Title: To direct the Secretary of Health and Human Services to issue guidance to States to educate providers, managed care entities, and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models, and for other purposes.
Policy area: Health

Summary:
This bill establishes programs and requires research to diversify the perinatal workforce and advance respectful maternal care delivery models.
Specifically, the Department of Health and Human Services (HHS) must award grants to education and training programs to grow and diversify the professions that make up the perinatal workforce. HHS must also disseminate guidance on respectful maternal care delivery. This guidance must cover, among other topics, recruiting and retaining maternity care providers from diverse backgrounds and incorporating trained midwives and other perinatal health workers into maternity care teams.
In addition, the National Institutes of Health must study best practices for culturally congruent maternity care. This is care that is in agreement with the preferred cultural values, beliefs, languages, worldview, and practices of health care consumers and other stakeholders.
The Government Accountability Office must also report on certain aspects of perinatal health care professions. The report must focus on barriers to entering those professions for low-income and minority women.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 945 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 945

To direct the Secretary of Health and Human Services to issue guidance 
   to States to educate providers, managed care entities, and other 
insurers about the value and process of delivering respectful maternal 
health care through diverse and multidisciplinary care provider models, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 8, 2021

  Ms. Moore of Wisconsin (for herself, Ms. Underwood, Ms. Adams, Mr. 
   Khanna, Ms. Velazquez, Mrs. McBath, Mr. Smith of Washington, Ms. 
   Scanlon, Mr. Lawson of Florida, Mrs. Hayes, Mr. Butterfield, Ms. 
Strickland, Mr. Ryan, Mr. Schiff, Mr. Johnson of Georgia, Mr. Horsford, 
    Ms. Wasserman Schultz, Ms. Barragan, Mr. Deutch, Mr. Payne, Mr. 
Blumenauer, Ms. Williams of Georgia, Mr. Moulton, Mr. Soto, Mr. Nadler, 
   Mr. Trone, Ms. Clarke of New York, Ms. Schakowsky, Ms. Bass, Ms. 
 Pressley, Mr. Evans, Ms. Blunt Rochester, Ms. Castor of Florida, Ms. 
  Houlahan, and Ms. Sewell) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To direct the Secretary of Health and Human Services to issue guidance 
   to States to educate providers, managed care entities, and other 
insurers about the value and process of delivering respectful maternal 
health care through diverse and multidisciplinary care provider models, 
                        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. 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 disseminate guidance to States to 
        educate providers, managed 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 encourage and incentivize hospitals, 
        health systems, midwifery practices, freestanding birth 
        centers, other maternity care provider groups, managed care 
        entities, 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 
                certified by the International Board of Lactation 
                Consultants Examiners--
                            (i) from racially, ethnically, and 
                        linguistically diverse backgrounds;
                            (ii) with experience practicing in racially 
                        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 education as 
                        established by the International Confederation 
                        of Midwives; and
                            (ii) perinatal health workers;
                    (C) to provide collaborative, culturally congruent 
                care; and
                    (D) to provide opportunities for individuals 
                enrolled in accredited midwifery education programs to 
                participate in job shadowing with maternity care teams 
                in hospitals, health systems, midwifery practices, and 
                freestanding birth centers.
    (b) Study on Respectful and Culturally Congruent Maternity Care.--
            (1) Study.--The Secretary of Health and Human Services 
        acting through the Director of the National Institutes of 
        Health (in this subsection referred to as the ``Secretary'') 
        shall conduct a study on best practices in respectful and 
        culturally congruent maternity care.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall--
                    (A) complete the study required by paragraph (1);
                    (B) submit to the Congress and make publicly 
                available a report on the results of such study; and
                    (C) include in such report--
                            (i) a compendium of examples of hospitals, 
                        health systems, midwifery practices, 
                        freestanding birth centers, other maternity 
                        care provider groups, managed care entities, 
                        and other insurers that are delivering 
                        respectful and culturally congruent maternal 
                        health care;
                            (ii) a compendium of examples of hospitals, 
                        health systems, midwifery practices, 
                        freestanding birth centers, other maternity 
                        care provider groups, managed care entities, 
                        and other insurers that have made progress in 
                        reducing disparities in maternal health 
                        outcomes and improving birthing experiences for 
                        pregnant and postpartum individuals from racial 
                        and ethnic minority groups; and
                            (iii) recommendations to hospitals, health 
                        systems, midwifery practices, freestanding 
                        birth centers, other maternity care provider 
                        groups, managed care entities, and other 
                        insurers, for best practices in respectful and 
                        culturally congruent maternity care.

SEC. 2. 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 following new section:

``SEC. 758. PERINATAL WORKFORCE GRANTS.

