,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #eigg ,,in ,,the ,,house ,,of ,,representatives ,may #be1 #bjah,ms4 ,kelly of ,illinois introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to improve ,federal efforts with respect to the prevention of maternal mortality1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,mothers and ,offspring ,mortality and ,morbidity ,awareness ,act or the ,,momma's ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,every year1 across the ,united ,states1 four million women give birth1 about #gjj women suffer fatal complications during pregnancy1 while giving birth1 or during the postpartum period1 and #fe1jjj women suffer near-fatal1 partum-related complications4 7#b7 ,the maternal mortality rate is often used as a proxy to measure the overall health of a population4 ,while the infant mortality rate in the ,united ,states has reached its lowest point1 the risk of death for women in the ,united ,states during pregnancy1 childbirth1 or the postpartum period is higher than such risk in any all other developed nations4 ,the estimated maternal mortality rate 7per #ajj1jjj live births7 for the #dh contiguous ,states and ,washington ,,dc increased from #ah4h percent in #bjjj to #bc4h percent in #bjad to #bf4f percent in #bjah4 ,this estimated rate is on par with such rate for underdeveloped nations such as ,iraq and ,afghanistan4 7#c7 ,international studies estimate the #bjae ,u4,s4 maternal mortality rate as #bf4d per #ajj1jjj live births1 which is almost twice the #bjae ,world ,health ,organization 7,,who7 estimation of #ad per #ajj1jjj live births4 7#d7 ,it is estimated that almost half of all maternal mortalities in the ,united ,states are preventable4 7#e7 ,african-,american women experience maternal-related deaths at three to four times the rate of non-,hispanic ,white women4 7#f7 ,the findings described in paragraphs 7#a7 through 7#e7 are of major concern to researchers1 academicians1 and epidemiologists at the ,centers for ,disease ,control and ,prevention 7,,cdc72 providers across the obstetrical continuum represented by organizations such as the ,preeclampsia ,foundation2 the ,american ,college of ,obstetricians and ,gynecologists2 the ,association of ,women's ,health1 ,obstetric1 and ,neonatal ,nurses2 the ,california ,maternal ,quality ,care ,collaborative2 ,black ,women's ,health ,imperative2 the ,national ,birth ,equity ,collaborative2 ,black ,mamas ,matter ,alliance2 the ,national ,association of ,certified ,professional ,midwives2 and the ,american ,college of ,nurse ,midwives4 7#g7 ,according to the ,,cdc1 the maternal mortality rate varies drastically for women by race and ethnicity4 ,there are #ab4g deaths per #ajj1jjj live births for ,white women1 #dc4e deaths per #ajj1jjj live births for ,african-,american women1 and #ad4d deaths per #ajj1jjj live births for women of other ethnicities4 ,while maternal mortality disparately impacts ,african-,american women1 the phenomenon traverses race1 ethnicity1 socioeconomic status1 educational background1 and geography4 7#h7 ,hemorrhage1 cardiovascular and coronary conditions1 cardiomyopathy1 infection1 embolism1 mental health conditions1 preeclampsia and eclampsia1 infection or sepsis1 and anesthesia complications are the predominant causes of maternal-related deaths and complications4 ,such conditions are largely preventable or manageable4 7#i7 ,the ,united ,states has not been able to submit a formal maternal mortality rate to international data repositories since #bjjg4 ,thus1 no official maternal mortality rate exists for the ,nation4 ,there can be no maternal mortality rate without streamlining maternal mortality-related data from the ,state level and extrapolating such data to the ,federal level4 7#aj7 ,in the ,united ,states1 death reporting and analysis is a ,state function rather than a ,federal process4 ,states report all deaths--including maternal deaths--on a semi-voluntary basis1 without standardization across ,states4 ,while the ,,cdc has the capacity and system for collecting death-related data based on death certificates1 these data are not sufficiently reported by ,states in an organized and standard format across ,states such that the ,,cdc is able to identify causes of maternal death and best practices for the prevention of such death4 7#aa7 ,vital registration systems often underestimate maternal mortality and are insufficient data sources from which to derive a full scope of medical and social determinant factors contributing to maternal deaths4 ,while the addition of pregnancy checkboxes on death certificates since #bjjc have likely improved ,states' abilities to identify pregnancy-related deaths1 they are not generally completed by obstetrical providers or persons trained to recognize pregnancy-related mortality4 ,thus1 these vital forms may be missing information or may capture inconsistent data4 ,due to varying maternal mortality-related analyses1 lack of reliability1 and