I 
116TH CONGRESS 
1ST SESSION H. R. 2902 
To support States in their work to end preventable morbidity and mortality 
in maternity care by using evidence-based quality improvement to protect 
the health of mothers during pregnancy, childbirth, and in the 
postpartum period and to reduce neonatal and infant mortality, to elimi-
nate racial disparities in maternal health outcomes, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 22, 2019 
Ms. ADAMS (for herself, Mr. BUTTERFIELD, Mr. KHANNA, Ms. HAALAND, Mr. 
CLAY, Ms. JOHNSON of Texas, Ms. WILSON of Florida, Ms. SCHA-
KOWSKY, Mrs. BEATTY, Ms. BARRAGA´N, and Mr. CRIST) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To support States in their work to end preventable morbidity 
and mortality in maternity care by using evidence-based 
quality improvement to protect the health of mothers 
during pregnancy, childbirth, and in the postpartum pe-
riod and to reduce neonatal and infant mortality, to 
eliminate racial disparities in maternal health outcomes, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Maternal Care Access 
and Reducing Emergencies Act’’ or the ‘‘Maternal CARE 
Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) In the United States, maternal mortality 
rates are among the highest in the developed world 
and increased by 26.6 percent between 2000 and 
2014. 
(2) Of the 4,000,000 American women who give 
birth each year, about 700 suffer fatal complications 
during pregnancy, while giving birth, or during the 
postpartum period, and an additional 50,000 are se-
verely injured. 
(3) It is estimated that about 60 percent of the 
maternal mortalities in the United States could be 
prevented and half of the maternal injuries in the 
United States could be reduced or eliminated with 
better care. 
(4) Data from the Centers for Disease Control 
and Prevention show that Black women are 3 to 4 
times more likely to die from pregnancy-related 
causes than White women. There are 42.8 deaths 
per 100,000 live births for Black women, compared 
to 13 deaths per 100,000 live births for White 
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women and 17.2 deaths per 100,000 live births for 
women nationally. 
(5) Black women’s risk of maternal mortality 
has remained higher than White women’s risk for 
the past 6 decades. 
(6) Black women in the United States suffer 
from life-threatening pregnancy complications twice 
as often as their White counterparts. 
(7) High rates of maternal mortality among 
Black women span income and education levels, as 
well as socioeconomic status; moreover, risk factors 
such as a lack of access to prenatal care and phys-
ical health conditions do not fully explain the racial 
disparity in maternal mortality. 
(8) A growing body of evidence indicates that 
stress from racism and racial discrimination results 
in conditions—including hypertension and pre-ec-
lampsia—that contribute to poor maternal health 
outcomes among Black women. 
(9) Pervasive racial bias against Black women 
and unequal treatment of Black women exist in the 
health care system, often resulting in inadequate 
treatment for pain and dismissal of cultural norms 
with respect to health. A 2016 study by University 
of Virginia researchers found that White medical 
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students and residents often believed biological 
myths about racial differences in patients, including 
that Black patients have less-sensitive nerve endings 
and thicker skin than their White counterparts. Pro-
viders, however, are not consistently required to un-
dergo implicit bias, cultural competency, or empathy 
training. 
(10) North Carolina has established a statewide 
Pregnancy Medical Home (PMH) program, which 
aims to reduce adverse maternal health outcomes 
and maternal deaths by incentivizing maternal 
health care providers to provide integral health care 
services to pregnant women and new mothers. Ac-
cording to the North Carolina Department of Health 
and Human Services Center for Health Statistics, 
the pregnancy-related mortality rate for Black 
women was approximately 5.1 times higher than 
that of White women in 2004. Almost a decade 
later, in 2013, the pregnancy-related mortality rates 
for Black women and White women were 24.3 and 
24.2 deaths per 100,000 live births, respectively. 
The PMH program has been credited with the con-
vergence in pregnancy-related mortality rates be-
cause the program partners each high-risk pregnant 
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and postpartum woman that is covered under Med-
icaid with a pregnancy care manager. 
SEC. 3. DEFINITIONS. 
In this Act: 
(1) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given that term in section 1101 of the Social Se-
curity Act (42 U.S.C. 1301) for purposes of title 
XIX of that Act (42 U.S.C. 1396 et seq.). 
SEC. 4. IMPLICIT BIAS TRAINING FOR HEALTH CARE PRO-
VIDERS. 
(a) GRANT PROGRAM.—The Secretary shall establish 
a grant program under which such Secretary awards 
grants to accredited schools of allopathic medicine, accred-
ited schools of osteopathic medicine, accredited nursing 
schools, other health professional training programs, and 
other entities for the purpose of supporting implicit bias 
training, with priority given to such training with respect 
to obstetrics and gynecology. 
(b) COLLABORATION REQUIRED.—In developing re-
quirements for implicit bias training carried out with 
grant funds awarded under this section, the Secretary 
shall collaborate with relevant stakeholders that specialize 
in addressing health equity, including— 
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(1) health care providers who serve pregnant 
women, including doctors, nurses, and midwives; 
(2) academic institutions, including schools and 
training programs described in subsection (a); 
(3) community-based health workers, including 
perinatal health workers, doulas, and home visitors; 
and 
(4) community-based organizations. 
