priated $5,000,000 for each of fiscal years 2022 through 
2026.’’. 
SEC. 204. STUDY ON REDUCING AND PREVENTING BIAS, 
RACISM, AND DISCRIMINATION IN MATER-
NITY CARE SETTINGS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall seek to enter into an agreement, 
not later than 90 days after the date of enactment of this 
Act, with the National Academies of Sciences, Engineer-
ing, and Medicine (referred to in this section as the ‘‘Na-
tional Academies’’) under which the National Academies 
agree to— 
(1) conduct a study on the design and imple-
mentation of programs to reduce and prevent bias, 
racism, and discrimination in maternity care settings 
and to advance respectful, culturally congruent, 
trauma-informed care; and 
(2) not later than 24 months after the date of 
enactment of this Act— 
(A) complete the study; and 
(B) transmit a report on the results of the 
study to the Congress. 
(b) POSSIBLE TOPICS.—The agreement entered into 
pursuant to subsection (a) may provide for the study of 
any of the following: 
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(1) The development of a scorecard or other 
evaluation standards for programs designed to re-
duce and prevent bias, racism, and discrimination in 
maternity care settings to assess the effectiveness of 
such programs in improving patient outcomes and 
patient experience for pregnant and postpartum in-
dividuals from racial and ethnic minority groups and 
their families. 
(2) Determination of the types and frequency of 
training to reduce and prevent bias, racism, and dis-
crimination in maternity care settings that are dem-
onstrated to improve patient outcomes or patient ex-
perience for pregnant and postpartum individuals 
from racial and ethnic minority groups and their 
families. 
SEC. 205. RESPECTFUL MATERNITY CARE COMPLIANCE 
PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall award grants to accredited hospitals, health 
systems, and other maternity care settings to establish as 
an integral part of quality implementation initiatives with-
in one or more hospitals or other birth settings a respect-
ful maternity care compliance program. 
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(b) PROGRAM REQUIREMENTS.—A respectful mater-
nity care compliance program funded through a grant 
under this section shall— 
(1) institutionalize mechanisms to allow pa-
tients receiving maternity care services, the families 
of such patients, or perinatal health workers sup-
porting such patients to report instances of racism 
or evidence of bias on the basis of race, ethnicity, or 
another protected class; 
(2) 
institutionalize 
response 
mechanisms 
through which representatives of the program can 
directly follow up with the patient, if possible, and 
the patient’s family in a timely manner; 
(3) prepare and make publicly available a 
hospital- or health system-wide strategy to reduce 
bias on the basis of race, ethnicity, or another pro-
tected class in the delivery of maternity care that in-
cludes— 
(A) information on the training programs 
to reduce and prevent bias, racism, and dis-
crimination on the basis of race, ethnicity, or 
another protected class for all employees in ma-
ternity care settings; 
(B) information on the number of cases re-
ported to the compliance program; and 
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(C) the development of methods to rou-
tinely assess the extent to which bias, racism, 
or discrimination on the basis of race, ethnicity, 
or another protected class are present in the de-
livery of maternity care to patients from racial 
and ethnic minority groups; 
(4) develop mechanisms to routinely collect and 
publicly report hospital-level data related to patient- 
reported experience of care; and 
(5) provide annual reports to the Secretary with 
information about each case reported to the compli-
ance program over the course of the year containing 
such information as the Secretary may require, such 
as— 
(A) de-identified demographic information 
on the patient in the case, such as race, eth-
nicity, gender identity, and primary language; 
(B) the content of the report from the pa-
tient or the family of the patient to the compli-
ance program; 
(C) the response from the compliance pro-
gram; and 
(D) to the extent applicable, institutional 
changes made as a result of the case. 
(c) SECRETARY REQUIREMENTS.— 
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(1) PROCESSES.—Not later than 180 days after 
the date of enactment of this Act, the Secretary 
shall establish processes for— 
(A) disseminating best practices for estab-
lishing and implementing a respectful maternity 
care compliance program within a hospital or 
other birth setting; 
(B) promoting coordination and collabora-
tion between hospitals, health systems, and 
other maternity care delivery settings on the es-
tablishment and implementation of respectful 
maternity care compliance programs; and 
(C) evaluating the effectiveness of respect-
ful maternity care compliance programs on ma-
ternal health outcomes and patient and family 
experiences, especially for patients from racial 
and ethnic minority groups and their families. 
