Title: Maternal Health Pandemic Response Act of 2020
Policy area: Health

Summary:
Maternal Health Pandemic Response Act of 2020
This bill addresses maternal health during the COVID-19 (i.e., coronavirus disease 2019) emergency by supporting data collection, development of COVID-19 therapeutics and workplace protections, and other activities.
Specifically, the Department of Health and Human Services must issue guidance for states and local health departments on collecting data on pregnancy and postpartum status in conjunction with COVID-19 tests. In addition, the bill provides funds for the Centers for Disease Control and Prevention (CDC) to expand particular maternal health surveillance programs. The CDC and the Centers for Medicare & Medicaid Services must also publish pregnancy and postpartum data related to COVID-19, and the CDC and the Indian Health Service must consult with tribes about collecting this data for tribal populations.
Additionally, the National Institutes of Health (NIH) and the Food and Drug Administration must collect information about the effects of COVID-19 therapeutics on pregnant and postpartum individuals. The NIH must also ensure that at least one vaccine will be suitable for that population and must support related research.
In addition, the Department of Labor must implement an emergency temporary standard to protect employees from workplace exposures to the virus that causes COVID-19 that specifically addresses pregnant and postpartum individuals. Certain regulatory requirements shall not apply in developing this standard.
The CDC must also carry out an education campaign about pregnancy and COVID-19 and must establish a task force that addresses maternity care during the COVID-19 emergency.
Furthermore, the Government Accountability Office must report on maternal health and public health emergency preparedness.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4769 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4769

To improve the public health response to addressing maternal mortality 
       and morbidity during the COVID-19 public health emergency.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

           September 30 (legislative day, September 29), 2020

 Ms. Warren (for herself, Mr. Booker, Ms. Harris, Mrs. Gillibrand, and 
  Ms. Smith) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To improve the public health response to addressing maternal mortality 
       and morbidity during the COVID-19 public health emergency.

