,,ii #aafth ,,congress #b;d ,session ,s4 #dbfi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #bb1 #bjbj,mr4 ,kaine 7for himself and ,ms4 ,murkowski7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to improve maternal health and promote safe motherhood4 #a4 ,short title ,this ,act may be cited as the ,mothers and ,newborns ,success ,act 4 #b4 ,findings and sense of the ,senate 7a7 ,findings ,congress finds the following3 7#a7 ,among developed nations1 the ,united ,states has disturbingly high rates of maternal and infant mortality4 7#b7 ,the ,united ,states published an official maternal mortality rate from vital statistics for the first time since #bjjg in #bjah4 ,the ,united ,states maternal mortality rate of #ag4d per #ajj1jjj live births1 is significantly higher than the ,organisation for ,economic ,co-operation and ,development 7referred to in this section as the ,,oecd7 average of #ad4j in #bjag1 according to modeling by the ,world ,bank4 7#c7 ,the ,united ,states infant mortality rate in #bjag was #e4h per #a1jjj live births1 while the ,,oecd average was #c4h per #a1jjj live births4 7#d7 ,in the ,united ,states1 there are significant maternal mortality and infant mortality inequities4 7#e7 ,the maternal mortality rate for non-,hispanic ,black women in #bjah was #cg4a per #ajj1jjj live births4 ,this rate is more than #b4e times higher than the maternal mortality rate of #ad4g for non-,hispanic ,white women and more than #c4a times higher than the maternal mortality rate of #aa4h for ,hispanic women of any race4 7#f7 ,the ,centers for ,disease ,control and ,prevention data from #bjjg through #bjaf shows that ,american ,indian_/,alaska ,native women also have significantly higher rates of pregnancy-related deaths than ,white1 ,hispanic1 and ,asian_/,pacific ,islander women4 ,american ,indian_/,alaska ,native women had a rate of #bi4g pregnancy-related deaths per #ajj1jjj live births from #bjjg through #bjaf1 which is #b4c times higher than the rate of #ab4g deaths per #ajj1jjj live births for ,white women during the same time period4 7#g7 ,the mortality rate for infants of non-,hispanic ,black women is #aa4j per #a1jjj live births and #i4b per #a1jjj live births for infants of ,american ,indian or ,alaska ,native women4 ,this rate is more than #b4c times higher than the infant mortality rate of non-,hispanic ,white infants at #d4g and more than #b4a times higher than the infant mortality rate of ,hispanic infants of any race at #e4a per #a1jjj live births4 7b7 ,sense of the ,senate ,it is the sense of the ,senate that the following should apply3 7#a7 ,the ,united ,states should dramatically reduce maternal and infant mortality1 ensure that all infants can grow up healthy and safe1 and protect women's health before1 during1 and after pregnancy4 7#b7 ,any pregnant woman choosing to have a child should be able to do so safely without regard to income1 race1 ethnicity1 employment status1 geographic location1 ability1 or any other socio-economic factor4 ,united ,states policy should support women's health so that women thrive and newborns have the maximum chance for a healthy life4 7#c7 ,the evidence of serious racial inequities in maternal and infant mortality1 especially between ,black women and ,white women demonstrates the persistence of racism and racial bias in our society and health care system4 ,a #bjae study funded by the ,national ,institute for ,biomedical and ,bioengineering of the ,national ,institutes of ,health found that most health care providers appear to harbor negative implicit biases towards people of color4 ,these biases were found to impact patient-provider interactions1 treatment decisions1 treatment adherence1 and patient health outcomes4 ,therefore1 the programs authorized by this ,act should be specifically deployed in ways to counter such inequities4 7#d7 ,in the next #e years1 the ,united ,states should aim to reduce its overall maternal and infant mortality rates such that they are no higher than the ,,oecd average4 ,the ,united ,states should dramatically reduce the maternal mortality and infant mortality inequities between ,black and ,american ,indian_/,alaskan ,native women and ,white women4 7#e7 ,by advancing evidence-based policies to improve maternal and infant health outcomes1 the ,united ,states can work to reduce and eliminate preventable maternal and infant mortality and severe maternal morbidity4 #c4 ,state maternal health innovation ,title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #ccj,m 7#db ,u4,s4,c4 #bed;c-#ai7 the following3 #ccj,n4 ,state maternal health innovation 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall continue in effect the ,state ,maternal ,health ,innovation ,program and the ,supporting ,maternal ,health ,innovation ,program to award competitive grants to eligible entities for the purpose of assisting ,states to implement ,state-specific actions that address racial1 ethnic and geographic inequities in maternal health and