I 
118TH CONGRESS 
1ST SESSION H. R. 3523 
To grow and diversify the perinatal workforce, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 18, 2023 
Ms. MOORE of Wisconsin (for herself, Ms. UNDERWOOD, Ms. ADAMS, Mr. 
ALLRED, Ms. BARRAGA´N, Mrs. BEATTY, Mr. BISHOP of Georgia, Mr. 
BLUMENAUER, 
Ms. 
BLUNT
ROCHESTER, 
Ms. 
BROWNLEY, 
Ms. 
BUDZINSKI, Ms. BUSH, Ms. CARAVEO, Mr. CARBAJAL, Mr. CARSON, Mr. 
CARTER of Louisiana, Mrs. CHERFILUS-MCCORMICK, Ms. CLARKE of 
New York, Mr. CLEAVER, Mr. COHEN, Ms. CRAIG, Ms. CROCKETT, Mr. 
DAVIS of Illinois, Ms. DEAN of Pennsylvania, Ms. ESCOBAR, Mr. 
ESPAILLAT, Mr. EVANS, Mrs. FOUSHEE, Mr. GARAMENDI, Ms. GARCIA 
of Texas, Mr. GARCI´A of Illinois, Mr. GREEN of Texas, Mrs. HAYES, Mr. 
HORSFORD, Mr. HUFFMAN, Mr. IVEY, Mr. JACKSON of Illinois, Ms. 
JACKSON LEE, Ms. JACOBS, Ms. JAYAPAL, Mr. JOHNSON of Georgia, Ms. 
KAMLAGER-DOVE, Mr. KRISHNAMOORTHI, Ms. KUSTER, Ms. LEE of Cali-
fornia, Mr. LIEU, Ms. LOFGREN, Mrs. MCBATH, Mrs. MCCLELLAN, Ms. 
MCCOLLUM, Mr. MCGOVERN, Mr. MEEKS, Ms. MENG, Mr. MFUME, Mr. 
MORELLE, Mr. MOULTON, Mr. MRVAN, Mr. MULLIN, Mrs. NAPOLITANO, 
Mr. NEGUSE, Ms. OCASIO-CORTEZ, Mr. PAPPAS, Mr. PAYNE, Mr. PHIL-
LIPS, Ms. PORTER, Ms. PRESSLEY, Mr. RUPPERSBERGER, Ms. SALINAS, 
Ms. SCANLON, Mr. SCHIFF, Mr. SCHNEIDER, Ms. SCHOLTEN, Mr. DAVID 
SCOTT of Georgia, Ms. SEWELL, Mr. SOTO, Ms. SPANBERGER, Ms. 
STANSBURY, Ms. STRICKLAND, Mrs. SYKES, Mr. TAKANO, Ms. TLAIB, 
Ms. TOKUDA, Mr. TONKO, Mrs. TORRES of California, Mrs. TRAHAN, Mr. 
TRONE, Mr. VARGAS, Mr. VEASEY, Ms. VELA´ZQUEZ, Ms. WASSERMAN 
SCHULTZ, Mrs. WATSON COLEMAN, Ms. WEXTON, Ms. WILLIAMS of 
Georgia, Mr. PASCRELL, Ms. DELBENE, and Mr. LYNCH) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
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A BILL 
To grow and diversify the perinatal workforce, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Perinatal Workforce 
Act’’. 
SEC. 2. HHS AGENCY DIRECTIVES. 
(a) GUIDANCE TO STATES.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, the Secretary of 
Health and Human Services shall issue and dissemi-
nate guidance to States to educate providers, man-
aged care entities, and other insurers about the 
value and process of delivering respectful maternal 
health care through diverse and multidisciplinary 
care provider models. 