    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 Health Pandemic Response 
Act of 2020''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) The World Health Organization declared COVID-19 a 
        ``Public Health Emergency of International Concern'' on January 
        30, 2020. By the beginning of August 2020, there have been over 
        18,000,000 confirmed cases of, and over 700,000 deaths 
        associated with, COVID-19 worldwide.
            (2) In the United States, the number of cases of COVID-19 
        has quickly surpassed the number of such cases in every other 
        nation, and as of August 5, 2020, over 4,000,000 cases and 
        156,000 deaths have been reported by the United States alone.
            (3) Longstanding systemic health and social inequities have 
        put communities of color at increased risk of contracting 
        COVID-19 or experiencing severe illness; age-adjusted 
        hospitalization rates from COVID-19 are highest for American 
        Indian and Alaska Native, Black, and Latinx people.
            (4) Prior to the start of the COVID-19 pandemic, the United 
        States was facing a maternal mortality and morbidity crisis, in 
        which the United States has the highest maternal mortality rate 
        in the developed world, and that rate is not improving.
            (5) More than 50,000 women in the United States annually 
        experience severe maternal morbidity, and much larger numbers 
        experience more common harmful challenges, such as prenatal and 
        postpartum anxiety and depression and lack of support for 
        meeting breastfeeding goals.
            (6) Compared to White women, Black and American Indian and 
        Alaska Native women in the United States are significantly more 
        likely to die from pregnancy-related complications, and Black 
        and American Indian and Alaska Native women suffer 
        disproportionately high rates of maternal morbidity.
            (7) The causes of maternal mortality and morbidity are 
        complex and include racial, ethnic, and socioeconomic 
        inequities; racism, bias, and discrimination; comorbidities; 
        and inadequate access to the health care system, including 
        behavioral health care, which are factors that have similarly 
        contributed to the racial disparities seen in COVID-19 
        outcomes.
            (8) The burden of morbidity and mortality in the United 
        States for both COVID-19 and maternal health outcomes has also 
        fallen disproportionately on Black, Latinx, and American Indian 
        and Alaska Native communities, who suffer the most from great 
        public health needs and are the most medically underserved.
            (9) According to the Centers for Disease Control and 
        Prevention, ``pregnant people have changes in their bodies that 
        may increase their risk of some infections'' and ``pregnant 
        people have had a higher risk of severe illness when infected 
        with viruses from the same family as COVID-19 and other viral 
        respiratory infections, such as influenza''.
            (10) As of June 25, 2020, the latest information from the 
        Centers for Disease Control and Prevention indicates that 
        pregnant women are more likely to be hospitalized and are at 
        higher risk for intensive care unit admissions than nonpregnant 
        women due to COVID-19, and Latinx and Black pregnant people 
        have been disproportionately infected by COVID-19.
            (11) Our understanding of the specific impact of COVID-19 
        on pregnant people is limited, in part due to a lack of robust 
        data collection, but the COVID-19 pandemic has further strained 
        the health care system and added another layer of fear and 
        vulnerability for pregnant people, with disproportionate 
        effects on people of color.
            (12) As of July 30, 2020, over 14,000 pregnant people in 
        the United States have tested positive for COVID-19 and 35 
        pregnant people have died as a result of COVID-19.
            (13) The World Health Organization states that everyone 
        ``has the right to safe and positive childbirth experience, 
        whether or not they have a confirmed COVID-19 infection, this 
        includes the right to respect and dignity, a companion of 
        choice, clear communication by maternity staff, pain relief 
        strategies, and mobility in labor when possible and the 
        position of choice''.
            (14) A COVID-19 public health response without concerted 
        Federal action and focus on maternal health care access and 
        quality, research, data collection, mitigating negative 
        socioeconomic consequences of the pandemic, and safeguarding 
        the right to safe and positive childbirth experience will risk 
        exacerbating the maternal mortality and morbidity crisis.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) COVID-19 public health emergency.--The term ``COVID-19 
        public health emergency'' means the period beginning on the 
        date that the public health emergency declared by the Secretary 
        of Health and Human Services under section 319 of the Public 
        Health Service Act (42 U.S.C. 247d) on January 31, 2020, with 
        respect to COVID-19 took effect, and ending on the later of the 
        end of such public health emergency or January 1, 2023.
            (2) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is anti-racist and is in agreement with the preferred 
        cultural values, beliefs, worldview, and practices of the 
        health care consumer and other stakeholders.
            (3) Indian tribe, tribal organization, and urban indian 
        organization.--The terms ``Indian Tribe'' and ``Tribal 
        organization'' have the meanings given the terms ``Indian 
        tribe'' and ``tribal organization'', respectively, in section 4 
        of the Indian Self-Determination and Education Assistance Act 
        (25 U.S.C. 5304), and the term ``urban Indian organization'' 
        has the meaning given such term in section 4 of the Indian 
        Health Care Improvement Act (25 U.S.C. 1603).
            (4) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during pregnancy or within one year of 
        the end of pregnancy, from a pregnancy complication, a chain of 
        events initiated by pregnancy, or the aggravation of an 
        unrelated condition by the physiologic effects of pregnancy.
            (5) Postpartum.--The term ``postpartum'' means the 1-year 
        period beginning on the last day of a person's pregnancy.
            (6) Respectful maternity care.--The term ``respectful 
        maternity care'' refers to care organized for, and provided to, 
        all pregnant and postpartum people in a manner that is 
        culturally congruent, maintains their dignity, privacy, and 
        confidentiality, ensures freedom from harm and mistreatment, 
        and enables informed choice and continuous support during 
        labor, childbirth, and postpartum.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means an unexpected outcome caused by labor and 
        delivery that results in significant short-term or long-term 
        consequences to the health of the pregnant person.

SEC. 4. EMERGENCY FUNDING FOR FEDERAL DATA COLLECTION, SURVEILLANCE, 
              AND RESEARCH ON MATERNAL HEALTH OUTCOMES DURING THE 
              COVID-19 PUBLIC HEALTH EMERGENCY.

