,,ii #aaeth ,,congress #b;d ,session ,s4 #ccfc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #bb1 #bjah,ms4 ,harris 7for herself1 ,mrs4 ,gillibrand1 ,mr4 ,cardin1 ,mr4 ,wyden1 ,mr4 ,blumenthal1 ,mr4 ,nelson1 ,mr4 ,jones1 ,mr4 ,merkley1 ,ms4 ,duckworth1 ,mr4 ,carper1 ,mr4 ,brown1 ,ms4 ,baldwin1 ,ms4 ,hirono1 and ,ms4 ,stabenow7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to support ,states in their work to end preventable morbidity and mortality in maternity care by using evidence-based quality improvement to protect the health of mothers during pregnancy1 childbirth1 and in the postpartum period and to reduce neonatal and infant mortality1 to eliminate racial disparities in maternal health outcomes1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,maternal ,care ,access and ,reducing ,emergencies ,act or the ,maternal ,,care ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,in the ,united ,states1 maternal mortality rates are among the highest in the developed world and increased by #bf4f percent between #bjjj and #bjad4 7#b7 ,of the #d1jjj1jjj ,american women who give birth each year1 about #gjj suffer fatal complications during pregnancy1 while giving birth1 or during the postpartum period1 and an additional #ej1jjj are severely injured4 7#c7 ,it is estimated that half of the maternal mortalities in the ,united ,states could be prevented and half of the maternal injuries in the ,united ,states could be reduced or eliminated with better care4 7#d7 ,data from the ,centers for ,disease ,control and ,prevention show that ,black women are #c to #d times more likely to die from pregnancy-related causes than ,white women4 ,there are #dj deaths per #ajj1jjj live births for ,black women1 compared to #ab4d deaths per #ajj1jjj live births for ,white women and #ag4h deaths per #ajj1jjj live births for women of other races4 7#e7 ,black women's risk of maternal mortality has remained higher than ,white women's risk for the past #f decades4 7#f7 ,black women in the ,united ,states suffer from life-threatening pregnancy complications twice as often as their ,white counterparts4 7#g7 ,high rates of maternal mortality among ,black women span income and education levels1 as well as socioeconomic status2 moreover1 risk factors such as a lack of access to prenatal care and physical health conditions do not fully explain the racial disparity in maternal mortality4 7#h7 ,a growing body of evidence indicates that stress from racism and racial discrimination results in conditions--including hypertension and pre-eclampsia--that contribute to poor maternal health outcomes among ,black women4 7#i7 ,pervasive racial bias against ,black women and unequal treatment of ,black women exist in the health care system1 often resulting in inadequate treatment for pain and dismissal of cultural norms with respect to health4 ,a #bjaf study by ,university of ,virginia researchers found that ,white medical students and residents often believed biological myths about racial differences in patients1 including that ,black patients have less-sensitive nerve endings and thicker skin than their ,white counterparts4 ,providers1 however1 are not consistently required to undergo implicit bias1 cultural competency1 or empathy training4 7#aj7 ,north ,carolina has established a statewide ,pregnancy ,medical ,home 7,,pmh7 program1 which aims to reduce adverse maternal health outcomes and maternal deaths by incentivizing maternal health care providers to provide integral health care services to pregnant women and new mothers4 ,according to the ,north ,carolina ,department of ,health and ,human ,services ,center for ,health ,statistics1 the pregnancy-related mortality rate for ,black women was approximately #e4a times higher than that of ,white women in #bjjd4 ,almost a decade later1 in #bjac1 the pregnancy-related mortality rates for ,black women and ,white women were #bd4c and #bd4b deaths per #ajj1jjj live births1 respectively4 ,the ,,pmh program has been credited with the convergence in pregnancy-related mortality rates because the program partners each high-risk pregnant and postpartum woman that is covered under ,medicaid with a pregnancy care manager4 #c4 ,implicit bias training for health care providers 7a7 ,grant program ,the ,secretary of ,health and ,human ,services 7referred to in this ,act as the ,secretary7 shall establish a grant program under which such ,secretary awards grants to accredited schools of allopathic medicine1 schools of osteopathic medicine1 nursing schools1 and other health professional training programs for the purpose of supporting evidence-based implicit bias training1 with priority given to such training with respect to obstetrics and gynecology4 7b7 ,implicit bias defined ,in this section1 the term implicit bias means-- 7#a7 bias in judgment or behavior that results from subtle cognitive processes1 including implicit attitudes and implicit stereotypes1 that often operate at a level below conscious awareness and without intentional control2 or 7#b7 implicit attitudes and stereotypes that result in beliefs or simple associations that a person makes between an object and its evaluation that are automatically activated by the mere presence 7actual