(2) CONTENTS.—The guidance required by 
paragraph (1) shall address how States can encour-
age and incentivize hospitals, health systems, mid-
wifery practices, freestanding birth centers, other 
maternity care provider groups, managed care enti-
ties, and other insurers— 
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(A) to recruit and retain maternity care 
providers, mental and behavioral health care 
providers acting in accordance with State law, 
and registered dietitians or nutrition profes-
sionals (as such term is defined in section 
1861(vv)(2) of the Social Security Act (42 
U.S.C. 1395x(vv)(2)))— 
(i) from racially, ethnically, and lin-
guistically diverse backgrounds; 
(ii) with experience practicing in ra-
cially and ethnically diverse communities; 
and 
(iii) who have undergone training on 
implicit bias and racism; 
(B) to incorporate into maternity care 
teams— 
(i) midwives who meet, at a minimum, 
the international definition of a midwife 
and global standards for midwifery edu-
cation as established by the International 
Confederation of Midwives; 
(ii) perinatal health workers; 
(iii) physician assistants; 
(iv) 
advanced 
practice 
registered 
nurses; and 
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(v) lactation consultants certified by 
the International Board of Lactation Con-
sultant Examiners; 
(C) to provide collaborative, culturally and 
linguistically congruent care; and 
(D) to provide opportunities for individuals 
enrolled in accredited midwifery education pro-
grams to participate in job shadowing with ma-
ternity care teams in hospitals, health systems, 
midwifery practices, and freestanding birth cen-
ters. 
(b) STUDY ON RESPECTFUL AND CULTURALLY AND 
LINGUISTICALLY CONGRUENT MATERNITY CARE.— 
(1) STUDY.—The Secretary of Health and 
Human Services acting through the Director of the 
National Institutes of Health (in this subsection re-
ferred to as the ‘‘Secretary’’) shall conduct a study 
on best practices in respectful and culturally and lin-
guistically congruent maternity care. 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Secretary shall— 
(A) complete the study required by para-
graph (1); 
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(B) submit to the Congress and make pub-
licly available a report on the results of such 
study; and 
(C) include in such report— 
(i) a compendium of examples of hos-
pitals, health systems, midwifery practices, 
freestanding birth centers, other maternity 
care provider groups, managed care enti-
ties, and other insurers that are delivering 
respectful and culturally and linguistically 
congruent maternal health care; 
(ii) a compendium of examples of hos-
pitals, health systems, midwifery practices, 
freestanding birth centers, other maternity 
care provider groups, managed care enti-
ties, and other insurers that have made 
progress in reducing disparities in mater-
nal health outcomes and improving birth-
ing 
experiences 
for 
pregnant 
and 
postpartum individuals from racial and 
ethnic minority groups; and 
(iii) recommendations to hospitals, 
health systems, midwifery practices, free-
standing birth centers, other maternity 
care provider groups, managed care enti-
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ties, and other insurers, for best practices 
in respectful and culturally and linguis-
tically congruent maternity care. 
SEC. 3. GRANTS TO GROW AND DIVERSIFY THE PERINATAL 
WORKFORCE. 
Title VII of the Public Health Service Act is amended 
by inserting after section 757 (42 U.S.C. 294f) the fol-
lowing new section: 
‘‘SEC. 758. PERINATAL WORKFORCE GRANTS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to entities to establish or expand programs de-
scribed in subsection (b) to grow and diversify the 
perinatal workforce. 
‘‘(b) USE OF FUNDS.—Recipients of grants under 
this section shall use the grants to grow and diversify the 
perinatal workforce by— 
‘‘(1) establishing accredited schools or pro-
grams that provide education and training to indi-
viduals seeking appropriate licensing and certifi-
cation as— 
‘‘(A) physician assistants who will complete 
clinical training in the field of maternal and 
perinatal health; 
‘‘(B) perinatal health workers; or 
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‘‘(C) midwives who meet, at a minimum, 
the international definition of a midwife and 
global standards for midwifery education as es-
tablished by the International Confederation of 
Midwives; and 
‘‘(2) expanding the capacity of existing accred-
ited schools or programs described in paragraph (1), 
for the purposes of increasing the number of stu-
dents enrolled in such accredited schools or pro-
grams, such as by awarding scholarships for stu-
dents (including students from racially, ethnically, 
and linguistically diverse backgrounds). 