improve maternal health outcomes1 including the prevention and reduction of maternal mortality and severe maternal morbidity4 7b7 ,use of funds ,an entity receiving a grant under this section may use such funds-- 7#a7 to translate recommendations on addressing maternal mortality and severe maternal morbidity into action through activities which may include-- 7,a7 establishing a ,state- or regional multi-,state-focused ,maternal ,health ,task ,force to create and implement a strategic plan2 7,b7 improving the collection1 analysis1 and application of ,state- or regional multi-,state-level data on maternal mortality and severe maternal morbidity2 and 7,c7 promoting and executing innovation in maternal health service delivery1 such as improving access to maternal health care services1 identifying and addressing workforce needs1 including maternal health provider shortages2 identifying and addressing implicit and explicit bias based on race or ethnicity2 or supporting postpartum and inter-pregnancy care services2 or 7#b7 to provide support to entities receiving assistance under paragraph 7#a71 and other initiatives of the ,department of ,health and ,human ,services to improve maternal health outcomes as the ,secretary determines appropriate1 ,states1 multi-,state regions and other stakeholders working to reduce and prevent maternal mortality and severe maternal morbidity through activities which may include-- 7,a7 providing capacity-building assistance to such entities to implement innovative and evidence-informed strategies2 and 7,b7 establishing or continuing the operation of a resource center to provide national guidance to such entities1 ,states1 and key stakeholders to improve maternal health4 7c7 ,alignment of activities ,an entity carrying out activities under subsection 7b77#a7 shall coordinate and align such activities with the activities to improve maternal health outcomes carried out by such entities under title ,v of the ,social ,security ,act4 7d7 ,eligible entities ,to be eligible for a grant under subsection 7a71 a domestic public or non-profit private entity1 ,indian ,tribe1 or ,tribal serving organization1 such as a ,tribal health department or other organization fulfilling similar functions for the ,tribe1 shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 ,in the case of applicants intending to carry out activities described in subsection 7b77#a71 such applicants shall demonstrate in such application that the entity has a commitment from a ,state or group of ,states to collaborate as part of the project on strengthening ,state-level capacity in achieving the program aims4 7e7 ,report to ,congress ,not later than ,january #a1 #bjbd1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report concerning the impact of the programs continued under this section on addressing inequities in maternal health and improving maternal health outcomes1 including the prevention and reduction of maternal mortality and severe maternal morbidity1 together with recommendations on whether to expand such programs to additional recipients and the estimated amount of funds needed to expand such programs4 7f7 ,authorization of appropriations ,to carry out this section1 including carrying out the programs referred to in subsection 7a7 on a national basis 7subject to the availability of appropriations71 there is authorized to be appropriated #ec1jjj1jjj for each of fiscal years #bjba through #bjbd4 4 #d4 ,safe motherhood ,section #cag,k of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7 is amended-- 7#a7 by redesignating subsections 7e7 and 7f7 as subsections 7h7 and 7i71 respectively2 7#b7 by inserting after subsection 7d7 the following3 7e7 ,levels of maternal and neonatal care 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish or continue in effect a program to award competitive grants to eligible entities to assist with the classification of birthing facilities based on the level of risk-appropriate maternal and neonatal care such entities can provide in order to strategically improve maternal and infant care delivery and health outcomes4 7#b7 ,use of funds ,an eligible entity receiving a grant under this subsection shall use such funds to-- 7,a7 coordinate an assessment of the risk-appropriate maternal and neonatal care of a ,state1 jurisdiction1 or region1 based on the most recent guidelines and policy statements issued by the professional associations representing relevant clinical specialties1 including obstetrics and gynecology and pediatrics2 and 7,b7 work with relevant stakeholders1 such as hospitals1 hospital associations1 perinatal quality collaboratives1 members of the communities most affected by racial1 ethnic1 and geographic maternal health inequities1 maternal mortality review committees1 and maternal and neonatal health care providers and community-based birth workers to review the findings of the assessment made of activities carried out under paragraph 7#a7 and implement changes1 