granularity in data1 current maternal mortality informatics do not fully encapsulate the myriad medical and socially determinant factors that contribute to such high maternal mortality rates within the ,united ,states compared to other developed nations4 ,non-standardization of data and lack of data sharing across ,states and between ,federal entities1 health networks1 and research institutions keep the ,nation in the dark about ways to prevent maternal deaths4 7#ab7 ,having reliable and valid ,state data aggregated at the ,federal level are critical to the ,nation's ability to quell surges in maternal death and imperative for researchers to identify long-lasting interventions4 7#ac7 ,leaders in maternal wellness highly recommend that maternal deaths be investigated at the ,state level first4 ,then1 have data regarding maternal deaths be standardized across ,states1 streamlined1 de-identified1 and sent once a year to a federally supervised database1 managed by a ,federal agency at the discretion of the ,secretary of ,health and ,human ,services4 ,such data standardization and collection would be similar in operation and effect to the ,national ,program of ,cancer ,registries housed at the ,,cdc and akin to the ,confidential ,enquiry in ,maternal ,deaths ,programme in the ,united ,kingdom4 ,such a maternal mortality and morbidities registry and surveillance would help providers1 academicians1 lawmakers1 and the public to address questions concerning the types of1 causes of1 and best practices to thwart1 pregnancy-related or pregnancy-associated mortalities and morbidities4 7#ad7 ,the ,united ,nations' ,millennium ,development ,goal #e;a aimed to reduce by three quarters1 between #aiij and #bjae1 the maternal mortality rate1 yet this metric has not been achieved4 ,in fact1 the maternal mortality rate in the ,united ,states has been estimated to have more than doubled between #bjjj and #bjad4 ,yet1 because national data are not fully available1 the ,united ,states does not have an official maternal mortality rate4 7#ae7 ,many ,states have struggled to establish or maintain ,maternal ,mortality ,review ,committees 7,,mmrc74 ,on the ,state level1 ,m,m,r,cs have lagged because ,states have not had the resources to mount local reviews4 ,state-level reviews are necessary as only the ,state departments of health have the authority to request medical records1 autopsy reports1 and police reports critical to the function of the ,,mmrc4 7#af7 ,the ,united ,kingdom regards maternal deaths as a health systems failure and a national committee of obstetrics experts review each maternal death or near-fatal childbirth complication4 ,such committee also establishes the predominant course of maternal-related deaths from conditions such as preeclampsia4 ,consequently1 the ,united ,kingdom has been able to reduce their incidences of preeclampsia to less than one in #aj1jjj women--its lowest rate since #aieb4 7#ag7 ,the ,united ,states has no comparable1 coordinated ,federal process by which to review cases of maternal mortality1 systems failures1 or best practices4 ,many ,states have active ,m,m,r,cs and leverage their work to impact maternal wellness4 ,for example1 the ,state of ,california has worked extensively with their ,state health departments1 health and hospital systems1 and research collaborative organizations1 including the ,california ,maternal ,quality ,care ,collaborative and the ,alliance for ,innovation on ,maternal ,health1 to establish ,m,m,r,cs1 wherein they have determined the most prevalent causes of maternal mortality and recorded and shared data with providers and researchers1 who have developed and implemented safety bundles and care protocols related to preeclampsia1 maternal hemorrhage1 and the like4 ,in this way1 the ,state of ,california has been able to leverage its maternal mortality review board system1 generate data1 and apply those data to effect changes in maternal care-related protocol4 ,to date1 the ,state of ,california has stymied its maternal mortality rate1 which is now comparable to the low rates of the ,united ,kingdom4 7#ah7 ,hospitals and health systems across the ,united ,states lack standardization of emergency obstetrical protocols before1 during1 and after delivery4 ,consequently1 many providers are delayed in recognizing critical signs indicating maternal distress that quickly escalate into fatal or near-fatal incidences4 ,moreover1 any attempt to address an obstetrical emergency that does not take into account both clinical and public health approaches falls woefully under the mark of excellent care delivery4 ,state-based maternal quality collaborative organizations1 including the ,alliance for ,innovation on ,maternal ,health 7,a,i,ms7 and ,california ,maternal ,quality ,care ,collaborative1 have formed obstetrical protocols1 tool kits1 and other resources to improve system care and response as they relate to maternal complications and warning signs for such conditions as maternal