Title: Maternal CARE Act
Policy area: Health

Summary:
Maternal Care Access and Reducing Emergencies Act or the Maternal CARE Act
This bill requires the Department of Health and Human Services to award grants to health professional training programs for training that addresses implicit bias (e.g., racial bias) in the practice of obstetrics and gynecology.
The Centers for Medicare & Medicaid Services and the Health Resources and Services Administration must award grants to up to 10 states for pregnancy medical home programs that reduce adverse maternal health outcomes and racial disparities. Among other requirements, such programs must prioritize the care of Medicaid enrollees.
The National Academy of Medicine must make recommendations for incorporating bias recognition in clinical skills tests at medical schools.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6698 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6698

   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 
eliminate racial disparities in maternal health outcomes, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 4, 2018

   Ms. Adams (for herself and Ms. Clarke of New York) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 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 period 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 Representatives of the 
United States of America in Congress assembled,

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 severely injured.
            (3) It is estimated that half 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 40 deaths per 100,000 live births for Black women, compared 
        to 12.4 deaths per 100,000 live births for White women and 17.8 
        deaths per 100,000 live births for women of other races.
            (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 physical 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-eclampsia--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 
        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. Providers, however, are not consistently 
        required to undergo 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. According 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 
        convergence in pregnancy-related mortality rates because the 
        program partners each high-risk pregnant and postpartum woman 
        that is covered under Medicaid with a pregnancy care manager.

SEC. 3. IMPLICIT BIAS TRAINING FOR HEALTH CARE PROVIDERS.

    (a) Grant Program.--The Secretary of Health and Human Services 
(referred to in this Act as the ``Secretary'') shall establish a grant 
program under which such Secretary awards grants to accredited schools 
of allopathic medicine, schools of osteopathic medicine, nursing 
schools, and other health professional training programs for the 
purpose of supporting evidence-based implicit bias training, with 
priority given to such training with respect to obstetrics and 
gynecology.
    (b) Implicit Bias Defined.--In this section, the term ``implicit 
bias'' means--
            (1) bias in judgment or behavior that results from subtle 
        cognitive processes, including implicit attitudes and implicit 
        stereotypes, that often operate at a level below conscious 
        awareness and without intentional 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 automatically activated by 
        the mere presence (actual or symbolic) of the attitude object.
    (c) 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 2019 through 2023.

SEC. 4. PREGNANCY MEDICAL HOME DEMONSTRATION PROJECT.

    (a) In General.--The Secretary, acting through the Administrator 
for the Centers for Medicare & Medicaid Services and the Administrator 
of the Health Resources and Services Administration, shall award grants 
to States for the purpose of establishing or operating State pregnancy 
medical home programs that meet the requirements of subsection (b) to 
deliver integrated health care services to pregnant women and new 
mothers and reduce adverse maternal health outcomes, maternal deaths, 
and racial health disparities in maternal mortality and morbidity.
    (b) State Pregnancy Medical Home Program Requirements.--A State 
pregnancy medical home program 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 
                health, and substance abuse treatment and support;
                    (B) health care providers who serve pregnant women, 
                including doctors, nurses, and midwives;
                    (C) community-based health workers, including 
                perinatal health workers, doulas, and home visitors; 
                and
                    (D) community-based organizations and individuals 
                representing the communities with--
                            (i) the highest overall rates of maternal 
                        mortality and morbidity; and
                            (ii) the greatest racial disparities in 
                        rates of maternal mortality and morbidity;
            (2) the State selects obstetric providers to participate in 
        the program as pregnancy medical homes, and requires that any 
        provider that wishes to participate in the program as a 
        pregnancy medical home--
                    (A) commits to following evidence-based practices 
                for maternity care, as developed by the State in 
                consultation with relevant stakeholders; and
                    (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 coordinating 
                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 enrolled in the State Medicaid plan under title XIX of 
        the Social 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.
            (2) Term of grants.--Grants under this section shall made 
        for a term of 5 years.
            (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.--
            (1) Report.--Not later than January 1, 2024, the 
        Administrator of the Health Resources and Services 
        Administration shall submit a report to Congress that 
        describes--
                    (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 mortality and morbidity.
            (2) Dissemination of best practices.--Not later than 
        January 1, 2024, the Administrator of the Health Resources and 
        Services Administration shall disseminate information on best 
        practices and models of care used by recipients of grants under 
        this section (including best practices and models of care 
        relating to the reduction of racial disparities 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 appropriated to 
carry out this section, $25,000,000 for each of fiscal years 2019 
through 2023, to remain available until expended.

SEC. 5. 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 
recommendations.
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