 

4 date of enactment of this Act, the Comptroller General 

5 of the United States shall submit to Congress a report 

6 on maternal health and public health emergency prepared7 ness. Such report shall include the information and rec8 ommendations described in subsection (b). 

9 (b) CONTENT OF REPORT.—The report under sub10 section (b) shall include the following: 

11 (1) A review of prenatal, labor and delivery, 

12 and postpartum experiences of individuals during 

13 such public health emergency, including— 

14 (A) barriers to accessing pregnancy, birth, 

15 and postpartum care during a pandemic; 

16 (B) public and private insurance coverage 

17 with respect to maternal health care, including 

18 telehealth services; 

19 (C) to the extent practicable, maternal and 

20 infant health outcomes by race and ethnicity 

21 (including quality of care, mortality, morbidity, 

22 cesarean section rates, preterm birth, preva23 lence of prenatal and postpartum mental health 

24 conditions and substance use disorders); 


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1 (D) with respect to such health outcomes, 

2 the impact of Federal and State policy changes 

3 during such public health emergency; 

4 (E) contributing factors to population5 based disparities in health outcomes, including 

6 bias and discrimination toward individuals from 

7 racial and ethnic minority groups; and 

8 (F) the effect of increased unemployment, 

9 paid family leave, changes in health care cov10 erage, and other social determinants of health 

11 for pregnant and postpartum individuals during 

12 the public health emergency. 

13 (2) Recommendations on improving the public 

14 health emergency response and preparedness efforts 

15 of the Federal Government with respect to maternal 

16 health, with a focus on outcomes for pregnant and 

17 postpartum individuals from racial and ethnic mi18 nority groups, including— 

19 (A) improving research, surveillance, and 

20 data collection with respect to maternal health; 

21 (B) factoring maternal health outcomes 

22 and disparities into decisions regarding dis23 tribution of resources; 

24 (C) improving the distribution of public 

25 health funds, data, and information to Indian 


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1 Tribes and Tribal organizations with regard to 

2 maternal health during a public health emer3 gency; and 

4 (D) improving communications during a 

5 public health emergency with— 

6 (i) maternity care providers; 

7 (ii) maternal mental and behavioral 

8 health care providers; 

9 (iii) researchers who specialize in ma10 ternal health, maternal mortality, or severe 

11 maternal morbidity; 

12 (iv) individuals who experienced preg13 nancy or childbirth during the COVID–19 

14 public health emergency; 

15 (v) representatives from community16 based organizations that address maternal 

17 health; and 

18 (vi) perinatal health workers. 

19 TITLE XI—PROTECTING MOMS 

20 AND BABIES AGAINST CLI21 MATE CHANGE 

22 SEC. 1101. DEFINITIONS. 

23 In this title, the following definitions apply: 

24 (1) ADVERSE MATERNAL AND INFANT HEALTH

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1 fant health outcomes’’ includes the outcomes of 

2 preterm birth, low birth weight, stillbirth, infant or 

3 maternal mortality, and severe maternal morbidity. 

4 (2) INSTITUTION OF HIGHER EDUCATION.—The 

5 term ‘‘institution of higher education’’ has the 

6 meaning given such term in section 101 of the High7 er Education Act of 1965 (20 U.S.C. 1001). 

8 (3) MINORITY-SERVING INSTITUTION.—The 

9 term ‘‘minority-serving institution’’ means an entity 

10 specified in any of paragraphs (1) through (7) of 

11 section 371(a) of the Higher Education Act of 1965 

12 (20 U.S.C. 1067q(a)). 

13 (4) RISKS ASSOCIATED WITH CLIMATE

14 CHANGE.—The term ‘‘risks associated with climate 

15 change’’ includes risks associated with extreme heat, 

16 air pollution, extreme weather events, and other en17 vironmental issues associated with climate change 

18 that can result in adverse maternal and infant 

19 health outcomes. 

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

21 the Secretary of Health and Human Services. 