hemorrhage1 hypertension1 and preeclampsia4 ,state perinatal quality collaboratives are working to identify health care processes that need to be improved and use the best available methods to make those changes as quickly as possible1 while the ,alliance for ,innovation on ,maternal ,health is working with ,states and health systems to align national1 ,state1 and hospital level quality improvement efforts through the creation and dissemination of maternal safety bundles to improve overall maternal health outcomes4 7#ai7 ,the ,,cdc reports that more than half of all maternal deaths occur in the immediate postpartum period--between #db days up to a full year--whereas more than one-third of pregnancy-related or pregnancy-associated deaths occur while a person is still pregnant4 ,yet1 for pregnant women1 ,medicaid coverage lapses at the end of the month on which the #fjth postpartum day lands4 7#bj7 ,a growing body of evidence-based research has shown the correlation between the stress associated with one's race--the stress of racism--and one's birthing outcomes4 ,the stress of sex and race discrimination and institutional racism has been demonstrated to contribute to a higher risk of maternal mortality1 irrespective of one's gestational age1 maternal age1 socioeconomic status1 or individual-level health risk factors1 including poverty1 limited access to prenatal care1 and poor physical and mental health 7although these are not nominal factors74 ,african-,american women remain the most at risk for pregnancy-associated or pregnancy-related causes of death4 ,when it comes to preeclampsia1 for example--which is related to obesity--,african-,american women of normal weight remain the most at risk of dying during the perinatal period compared to non-,african-,american obese women4 7#ba7 ,the rising ,u4,s4 maternal mortality rate is predominantly driven by the disproportionately high rates of ,african-,american maternal mortality4 7#bb7 ,african-,american women are three to four times more likely to die from pregnancy or maternal-related distress than are ,white women1 yielding one of the greatest and most disconcerting racial disparities in public health4 7#bc7 ,compared to women from other racial and ethnic demographics1 ,african-,american women across the socioeconomic spectrum experience prolonged1 unrelenting stress related to racial and gender discrimination1 contributing to higher rates of maternal mortality1 giving birth to low-weight babies1 and experiencing pre-term birth4 ,racism is a risk-factor for these aforementioned experiences4 ,this cumulative stress often extends across the life course and is situated in everyday spaces where ,african-,american women establish livelihood4 ,structural barriers1 lack of access to care1 and genetic predispositions to health vulnerabilities exacerbate ,african-,american women's likelihood to experience poor or fatal birthing outcomes1 but do not fully account for the great disparity4 7#bd7 ,african-,american women are twice as likely to experience postpartum depression1 and disproportionately higher rates of preeclampsia compared to ,white women4 7#be7 ,racism is deeply ingrained in ,united ,states systems1 including in health care delivery systems between patients and providers1 often resulting in disparate treatment for pain1 irreverence for cultural norms with respect to health1 and dismissiveness4 ,research has demonstrated that patients respond more warmly and adhere to medical treatment plans at a higher degree with providers of the same race or ethnicity or with providers with great ability to exercise empathy4 ,however1 the provider pool is not primed with many people of color1 nor are providers 7whether student-doctors in training or licensed practitioners7 consistently required to undergo implicit bias1 cultural competency1 or empathy training on a consistent1 on-going basis4 #c4 ,improving ,federal efforts with respect to prevention of maternal mortality 7a7 ,technical assistance for ,states with respect to reporting maternal mortality ,not later than one year after the date of enactment of this ,act1 the ,director of the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,director7 shall provide technical assistance to ,states that elect to report on maternal mortality for the purpose of encouraging uniformity in the reporting of such data and to encourage the sharing of such data among the respective ,states4 7b7 ,best practices relating to prevention of maternal mortality ,not later than one year after the date of enactment of this ,act1 the ,director shall issue best practices to ,state maternal mortality review committees on how best to identify1 review1 and prevent maternal mortality4 ,in issuing such best practices1 the ,director shall take into account any data made available by ,states relating to maternal mortality4 7c7 ,alliance for ,innovation on ,maternal ,health ,grant ,program 7#a7 ,in general ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,associate ,administrator of the ,maternal and ,child ,health ,bureau of the ,health ,resources and ,services ,administration1 shall establish a grant program to be known as the ,alliance for ,innovation on ,maternal ,health ,grant ,program 7referred to in this subsection as ,,aim7 under which the ,secretary shall award grants to eligible entities for the purpose of directing widespread adoption and implementation of maternal safety bundles through collaborative ,state-based teams and collecting and analyzing process1 structure1 and outcome data to drive continuous improvement in the implementation of such safety bundles by such ,state-based teams with the ultimate goal of eliminating preventable maternal mortality and severe maternal morbidity in the ,united ,states4 7#b7 ,eligible entities ,in order to be eligible for a grant under paragraph 7#a71 an entity shall-- 7,a7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7,b7 demonstrate in such application that the entity is an interdisciplinary1 multi-stakeholder national organization with a national data-driven maternal safety and quality improvement initiative based on implementation approaches that have been proven to improve maternal safety and outcomes in the ,united ,states4 7#c7 ,use of funds ,an eligible entity that receives a grant under paragraph 7#a7 shall use such grant funds-- 7,a7 to develop and implement1 through a robust1 multi-stakeholder process1 maternal safety bundles to assist ,states and health care systems in aligning national1 ,state1 and hospital-level quality improvement efforts to improve maternal health outcomes1 specifically the reduction of maternal mortality and severe maternal morbidity2 7,b7 to ensure1 in developing and implementing maternal safety bundles under subparagraph 7,a71 that such maternal safety bundles-- 7i7 satisfy the quality improvement needs of a ,state or health care system by factoring in the results and findings of relevant data reviews1 such as reviews conducted by a ,state maternal mortality review committee2 and 7ii7 address topics such as-- 7,i7 obstetric hemorrhage2 7,,ii7 maternal mental health2 7,,iii7 the maternal venous system2 7,,iv7 obstetric care for women with opioid use disorder2 7,v7 postpartum care basics for maternal safety2 7,,vi7 reduction of peripartum racial and ethnic disparities2 7,,vii7 reduction of primary caesarean birth2 7,,viii7 severe hypertension in pregnancy2 7,,ix7 severe maternal morbidity reviews2 7,x7 support after a several maternal morbidity event2 and 7,,xi7 thromboembolism2 and 7,c7 to provide ongoing technical assistance at the national and ,state levels to support implementation of maternal safety bundles under subparagraph 7,a74 7#d7 ,maternal safety bundle defined ,for purposes of this subsection1 the term maternal safety bundle means standardized1 evidence-informed processes to improve variation in response to maternal care4 7#e7 ,authorization of appropriations ,for purposes of carrying out this subsection1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjai through #bjbc4 7d7 ,expansion of ,medicaid and ,,chip coverage for pregnant and postpartum women 7#a7 ,extending ,medicaid coverage for pregnant and postpartum women ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7,a7 in subsection 7e7-- 7i7 in paragraph 7#e71 by striking #fj-;day and inserting one-year2 and 7ii7 in paragraph 7#f71 by striking #fj-;day and inserting one-year2 and 7,b7 in subsection 7l77#a77;,a71 by striking #fj-;day and inserting one-year4 7#b7 ,extending ,medicaid coverage for lawful residents ,section #aijc7v77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d77;,a77 is amended by striking #fj-;day and inserting one-year4 7#c7 ,extending ,,chip coverage for pregnant and postpartum women ,section #baab7;d77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is amended by striking #fj-;day and inserting one-year4 7#d7 ,maintenance of effort 7,a7 ,medicaid ,section #aijb7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,subject to subparagraph 7,b71 during the period that begins on the date of enactment of this paragraph and ends on the date that is five years after such date of enactment1 as a condition for receiving any ,federal payments under section #aijc7;a7 for calendar quarters occurring during such period1 a ,state1 including a ,state described in paragraph 7#d77;,b7 that elects to meet the requirement of subsection 7a77#aj77;,a77i77,,iv71 shall not have in effect1 with respect to women who are eligible for medical assistance because of such subsection 7a77#aj77;,a77i77,,iv7 or section #aijc7v77#d77;,a77i71 eligibility standards1 methodologies1 or procedures under the ,state plan 7or a waiver of such plan7 that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 that are in effect on the date of enactment of this paragraph4 7,b7 ,a ,state's determination of income in accordance with subsection 7e77#ad7 shall not be considered to be eligibility standards1 