‘‘(c) PRIORITIZATION.—In awarding grants under 
this section, the Secretary shall give priority to a school 
or program described in subsection (b) that— 
‘‘(1) has demonstrated a commitment to re-
cruiting and retaining students and faculty from ra-
cial and ethnic minority groups; 
‘‘(2) has developed a strategy to recruit and re-
tain a diverse pool of students into the school or pro-
gram described in subsection (b) that is supported 
by funds received through the grant, particularly 
from racial and ethnic minority groups and other 
underserved populations; 
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‘‘(3) has developed a strategy to recruit and re-
tain students who plan to practice in a health pro-
fessional shortage area designated under section 
332; 
‘‘(4) has developed a strategy to recruit and re-
tain students who plan to practice in an area with 
significant racial and ethnic disparities in maternal 
health outcomes, to the extent practicable; and 
‘‘(5) includes in the standard curriculum for all 
students within the school or program described in 
subsection (b) a bias, racism, or discrimination 
training program that includes training on implicit 
bias and racism. 
‘‘(d) REPORTING.—As a condition on receipt of a 
grant under this section for a school or program described 
in subsection (b), an entity shall agree to submit to the 
Secretary an annual report on the activities conducted 
through the grant, including— 
‘‘(1) the number and demographics of students 
participating in the school or program; 
‘‘(2) the extent to which students in the school 
or program are entering careers in— 
‘‘(A) health professional shortage areas 
designated under section 332; and 
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‘‘(B) areas with elevated rates of maternal 
mortality, severe maternal morbidity, maternal 
health disparities, or other adverse perinatal or 
childbirth outcomes, to the extent such data are 
available; and 
‘‘(3) whether the school or program has in-
cluded in the standard curriculum for all students a 
bias, racism, or discrimination training program that 
includes explicit and implicit bias, and if so the ef-
fectiveness of such training program. 
‘‘(e) PERIOD OF GRANTS.—The period of a grant 
under this section shall be up to 5 years. 
‘‘(f) APPLICATION.—To seek a grant under this sec-
tion, an entity shall submit to the Secretary an application 
at such time, in such manner, and containing such infor-
mation as the Secretary may require, including any infor-
mation necessary for prioritization under subsection (c). 
‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 
provide, directly or by contract, technical assistance to en-
tities seeking or receiving a grant under this section on 
the development, use, evaluation, and postgrant period 
sustainability of the school or program described in sub-
section (b) that is proposed to be, or is being, established 
or expanded through the grant. 
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‘‘(h) REPORT BY THE SECRETARY.—Not later than 
4 years after the date of enactment of this section, the 
Secretary shall prepare and submit to the Congress, and 
post on the internet website of the Department of Health 
and Human Services, a report on the effectiveness of the 
grant program under this section at— 
‘‘(1) recruiting students from racial and ethnic 
minority groups; 
‘‘(2) increasing the number of health profes-
sionals described in subparagraphs (A), (B), and (C) 
of subsection (b)(1) from racial and ethnic minority 
groups and other underserved populations; 
‘‘(3) increasing the number of such health pro-
fessionals working in health professional shortage 
areas designated under section 332; and 
‘‘(4) increasing the number of such health pro-
fessionals working in areas with significant racial 
and ethnic disparities in maternal health outcomes, 
to the extent such data are available. 
‘‘(i) DEFINITION.—In this section, the term ‘racial 
and ethnic minority group’ has the meaning given such 
term in section 1707(g)(1). 
‘‘(j) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
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priated $15,000,000 for each of fiscal years 2024 through 
2028.’’. 
SEC. 4. GRANTS TO GROW AND DIVERSIFY THE NURSING 
WORKFORCE IN MATERNAL AND PERINATAL 
HEALTH. 
Title VIII of the Public Health Service Act is amend-
ed by inserting after section 811 of that Act (42 U.S.C. 