22 (6) STAKEHOLDER ORGANIZATION.—The term 

23 ‘‘stakeholder organization’’ means— 


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1 (A) a community-based organization with 

2 expertise in providing assistance to vulnerable 

3 individuals; 

4 (B) a nonprofit organization with expertise 

5 in maternal or infant health or environmental 

6 justice; and 

7 (C) a patient advocacy organization rep8 resenting vulnerable individuals. 

9 (7) VULNERABLE INDIVIDUAL.—The term ‘‘vul10 nerable individual’’ means— 

11 (A) an individual who is pregnant; 

12 (B) an individual who was pregnant during 

13 any portion of the preceding 1-year period; and 

14 (C) an individual under 3 years of age. 

15 SEC. 1102. GRANT PROGRAM TO PROTECT VULNERABLE 

16 MOTHERS AND BABIES FROM CLIMATE 

17 CHANGE RISKS. 

18 (a) IN GENERAL.—Not later than 180 days after the 

19 date of enactment of this Act, the Secretary shall establish 

20 a grant program (in this section referred to as the ‘‘Pro21 gram’’) to protect vulnerable individuals from risks associ22 ated with climate change. 

23 (b) GRANT AUTHORITY.—In carrying out the Pro24 gram, the Secretary may award, on a competitive basis, 

25 grants to 10 covered entities. 


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1 (c) APPLICATIONS.—To be eligible for a grant under 

2 the Program, a covered entity shall submit to the Sec3 retary an application at such time, in such form, and con4 taining such information as the Secretary may require, 

5 which shall include, at a minimum, a description of the 

6 following: 

7 (1) Plans for the use of grant funds awarded 

8 under the Program and how patients and stake9 holder organizations were involved in the develop10 ment of such plans. 

11 (2) How such grant funds will be targeted to 

12 geographic areas that have disproportionately high 

13 levels of risks associated with climate change for vul14 nerable individuals. 

15 (3) How such grant funds will be used to ad16 dress racial and ethnic disparities in— 

17 (A) adverse maternal and infant health 

18 outcomes; and 

19 (B) exposure to risks associated with cli20 mate change for vulnerable individuals. 

21 (4) Strategies to prevent an initiative assisted 

22 with such grant funds from causing— 

23 (A) adverse environmental impacts; 

24 (B) displacement of residents and busi25 nesses; 


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1 (C) rent and housing price increases; or 

2 (D) disproportionate adverse impacts on 

3 racial and ethnic minority groups and other un4 derserved populations. 

5 (d) SELECTION OF GRANT RECIPIENTS.— 

6 (1) TIMING.—Not later than 270 days after the 

7 date of enactment of this Act, the Secretary shall se8 lect the recipients of grants under the Program. 

9 (2) CONSULTATION.—In selecting covered enti10 ties for grants under the Program, the Secretary 

11 shall consult with— 

12 (A) representatives of stakeholder organi13 zations; 

14 (B) the Administrator of the Environ15 mental Protection Agency; 

16 (C) the Administrator of the National Oce17 anic and Atmospheric Administration; and 

18 (D) from the Department of Health and 

19 Human Services— 

20 (i) the Deputy Assistant Secretary for 

21 Minority Health; 

22 (ii) the Administrator of the Centers 

23 for Medicare & Medicaid Services; 

24 (iii) the Administrator of the Health 

25 Resources and Services Administration; 


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1 (iv) the Director of the National Insti2 tutes of Health; and 

3 (v) the Director of the Centers for 

4 Disease Control and Prevention. 

5 (3) PRIORITY.—In selecting a covered entity to 

6 be awarded a grant under the Program, the Sec7 retary shall give priority to covered entities that 

8 serve a county— 

9 (A) designated, or located in an area des10 ignated, as a nonattainment area pursuant to 

11 section 107 of the Clean Air Act (42 U.S.C. 