    To conduct or support data collection, surveillance, and research 
on maternal health as a result of the COVID-19 public health emergency, 
including support to assist in the capacity building for State, Tribal, 
territorial, and local public health departments to collect and 
transmit racial, ethnic, and other demographic data related to maternal 
health, there are authorized to be appropriated--
            (1) $100,000,000 for the Surveillance for Emerging Threats 
        to Mothers and Babies program of the Centers for Disease 
        Control and Prevention, to support the Centers for Disease 
        Control and Prevention in its efforts to--
                    (A) work with public health, clinical, and 
                community-based organizations to provide timely, 
                continually updated guidance to families and health 
                care providers on ways to reduce risk to mothers and 
                babies and tailor interventions to improve their long-
                term health;
                    (B) partner with more State, Tribal, territorial, 
                and local public health programs in the collection and 
                analysis of clinical data on the impact of COVID-19 on 
                pregnant and postpartum patients and their newborns, 
                including among pregnant people of color; and
                    (C) establish regionally based centers of 
                excellence to offer medical, public health, and other 
                knowledge to ensure communities, especially communities 
                of color, can help pregnant and postpartum patients and 
                infants get the care they need;
            (2) $30,000,000 for the Enhancing Reviews and Surveillance 
        to Eliminate Maternal Mortality program (commonly known as the 
        ``ERASE MM program'') of the Centers for Disease Control and 
        Prevention, to support the Centers for Disease Control and 
        Prevention in expanding its partnerships with States and Indian 
        Tribes and provide technical assistance to existing Maternal 
        Mortality Review Committees; and
            (3) $45,000,000 for the Pregnancy Risk Assessment 
        Monitoring System (commonly known as the ``PRAMS'') of the 
        Centers for Disease Control and Prevention, to support the 
        Centers for Disease Control and Prevention in its efforts to--
                    (A) create a COVID-19 supplement to its PRAMS 
                questionnaire;
                    (B) add questions around experiences of respectful 
                maternity care in prenatal, intrapartum, and postpartum 
                care;
                    (C) conduct a rapid assessment of COVID-19 
                awareness, impact on care and experiences, and use of 
                preventive measures among pregnant, laboring and 
                birthing, and postpartum people during the COVID-19 
                public health emergency; and
                    (D) work to transition the survey to an electronic 
                platform and expand the survey to a larger population, 
                with a special focus on reaching underrepresented 
                communities;
            (4) $15,000,000 for the National Institute of Child Health 
        and Human Development, to conduct or support research for 
        interventions to mitigate the effects of the COVID-19 public 
        health emergency on pregnant and postpartum people, including 
        Black, Latinx, Asian-American and Pacific Islander, and 
        American Indian and Alaska Native people.

SEC. 5. COVID-19 MATERNAL HEALTH DATA COLLECTION AND DISCLOSURE.