methodologies1 or procedures that are more restrictive than the standards1 methodologies1 or procedures in effect under the ,state plan 7or a waiver of such plan7 on the date of enactment of this paragraph for purposes of determining compliance with the requirement of subparagraph 7,a74 4 7,b7 ,,chip ,section #baje7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77 is amended by adding at the end the following new paragraph3 7#d7 ,in eligibility standards for targeted low-income pregnant women ,during the period that begins on the date of enactment of this paragraph and ends on the date that is five years after such date of enactment1 as a condition of receiving payments under subsection 7a7 and section #aijc7;a71 a ,state that elects to provide pregnancy-related assistance to targeted low-income pregnant women 7as defined in section #baab7;d771 or women who are eligible for such assistance through the application of section #aijc7v77#d77;,a77i7 under section #bajg7;e77#a71 shall not have in effect1 with respect to such women1 eligibility standards1 methodologies1 or procedures under the ,state child health plan 7or a waiver of such plan7 that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 that are in effect on the date of enactment of this paragraph4 4 7#e7 ,effective date 7,a7 ,in general ,except as otherwise provided and subject to subparagraph 7,b71 the amendments made by this subsection shall take effect with respect to eligibility determinations made with respect to a ,state plan under title ,,xix of the ,social ,security ,act or a ,state child health plan under title ,,xxi of such ,act on or after the date that is one year after the date of enactment of this ,act4 7,b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act or a ,state child health plan under title ,,xxi of such ,act that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this subsection1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 7e7 ,regional centers of excellence ,part ,p of title ,,iii of the ,public ,health ,service ,act is amended by adding at the end the following new section3 #cii,v-#g4 ,regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education 7a7 ,in general ,not later than one year after the date of enactment of this section1 the ,secretary1 in consultation with such other agency heads as the ,secretary determines appropriate1 shall1 subject to the availability of appropriations1 award cooperative agreements for the establishment or support of regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education for the purpose of enhancing and improving how health care professionals are educated in implicit bias and delivering culturally competent health care4 7b7 ,eligibility ,to be eligible to receive a cooperative agreement under subsection 7a71 an entity shall-- 7#a7 be an entity specified by the ,secretary that provides educational opportunities for students in a health care profession1 which may include a health system1 teaching hospital1 birthing center1 community health center1 physician's office1 medical school1 school of public health1 or any other health professional school or a program at an institution of higher education focused on the prevention1 treatment1 or recovery of health conditions that contribute to maternal mortality and the prevention of maternal mortality2 7#b7 demonstrate community engagement and participation through community partners such as mental health counselors and social workers2 and 7#c7 provide to the ,secretary such information1 at such time and in such manner1 as the ,secretary may require4 7c7 ,diversity ,in awarding a cooperative agreement under subsection 7a71 the ,secretary shall take into account any regional differences among eligible entities and make an effort to ensure geographic diversity among award recipients4 7d7 ,dissemination of information 7#a7 ,public availability ,the ,secretary shall make publicly available on the ,internet website of the ,department of ,health and ,human ,services information submitted to the ,secretary under subsection 7b77#c74 7#b7 ,evaluation ,the ,secretary shall evaluate each regional center of excellence established or supported pursuant to subsection 7a7 and disseminate the findings resulting from each such evaluation to the appropriate public and private entities4 7e7 ,maternal mortality defined ,in this section1 the term maternal mortality means death that occurs to a woman during pregnancy or within the one-year period following the end of such pregnancy4 7f7 ,authorization of appropriations ,for purposes of carrying out this section1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 7f7 ,definitions ,in this section3 7#a7 ,maternal mortality ,the term maternal mortality means death that occurs to a woman during pregnancy or within the one-year period following the end of such pregnancy4 7#b7 ,severe maternal morbidity ,the term severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a woman's health4