as appropriate1 based on identified gaps in perinatal services and differences in maternal and neonatal outcomes in the ,state1 jurisdiction1 or region for which such an assessment was conducted to support the provision of risk-appropriate care4 7#c7 ,eligible entities ,to be eligible for a grant under this subsection1 a ,state health department1 ,indian ,tribe or other ,tribal serving organization1 such as a ,tribal health department or other organization fulfilling similar functions for the ,tribe1 shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#d7 ,period ,a grant awarded under this subsection shall be made for a period of #c years4 ,any supplemental award made to a grantee under this subsection may be made for a period of less than #c years4 7#e7 ,report to ,congress ,not later than ,january #a1 #bjbc1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report concerning the impact of the programs established or continued under this subsection4 7f7 ,pregnancy checkbox quality assurance 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may establish or continue a program to award competitive grants and provide technical assistance to eligible entities to implement a quality assurance process to improve the validity of the pregnancy checkbox data from death certificates4 7#b7 ,use of funds ,eligible entities receiving a grant under this subsection shall use grant funds to implement a quality assurance process to improve the validity of the pregnancy checkbox data from death certificates in the ,state or within the ,indian ,tribe4 ,activities funded under the grant may include the following3 7,a7 ,reviewing death certificates for women of reproductive age and individuals with a pregnancy checkbox marked4 7,b7 ,attempting to confirm the pregnancy of a decedent by searching for a matching birth or fetal death record 7or other matching state administrative data source71 contacting the death certifier1 or reviewing the medical record4 7,c7 ,amending death certificates or death record files1 as appropriate1 and sending the updated file to the ,national ,center for ,health ,statistics4 7,d7 ,providing training to death certifiers about completing the death certificate4 7,e7 ,building awareness among death certifiers and health department staff about the pregnancy checkbox4 7,f7 ,coordinating quality assurance activities among ,state maternal and child health programs1 ,state vital records offices1 and maternal mortality review committee members and abstractors4 7#c7 ,eligible entities ,to be eligible for a grant under this subsection1 a ,state health department1 ,indian ,tribe1 or other ,tribal serving organization1 such as a ,tribal health department or other organization fulfilling similar functions for the ,tribe1 shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#d7 ,report to ,congress ,not later than ,january #a1 #bjbc1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report concerning the impact of the programs established or continued under this subsection4 2 and 7#c7 in subsection 7i7 7as so redesignated71 by striking #eh1jjj1jjj for each of fiscal years #bjai through #bjbc and inserting #ha1jjj1jjj for each of fiscal years #bjba through #bjbc4 #e4 ,pregnancy risk assessment monitoring system ,section #cag,k of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7 is amended by inserting after subsection 7f7 7as added by section #d7 the following3 7h7 ,pregnancy risk assessment monitoring system 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may establish or continue activities to collect data on maternal attitudes and experiences during the prepregnancy1 pregnancy1 labor and delivery1 and postpartum periods4 ,the ,secretary may expand data collection to all ,states1 ,indian ,tribes1 and territories1 and to the extent practicable1 compile and publish population-based findings on the health and well-being of women1 mothers and infants4 7#b7 ,enhanced surveillance activities and technical assistance ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention may support enhanced surveillance activities and provide technical assistance to ,states and ,indian ,tribes to improve data collection and ensure an adequate representation of racial1 ethnic and other communities of color in related datasets4 4 #f4 ,postpartum care coordination pilot program ,title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #ccj,n 7as added by section #c7 the following3 #ccj,o4 ,postpartum care coordination pilot program 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 and in consultation with experts representing a variety of clinical specialties1 including obstetrics and gynecology1 ,state1 ,tribal1 or local public health officials1 1 and in coordination with existing efforts to address postpartum care1 including activities conducted under section #ccj;,h1 shall establish a program to award competitive grants to not more than #aj eligible entities for the purpose of-- 7#a7 identifying and