```

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 423 Introduced in Senate (IS)]

<DOC>

117th CONGRESS
  1st Session
                                 S. 423

  To direct the Secretary of Health and Human Services to establish a 
  grant program to protect vulnerable mothers and babies from climate 
                 change risks, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           February 24, 2021

Mr. Markey (for himself, Mr. Merkley, Mr. Blumenthal, Mr. Sanders, and 
  Mr. Bennet) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
  To direct the Secretary of Health and Human Services to establish a 
  grant program to protect vulnerable mothers and babies from climate 
                 change risks, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Protecting Moms 
and Babies Against Climate Change Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Grant program to protect vulnerable mothers and babies from 
                            climate change risks.
Sec. 3. Grant program for education and training at health profession 
                            schools.
Sec. 4. NIH Consortium on Birth and Climate Change Research.
Sec. 5. Strategy for identifying climate change risk zones for 
                            vulnerable mothers and babies.
Sec. 6. Definitions.

SEC. 2. GRANT PROGRAM TO PROTECT VULNERABLE MOTHERS AND BABIES FROM 
              CLIMATE CHANGE RISKS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
establish a grant program (in this section referred to as the 
``Program'') to protect vulnerable individuals from risks associated 
with climate change.
    (b) Grant Authority.--In carrying out the Program, the Secretary 
may award, on a competitive basis, grants to 10 covered entities.
    (c) Applications.--To be eligible for a grant under the Program, a 
covered entity shall submit to the Secretary an application at such 
time, in such form, and containing such information as the Secretary 
may require, which shall include, at a minimum, a description of the 
following:
            (1) Plans for the use of grant funds awarded under the 
        Program and how patients and stakeholder organizations were 
        involved in the development of such plans.
            (2) How such grant funds will be targeted to geographic 
        areas that have disproportionately high levels of risks 
        associated with climate change for vulnerable individuals.
            (3) How such grant funds will be used to address racial and 
        ethnic disparities in--
                    (A) adverse maternal and infant health outcomes; 
                and
                    (B) exposure to risks associated with climate 
                change for vulnerable individuals.
            (4) Strategies to prevent an initiative assisted with such 
        grant funds from causing--
                    (A) adverse environmental impacts;
                    (B) displacement of residents and businesses;
                    (C) rent and housing price increases; or
                    (D) disproportionate adverse impacts on racial and 
                ethnic minority groups and other underserved 
                populations.
    (d) Selection of Grant Recipients.--
            (1) Timing.--Not later than 270 days after the date of the 
        enactment of this Act, the Secretary shall select the 
        recipients of grants under the Program.
            (2) Consultation.--In selecting covered entities for grants 
        under the Program, the Secretary shall consult with--
                    (A) representatives of stakeholder organizations;
                    (B) the Administrator of the Environmental 
                Protection Agency;
                    (C) the Administrator of the National Oceanic and 
                Atmospheric Administration; and
                    (D) from the Department of Health and Human 
                Services--
                            (i) the Deputy Assistant Secretary for 
                        Minority Health;
                            (ii) the Administrator of the Centers for 
                        Medicare & Medicaid Services;
                            (iii) the Administrator of the Health 
                        Resources and Services Administration;
                            (iv) the Director of the National 
                        Institutes of Health; and
                            (v) the Director of the Centers for Disease 
                        Control and Prevention.
            (3) Priority.--In selecting a covered entity to be awarded 
        a grant under the Program, the Secretary shall give priority to 
        covered entities that serve a county--
                    (A) designated, or located in an area designated, 
                as a nonattainment area pursuant to section 107 of the 
                Clean Air Act (42 U.S.C. 7407) for any air pollutant 
                for which air quality criteria have been issued under 
                section 108(a) of such Act (42 U.S.C. 7408(a));
                    (B) with a level of vulnerability of moderate-to-
                high or higher, according to the Social Vulnerability 
                Index of the Centers for Disease Control and 
                Prevention; or
                    (C) with temperatures that pose a risk to human 
                health, as determined by the Secretary, in consultation 
                with the Administrator of the National Oceanic and 
                Atmospheric Administration and the Chair of the United 
                States Global Change Research Program, based on the 
                best available science.