296j) the following: 
‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to schools of nursing to grow and diversify the 
perinatal nursing workforce. 
‘‘(b) USE OF FUNDS.—Recipients of grants under 
this section shall use the grants to grow and diversify the 
perinatal nursing workforce by providing scholarships to 
students seeking to become— 
‘‘(1) nurse practitioners whose education in-
cludes a focus on maternal and perinatal health; 
‘‘(2) certified nurse-midwives; or 
‘‘(3) clinical nurse specialists whose education 
includes a focus on maternal and perinatal health. 
‘‘(c) PRIORITIZATION.—In awarding grants under 
this section, the Secretary shall give priority to any school 
of nursing that— 
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‘‘(1) has developed a strategy to recruit and re-
tain a diverse pool of students seeking to enter ca-
reers focused on maternal and perinatal health, par-
ticularly students from racial and ethnic minority 
groups and other underserved populations; 
‘‘(2) has developed a partnership with a prac-
tice setting in a health professional shortage area 
designated under section 332 for the clinical place-
ments of the school’s students; 
‘‘(3) has developed a strategy to recruit and re-
tain students who plan to practice in an area with 
significant racial and ethnic disparities in maternal 
health outcomes, to the extent practicable; and 
‘‘(4) includes in the standard curriculum for all 
students seeking to enter careers focused on mater-
nal and perinatal health a bias, racism, or discrimi-
nation training program that includes education on 
implicit bias and racism. 
‘‘(d) REPORTING.—As a condition on receipt of a 
grant under this section, a school of nursing shall agree 
to submit to the Secretary an annual report on the activi-
ties conducted through the grant, including, to the extent 
practicable— 
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‘‘(1) the number and demographics of students 
in the school of nursing seeking to enter careers fo-
cused on maternal and perinatal health; 
‘‘(2) the extent to which such students are pre-
paring to enter careers in— 
‘‘(A) health professional shortage areas 
designated under section 332; and 
‘‘(B) areas with elevated rates of maternal 
mortality, severe maternal morbidity, maternal 
health disparities, or other adverse perinatal or 
childbirth outcomes, to the extent such data are 
available; and 
‘‘(3) whether the standard curriculum for all 
students seeking to enter careers focused on mater-
nal and perinatal health includes a bias, racism, or 
discrimination training program that includes edu-
cation on implicit bias and racism. 
‘‘(e) PERIOD OF GRANTS.—The period of a grant 
under this section shall be up to 5 years. 
‘‘(f) APPLICATION.—To seek a grant under this sec-
tion, an entity shall submit to the Secretary an applica-
tion, at such time, in such manner, and containing such 
information as the Secretary may require, including any 
information necessary for prioritization under subsection 
(c). 
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‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 
provide, directly or by contract, technical assistance to 
schools of nursing seeking or receiving a grant under this 
section on the processes of awarding and evaluating schol-
arships through the grant. 
‘‘(h) REPORT BY THE SECRETARY.—Not later than 
4 years after the date of enactment of this section, the 
Secretary shall prepare and submit to the Congress, and 
post on the internet website of the Department of Health 
and Human Services, a report on the effectiveness of the 
grant program under this section at— 
‘‘(1) recruiting students from racial and ethnic 
minority groups and other underserved populations; 
‘‘(2) increasing the number of advanced prac-
tice registered nurses entering careers focused on 
maternal and perinatal health from racial and ethnic 
minority groups and other underserved populations; 
‘‘(3) increasing the number of advanced prac-
tice registered nurses entering careers focused on 
maternal and perinatal health working in health pro-
fessional shortage areas designated under section 
332; and 
‘‘(4) increasing the number of advanced prac-
tice registered nurses entering careers focused on 
maternal and perinatal health working in areas with 
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significant racial and ethnic disparities in maternal 
health outcomes, to the extent such data are avail-
able. 
‘‘(i) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $15,000,000 for each of fiscal years 2024 through 
2028.’’. 