(2) STUDY.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of enactment of this Act, the Sec-
retary shall, through a contract with an inde-
pendent research organization, conduct a study 
on strategies to address— 
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(i) racism or bias on the basis of race, 
ethnicity, or another protected class in the 
delivery of maternity care services; and 
(ii) successful implementation of re-
spectful care initiatives. 
(B) COMPONENTS OF STUDY.—The study 
shall include the following: 
(i) An assessment of the reports sub-
mitted to the Secretary from the respectful 
maternity care compliance programs pur-
suant to subsection (b)(5). 
(ii) Based on such assessment, rec-
ommendations for potential accountability 
mechanisms related to cases of racism or 
bias on the basis of race, ethnicity, or an-
other protected class in the delivery of ma-
ternity care services at hospitals and other 
birth settings. Such recommendations shall 
take into consideration medical and non- 
medical factors that contribute to adverse 
patient experiences and maternal health 
outcomes. 
(C) REPORT.—The Secretary shall submit 
to the Congress and make publicly available a 
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report on the results of the study under this 
paragraph. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
such sums as may be necessary for fiscal years 2022 
through 2027. 
SEC. 206. GAO REPORT. 
(a) IN GENERAL.—Not later than 2 years after the 
date of enactment of this Act and annually thereafter, the 
Comptroller General of the United States shall submit to 
the Congress and make publicly available a report on the 
establishment of respectful maternity care compliance pro-
grams within hospitals, health systems, and other mater-
nity care settings. 
(b) MATTERS INCLUDED.—The report under para-
graph (1) shall include the following: 
(1) Information regarding the extent to which 
hospitals, health systems, and other maternity care 
settings have elected to establish respectful mater-
nity care compliance programs, including— 
(A) which hospitals and other birth set-
tings elect to establish compliance programs 
and when such programs are established; 
(B) to the extent practicable, impacts of 
the establishment of such programs on mater-
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nal health outcomes and patient and family ex-
periences in the hospitals and other birth set-
tings that have established such programs, es-
pecially for patients from racial and ethnic mi-
nority groups and their families; 
(C) information on geographic areas, and 
types of hospitals or other birth settings, where 
respectful maternity care compliance programs 
are not being established and information on 
factors contributing to decisions to not establish 
such programs; and 
(D) recommendations for establishing re-
spectful maternity care compliance programs in 
geographic areas, and types of hospitals or 
other birth settings, where such programs are 
not being established. 
(2) Whether the funding made available to 
carry out this section has been sufficient and, if ap-
plicable, recommendations for additional appropria-
tions to carry out this section. 
(3) Such other information as the Comptroller 
General determines appropriate. 
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TITLE III—PROTECTING MOMS 
WHO SERVED 
SEC. 301. SUPPORT FOR MATERNITY CARE COORDINATION. 
(a) PROGRAM
ON MATERNITY CARE COORDINA-
TION.— 
(1) IN GENERAL.—The Secretary of Veterans 
Affairs shall carry out the maternity care coordina-
tion program described in Veterans Health Adminis-
tration Handbook 1330.03, or any successor hand-
book. 
(2) TRAINING AND SUPPORT.—In carrying out 
the program under paragraph (1), the Secretary 
shall provide to community maternity care providers 
training and support with respect to the unique 
needs of pregnant and postpartum veterans, particu-
larly regarding mental and behavioral health condi-
tions relating to the service of the veterans in the 
Armed Forces. 
(b) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized 
to 
be 
appropriated 
to 
the 
Secretary 
$15,000,000 for fiscal year 2022 for the maternity care 
coordination program. Such amounts are authorized in ad-
dition to any other amounts authorized for such purpose. 
(c) DEFINITIONS.—In this section: 
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(1) The term ‘‘community maternity care pro-
viders’’ means maternity care providers located at 
non-Department facilities who provide maternity 
care to veterans under section 1703 of title 38, 
United States Code, or other provisions of law ad-
ministered by the Secretary of Veterans Affairs. 