disseminating best practices to improve care and outcomes for women1 including women with chronic health conditions prepregnancy and those with ongoing pregnancy-related conditions1 in the postpartum period of at least one year following birth1 which may include-- 7,a7 information on evidence-based and evidence-informed practices to improve the quality of care2 7,b7 best practices for connecting women to primary or specialized care1 including behavioral health services1 in the postpartum period2 7,c7 information on addressing social and clinical determinants of health that impact women in the postpartum period2 and 7,d7 information on the most appropriate course of care during the postpartum period1 including continued access to maternity care providers and ways to strengthen capabilities of primary care providers and specialists1 including cardiologists and endocrinologists to recognize and treat conditions that may result from or be exacerbated by pregnancy2 7#b7 collaborating with ,state-based maternal mortality review committees1 ,state-based perinatal quality care collaboratives and other relevant initiatives to-- 7,a7 identify risk factors and systems issues for the development of best practices2 and 7,b7 disseminate best practices2 7#c7 providing technical assistance and supporting the implementation of best practices identified in paragraph 7#a7 to entities and providers providing health care and social support services to postpartum women2 7#d7 identifying1 developing1 and evaluating new models of care that improve maternal health outcomes1 which may include the integration of community-based services1 behavioral health1 and clinical care1 including interprofessional education for team-based care2 and 7#e7 developing condition-specific consumer materials directed toward women to help them better manage their physical and behavioral health in the postpartum period4 7b7 ,eligible entities ,to be eligible for a grant under subsection 7a71 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 capable of carrying out data-driven maternal safety and quality improvement initiatives in the areas of obstetrics and gynecology or maternal health4 7c7 ,report to ,congress ,not later than ,january #a1 #bjbe1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report concerning the impact of the programs established or continued under this section4 7d7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #g4 ,maternal health research network ,subpart #g of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;g et seq47 is amended by adding at the end the following3 #deb;,h4 ,maternal health research network 7a7 ,establishment ,the ,secretary1 acting through the ,director of the ,national ,institutes of ,health1 shall establish a ,national ,maternal ,health ,research ,network 7referred to in this section as the ,network71 to more effectively support innovative research to reduce maternal mortality and promote maternal health4 7b7 ,activities ,the ,secretary1 acting through the ,network1 may carry out activities to support mechanistic1 translational1 clinical1 behavioral1 or epidemiologic research1 as well as community-informed research on structural risk factors to address unmet maternal health research needs specific to the underlying causes of maternal mortality and severe maternal morbidity and their treatment4 ,such activities should be focused on optimizing improved diagnostics and clinical treatments1 improving health outcomes1 and reducing inequities4 7c7 ,existing networks ,in carrying out this section1 the ,secretary may utilize or coordinate with the ,maternal ,fetal ,medicine ,units ,network and the ,obstetric-,fetal ,pharmacology ,research ,centers ,network4 7d7 ,use of funds ,amounts appropriated to carry out this section may be used to support the ,network for activities related to maternal mortality or severe maternal morbidity that lead to potential therapies or clinical practices that will improve maternal health outcomes and reduce inequities4 ,amounts provided to such ,network shall be used to supplement1 and not supplant1 other funding provided to such ,network for such activities4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ej1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #h4 ,telehealth demonstration program ,section #ccj;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c7 is amended-- 7#a7 by redesignating subsections 7h7 through 7j7 as subsections 7i7 through 7k71 respectively2 and 7#b7 by inserting after subsection 7g71 the following3 7h7 ,telehealth demonstration program 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall continue in effect the ,rural ,maternity and ,obstetrics ,management ,strategies 7,,rmoms7 ,program to award competitive grants to eligible entities for the purpose of improving access to1 and continuity of1 maternal and obstetrics care in rural communities4 7#b7 ,use of funds ,an entity receiving a grant under this subsection shall use grant funds to