12 7407) for any air pollutant for which air quality 

13 criteria have been issued under section 108(a) 

14 of such Act (42 U.S.C. 7408(a)); 

15 (B) with a level of vulnerability of mod16 erate-to-high or higher, according to the Social 

17 Vulnerability Index of the Centers for Disease 

18 Control and Prevention; or 

19 (C) with temperatures that pose a risk to 

20 human health, as determined by the Secretary, 

21 in consultation with the Administrator of the 

22 National Oceanic and Atmospheric Administra23 tion and the Chair of the United States Global 

24 Change Research Program, based on the best 

25 available science. 


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1 (4) LIMITATION.—A covered entity awarded 

2 grant funds under the Program may not use such 

3 grant funds to serve a county that is served by any 

4 other recipient of a grant under the Program. 

5 (e) USE OF FUNDS.—A covered entity awarded grant 

6 funds under the Program may only use such grant funds 

7 for the following: 

8 (1) Initiatives to identify risks associated with 

9 climate change for vulnerable individuals and to pro10 vide services and support to such individuals that 

11 address such risks, including— 

12 (A) training for health care providers, 

13 doulas, and other employees in hospitals, birth 

14 centers, midwifery practices, and other health 

15 care practices that provide prenatal or labor 

16 and delivery services to vulnerable individuals 

17 on the identification of, and patient counseling 

18 relating to, risks associated with climate change 

19 for vulnerable individuals; 

20 (B) hiring, training, or providing resources 

21 to community health workers and perinatal 

22 health workers who can help identify risks asso23 ciated with climate change for vulnerable indi24 viduals, provide patient counseling about such 


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1 risks, and carry out the distribution of relevant 

2 services and support; 

3 (C) enhancing the monitoring of risks as4 sociated with climate change for vulnerable in5 dividuals, including by— 

6 (i) collecting data on such risks in 

7 specific census tracts, neighborhoods, or 

8 other geographic areas; and 

9 (ii) sharing such data with local 

10 health care providers, doulas, and other 

11 employees in hospitals, birth centers, mid12 wifery practices, and other health care 

13 practices that provide prenatal or labor 

14 and delivery services to local vulnerable in15 dividuals; and 

16 (D) providing vulnerable individuals— 

17 (i) air conditioning units, residential 

18 weatherization support, filtration systems, 

19 household appliances, or related items; 

20 (ii) direct financial assistance; and 

21 (iii) services and support, including 

22 housing and transportation assistance, to 

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1 canes, wildfires, droughts, and related 

2 events. 

3 (2) Initiatives to mitigate levels of and exposure 

4 to risks associated with climate change for vulner5 able individuals, which shall be based on the best 

6 available science and which may include initiatives 

7 to— 

8 (A) develop, maintain, or expand urban or 

9 community forestry initiatives and tree canopy 

10 coverage initiatives; 

11 (B) improve infrastructure, including 

12 buildings and paved surfaces; 

13 (C) develop or improve community out14 reach networks to provide culturally and lin15 guistically appropriate information and notifica16 tions about risks associated with climate change 

17 for vulnerable individuals; and 

18 (D) provide enhanced services to racial and 

19 ethnic minority groups and other underserved 

20 populations. 

21 (f) LENGTH OF AWARD.—A grant under this section 

22 shall be disbursed over 4 fiscal years. 

23 (g) TECHNICAL ASSISTANCE.—The Secretary shall 

24 provide technical assistance to a covered entity awarded 

25 a grant under the Program to support the development, 


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1 implementation, and evaluation of activities funded with 

2 such grant. 

3 (h) REPORTS TO SECRETARY.— 

4 (1) ANNUAL REPORT.—For each fiscal year 

5 during which a covered entity is disbursed grant 

6 funds under the Program, such covered entity shall 

7 submit to the Secretary a report that summarizes 

8 the activities carried out by such covered entity with 

9 such grant funds during such fiscal year, including 

10 a description of the following: 

11 (A) The involvement of stakeholder organi12 zations in the implementation of initiatives as13 sisted with such grant funds. 