SEC. 5. GAO REPORT. 
(a) IN GENERAL.—Not later than 2 years after the 
date of enactment of this Act and every 5 years thereafter, 
the Comptroller General of the United States shall submit 
to Congress a report on barriers to maternal health edu-
cation and access to care in the United States. Such report 
shall include the information and recommendations de-
scribed in subsection (b). 
(b) CONTENT OF REPORT.—The report under sub-
section (a) shall include— 
(1) an assessment of current barriers to enter-
ing and successfully completing accredited midwifery 
education programs, and recommendations for ad-
dressing such barriers, particularly for low-income 
women and women from racial and ethnic minority 
groups; 
(2) an assessment of current barriers to enter-
ing and successfully completing accredited education 
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programs for other health professional careers re-
lated to maternity care, including maternity care 
providers, mental and behavioral health care pro-
viders acting in accordance with State law, and reg-
istered dietitians or nutrition professionals (as such 
term is defined in section 1861(vv)(2) of the Social 
Security Act (42 U.S.C. 1395x(vv)(2))), particularly 
for low-income women and women from racial and 
ethnic minority groups; 
(3) an assessment of current barriers that pre-
vent midwives from meeting the international defini-
tion of a midwife and global standards for midwifery 
education as established by the International Con-
federation of Midwives, and recommendations for 
addressing such barriers, particularly for low-income 
women and women from racial and ethnic minority 
groups; 
(4) an assessment of disparities in access to 
maternity care providers, mental or behavioral 
health care providers acting in accordance with 
State law, and registered dietitians or nutrition pro-
fessionals (as such term is defined in section 
1861(vv)(2) of the Social Security Act (42 U.S.C. 
1395x(vv)(2))), and perinatal health workers, strati-
fied by race, ethnicity, gender identity, primary lan-
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guage, geographic location, and insurance type and 
recommendations to promote greater access equity; 
and 
(5) recommendations to promote greater equity 
in compensation for perinatal health workers under 
public and private insurers, particularly for such in-
dividuals from racially and ethnically diverse back-
grounds. 
SEC. 6. DEFINITIONS. 
In this Act: 
(1) CULTURALLY
AND
LINGUISTICALLY
CON-
GRUENT.—The term ‘‘culturally and linguistically 
congruent’’, with respect to care or maternity care, 
means care that is in agreement with the preferred 
cultural values, beliefs, worldview, language, and 
practices of the health care consumer and other 
stakeholders. 
(2) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means a death occurring during or 
within a 1-year period after pregnancy, caused by 
pregnancy-related or childbirth complications, in-
cluding a suicide, overdose, or other death resulting 
from a mental health or substance use disorder at-
tributed to or aggravated by pregnancy-related or 
childbirth complications. 
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(3) MATERNITY
CARE
PROVIDER.—The term 
‘‘maternity care provider’’ means a health care pro-
vider who— 
(A) is a physician, physician assistant, 
midwife who meets at a minimum the inter-
national definition of a midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
Midwives, advanced practice registered nurse, 
or a lactation consultant certified by the Inter-
national Board of Lactation Consultant Exam-
iners; and 
(B) has a focus on maternal or perinatal 
health. 
(4) PERINATAL HEALTH WORKER.—The term 
‘‘perinatal health worker’’ means a nonclinical health 
worker focused on maternal or perinatal health, such 
as a doula, community health worker, peer sup-
porter, lactation educator or counselor, nutritionist 
or dietitian, childbirth educator, social worker, home 
visitor, patient navigator or coordinator, or language 
interpreter. 
(5) POSTPARTUM.—The term ‘‘postpartum’’ re-
fers to the 1-year period beginning on the last day 
of the pregnancy of an individual. 
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(6) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘‘racial and ethnic minority group’’ has the 
meaning given such term in section 1707(g)(1) of 
the Public Health Service Act (42 U.S.C. 300u– 
6(g)(1)). 
Æ 
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