Title: Kira Johnson Act
Policy area: Health

Summary:
Kira Johnson Act
This bill directs the Department of Health and Human Services (HHS) to award grants to improve outcomes and reduce bias, racism, and discrimination in maternal care settings. Specifically, HHS must award grants to (1) community-based programs to improve maternal health outcomes for African American women, (2) eligible entities to provide certain training to health care providers and others who work in maternity care settings, and (3) specified health care facilities to establish respectful maternity care compliance offices. The National Academies of Sciences, Engineering, and Medicine must study issues related to the training programs, and the Government Accountability Office must study the implementation and impact of the compliance offices.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6144 Introduced in House (IH)]

<DOC>






116th CONGRESS
  2d Session
                                H. R. 6144

    To make investments in community-based organizations and other 
     initiatives to prevent maternal mortality and severe maternal 
     morbidity, especially for Black women, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 9, 2020

   Ms. Adams (for herself, Ms. Underwood, Ms. Sewell of Alabama, Ms. 
Norton, Ms. Scanlon, Ms. Moore, Mr. Clay, Mr. Khanna, Ms. Pressley, and 
    Mr. Lawson of Florida) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To make investments in community-based organizations and other 
     initiatives to prevent maternal mortality and severe maternal 
     morbidity, especially for Black women, 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 ``Kira Johnson Act''.

SEC. 2. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE BLACK 
              MATERNAL HEALTH OUTCOMES.

    (a) Awards.--Following the 1-year period described in subsection 
(c), the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary''), acting through the Administrator of 
the Health Resources and Services Administration, shall award grants to 
eligible entities to establish or expand programs to prevent maternal 
mortality and severe maternal morbidity among Black women.
    (b) Eligibility.--To be eligible to seek a grant under this 
section, an entity shall be a community-based organization offering 
programs and resources aligned with evidence-based practices for 
improving maternal health outcomes for Black women.
    (c) Outreach and Technical Assistance Period.--During the 1-year 
period beginning on the date of enactment of this Act, the Secretary 
shall--
            (1) conduct outreach to encourage eligible entities to 
        apply for grants under this section; and
            (2) provide technical assistance to eligible entities on 
        best practices for applying for grants under this section.
    (d) Special Consideration.--
            (1) Outreach.--In conducting outreach under subsection (c), 
        the Secretary shall give special consideration to eligible 
        entities that--
                    (A) are based in, and provide support for, 
                communities with--
                            (i) high rates of adverse maternal health 
                        outcomes; and
                            (ii) significant racial and ethnic 
                        disparities in maternal health outcomes;
                    (B) are led by Black women; and
                    (C) offer programs and resources that are aligned 
                with evidence-based practices for improving maternal 
                health outcomes for Black women.
            (2) Awards.--In awarding grants under this section, the 
        Secretary shall give special consideration to eligible entities 
        that--
                    (A) are described in subparagraphs (A), (B), and 
                (C) of paragraph (1);
                    (B) offer programs and resources designed in 
                consultation with and intended for Black women; and
                    (C) offer programs and resources in the communities 
                in which the respective eligible entities are located 
                that--
                            (i) promote maternal mental health and 
                        maternal substance use disorder treatments that 
                        are aligned with evidence-based practices for 
                        improving maternal mental health outcomes for 
                        Black women;
                            (ii) address social determinants of health 
                        for women in the prenatal and postpartum 
                        periods, including--
                                    (I) housing;
                                    (II) transportation;
                                    (III) nutrition counseling;
                                    (IV) healthy foods;
                                    (V) lactation support;
                                    (VI) lead abatement and other 
                                efforts to improve air and water 
                                quality;
                                    (VII) child care access;
                                    (VIII) car seat installation;
                                    (IX) wellness and stress management 
                                programs; or
                                    (X) coordination across safety-net 
                                and social support services and 
                                programs;
                            (iii) promote evidence-based health 
                        literacy and pregnancy, childbirth, and 
                        parenting education for women in the prenatal 
                        and postpartum periods;
                            (iv) provide support from doulas and other 
                        perinatal health workers to women from 
                        pregnancy through the postpartum period;
                            (v) provide culturally congruent training 
                        to perinatal health workers such as doulas, 
                        community health workers, peer supporters, 
                        certified lactation consultants, nutritionists 
                        and dietitians, social workers, home visitors, 
                        and navigators;
                            (vi) conduct or support research on Black 
                        maternal health issues; or
                            (vii) have developed other programs and 
                        resources that address community-specific needs 
                        for women in the prenatal and postpartum 
                        periods and are aligned with evidence-based 
                        practices for improving maternal health 
                        outcomes for Black women.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance on--
            (1) capacity building to establish or expand programs to 
        prevent adverse maternal health outcomes among Black women;
            (2) best practices in data collection, measurement, 
        evaluation, and reporting; and
            (3) planning for sustaining programs to prevent maternal 
        mortality and severe maternal morbidity among Black women after 
        the period of the grant.
    (f) Evaluation.--Not later than the end of fiscal year 2026, the 
Secretary shall submit to the Congress an evaluation of the grant 
program under this section that--
            (1) assesses the effectiveness of outreach efforts during 
        the application process in diversifying the pool of grant 
        recipients;
            (2) makes recommendations for future outreach efforts to 
        diversify the pool of grant recipients for Department of Health 
        and Human Services grant programs and funding opportunities;
            (3) assesses the effectiveness of programs funded by grants 
        under this section in improving maternal health outcomes for 
        Black women; and
            (4) makes recommendations for future Department of Health 
        and Human Services grant programs and funding opportunities 
        that deliver funding to community-based organizations to 
        improve Black maternal health outcomes through programs and 
        resources that are aligned with evidence-based practices for 
        improving maternal health outcomes for Black women.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2021 through 2025.