14 (B) Relevant health and environmental 

15 data, disaggregated, to the extent practicable, 

16 by race, ethnicity, gender, and pregnancy sta17 tus. 

18 (C) Qualitative feedback received from vul19 nerable individuals with respect to initiatives 

20 assisted with such grant funds. 

21 (D) Criteria used in selecting the geo22 graphic areas assisted with such grant funds. 

23 (E) Efforts to address racial and ethnic 

24 disparities in adverse maternal and infant 

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1 ated with climate change for vulnerable individ2 uals. 

3 (F) Any negative and unintended impacts 

4 of initiatives assisted with such grant funds, in5 cluding— 

6 (i) adverse environmental impacts; 

7 (ii) displacement of residents and 

8 businesses; 

9 (iii) rent and housing price increases; 

10 and 

11 (iv) disproportionate adverse impacts 

12 on racial and ethnic minority groups and 

13 other underserved populations. 

14 (G) How the covered entity will address 

15 and prevent any impacts described in subpara16 graph (F). 

17 (2) PUBLICATION.—Not later than 30 days 

18 after the date on which a report is submitted under 

19 paragraph (1), the Secretary shall publish such re20 port on a public website of the Department of 

21 Health and Human Services. 

22 (i) REPORT TO CONGRESS.—Not later than the date 

23 that is 5 years after the date on which the Program is 

24 established, the Secretary shall submit to Congress and 

25 publish on a public website of the Department of Health 


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1 and Human Services a report on the results of the Pro2 gram, including the following: 

3 (1) Summaries of the annual reports submitted 

4 under subsection (h). 

5 (2) Evaluations of the initiatives assisted with 

6 grant funds under the Program. 

7 (3) An assessment of the effectiveness of the 

8 Program in— 

9 (A) identifying risks associated with cli10 mate change for vulnerable individuals; 

11 (B) providing services and support to such 

12 individuals; 

13 (C) mitigating levels of and exposure to 

14 such risks; and 

15 (D) addressing racial and ethnic disparities 

16 in adverse maternal and infant health outcomes 

17 and in exposure to such risks. 

18 (4) A description of how the Program could be 

19 expanded, including— 

20 (A) monitoring efforts or data collection 

21 that would be required to identify areas with 

22 high levels of risks associated with climate 

23 change for vulnerable individuals; 


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1 (B) how such areas could be identified 

2 using the strategy developed under section 5; 

3 and 

4 (C) recommendations for additional fund5 ing. 

6 (j) DEFINITION OF COVERED ENTITY.—In this sec7 tion, the term ‘‘covered entity’’ means a consortium of or8 ganizations serving a county that— 

9 (1) shall include a community-based organiza10 tion; and 

11 (2) may include— 

12 (A) another stakeholder organization; 

13 (B) the government of such county; 

14 (C) the governments of one or more mu15 nicipalities within such county; 

16 (D) a State or local public health depart17 ment or emergency management agency; 

18 (E) a local health care practice, which may 

19 include a licensed and accredited hospital, birth 

20 center, midwifery practice, or other health care 

21 practice that provides prenatal or labor and de22 livery services to vulnerable individuals; 

23 (F) an Indian Tribe or Tribal organization 

24 (as such terms are defined in section 4 of the 


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1 Indian Self-Determination and Education As2 sistance Act (25 U.S.C. 5304)); 

3 (G) an Urban Indian organization (as de4 fined in section 4 of the Indian Health Care 

5 Improvement Act (25 U.S.C. 1603)); and 

6 (H) an institution of higher education. 

7 (k) AUTHORIZATION OF APPROPRIATIONS.—There is 

8 authorized to be appropriated to carry out this section 

9 $100,000,000 for the period of fiscal years 2022 through 

10 2025. 