(c) IMPLICIT BIAS TRAINING DEFINED.—In this sec-
tion, the term ‘‘implicit bias training’’ means evidence- 
based, on-going professional development and support, 
with respect to— 
(1) bias in judgment or behavior that results 
from subtle cognitive processes, including implicit at-
titudes and implicit stereotypes, that often operate 
at a level below conscious awareness and without in-
tentional control; or 
(2) implicit attitudes and stereotypes that result 
in beliefs or simple associations that a person makes 
between an object and its evaluation that are auto-
matically activated by the mere presence (actual or 
symbolic) of the attitude object. 
(d) PRIORITIZATION.—In awarding grants under this 
section, the Secretary shall give priority to awarding 
grants to schools, programs, or entities located in or serv-
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ing areas with the greatest needs, based such factors as 
the Secretary may consider, including racial disparities in 
maternal mortality and the incidence of severe maternal 
morbidity rates. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated for purposes of carrying 
out the grant program under subsection (a), $5,000,000 
for each of fiscal years 2020 through 2024. 
SEC. 5. PREGNANCY MEDICAL HOME DEMONSTRATION 
PROJECT. 
(a) AUTHORITY TO AWARD GRANTS.—The Secretary 
shall award grants to States for the purpose of estab-
lishing or operating State pregnancy medical home pro-
grams that meet the requirements of subsection (b) to de-
liver integrated health care services to pregnant women 
and new mothers and reduce adverse maternal health out-
comes, maternal deaths, and racial health disparities in 
maternal mortality and morbidity. 
(b) STATE PREGNANCY MEDICAL HOME PROGRAM 
REQUIREMENTS.—A State pregnancy medical home pro-
gram meets the requirements of this subsection if— 
(1) the State works with relevant stakeholders 
to develop and carry out the program, including— 
(A) State and local agencies responsible for 
Medicaid, public health, social services, mental 
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health, and substance abuse treatment and sup-
port; 
(B) health care providers who serve preg-
nant women, including doctors, nurses, and 
midwives; 
(C) community-based health workers, in-
cluding perinatal health workers, doulas, and 
home visitors; and 
(D) community-based organizations and 
individuals 
representing 
the 
communities 
with— 
(i) the highest overall rates of mater-
nal mortality and morbidity; and 
(ii) the greatest racial disparities in 
rates of maternal mortality and morbidity; 
(2) the State selects health care providers who 
serve pregnant women, including doctors, nurses, 
and midwives, to participate in the program as preg-
nancy medical homes, and requires that any provider 
that wishes to participate in the program as a preg-
nancy medical home— 
(A) commits to following evidence-based 
practices for maternity care, as developed by 
the State in consultation with relevant stake-
holders; and 
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(B) completes training to provide culturally 
and linguistically competent care; 
(3) under the program, each pregnancy medical 
home is required to conduct a standardized medical, 
obstetric, and psychosocial risk assessment for every 
patient of the medical home who is pregnant at the 
patient’s first prenatal appointment with the medical 
home; 
(4) under the program, a care manager— 
(A) is assigned to each pregnancy medical 
home; and 
(B) coordinates care (including coordi-
nating resources and referrals for health care 
and social services that are not available from 
the pregnancy medical home) for each patient 
of a pregnancy medical home who is eligible for 
services under the program; and 
(5) the program prioritizes pregnant and 
postpartum women who are uninsured or enrolled in 
the State Medicaid plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.), or a 
waiver of such plan. 
(c) GRANTS.— 
(1) LIMITATION.—The Secretary may award a 
grant under this section to up to 10 States. 
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(2) PERIOD.—Grants under this section shall 
be for a 5-year period. 
(3) 
PRIORITIZATION.—In 
awarding 
grants 
under this section, the Secretary shall give priority 
to the States with the greatest racial disparities in 
maternal mortality and severe morbidity rates. 
(d) REPORT ON GRANT IMPACT AND DISSEMINATION 
OF BEST PRACTICES.—Not later than 1 year after all the 
grant periods awarded under this section have ended, the 
Secretary shall— 
(1) submit a report to Congress that de-
scribes— 
(A) the impact of the grants awarded 
under this section on maternal and child health; 
(B) best practices and models of care used 
by recipients of grants under this section; and 
(C) obstacles faced by recipients of grants 
under this section in delivering care, improving 
maternal and child health, and reducing racial 
disparities in rates of maternal and infant mor-
tality and morbidity; and 
(2) disseminate information on best practices 
and models of care used by recipients of grants 
under this section (including best practices and mod-
els of care relating to the reduction of racial dispari-
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ties in rates of maternal and infant mortality and 
morbidity) to interested parties, including health 
providers, medical schools, relevant State and local 
agencies, and the general public. 
(e) AUTHORIZATION.—There are authorized to be ap-
propriated to carry out this section, $25,000,000 for each 
of fiscal years 2020 through 2024, to remain available 
until expended. 
SEC. 6. NATIONAL ACADEMY OF MEDICINE STUDY. 
(a) IN GENERAL.—The Secretary shall enter into an 
arrangement with the National Academy of Medicine 
under which the National Academy agrees to study and 
make recommendations for incorporating bias recognition 
in clinical skills testing for accredited schools of allopathic 
medicine and accredited schools of osteopathic medicine. 
(b) REPORT.—The arrangement under subsection (a) 
shall provide for submission by the National Academy of 
Medicine to the Secretary and Congress, not later than 
3 years after the date of enactment of this Act, of a report 
on the results of the study that includes such rec-
ommendations. 
Æ 
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