            (4) Limitation.--A recipient of grant funds under the 
        Program may not use such grant funds to serve a county that is 
        served by any other recipient of a grant under the Program.
    (e) Use of Funds.--A covered entity awarded grant funds under the 
Program may only use such grant funds for the following:
            (1) Initiatives to identify risks associated with climate 
        change for vulnerable individuals and to provide services and 
        support to such individuals that address such risks, which may 
        include--
                    (A) training for health care providers, doulas, and 
                other employees in hospitals, birth centers, midwifery 
                practices, and other health care practices that provide 
                prenatal or labor and delivery services to vulnerable 
                individuals on the identification of, and patient 
                counseling relating to, risks associated with climate 
                change for vulnerable individuals;
                    (B) hiring, training, or providing resources to 
                community health workers and perinatal health workers 
                who can help identify risks associated with climate 
                change for vulnerable individuals, provide patient 
                counseling about such risks, and carry out the 
                distribution of relevant services and support;
                    (C) enhancing the monitoring of risks associated 
                with climate change for vulnerable individuals, 
                including by--
                            (i) collecting data on such risks in 
                        specific census tracts, neighborhoods, or other 
                        geographic areas; and
                            (ii) sharing such data with local health 
                        care providers, doulas, and other employees in 
                        hospitals, birth centers, midwifery practices, 
                        and other health care practices that provide 
                        prenatal or labor and delivery services to 
                        local vulnerable individuals; and
                    (D) providing vulnerable individuals--
                            (i) air conditioning units, residential 
                        weatherization support, filtration systems, 
                        household appliances, or related items;
                            (ii) direct financial assistance; and
                            (iii) services and support, including 
                        housing and transportation assistance, to 
                        prepare for or recover from extreme weather 
                        events, which may include floods, hurricanes, 
                        wildfires, droughts, and related events.
            (2) Initiatives to mitigate levels of and exposure to risks 
        associated with climate change for vulnerable individuals, 
        which shall be based on the best available science and which 
        may include initiatives to--
                    (A) develop, maintain, or expand urban or community 
                forestry initiatives and tree canopy coverage 
                initiatives;
                    (B) improve infrastructure, including buildings and 
                paved surfaces;
                    (C) develop or improve community outreach networks 
                to provide culturally and linguistically appropriate 
                information and notifications about risks associated 
                with climate change for vulnerable individuals; and
                    (D) provide enhanced services to racial and ethnic 
                minority groups and other underserved populations.
    (f) Length of Award.--A grant under this section shall be disbursed 
over 4 fiscal years.
    (g) Technical Assistance.--The Secretary shall provide technical 
assistance to a covered entity awarded a grant under the Program to 
support the development, implementation, and evaluation of activities 
funded with such grant.
    (h) Reports to Secretary.--
            (1) Annual report.--For each fiscal year during which a 
        covered entity is disbursed grant funds under the Program, such 
        covered entity shall submit to the Secretary a report that 
        summarizes the activities carried out by such covered entity 
        with such grant funds during such fiscal year, which shall 
        include a description of the following:
                    (A) The involvement of stakeholder organizations in 
                the implementation of initiatives assisted with such 
                grant funds.
                    (B) Relevant health and environmental data, 
                disaggregated, to the extent practicable, by race, 
                ethnicity, gender, and pregnancy status.
                    (C) Qualitative feedback received from vulnerable 
                individuals with respect to initiatives assisted with 
                such grant funds.
                    (D) Criteria used in selecting the geographic areas 
                assisted with such grant funds.
                    (E) Efforts to address racial and ethnic 
                disparities in adverse maternal and infant health 
                outcomes and in exposure to risks associated with 
                climate change for vulnerable individuals.