    (a) Data Collection.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and the Administrator of 
the Centers for Medicare & Medicaid Services, shall make publicly 
available, on the website of the Centers for Disease Control and 
Prevention, pregnancy and postpartum data collected across all 
surveillance systems relating to COVID-19, disaggregated by race, 
ethnicity, State, and Tribal location including the following:
            (1) Data related to all COVID-19 diagnostic testing, 
        including the number of pregnant people and postpartum people 
        tested and the number of positive cases.
            (2) Data related to all suspected cases of COVID-19 in 
        pregnant, birthing, and postpartum people who did not undergo 
        testing.
            (3) Data related to all COVID-19 serologic testing, 
        including the number of pregnant and postpartum people tested 
        and the number of such serologic tests that were positive.
            (4) Data related to treatment for COVID-19, including 
        hospitalizations, emergency room, and intensive care unit 
        admissions of pregnant, birthing, and postpartum people related 
        to COVID-19.
            (5) Data related to COVID-19 outcomes, including total 
        fatalities and case fatality (expressed as the proportion of 
        people who were infected with COVID-19 and died from the virus) 
        of pregnant and postpartum people.
            (6) Data related to pregnancy and infant health outcomes 
        for pregnant people with confirmed or suspected COVID-19, which 
        may include stillbirths, maternal mortality and morbidity, 
        infant mortality, preterm births, low-birth weight infants, and 
        cesarean section births.
    (b) Timeline.--The Secretary shall update the data made available 
under this section not less frequently than monthly, during the COVID-
19 public health emergency and for at least one month after the end of 
the COVID-19 public health emergency.
    (c) Privacy.--In publishing data under this section, the Secretary 
shall take all necessary steps to protect the privacy of people whose 
information is included in such data, including by complying with--
            (1) privacy protections under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (42 U.S.C. 1320d-2 note); and
            (2) protections from all inappropriate internal use by an 
        entity that collects, stores, or receives the data, including 
        use of such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from inappropriate uses.
    (d) Indian Health Service.--The Director of the Indian Health 
Service and Director of the Centers for Disease Control and Prevention 
shall consult with Indian Tribes and confer with urban Indian 
organizations on data collection and reporting for purposes of this 
section.
    (e) Data Collection Guidance.--The Secretary shall issue guidance 
to States and local public health departments to ensure that all 
relevant demographic data, including pregnancy and postpartum status, 
are collected and included when sending COVID-19 testing specimen to 
laboratories, and State and local health departments and Indian Tribes 
are disaggregating data on COVID-19 status in data on maternal and 
infant morbidity and mortality. The Secretary shall ensure that the 
guidance is developed in consultation with Indian Tribes to ensure that 
it includes tribally developed best practices on reducing 
misclassification of American Indian and Alaska Native people in 
Federal, State, and local public health surveillance systems.

SEC. 6. INCLUSION OF PREGNANT PEOPLE AND LACTATING PEOPLE IN VACCINE 
              AND THERAPEUTIC DEVELOPMENT FOR COVID-19.

    (a) In General.--The Director of the National Institutes of Health 
shall--
            (1) support and advance the responsible inclusion of 
        pregnant and lactating people in COVID-19 therapeutic and 
        vaccine clinical trials when safe and appropriate;
            (2) prioritize the implementation of final recommendations 
        made by the Task Force on Research Specific to Pregnant Women 
        and Lactating Women to improve the inclusion of pregnant and 
        lactating people in clinical research when safe and 
        appropriate, particularly as these recommendations apply to the 
        development and issuance of safe and effective COVID-19 
        therapeutics and vaccines; and
            (3) ensure that at least one COVID-19 vaccine developed and 
        made available for use in the United States is suitable for 
        pregnant people and lactating people.
    (b) Requirements.--
            (1) Reporting requirements.--The Director of the National 
        Institutes of Health shall collect information from every 
        developer of a drug or biological product for the treatment or 
        prevention of COVID-19 in the clinical stages of development 
        that received Federal funding from the Department of Health and 
        Human Services and its subagencies regarding--
                    (A) how evidence is being generated to evaluate the 
                safety, efficacy, and appropriate dosing of the drug or 
                biological product among pregnant people and lactating 
                people;
                    (B) plans for the systematic collection of data 
                from people who are inadvertently exposed to the drug 
                or biological product while pregnant or lactating;
                    (C) plans for the inclusion of pregnant people and 
                lactating people, including racial and ethnic 
                minorities disproportionately affected by COVID-19, in 
                clinical trials or the rationale for exclusion; and
                    (D) plans for performing Developmental and 
                Reproductive Toxicology studies, or the rationale for 
                not performing such studies.
            (2) Drug approvals and biological product licensing.--The 
        Commissioner of Food and Drugs shall require a drug or 
        biological product developer submit, as part of an application 
        for approval of a drug under section 505 of the Federal Food, 
        Drug, and Cosmetic Act (21 U.S.C. 355) or licensing of a 
        biological product under section 351 of the Public Health 
        Service Act (42 U.S.C. 262) for the treatment or prevention of 
        COVID-19--
                    (A) an adequate representation of the effect of the 
                drug or biological product on pregnant people and 
                lactating people, either through the inclusion of 
                pregnant people and lactating people in clinical trials 
                when safe and appropriate or other research, or through 
                a scientific and ethical justification as to why 
                pregnant people or lactating people were not included 
                in clinical trials; and
                    (B) a comprehensive plan for the collection of 
                additional evidence of safety and efficacy for pregnant 
                and lactating people after approval under such section 
                505 or licensure under such section 351, or after 
                issuance of an emergency use authorization under 
                section 564 of the Federal Food, Drug, and Cosmetic Act 
                (21 U.S.C. 360bbb-3).