SEC. 3. TRAINING FOR ALL EMPLOYEES IN MATERNITY CARE SETTINGS.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by adding at the end the following new section:

``SEC. 742. TRAINING FOR ALL EMPLOYEES IN MATERNITY CARE SETTINGS.

    ``(a) Grants.--The Secretary shall award grants for programs to 
reduce and prevent bias, racism, and discrimination in maternity care 
settings.
    ``(b) Special Consideration.--In awarding grants under subsection 
(a), the Secretary shall give special consideration to applications for 
programs that would--
            ``(1) apply to all birthing professionals and any employees 
        who interact with pregnant and postpartum women in the provider 
        setting, including front desk employees, sonographers, 
        schedulers, health care professionals, hospital or health 
        system administrators, and security staff;
            ``(2) emphasize periodic, as opposed to one-time, trainings 
        for all birthing professionals and employees described in 
        paragraph (1);
            ``(3) address implicit bias and explicit bias;
            ``(4) be delivered in ongoing education settings for 
        providers maintaining their licenses, with a preference for 
        trainings that provide continuing education units and 
        continuing medical education;
            ``(5) include trauma-informed care best practices and an 
        emphasis on shared decision making between providers and 
        patients;
            ``(6) include a service-learning component that sends 
        providers to work in underserved communities to better 
        understand patients' lived experiences;
            ``(7) be delivered in undergraduate programs that funnel 
        into medical schools, like biology and pre-medicine majors;
            ``(8) be delivered in settings that apply to providers of 
        the special supplemental nutrition program for women, infants, 
        and children under section 17 of the Child Nutrition Act of 
        1966;
            ``(9) integrate bias training in obstetric emergency 
        simulation trainings;
            ``(10) offer training to all maternity care providers on 
        the value of racially, ethnically, and professionally diverse 
        maternity care teams to provide culturally congruent care, 
        including doulas, community health workers, peer supporters, 
        certified lactation consultants, nutritionists and dietitians, 
        social workers, home visitors, and navigators; or
            ``(11) be based on one or more programs designed by a 
        historically Black college or university.
    ``(c) Application.--To seek a grant under subsection (a), an entity 
shall submit an application at such time, in such manner, and 
containing such information as the Secretary may require.
    ``(d) Reporting.--Each recipient of a grant under this section 
shall annually submit to the Secretary a report on the status of 
activities conducted using the grant, including, as applicable, a 
description of the impact of training provided through the grant on 
patient outcomes and patient experience for women of color and their 
families.
    ``(e) Best Practices.--Based on the annual reports submitted 
pursuant to subsection (d), the Secretary--
            ``(1) shall produce an annual report on the findings 
        resulting from programs funded through this section;
            ``(2) shall disseminate such report to all recipients of 
        grants under this section and to the public; and
            ``(3) may include in such report findings on best practices 
        for improving patient outcomes and patient experience for women 
        of color and their families in maternity care settings.
    ``(f) Definitions.--In this section:
            ``(1) The term `postpartum' means the one-year period 
        beginning on the last day of a woman's pregnancy.
            ``(2) The term `culturally congruent' means in agreement 
        with the preferred cultural values, beliefs, worldview, and 
        practices of the health care consumer and other stakeholders.
    ``(g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2021 through 2025.''.