                    (F) Any negative and unintended impacts of 
                initiatives assisted with such grant funds, including--
                            (i) adverse environmental impacts;
                            (ii) displacement of residents and 
                        businesses;
                            (iii) rent and housing price increases; and
                            (iv) disproportionate adverse impacts on 
                        racial and ethnic minority groups and other 
                        underserved populations.
                    (G) How the covered entity will address and prevent 
                any impacts described in subparagraph (F).
            (2) Publication.--Not later than 30 days after the date on 
        which a report is submitted under paragraph (1), the Secretary 
        shall publish such report on a public website of the Department 
        of Health and Human Services.
    (i) Report to Congress.--Not later than the date that is 5 years 
after the date on which the Program is established, the Secretary shall 
submit to Congress and publish on a public website of the Department of 
Health and Human Services a report on the results of the Program, 
including the following:
            (1) Summaries of the annual reports submitted under 
        subsection (h).
            (2) Evaluations of the initiatives assisted with grant 
        funds under the Program.
            (3) An assessment of the effectiveness of the Program in--
                    (A) identifying risks associated with climate 
                change for vulnerable individuals;
                    (B) providing services and support to such 
                individuals;
                    (C) mitigating levels of and exposure to such 
                risks; and
                    (D) addressing racial and ethnic disparities in 
                adverse maternal and infant health outcomes and in 
                exposure to such risks.
            (4) A description of how the Program could be expanded, 
        including--
                    (A) monitoring efforts or data collection that 
                would be required to identify areas with high levels of 
                risks associated with climate change for vulnerable 
                individuals;
                    (B) how such areas could be identified using the 
                strategy developed under section 5; and
                    (C) recommendations for additional funding.
    (j) Covered Entity Defined.--In this section, the term ``covered 
entity'' means a consortium of organizations serving a county that--
            (1) shall include a community-based organization; and
            (2) may include--
                    (A) another stakeholder organization;
                    (B) the government of such county;
                    (C) the governments of one or more municipalities 
                within such county;
                    (D) a State or local public health department or 
                emergency management agency;
                    (E) a local health care practice, which may include 
                a licensed and accredited hospital, birth center, 
                midwifery practice, or other health care practice that 
                provides prenatal or labor and delivery services to 
                vulnerable individuals;
                    (F) an Indian tribe or tribal organization (as such 
                terms are defined in section 4 of the Indian Self-
                Determination and Education Assistance Act (25 U.S.C. 
                5304));
                    (G) an Urban Indian organization (as defined in 
                section 4 of the Indian Health Care Improvement Act (25 
                U.S.C. 1603)); and
                    (H) an institution of higher education.
    (k) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $100,000,000 for fiscal years 
2021 through 2024.

SEC. 3. GRANT PROGRAM FOR EDUCATION AND TRAINING AT HEALTH PROFESSION 
              SCHOOLS.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
establish a grant program (in this section referred to as the 
``Program'') to provide funds to health profession schools to support 
the development and integration of education and training programs for 
identifying and addressing risks associated with climate change for 
vulnerable individuals.
    (b) Grant Authority.--In carrying out the Program, the Secretary 
may award, on a competitive basis, grants to health profession schools.
    (c) Application.--To be eligible for a grant under the Program, a 
health profession school shall submit to the Secretary an application 
at such time, in such form, and containing such information as the 
Secretary may require, which shall include, at a minimum, a description 
of the following:
            (1) How such health profession school will engage with 
        vulnerable individuals, and stakeholder organizations 
        representing such individuals, in developing and implementing 
        the education and training programs supported by grant funds 
        awarded under the Program.
            (2) How such health profession school will ensure that such 
        education and training programs will address racial and ethnic 
        disparities in exposure to, and the effects of, risks 
        associated with climate change for vulnerable individuals.