11 SEC. 1103. GRANT PROGRAM FOR EDUCATION AND TRAIN12 ING AT HEALTH PROFESSION SCHOOLS. 

13 (a) IN GENERAL.—Not later than 1 year after the 

14 date of enactment of this Act, the Secretary shall establish 

15 a grant program (in this section referred to as the ‘‘Pro16 gram’’) to provide funds to health profession schools to 

17 support the development and integration of education and 

18 training programs for identifying and addressing risks as19 sociated with climate change for vulnerable individuals. 

20 (b) GRANT AUTHORITY.—In carrying out the Pro21 gram, the Secretary may award, on a competitive basis, 

22 grants to health profession schools. 

23 (c) APPLICATION.—To be eligible for a grant under 

24 the Program, a health profession school shall submit to 

25 the Secretary an application at such time, in such form, 


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1 and containing such information as the Secretary may re2 quire, including a description of the following: 

3 (1) How such health profession school will en4 gage with vulnerable individuals, and stakeholder or5 ganizations representing such individuals, in devel6 oping and implementing the education and training 

7 programs supported by grant funds awarded under 

8 the Program. 

9 (2) How such health profession school will en10 sure that such education and training programs will 

11 address racial and ethnic disparities in exposure to, 

12 and the effects of, risks associated with climate 

13 change for vulnerable individuals. 

14 (d) USE OF FUNDS.—A health profession school 

15 awarded a grant under the Program shall use the grant 

16 funds to develop, and integrate into the curriculum and 

17 continuing education of such health profession school, edu18 cation and training on each of the following: 

19 (1) Identifying risks associated with climate 

20 change for vulnerable individuals and individuals 

21 with the intent to become pregnant. 

22 (2) How risks associated with climate change 

23 affect vulnerable individuals and individuals with the 

24 intent to become pregnant. 


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1 (3) Racial and ethnic disparities in exposure to, 

2 and the effects of, risks associated with climate 

3 change for vulnerable individuals and individuals 

4 with the intent to become pregnant. 

5 (4) Patient counseling and mitigation strategies 

6 relating to risks associated with climate change for 

7 vulnerable individuals. 

8 (5) Relevant services and support for vulnerable 

9 individuals relating to risks associated with climate 

10 change and strategies for ensuring vulnerable indi11 viduals have access to such services and support. 

12 (6) Implicit and explicit bias, racism, and dis13 crimination. 

14 (7) Related topics identified by such health pro15 fession school based on the engagement of such 

16 health profession school with vulnerable individuals 

17 and stakeholder organizations representing such in18 dividuals. 

19 (e) PARTNERSHIPS.—In carrying out activities with 

20 grant funds, a health profession school awarded a grant 

21 under the Program may partner with— 

22 (1) a State or local public health department; 

23 (2) a health care professional membership orga24 nization; 

25 (3) a stakeholder organization; 


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1 (4) a health profession school; or 

2 (5) an institution of higher education. 

3 (f) REPORTS TO SECRETARY.— 

4 (1) ANNUAL REPORT.—For each fiscal year 

5 during which a health profession school is disbursed 

6 grant funds under the Program, such health profes7 sion school shall submit to the Secretary a report 

8 that describes the activities carried out with such 

9 grant funds during such fiscal year. 

10 (2) FINAL REPORT.—Not later than the date 

11 that is 1 year after the end of the last fiscal year 

12 during which a health profession school is disbursed 

13 grant funds under the Program, the health profes14 sion school shall submit to the Secretary a final re15 port that summarizes the activities carried out with 

16 such grant funds. 

17 (g) REPORT TO CONGRESS.—Not later than the date 

18 that is 6 years after the date on which the Program is 

19 established, the Secretary shall submit to Congress and 

20 publish on a public website of the Department of Health 

21 and Human Services a report that includes— 

22 (1) a summary of the reports submitted under 

23 subsection (f); and 

24 (2) recommendations to improve education and 

25 training programs at health profession schools with 


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1 respect to identifying and addressing risks associ2 ated with climate change for vulnerable individuals. 