SEC. 4. STUDY ON REDUCING AND PREVENTING BIAS, RACISM, AND 
              DISCRIMINATION IN MATERNITY 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, 
Engineering, and Medicine (referred to in this section as the 
``National Academies'') under which the National Academies agrees to--
            (1) conduct a study on the design and implementation of 
        programs to reduce and prevent bias, racism, and discrimination 
        in maternity care settings; and
            (2) not later than 24 months after the date of enactment of 
        this Act, complete the study and 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:
            (1) The development of a scorecard for programs designed to 
        reduce 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 women of color and their families.
            (2) Determination of the types of training to reduce and 
        prevent bias, racism, and discrimination in maternity care 
        settings that are demonstrated to improve patient outcomes or 
        patient experience for women of color and their families.

SEC. 5. RESPECTFUL MATERNITY CARE COMPLIANCE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award grants 
to accredited hospitals, health systems, and other maternity care 
delivery settings to establish within one or more hospitals or other 
birth settings a respectful maternity care compliance office.
    (b) Office Requirements.--A respectful maternity care compliance 
office funded through a grant under this section shall--
            (1) institutionalize mechanisms to allow patients receiving 
        maternity care services, the families of such patients, or 
        doulas or other perinatal workers supporting such patients to 
        report instances of disrespect or evidence of bias on the basis 
        of race, ethnicity, or another protected class;
            (2) institutionalize response mechanisms through which 
        representatives of the office 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 protected class in the delivery of 
        maternity care that includes--
                    (A) information on the training programs to reduce 
                and prevent bias, racism, and discrimination on the 
                basis of race, ethnicity, or another protected class 
                for all employees in maternity care settings; and
                    (B) the development of methods to routinely assess 
                the extent to which bias, racism, or discrimination on 
                the basis of race, ethnicity, or another protected 
                class are present in the delivery of maternity care to 
                minority patients; and
            (4) provide annual reports to the Secretary with 
        information about each case reported to the compliance office 
        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, ethnicity, gender 
                identity, and primary language;
                    (B) the content of the report from the patient or 
                the family of the patient to the compliance office; and
                    (C) the response from the compliance office.
    (c) Secretary Requirements.--
            (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 establishing 
                and implementing a respectful maternity care compliance 
                office within a hospital or other birth setting;
                    (B) promoting coordination and collaboration 
                between hospitals, health systems, and other maternity 
                care delivery settings on the establishment and 
                implementation of respectful maternity care compliance 
                offices; and
                    (C) evaluating the effectiveness of respectful 
                maternity care compliance offices on maternal health 
                outcomes and patient and family experiences, especially 
                for minority patients and their families.
            (2) Study.--
                    (A) In general.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary shall, 
                through a contract with an independent research 
                organization, conduct a study on strategies to address 
                disrespect or bias on the basis of race, ethnicity, or 
                another protected class in the delivery of maternity 
                care services.
                    (B) Components of study.--The study shall include 
                the following:
                            (i) An assessment of the reports submitted 
                        to the Secretary from the respectful maternity 
                        care compliance offices pursuant to subsection 
                        (b)(4).
                            (ii) Based on such assessment, 
                        recommendations for potential accountability 
                        mechanisms related to cases of disrespect or 
                        bias on the basis of race, ethnicity, or 
                        another protected class in the delivery of 
                        maternity 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 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 2021 through 2026.

SEC. 6. GAO REPORT.

    (a) In General.--Not later than 2 years after date of enactment of 
this Act and every 2 years 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 
offices within hospitals, health systems, and other maternity care 
settings.
    (b) Matters Included.--The report under paragraph (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 maternity care compliance offices, 
        including--
                    (A) which hospitals and other birth settings elect 
                to establish compliance offices and when such offices 
                are established;
                    (B) to the extent practicable, impacts of the 
                establishment of such offices on maternal health 
                outcomes and patient and family experiences in the 
                hospitals and other birth settings that have 
                established such offices, especially for minority women 
                and their families;
                    (C) information on geographic areas, and types of 
                hospitals or other birth settings, where respectful 
                maternity care compliance offices are not being 
                established and information on factors contributing to 
                decisions to not establish such offices; and
                    (D) recommendations for establishing respectful 
                maternity care compliance offices in geographic areas, 
                and types of hospitals or other birth settings, where 
                such offices are not being established.
            (2) Whether the funding made available to carry out section 
        6 has been sufficient and, if applicable, recommendations for 
        additional appropriations to carry out section 6.
            (3) Such other information as the Comptroller General 
        determines appropriate.

SEC. 7. DEFINITIONS.

    In this Act:
            (1) The term ``postpartum'' means the one-year period 
        beginning on the last day of a woman's pregnancy.
            (2) The term ``culturally congruent'' means in agreement 
        with the preferred cultural values, beliefs, worldview, and 
        practices of the health care consumer and other stakeholders.
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