    ``(a) In General.--The Secretary shall award grants to entities to 
establish or expand programs described in subsection (b) to grow and 
diversify the perinatal workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the perinatal workforce by--
            ``(1) establishing schools or programs that provide 
        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 purposes 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 recruiting and 
        retaining students and faculty from racial and ethnic minority 
        groups;
            ``(2) has developed a strategy to recruit and retain a 
        diverse pool of students into the perinatal workforce program 
        or school supported by funds received through the grant, 
        particularly from racial and ethnic minority groups and other 
        underserved populations;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in a health professional shortage 
        area designated under section 332;
            ``(4) has developed a strategy to recruit and retain 
        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 program that includes 
        training on implicit bias and racism.
    ``(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 program or school 
        are entering careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                disparities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the program or school has included in the 
        standard curriculum for all students a bias, racism, or 
        discrimination training program that includes explicit and 
        implicit bias, and if so the effectiveness 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 section, an entity 
shall submit to the Secretary an application at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to entities 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.
    ``(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 assistants 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 assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, working in 
        health professional shortage areas designated under section 
        332; and
            ``(4) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, working in 
        areas with significant racial and ethnic disparities in 
        maternal health outcomes, to the extent such data are 
        available.
    ``(i) Definition.--In this section, the term `racial and ethnic 
minority group' has the meaning given such term in section 1707(g).
    ``(j) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2022 through 2026.''.

SEC. 3. GRANTS TO GROW AND DIVERSIFY THE NURSING WORKFORCE IN MATERNAL 
              AND PERINATAL HEALTH.

    Title VIII of the Public Health Service Act is amended 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 includes a focus 
        on maternal and perinatal health; or
            ``(2) clinical nurse specialists whose education includes a 
        focus on maternal and perinatal health.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any school of nursing that--
            ``(1) has developed a strategy to recruit and retain a 
        diverse pool of students seeking to enter careers focused on 
        maternal and perinatal health, particularly students from 
        racial and ethnic minority groups and other underserved 
        populations;
            ``(2) has developed a partnership with a practice setting 
        in a health professional shortage area designated under section 
        332 for the clinical placements of the school's students;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic disparities in maternal health outcomes, to 
        the extent practicable; and
            ``(4) includes in the standard curriculum for all students 
        seeking to enter careers focused on maternal and perinatal 
        health a bias, racism, or discrimination training program that 
        includes education on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section, a school of nursing shall agree to submit to the Secretary an 
annual report on the activities conducted through the grant, including, 
to the extent practicable--
            ``(1) the number and demographics of students in the school 
        of nursing seeking to enter careers focused on maternal and 
        perinatal health;
            ``(2) the extent to which such students are preparing to 
        enter careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                disparities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the standard curriculum for all students 
        seeking to enter careers focused on maternal and perinatal 
        health includes a bias, racism, or discrimination training 
        program that includes education on implicit bias and racism.
    ``(e) Period of Grants.--The period of a grant under this section 
shall be up to 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application, at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to schools of nursing seeking or 
receiving a grant under this section on the processes of awarding and 
evaluating scholarships through the grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups and other underserved populations;
            ``(2) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health from racial and ethnic minority groups and 
        other underserved populations;
            ``(3) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health working in health professional shortage 
        areas designated under section 332; and
            ``(4) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health working in areas with significant racial 
        and ethnic disparities in maternal health outcomes, to the 
        extent such data are available.
    ``(i) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2022 through 2026.''.

SEC. 4. GAO REPORT.

    (a) In General.--Not later than two years after the date of 
enactment of this Act and every five years thereafter, the Comptroller 
General of the United States shall submit to Congress a report on 
barriers to maternal health education and access to care in the United 
States. Such report shall include the information and recommendations 
described in subsection (b).
    (b) Content of Report.--The report under subsection (a) shall 
include--
            (1) an assessment of current barriers to entering 
        accredited midwifery education programs, and recommendations 
        for addressing such barriers, particularly for low-income women 
        and women from racial and ethnic minority groups;
            (2) an assessment of current barriers to entering and 
        successfully completing accredited education programs for other 
        health professional careers related to maternity care, 
        including 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 certified 
        by the International Board of Lactation Consultants Examiners, 
        particularly for low-income women and women from racial and 
        ethnic minority groups;
            (3) an assessment of current barriers that prevent midwives 
        from meeting the international definition of the midwife and 
        global standards for midwifery education as established by the 
        International Confederation of Midwives, and recommendations 
        for addressing such barriers, particularly for low-income women 
        and women from racial and ethnic minority groups;
            (4) an assessment of disparities in access to maternity 
        care providers, mental or behavioral health care providers 
        acting in accordance with State law, 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))), lactation consultants certified by the 
        International Board of Lactation Consultants Examiners, and 
        perinatal health workers, stratified by race, ethnicity, gender 
        identity, geographic location, and insurance type and 
        recommendations to promote greater access equity; and
            (5) recommendations to promote greater equity in 
        compensation for perinatal health workers under public and 
        private insurers, particularly for such individuals from 
        racially and ethnically diverse backgrounds.

SEC. 5. DEFINITIONS.

    In this Act:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (4) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (5) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
                                 <all>