3 (h) DEFINITION OF HEALTH PROFESSION

4 SCHOOL.—In this section, the term ‘‘health profession 

5 school’’ means an accredited— 

6 (1) medical school; 

7 (2) school of nursing; 

8 (3) midwifery program; 

9 (4) physician assistant education program; 

10 (5) teaching hospital; 

11 (6) residency or fellowship program; or 

12 (7) other school or program determined appro13 priate by the Secretary. 

14 (i) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section 

16 $5,000,000 for the period of fiscal years 2022 through 

17 2025. 

18 SEC. 1104. NIH CONSORTIUM ON BIRTH AND CLIMATE 

19 CHANGE RESEARCH. 

20 (a) ESTABLISHMENT.—Not later than one year after 

21 the date of enactment of this Act, the Director of the Na22 tional Institutes of Health shall establish the Consortium 

23 on Birth and Climate Change Research (in this section 

24 referred to as the ‘‘Consortium’’). 

25 (b) DUTIES.— 


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1 (1) IN GENERAL.—The Consortium shall co2 ordinate, across the institutes, centers, and offices of 

3 the National Institutes of Health, research on the 

4 risks associated with climate change for vulnerable 

5 individuals. 

6 (2) REQUIRED ACTIVITIES.—In carrying out 

7 paragraph (1), the Consortium shall— 

8 (A) establish research priorities, including 

9 by prioritizing research that— 

10 (i) identifies the risks associated with 

11 climate change for vulnerable individuals 

12 with a particular focus on disparities in 

13 such risks among racial and ethnic minor14 ity groups and other underserved popu15 lations; and 

16 (ii) identifies strategies to reduce lev17 els of, and exposure to, such risks, with a 

18 particular focus on risks among racial and 

19 ethnic minority groups and other under20 served populations; 

21 (B) identify gaps in available data related 

22 to such risks; 

23 (C) identify gaps in, and opportunities for, 

24 research collaborations; 


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1 (D) identify funding opportunities for com2 munity-based organizations and researchers 

3 from racially, ethnically, and geographically di4 verse backgrounds; and 

5 (E) publish annual reports on the work 

6 and findings of the Consortium on a public 

7 website of the National Institutes of Health. 

8 (c) MEMBERSHIP.—The Director of the National In9 stitutes of Health shall appoint to the Consortium rep10 resentatives of such institutes, centers, and offices of the 

11 National Institutes of Health as the Director considers ap12 propriate, including representatives of— 

13 (1) the National Institute of Environmental 

14 Health Sciences; 

15 (2) the National Institute on Minority Health 

16 and Health Disparities; 

17 (3) the Eunice Kennedy Shriver National Insti18 tute of Child Health and Human Development; 

19 (4) the National Institute of Nursing Research; 

20 and 

21 (5) the Office of Research on Women’s Health. 

22 (d) CHAIRPERSON.—The Chairperson of the Consor23 tium shall be designated by the Director and selected from 

24 among the representatives appointed under subsection (c). 


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1 (e) CONSULTATION.—In carrying out the duties de2 scribed in subsection (b), the Consortium shall consult 

3 with— 

4 (1) the heads of relevant Federal agencies, in5 cluding— 

6 (A) the Environmental Protection Agency; 

7 (B) the National Oceanic and Atmospheric 

8 Administration; 

9 (C) the Occupational Safety and Health 

10 Administration; and 

11 (D) from the Department of Health and 

12 Human Services— 

13 (i) the Office of Minority Health in 

14 the Office of the Secretary; 

15 (ii) the Centers for Medicare & Med16 icaid Services; 

17 (iii) the Health Resources and Serv18 ices Administration; 

19 (iv) the Centers for Disease Control 

20 and Prevention; 

21 (v) the Indian Health Service; and 

22 (vi) the Administration for Children 

23 and Families; and 

24 (2) representatives of— 

25 (A) stakeholder organizations; 


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1 (B) health care providers and professional 

2 membership organizations with expertise in ma3 ternal health or environmental justice; 

4 (C) State and local public health depart5 ments; 

6 (D) licensed and accredited hospitals, birth 

7 centers, midwifery practices, or other health 

8 care practices that provide prenatal or labor 

9 and delivery services to vulnerable individuals; 

10 and 

11 (E) institutions of higher education, in12 cluding such institutions that are minority-serv13 ing institutions or have expertise in maternal 

14 health or environmental justice. 