    (d) Use of Funds.--A health profession school awarded a grant under 
the Program shall use the grant funds to develop, and integrate into 
the curriculum and continuing education of such health profession 
school, education and training on each of the following:
            (1) Identifying risks associated with climate change for 
        vulnerable individuals and individuals with the intent to 
        become pregnant.
            (2) How risks associated with climate change affect 
        vulnerable individuals and individuals with the intent to 
        become pregnant.
            (3) Racial and ethnic disparities in exposure to, and the 
        effects of, risks associated with climate change for vulnerable 
        individuals and individuals with the intent to become pregnant.
            (4) Patient counseling and mitigation strategies relating 
        to risks associated with climate change for vulnerable 
        individuals.
            (5) Relevant services and support for vulnerable 
        individuals relating to risks associated with climate change 
        and strategies for ensuring vulnerable individuals have access 
        to such services and support.
            (6) Implicit and explicit bias, racism, and discrimination.
            (7) Related topics identified by such health profession 
        school based on the engagement of such health profession school 
        with vulnerable individuals and stakeholder organizations 
        representing such individuals.
    (e) Partnerships.--In carrying out activities with grant funds, a 
health profession school awarded a grant under the Program may partner 
with one or more of the following:
            (1) A State or local public health department.
            (2) A health care professional membership organization.
            (3) A stakeholder organization.
            (4) A health profession school.
            (5) An institution of higher education.
    (f) Reports to Secretary.--
            (1) Annual report.--For each fiscal year during which a 
        health profession school is disbursed grant funds under the 
        Program, such health profession school shall submit to the 
        Secretary a report that describes the activities carried out 
        with such grant funds during such fiscal year.
            (2) Final report.--Not later than the date that is 1 year 
        after the end of the last fiscal year during which a health 
        profession school is disbursed grant funds under the Program, 
        the health profession school shall submit to the Secretary a 
        final report that summarizes the activities carried out with 
        such grant funds.
    (g) Report to Congress.--Not later than the date that is 6 years 
after the date on which the Program is established, the Secretary shall 
submit to Congress and publish on a public website of the Department of 
Health and Human Services a report that includes the following:
            (1) A summary of the reports submitted under subsection 
        (f).
            (2) Recommendations to improve education and training 
        programs at health profession schools with respect to 
        identifying and addressing risks associated with climate change 
        for vulnerable individuals.
    (h) Health Profession School Defined.--In this section, the term 
``health profession school'' means an accredited--
            (1) medical school;
            (2) school of nursing;
            (3) midwifery program;
            (4) physician assistant education program;
            (5) teaching hospital;
            (6) residency or fellowship program; or
            (7) other school or program determined appropriate by the 
        Secretary.
    (i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for fiscal years 2021 
through 2024.

SEC. 4. NIH CONSORTIUM ON BIRTH AND CLIMATE CHANGE RESEARCH.

    (a) Establishment.--Not later than 1 year after the date of the 
enactment of this Act, the Director of the National Institutes of 
Health shall establish the Consortium on Birth and Climate Change 
Research (in this section referred to as the ``Consortium'').
    (b) Duties.--
            (1) In general.--The Consortium shall coordinate, across 
        the institutes, centers, and offices of the National Institutes 
        of Health, research on the risks associated with climate change 
        for vulnerable individuals.
            (2) Required activities.--In carrying out paragraph (1), 
        the Consortium shall--
                    (A) establish research priorities, including by 
                prioritizing research that--
                            (i) identifies the risks associated with 
                        climate change for vulnerable individuals with 
                        a particular focus on disparities in such risks 
                        among racial and ethnic minority groups and 
                        other underserved populations; and
                            (ii) identifies strategies to reduce levels 
                        of, and exposure to, such risks, with a 
                        particular focus on risks among racial and 
                        ethnic minority groups and other underserved 
                        populations;
                    (B) identify gaps in available data related to such 
                risks;
                    (C) identify gaps in, and opportunities for, 
                research collaborations;
                    (D) identify funding opportunities for community-
                based organizations and researchers from racially, 
                ethnically, and geographically diverse backgrounds; and
                    (E) publish annual reports on the work and findings 
                of the Consortium on a public website of the National 
                Institutes of Health.