develop a sustainable consortium approach to coordinate maternal and obstetrics care within a rural region-- 7,a7 through a focus on-- 7i7 rural regional approaches to risk appropriate care2 7ii7 an approach to coordinating a continuum of care for prepregnancy1 pregnancy1 labor and delivery1 postpartum1 and interpregnancy services2 7iii7 leveraging telehealth and specialty care to enhance case management of higher-risk expectant mothers living in geographically isolated areas2 and 7iv7 demonstrating financial sustainability through improved maternal and neonatal outcomes and potential cost savings2 and 7,b7 by testing and improving upon strategies to improve access to1 and continuity of1 obstetrics care in rural communities and reduce geographic inequities in maternal health through the use of data and outcome measures spanning the continuum of care from prepregnancy through pregnancy1 labor1 delivery1 and the postpartum period4 7#c7 ,eligible entities ,to be eligible for a grant under paragraph 7#a71 a domestic public or non-profit private entity1 including ,indian ,tribes1 and ,tribal serving organizations such as a ,tribal health department or other organization fulfilling similar functions for the ,tribe1 shall-- 7,a7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require2 7,b7 propose to carry out activities that exclusively target populations residing in rural counties or rural census tracts in urban counties as designated by the ,health ,resources and ,services ,administration2 and 7,c7 demonstrate a formal arrangement among a consortium of three or more entities1 including the applicant1 to build a rural based system of perinatal and maternal care4 7#d7 ,report to ,congress ,not later than ,january #a1 #bjbc1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report concerning the impact of the programs continued under this subsection together with recommendations on whether to expand such programs and the estimated amount of funds needed to expand such programs4 7#e7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #ab1jjj1jjj for each of fiscal years #bjba through #bjbc4 4 #i4 ,public and provider awareness campaign promoting maternal and child health 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and in coordination with ,state1 local1 territorial1 health departments1 ,indian ,tribes1 ,tribal serving organizations1 public health experts and associations1 the medical and allied professional community1 and minority health organizations1 shall award competitive grants to eligible entities to establish a national evidence-based public and provider awareness campaign on the importance of maternal and child health1 including identifying and responding to maternal health warning signs and vaccinations for the health of pregnant women and their children1 with the goal of increasing vaccination rates among pregnant women and children1 reducing racism and racial1 ethnic1 and geographic inequities in maternal and child health1 and reducing maternal mortality and severe maternal morbidity4 7b7 ,use of funds ,an entity receiving a grant under this section shall use grant funds to supplement1 not supplant1 any ,federal1 ,state1 or local funds supporting the establishment of a national evidence-based public and provider awareness campaign with all resources in an accessible format that-- 7#a7 increases awareness and knowledge of maternal health warning signs and how to respond to those signs as well as the safety and effectiveness of vaccines for pregnant women and their children2 7#b7 provides targeted evidence-based1 culturally and linguistically appropriate resources to pregnant women1 particularly in communities with low rates of vaccination and in rural and underserved areas2 and 7#c7 provides evidence-based information and resources on the importance of maternal and child health1 including maternal health warning signs and the safety of vaccinations for pregnant women and their children to public health departments and health care providers that care for pregnant women4 7c7 ,eligible entities ,to be eligible for a grant under this section1 a public or private entity shall submit to the ,secretary of ,health and ,human ,services an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,collaboration ,the ,secretary of ,health and ,human ,services shall ensure that the information and resources developed for the campaign under this section are disseminated to other divisions of the ,department of ,health and ,human ,services working to improve maternal and child health outcomes4 7e7 ,evaluation ,not later than ,january #a1 #bjbe1 the ,secretary of ,health and ,human ,services shall establish quantitative and qualitative metrics to evaluate the campaign under this section and shall submit a report detailing the campaign's impact to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7f7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #b1jjj1jjj for each of fiscal years #bjba through #bjbe4