or symbolic7 of the attitude object4 7c7 ,authorization of appropriations ,there are authorized to be appropriated for purposes of carrying out the grant program under subsection 7a71 #e1jjj1jjj for each of fiscal years #bjai through #bjbc4 #d4 ,pregnancy medical home demonstration project 7a7 ,in general ,the ,secretary1 acting through the ,administrator for the ,centers for ,medicare ,medicaid ,services and the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to ,states for the purpose of establishing or operating ,state pregnancy medical home programs that meet the requirements of subsection 7b7 to deliver integrated health care services to pregnant women and new mothers and reduce adverse maternal health outcomes1 maternal deaths1 and racial health disparities in maternal mortality and morbidity4 7b7 ,state pregnancy medical home program requirements ,a ,state pregnancy medical home program meets the requirements of this subsection if-- 7#a7 the ,state works with relevant stakeholders to develop and carry out the program1 including-- 7,a7 ,state and local agencies responsible for ,medicaid1 public health1 social services1 mental health1 and substance abuse treatment and support2 7,b7 health care providers who serve pregnant women1 including doctors1 nurses1 and midwives2 7,c7 community-based health workers1 including perinatal health workers1 doulas1 and home visitors2 and 7,d7 community-based organizations and individuals representing the communities with-- 7i7 the highest overall rates of maternal mortality and morbidity2 and 7ii7 the greatest racial disparities in rates of maternal mortality and morbidity2 7#b7 the ,state selects obstetric providers to participate in the program as pregnancy medical homes1 and requires that any provider that wishes to participate in the program as a pregnancy medical home-- 7,a7 commits to following evidence-based practices for maternity care1 as developed by the ,state in consultation with relevant stakeholders2 and 7,b7 completes training to provide culturally and linguistically competent care2 7#c7 under the program1 each pregnancy medical home is required to conduct a standardized medical1 obstetric1 and psychosocial risk assessment for every patient of the medical home who is pregnant at the patient's first prenatal appointment with the medical home2 7#d7 under the program1 a care manager-- 7,a7 is assigned to each pregnancy medical home2 and 7,b7 coordinates care 7including coordinating resources and referrals for health care and social services that are not available from the pregnancy medical home7 for each patient of a pregnancy medical home who is eligible for services under the program2 and 7#e7 the program prioritizes pregnant and postpartum women who are enrolled in the ,state ,medicaid plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a waiver of such plan4 7c7 ,grants 7#a7 ,limitation ,the ,secretary may award a grant under this section to up to #aj ,states4 7#b7 ,term of grants ,grants under this section shall be made for a term of #e years4 7#c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to the ,states with the greatest racial disparities in maternal mortality and severe morbidity rates4 7d7 ,report on grant impact and dissemination of best practices 7#a7 ,report ,not later than ,january #a1 #bjbd1 the ,administrator of the ,health ,resources and ,services ,administration shall submit a report to ,congress that describes-- 7,a7 the impact of the grants awarded under this section on maternal and child health2 7,b7 best practices and models of care used by recipients of grants under this section2 and 7,c7 obstacles faced by recipients of grants under this section in delivering care1 improving maternal and child health1 and reducing racial disparities in rates of maternal and infant mortality and morbidity4 7#b7 ,dissemination of best practices ,not later than ,january #a1 #bjbd1 the ,administrator of the ,health ,resources and ,services ,administration shall disseminate information on best practices and models of care used by recipients of grants under this section 7including best practices and models of care relating to the reduction of racial disparities in rates of maternal and infant mortality and morbidity7 to interested parties1 including health providers1 medical schools1 relevant ,state and local agencies1 and the general public4 7e7 ,authorization ,there are authorized to be appropriated to carry out this section1 #be1jjj1jjj for each of fiscal years #bjai through #bjbc1 to remain available until expended4 #e4 ,national ,academy of ,medicine ,study 7a7 ,in general ,the ,secretary shall enter into an arrangement with the ,national ,academy of ,medicine under which the ,national ,academy agrees to study and make recommendations for incorporating bias recognition in clinical skills testing for accredited schools of allopathic medicine and accredited schools of osteopathic medicine4 7b7 ,report ,the arrangement under subsection 7a7 shall provide for submission by the ,national ,academy of ,medicine to the ,secretary and ,congress1 not later than #c years after the date of enactment of this ,act1 of a report on the results of the study that includes such recommendations4