SEC. 7. PUBLIC HEALTH COMMUNICATION REGARDING MATERNAL CARE DURING 
              COVID-19.

    (a) Public Health Campaign.--The Director of the Centers for 
Disease Control and Prevention shall undertake a robust public health 
education effort to enhance access by pregnant people, their employers, 
and their providers to accurate, evidence-based health information 
about COVID-19 and pregnancy, safety, and risk, with a particular focus 
on reaching pregnant people in underserved communities.
    (b) Emergency Temporary Standard.--
            (1) In general.--In consideration of the grave risk 
        presented by COVID-19 and the need to strengthen protections 
        for employees, pursuant to section 6(c)(1) of the Occupational 
        Safety and Health Act of 1970 (29 U.S.C. 655(c)(1)) and 
        notwithstanding the provisions of law and the Executive order 
        listed in paragraph (3), not later than 7 days after the date 
        of enactment of this Act, the Secretary of Labor shall 
        promulgate an emergency temporary standard to protect all 
        employees at occupational risk from occupational exposure to 
        SARS-CoV-2.
            (2) Pregnant and postpartum employees.--The emergency 
        temporary standard promulgated under this subsection shall 
        include consideration of the risks and needs specific to 
        pregnant and postpartum employees.
            (3) Inapplicable provisions of law and executive order.--
        The requirements of chapter 6 of title 5, United States Code 
        (commonly referred to as the ``Regulatory Flexibility Act''), 
        subchapter I of chapter 35 of title 44, United States Code 
        (commonly referred to as the ``Paperwork Reduction Act''), the 
        Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1501 et seq.), 
        and Executive Order 12866 (58 Fed. Reg. 190; relating to 
        regulatory planning and review), as amended, shall not apply to 
        the standard promulgated under this subsection.
    (c) Task Force on Birthing Experience and Safe, Respectful 
Maternity Care in Response to the COVID-19 Public Health Emergency.--
            (1) Establishment.--The Secretary, in consultation with the 
        Director of the Centers for Disease Control and Prevention and 
        the Administrator of the Health Resources and Services 
        Administration, shall convene a task force to develop Federal 
        recommendations regarding respectful maternity care, including 
        safe birth care and postpartum care, during the COVID-19 public 
        health emergency.
            (2) Duties.--The task force established under paragraph (1) 
        shall develop, publicly post, and update Federal 
        recommendations in multiple languages to ensure quality, 
        provide nondiscriminatory maternity care, promote positive 
        birthing experiences, and improve maternal health outcomes 
        during the COVID-19 public health emergency, with a particular 
        focus on outcomes for communities of color and rural 
        populations. Such guidelines and recommendations shall--
                    (A) address, with particular attention to ensuring 
                equitable treatment on the basis of race and 
                ethnicity--
                            (i) measures to facilitate respectful 
                        maternity care;
                            (ii) strategies to increase access to 
                        specialized care for those with high-risk 
                        pregnancies or pregnant individuals with 
                        elevated risk factors;
                            (iii) COVID-19 diagnostic testing for 
                        pregnant and laboring patients;
                            (iv) birthing without one's chosen 
                        companions, with one's chosen companions, and 
                        with smartphone or other telehealth connection 
                        to one's chosen companions;
                            (v) newborn separation after birth in 
                        relation to maternal COVID-19 status;
                            (vi) breast milk feeding in relation to 
                        maternal COVID-19 status;
                            (vii) licensure, training, scope of 
                        practice, and Medicaid and other insurance 
                        reimbursement for certified midwives, certified 
                        nurse-midwives, certified professional 
                        midwives, in a manner that facilitates 
                        inclusion of midwives of color and midwives 
                        from underserved communities;
                            (viii) financial support for perinatal 
                        health workers who provide non-clinical support 
                        to people from pregnancy through the postpartum 
                        period, such as a doula, community health 
                        worker, peer supporter, lactation consultant, 
                        nutritionist or dietitian, social worker, home 
                        visitor, or a patient navigator in a manner 
                        that facilitates inclusion from underserved 
                        communities;
                            (ix) how to identify, address, and treat 
                        prenatal and postpartum mental and behavioral 
                        health conditions, such as anxiety, substance 
                        use disorder, and depression, which may have 
                        arisen or increased during the COVID-19 public 
                        health emergency;
                            (x) strategies to address hospital capacity 