15 SEC. 1105. STRATEGY FOR IDENTIFYING CLIMATE CHANGE 

16 RISK ZONES FOR VULNERABLE MOTHERS 

17 AND BABIES. 

18 (a) IN GENERAL.—The Secretary, acting through the 

19 Director of the Centers for Disease Control and Preven20 tion, shall develop a strategy (in this section referred to 

21 as the ‘‘Strategy’’) for designating areas that the Sec22 retary determines to have a high risk of adverse maternal 

23 and infant health outcomes among vulnerable individuals 

24 as a result of risks associated with climate change. 

25 (b) STRATEGY REQUIREMENTS.— 


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1 (1) IN GENERAL.—In developing the Strategy, 

2 the Secretary shall establish a process to identify 

3 areas where vulnerable individuals are exposed to a 

4 high risk of adverse maternal and infant health out5 comes as a result of risks associated with climate 

6 change in conjunction with other factors that can 

7 impact such health outcomes, including— 

8 (A) the incidence of diseases associated 

9 with air pollution, extreme heat, and other envi10 ronmental factors; 

11 (B) the availability and accessibility of ma12 ternal and infant health care providers; 

13 (C) English-language proficiency among 

14 women of reproductive age; 

15 (D) the health insurance status of women 

16 of reproductive age; 

17 (E) the number of women of reproductive 

18 age who are members of racial or ethnic groups 

19 with disproportionately high rates of adverse 

20 maternal and infant health outcomes; 

21 (F) the socioeconomic status of women of 

22 reproductive age, including with respect to— 

23 (i) poverty; 

24 (ii) unemployment; 

25 (iii) household income; and 


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1 (iv) educational attainment; and 

2 (G) access to quality housing, transpor3 tation, and nutrition. 

4 (2) RESOURCES.—In developing the Strategy, 

5 the Secretary shall identify, and incorporate a de6 scription of, the following: 

7 (A) Existing mapping tools or Federal pro8 grams that identify— 

9 (i) risks associated with climate 

10 change for vulnerable individuals; and 

11 (ii) other factors that can influence 

12 maternal and infant health outcomes, in13 cluding the factors described in paragraph 

14 (1). 

15 (B) Environmental, health, socioeconomic, 

16 and demographic data relevant to identifying 

17 risks associated with climate change for vulner18 able individuals. 

19 (C) Existing monitoring networks that col20 lect data described in subparagraph (B), and 

21 any gaps in such networks. 

22 (D) Federal, State, and local stakeholders 

23 involved in maintaining monitoring networks 

24 identified under subparagraph (C), and how 


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1 such stakeholders are coordinating their moni2 toring efforts. 

3 (E) Additional monitoring networks, and 

4 enhancements to existing monitoring networks, 

5 that would be required to address gaps identi6 fied under subparagraph (C), including at the 

7 subcounty and census tract level. 

8 (F) Funding amounts required to establish 

9 the monitoring networks identified under sub10 paragraph (E) and recommendations for Fed11 eral, State, and local coordination with respect 

12 to such networks. 

13 (G) Potential uses for data collected and 

14 generated as a result of the Strategy, including 

15 how such data may be used in determining re16 cipients of grants under the program estab17 lished by section 2 or other similar programs. 

18 (H) Other information the Secretary con19 siders relevant for the development of the Strat20 egy. 