(2) The term ‘‘non-Department facilities’’ has 
the meaning given that term in section 1701 of title 
38, United States Code. 
SEC. 302. REPORT ON MATERNAL MORTALITY AND SEVERE 
MATERNAL MORBIDITY AMONG PREGNANT 
AND POSTPARTUM VETERANS. 
(a) GAO REPORT.—Not later than two years after 
the date of the enactment of this Act, the Comptroller 
General of the United States shall submit to the Commit-
tees on Veterans’ Affairs of the Senate and the House of 
Representatives, and make publicly available, a report on 
maternal mortality and severe maternal morbidity among 
pregnant and postpartum veterans, with a particular focus 
on racial and ethnic disparities in maternal health out-
comes for veterans. 
(b) MATTERS INCLUDED.—The report under sub-
section (a) shall include the following: 
(1) To the extent practicable— 
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(A) 
the 
number 
of 
pregnant 
and 
postpartum veterans who have experienced a 
pregnancy-related death or pregnancy-associ-
ated death in the most recent 10 years of avail-
able data; 
(B) the rate of pregnancy-related deaths 
per 100,000 live births for pregnant and 
postpartum veterans; 
(C) the number of cases of severe maternal 
morbidity among pregnant and postpartum vet-
erans in the most recent year of available data; 
(D) the racial and ethnic disparities in ma-
ternal mortality and severe maternal morbidity 
rates among pregnant and postpartum veterans; 
(E) identification of the causes of maternal 
mortality and severe maternal morbidity that 
are unique to veterans, including post-traumatic 
stress disorder, military sexual trauma, and in-
fertility or miscarriages that may be caused by 
such service; 
(F) identification of the causes of maternal 
mortality and severe maternal morbidity that 
are unique to veterans from racial and ethnic 
minority groups; 
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(G) identification of any correlations be-
tween the former rank of veterans and their 
maternal health outcomes; 
(H) the number of veterans who have been 
diagnosed with infertility by Veterans Health 
Administration providers each year in the most 
recent five years, disaggregated by age, race, 
ethnicity, sex, marital status, sexual orientation, 
gender identity, and geographical location; 
(I) the number of veterans who receive a 
clinical diagnosis of unexplained infertility by 
Veterans Health Administration providers each 
year in the most recent five years; and 
(J) the extent to which the rate of inci-
dence of clinically diagnosed infertility among 
veterans compare or differ to the rate of inci-
dence of clinically diagnosed infertility among 
the civilian population. 
(2) An assessment of the barriers to deter-
mining the information required under paragraph 
(1) and recommendations for improvements in track-
ing maternal health outcomes among pregnant and 
postpartum veterans— 
(A) who have health care coverage through 
the Department; 
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(B) enrolled in the TRICARE program; 
(C) with employer-based or private insur-
ance; 
(D) enrolled in the Medicaid program; and 
(E) who are uninsured. 
(3) Recommendations for legislative and admin-
istrative actions to increase access to mental and be-
havioral health care for pregnant and postpartum 
veterans who screen positively for maternal mental 
or behavioral health conditions. 
(4) Recommendations to address homelessness, 
food insecurity, poverty, and related issues among 
pregnant and postpartum veterans. 
(5) Recommendations on how to effectively edu-
cate maternity care providers on best practices for 
providing maternity care services to veterans that 
addresses the unique maternal health care needs of 
veteran populations. 
(6) Recommendations to reduce maternal mor-
tality and severe maternal morbidity among preg-
nant and postpartum veterans and to address racial 
and ethnic disparities in maternal health outcomes 
for each of the groups described in subparagraphs 
(A) through (E) of paragraph (2). 
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(7) Recommendations to improve coordination 
of care between the Department and non-Depart-
ment facilities for pregnant and postpartum vet-
erans, including recommendations to improve— 
(A) health record interoperability; and 
(B) training for the directors of the Vet-
erans Integrated Service Networks, directors of 
medical facilities of the Department, chiefs of 
staff of such facilities, maternity care coordina-
tors, and staff of relevant non-Department fa-
cilities. 