                        concerns in communities with a surge in COVID-
                        19 cases and to provide childbearing people 
                        with options that reduce potential for cross-
                        contamination and increase the ability to 
                        implement their care preferences while 
                        maintaining safety and quality, such as the use 
                        of auxiliary maternity units and freestanding 
                        birth centers;
                            (xi) how to identify and address racism, 
                        bias, and discrimination in the delivery 
                        treatment and support to pregnant and 
                        postpartum people, including evaluating the 
                        value of training for hospital staff on 
                        implicit bias and racism, respectful maternity 
                        care, and demographic data collection; and
                            (xii) such other matters as the task force 
                        determines appropriate;
                    (B) identify barriers to the implementation of the 
                guidelines and recommendations;
                    (C) take into consideration existing State and 
                other programs that have demonstrated effectiveness in 
                addressing pregnancy, birth, and postpartum care during 
                the COVID-19 public health emergency; and
                    (D) identify policies specific to COVID-19 that 
                should be discontinued when safely possible and those 
                that should be continued as the public health emergency 
                abates.
            (3) Membership.--The task force established under paragraph 
        (1) shall be comprised of--
                    (A) representatives of the Department of Health and 
                Human Services, including representatives of--
                            (i) the Secretary;
                            (ii) the Director of the Centers for 
                        Disease Control and Prevention;
                            (iii) the Administrator of the Health 
                        Resources and Services Administration;
                            (iv) the Administrator of the Centers for 
                        Medicare & Medicaid Services;
                            (v) the Director of the Agency for 
                        Healthcare Research and Quality; and
                            (vi) the Director of the Indian Health 
                        Service;
                    (B) at least 3 State, local, or territorial public 
                health officials representing departments of public 
                health, who shall represent jurisdictions from 
                different regions of the United States with relatively 
                high concentrations of historically marginalized 
                populations, to be appointed by the Secretary;
                    (C) at least 1 Tribal public health official 
                representing departments of public health;
                    (D) 1 or more representatives of a community-based 
                organization that addresses adverse maternal health 
                outcomes with a specific focus on racial and ethnic 
                inequities in maternal health outcomes, appointed by 
                the Secretary, with special consideration given to 
                organizations led by a person of color or from 
                communities with significant minority populations;
                    (E) 1 or more obstetrician-gynecologist or other 
                physician who provides obstetric care, with special 
                consideration for physicians who are from, or work in, 
                communities experiencing the highest rates of COVID-19 
                mortality and morbidity;
                    (F) 1 or more nurse, such as a certified nurse-
                midwife, women's health nurse practitioner, or other 
                nurse who provides obstetric care, with special 
                consideration for nurses who are from, or work in, 
                communities experiencing the highest rates of COVID-19 
                mortality and morbidity;
                    (G) 1 or more perinatal health workers who provide 
                non-clinical support to people from pregnancy through 
                postpartum period, such as a doula, community health 
                worker, peer supporter, lactation consultant, 
                nutritionist or dietitian, social worker, home visitor, 
                or patient navigator;
                    (H) 1 or more patients who were pregnant or gave 
                birth during the COVID-19 public health emergency;
                    (I) 1 or more patients who contracted COVID-19 and 
                later gave birth;
                    (J) 1 or more patients who have received support 
                from a perinatal health worker who provides prenatal 
                and postpartum support, such as a doula, community 
                health worker, peer supporter, lactation consultant, 
                nutritionist or dietitian, social worker, home visitor, 
                or a patient navigator, or a spouse or family member of 
                such patient; and
                    (K) racially and ethnically diverse representation 
                from at least 3 independent experts with knowledge or 
                field experience with racial and ethnic disparities in 
                public health, women's health, or maternal mortality 
                and severe maternal morbidity.