21 (c) COORDINATION AND CONSULTATION.—In devel22 oping the Strategy, the Secretary shall— 

23 (1) coordinate with the Administrator of the 

24 Environmental Protection Agency and the AdminisVerDate Sep 11 2014 21:40 Mar 08, 2021 Jkt 019200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\S346.IS S346

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1 trator of the National Oceanic and Atmospheric Ad2 ministration; and 

3 (2) consult with— 

4 (A) stakeholder organizations; 

5 (B) health care providers and professional 

6 membership organizations with expertise in ma7 ternal health or environmental justice; 

8 (C) State and local public health depart9 ments; 

10 (D) licensed and accredited hospitals, birth 

11 centers, midwifery practices, or other health 

12 care providers that provide prenatal or labor 

13 and delivery services to vulnerable individuals; 

14 and 

15 (E) institutions of higher education, in16 cluding such institutions that are minority-serv17 ing institutions or have expertise in maternal 

18 health or environmental justice. 

19 (d) NOTICE AND COMMENT.—At least 240 days be20 fore the date on which the Strategy is published in accord21 ance with subsection (e), the Secretary shall provide— 

22 (1) notice of the Strategy on a public website 

23 of the Department of Health and Human Services; 

24 and 


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1 (2) an opportunity for public comment of at 

2 least 90 days. 

3 (e) PUBLICATION.—Not later than 18 months after 

4 the date of enactment of this Act, the Secretary shall pub5 lish on a public website of the Department of Health and 

6 Human Services— 

7 (1) the Strategy; 

8 (2) the public comments received under sub9 section (d); and 

10 (3) the responses of the Secretary to such pub11 lic comments. 

12 TITLE XII—MATERNAL 

13 VACCINATIONS 

14 SEC. 1201. MATERNAL VACCINATION AWARENESS AND EQ15 UITY CAMPAIGN. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services (in this section referred to as the ‘‘Sec18 retary’’), acting through the Director of the Centers for 

19 Disease Control and Prevention, shall carry out a national 

20 campaign to— 

21 (1) increase awareness of the importance of ma22 ternal vaccinations for the health of pregnant and 

23 postpartum individuals and their children; and 


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1 (2) increase maternal vaccination rates, with a 

2 focus on communities with historically high rates of 

3 unvaccinated individuals. 

4 (b) CONSULTATION.—In carrying out the campaign 

5 under this section, the Secretary shall consult with rel6 evant community-based organizations, health care profes7 sional associations and public health associations, State 

8 public health departments and local public health depart9 ments, Tribal-serving organizations, nonprofit organiza10 tions, and nationally recognized private entities. 

11 (c) ACTIVITIES.—The campaign under this section 

12 shall— 

13 (1) focus on increasing maternal vaccination 

14 rates in communities with historically high rates of 

15 unvaccinated individuals, including for pregnant and 

16 postpartum individuals from racial and ethnic mi17 nority groups; 

18 (2) include efforts to engage with pregnant and 

19 postpartum individuals in communities with histori20 cally high rates of unvaccinated individuals to seek 

21 input on the development and effectiveness of the 

22 campaign; 

23 (3) provide evidence-based, culturally congruent 

24 resources and communications efforts; and 


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1 (4) be carried out in partnership with trusted 

2 individuals and entities in communities with histori3 cally high rates of unvaccinated individuals, includ4 ing community-based organizations, community 

5 health centers, perinatal health workers, and mater6 nity care providers. 

7 (d) COLLABORATION.—The Secretary shall ensure 

8 that the information and resources developed for the cam9 paign under this section are made publicly available and 

10 shared with relevant Federal, State, and local entities. 

11 (e) EVALUATION.—Not later than the end of fiscal 

12 year 2025, the Secretary shall— 

13 (1) establish quantitative and qualitative 

14 metrics to evaluate the campaign under this section; 

15 and 

16 (2) submit a report detailing the impact of the 

17 campaign under this section to Congress. 

18 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there is authorized to be appropriated 

20 $2,000,000 for each of fiscal years 2022 through 2026. 

Æ 


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