    (c) Membership.--The Director shall appoint to the Consortium 
representatives of such institutes, centers, and offices of the 
National Institutes of Health as the Director considers appropriate, 
including, at a minimum, representatives of--
            (1) the National Institute of Environmental Health 
        Sciences;
            (2) the National Institute on Minority Health and Health 
        Disparities;
            (3) the Eunice Kennedy Shriver National Institute of Child 
        Health and Human Development;
            (4) the National Institute of Nursing Research; and
            (5) the Office of Research on Women's Health.
    (d) Chairperson.--The Chairperson of the Consortium shall be 
designated by the Director and selected from among the representatives 
appointed under subsection (c).
    (e) Consultation.--In carrying out the duties described in 
subsection (b), the Consortium shall consult with--
            (1) the heads of relevant Federal agencies, including--
                    (A) the Environmental Protection Agency;
                    (B) the National Oceanic and Atmospheric 
                Administration;
                    (C) the Occupational Safety and Health 
                Administration; and
                    (D) from the Department of Health and Human 
                Services--
                            (i) the Office of Minority Health in the 
                        Office of the Secretary;
                            (ii) the Centers for Medicare & Medicaid 
                        Services;
                            (iii) the Health Resources and Services 
                        Administration;
                            (iv) the Centers for Disease Control and 
                        Prevention;
                            (v) the Indian Health Service; and
                            (vi) the Administration for Children and 
                        Families; and
            (2) representatives of--
                    (A) stakeholder organizations;
                    (B) health care providers and professional 
                membership organizations with expertise in maternal 
                health or environmental justice;
                    (C) State and local public health departments;
                    (D) licensed and accredited hospitals, birth 
                centers, midwifery practices, or other health care 
                practices that provide prenatal or labor and delivery 
                services to vulnerable individuals; and
                    (E) institutions of higher education, including 
                such institutions that are minority-serving 
                institutions or have expertise in maternal health or 
                environmental justice.

SEC. 5. STRATEGY FOR IDENTIFYING CLIMATE CHANGE RISK ZONES FOR 
              VULNERABLE MOTHERS AND BABIES.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall develop a strategy (in this section referred to as the 
``Strategy'') for designating areas that the Secretary determines to 
have a high risk of adverse maternal and infant health outcomes among 
vulnerable individuals as a result of risks associated with climate 
change.
    (b) Strategy Requirements.--
            (1) In general.--In developing the Strategy, the Secretary 
        shall establish a process to identify areas where vulnerable 
        individuals are exposed to a high risk of adverse maternal and 
        infant health outcomes as a result of risks associated with 
        climate change in conjunction with other factors that can 
        impact such health outcomes, including--
                    (A) the incidence of diseases associated with air 
                pollution, extreme heat, and other environmental 
                factors;
                    (B) the availability and accessibility of maternal 
                and infant health care providers;
                    (C) English-language proficiency among women of 
                reproductive age;
                    (D) the health insurance status of women of 
                reproductive age;
                    (E) the number of women of reproductive age who are 
                members of racial or ethnic groups with 
                disproportionately high rates of adverse maternal and 
                infant health outcomes;
                    (F) the socioeconomic status of women of 
                reproductive age, including with respect to--
                            (i) poverty;
                            (ii) unemployment;
                            (iii) household income; and
                            (iv) educational attainment; and
                    (G) access to quality housing, transportation, and 
                nutrition.
            (2) Resources.--In developing the Strategy, the Secretary 
        shall identify, and incorporate a description of, the 
        following:
                    (A) Existing mapping tools or Federal programs that 
                identify--
                            (i) risks associated with climate change 
                        for vulnerable individuals; and
                            (ii) other factors that can influence 
                        maternal and infant health outcomes, including 
                        the factors described in paragraph (1).