SEC. 8. GAO REPORT ON MATERNAL HEALTH AND PUBLIC HEALTH EMERGENCY 
              PREPAREDNESS.

    Not later than 1 year after the end of the public health emergency 
declared by the Secretary of Health and Human Services under section 
319 of the Public Health Service Act (42 U.S.C. 247d) on January 31, 
2020, with respect to COVID-19, the Comptroller General of the United 
States shall submit to the appropriate committees of Congress a report 
on maternal health and public health emergency preparedness, including 
prenatal, labor and delivery, and postpartum care during the COVID-19 
public health emergency, including the following:
            (1) A review of the prenatal, labor and delivery, and 
        postpartum experiences of people during the COVID-19 public 
        health emergency, which shall--
                    (A) identify barriers to accessing pregnancy, 
                birth, and postpartum care during a pandemic;
                    (B) assess the extent to which public and private 
                insurers were providing coverage for maternal health 
                care during the public health emergency, including for 
                telehealth services;
                    (C) to the extent practicable, analyze maternal and 
                infant health outcomes by race and ethnicity (including 
                quality of care, mortality, morbidity, cesarean section 
                rates, preterm birth, prevalence of prenatal and 
                postpartum anxiety and depression) during the COVID-19 
                public health emergency and the impact of Federal and 
                State policy changes made in response to the COVID-19 
                pandemic on such outcomes;
                    (D) identify contributors to population-based 
                disparities seen in COVID-19 outcomes, such as racial 
                profiling of, and bias and discrimination against 
                Black, American Indian and Alaska Native, Latinx, and 
                Asian-American and Pacific Islander people; and
                    (E) review the impact of increased unemployment, 
                paid family leave, changes in health care coverage, and 
                other social determinants of health for pregnant and 
                postpartum people during the public health emergency.
            (2) Consultation with maternity care providers, maternal 
        mental and behavioral health care specialists, researchers who 
        specialize in women's health or maternal mortality and severe 
        maternal morbidity, people who experienced pregnancy or 
        childbirth during the COVID-19 public health emergency, 
        representatives from community-based organizations that address 
        maternal health, and perinatal health workers who provide 
        nonclinical support to pregnant and postpartum people (such as 
        a doula, community health worker, peer support, certified 
        lactation consultant, nutritionist or dietician, social worker, 
        home visitor, or navigator).
            (3) Recommendations to improve the public health emergency 
        response and preparedness efforts of the Federal Government 
        specific to maternal health, with a particular focus on 
        outcomes for minority women, including--
                    (A) ways to improve research, surveillance, and 
                data collection of the Federal Government related to 
                maternal health;
                    (B) ways for the Federal Government to factor 
                maternal health outcomes and disparities into decisions 
                regarding distribution of resources, including COVID-19 
                tests, personal protective equipment, and emergency 
                funding;
                    (C) the extent to which guidelines and 
                recommendations of the Federal Government related to 
                maternal health care during the COVID-19 public health 
                emergency were culturally congruent and linguistically 
                competent for minority women; and
                    (D) ways to improve the distribution of public 
                health funds, data, and information to Indian Tribes 
                and Tribal organizations with regard to maternal health 
                during the COVID-19 public health emergency.
                                 <all>