(8) An assessment of the authority of the Sec-
retary of Veterans Affairs to access maternal health 
data collected by the Department of Health and 
Human Services and, if applicable, recommendations 
to increase such authority. 
(9) Any other information the Comptroller Gen-
eral determines appropriate with respect to the re-
duction of maternal mortality and severe maternal 
morbidity among pregnant and postpartum veterans 
and to address racial and ethnic disparities in ma-
ternal health outcomes for veterans. 
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TITLE IV—PERINATAL 
WORKFORCE 
SEC. 401. 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— 
(A) to recruit and retain maternity care 
providers, mental and behavioral health care 
providers acting in accordance with State law, 
registered 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))), and lactation consultants cer-
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tified by the International Board of Lactation 
Consultants Examiners— 
(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 the midwife 
and global standards for midwifery edu-
cation as established by the International 
Confederation of Midwives; and 
(ii) perinatal health workers; 
(C) to provide collaborative, culturally con-
gruent 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. 
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(b) STUDY ON RESPECTFUL AND CULTURALLY CON-
GRUENT 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 con-
gruent 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); 
(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 congruent mater-
nal health care; 
(ii) a compendium of examples of hos-
pitals, health systems, midwifery practices, 
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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-
ties, and other insurers, for best practices 
in respectful and culturally congruent ma-
ternity care. 
SEC. 
402. 
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. 
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‘‘(b) USE OF FUNDS.—Recipients of grants under 
this section shall use the grants to grow and diversify the 
perinatal workforce by— 
‘‘(1) establishing schools or programs that pro-
vide education and training to individuals seeking 
appropriate licensing or certification as— 
‘‘(A) physician assistants who will complete 
clinical training in the field of maternal and 
perinatal health; or 
‘‘(B) perinatal health workers; and 
‘‘(2) expanding the capacity of existing schools 
or programs described in paragraph (1), for the pur-
poses of increasing the number of students enrolled 
in such schools or programs, including by awarding 
scholarships for students. 
‘‘(c) PRIORITIZATION.—In awarding grants under 
this section, the Secretary shall give priority to any entity 
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 perinatal 
workforce program or school supported by funds re-
ceived through the grant, particularly from racial 
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and ethnic minority groups and other underserved 
populations; 
‘‘(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 perinatal workforce program or 
school a bias, racism, or discrimination training pro-
gram that includes training on implicit bias and rac-
ism. 
‘‘(d) REPORTING.—As a condition on receipt of a 
grant under this section for a perinatal workforce program 
or school, 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 program or school; 
‘‘(2) the extent to which students in the pro-
gram or school are entering careers in— 
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‘‘(A) health professional shortage areas 
designated under section 332; and 
‘‘(B) areas with significant racial and eth-
nic disparities in maternal health outcomes, to 
the extent such data are available; and 
‘‘(3) whether the program or school 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 post-grant period 
sustainability of the perinatal workforce programs or 
schools proposed to be, or 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 physician assist-
ants who will complete clinical training in the field 
of maternal and perinatal health, and perinatal 
health workers, from racial and ethnic minority 
groups and other underserved populations; 
‘‘(3) increasing the number of physician assist-
ants who will complete clinical training in the field 
of maternal and perinatal health, and perinatal 
health workers, working in health professional short-
age areas designated under section 332; and 
‘‘(4) increasing the number of physician assist-
ants who will complete clinical training in the field 
of maternal and perinatal health, and perinatal 
health workers, working in areas with significant ra-
cial and ethnic disparities in maternal health out-
comes, to the extent such data are available. 
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‘‘(i) DEFINITION.—In this section, the term ‘racial 
and ethnic minority group’ has the meaning given such 
term in section 1707(g). 
‘‘(j) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $15,000,000 for each of fiscal years 2022 through 
2026.’’. 
SEC. 403. 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; or 
‘‘(2) clinical nurse specialists whose education 
includes a focus on maternal and perinatal health. 
VerDate Sep 11 2014 
21:43 Mar 08, 2021
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pamtmann on DSKBC07HB2PROD with BILLS