                    (B) Environmental, health, socioeconomic, and 
                demographic data relevant to identifying risks 
                associated with climate change for vulnerable 
                individuals.
                    (C) Existing monitoring networks that collect data 
                described in subparagraph (B), and any gaps in such 
                networks.
                    (D) Federal, State, and local stakeholders involved 
                in maintaining monitoring networks identified under 
                subparagraph (C), and how such stakeholders are 
                coordinating their monitoring efforts.
                    (E) Additional monitoring networks, and 
                enhancements to existing monitoring networks, that 
                would be required to address gaps identified under 
                subparagraph (C), including at the subcounty and census 
                tract level.
                    (F) Funding amounts required to establish the 
                monitoring networks identified under subparagraph (E) 
                and recommendations for Federal, State, and local 
                coordination with respect to such networks.
                    (G) Potential uses for data collected and generated 
                as a result of the Strategy, including how such data 
                may be used in determining recipients of grants under 
                the program established by section 2 or other similar 
                programs.
                    (H) Other information the Secretary considers 
                relevant for the development of the Strategy.
    (c) Coordination and Consultation.--In developing the Strategy, the 
Secretary shall--
            (1) coordinate with the Administrator of the Environmental 
        Protection Agency and the Administrator of the National Oceanic 
        and Atmospheric Administration; and
            (2) consult with--
                    (A) stakeholder organizations;
                    (B) health care providers and professional 
                membership organizations with expertise in maternal 
                health or environmental justice;
                    (C) State and local public health departments;
                    (D) licensed and accredited hospitals, birth 
                centers, midwifery practices, or other health care 
                providers that provide prenatal or labor and delivery 
                services to vulnerable individuals; and
                    (E) institutions of higher education, including 
                such institutions that are minority-serving 
                institutions or have expertise in maternal health or 
                environmental justice.
    (d) Notice and Comment.--At least 240 days before the date on which 
the Strategy is published in accordance with subsection (e), the 
Secretary shall provide--
            (1) notice of the Strategy on a public website of the 
        Department of Health and Human Services; and
            (2) an opportunity for public comment of at least 90 days.
    (e) Publication.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall publish on a public website 
of the Department of Health and Human Services--
            (1) the Strategy;
            (2) the public comments received under subsection (d); and
            (3) the responses of the Secretary to such public comments.

SEC. 6. DEFINITIONS.

    In this Act, the following definitions apply:
            (1) Adverse maternal and infant health outcomes.--The term 
        ``adverse maternal and infant health outcomes'' includes the 
        outcomes of preterm birth, low birth weight, stillbirth, infant 
        or maternal mortality, and severe maternal morbidity.
            (2) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given such 
        term in section 101 of the Higher Education Act of 1965 (20 
        U.S.C. 1001).
            (3) Minority-serving institution.--The term ``minority-
        serving institution'' means an entity specified in any of 
        paragraphs (1) through (7) of section 371(a) of the Higher 
        Education Act of 1965 (20 U.S.C. 1067q(a)).
            (4) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)).
            (5) Risks associated with climate change.--The term ``risks 
        associated with climate change'' includes risks associated with 
        extreme heat, air pollution, extreme weather events, and other 
        environmental issues associated with climate change that can 
        result in adverse maternal and infant health outcomes.
            (6) Stakeholder organization.--The term ``stakeholder 
        organization'' means--
                    (A) a community-based organization with expertise 
                in providing assistance to vulnerable individuals;
                    (B) a nonprofit organization with expertise in 
                maternal or infant health or environmental justice; or
                    (C) a patient advocacy organization representing 
                vulnerable individuals.
            (7) Vulnerable individual.--The term ``vulnerable 
        individual'' means--
                    (A) an individual who is pregnant;
                    (B) an individual who was pregnant during any 
                portion of the preceding 1-year period; and
                    (C) an individual under 3 years of age.
                                 <all>
```