,,ii #aagth ,,congress #ast ,session ,s4 #cdg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bb1 #bjba,ms4 ,smith 7for herself1 ,mr4 ,blumenthal1 ,ms4 ,klobuchar1 and ,mr4 ,markey7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to improve the collection and review of maternal health data to address maternal mortality1 severe maternal morbidity1 and other adverse maternal health outcomes4 #a4 ,short title ,this ,act may be cited as the ,data to ,save ,moms ,act4 #b4 ,definitions ,in this ,act3 7#a7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 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 ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#b7 ,maternal mortality ,the term maternal mortality means a death occurring during or within a one-year period after pregnancy1 caused by pregnancy-related or childbirth complications1 including a suicide1 overdose1 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications4 7#c7 ,perinatal health worker ,the term perinatal health worker means a doula1 community health worker1 peer supporter1 breastfeeding and lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 language interpreter1 or navigator4 7#d7 ,postpartum and postpartum period ,the terms postpartum and postpartum period refer to the #a-year period beginning on the last day of the pregnancy of an individual4 7#e7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#f7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including mental health conditions and substance use disorders1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#g7 ,social determinants of maternal health ,the term social determinants of maternal health means non-clinical factors that impact maternal health outcomes1 including-- 7,a7 economic factors1 which may include poverty1 employment1 food security1 support for and access to lactation and other infant feeding options1 housing stability1 and related factors2 7,b7 neighborhood factors1 which may include quality of housing1 access to transportation1 access to child care1 availability of healthy foods and nutrition counseling1 availability of clean water1 air and water quality1 ambient temperatures1 neighborhood crime and violence1 access to broadband1 and related factors2 7,c7 social and community factors1 which may include systemic racism1 gender discrimination or discrimination based on other protected classes1 workplace conditions1 incarceration1 and related factors2 7,d7 household factors1 which may include ability to conduct lead testing and abatement1 car seat installation1 indoor air temperatures1 and related factors2 7,e7 education access and quality factors1 which may include educational attainment1 language and literacy1 and related factors2 and 7,f7 health care access factors1 including health insurance coverage1 access to culturally congruent health care services1 providers1 and non-clinical support1 access to home visiting services1 access to wellness and stress management programs1 health literacy1 access to telehealth and items required to receive telehealth services1 and related factors4 #c4 ,funding for maternal mortality review committees to promote representative community engagement 7a7 ,in general ,section #cag,k7d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77 is amended by adding at the end the following3 7#i7 ,grants to promote representative community engagement in maternal mortality review committees 7,a7 ,in general ,the ,secretary may1 using funds made available pursuant to subparagraph 7,c71 provide assistance to an applicable maternal mortality review committee of a ,state1 ,indian tribe1 tribal organization1 or urban ,indian organization-- 7i7 to select for inclusion in the membership of such a committee community members from the ,state1 ,indian tribe1 tribal organization1 or urban ,indian organization by-- 7,i7 prioritizing community members who can increase the diversity of the committee's membership with respect to race and ethnicity1 location1 and professional background1 including members with non-clinical experiences2 and 7,,ii7 to the extent applicable1 using funds reserved under subsection 7f71 to address barriers to maternal mortality review committee participation for community members1 including required training1 transportation barriers1 compensation1 and other supports as may be necessary2 7ii7 to establish initiatives to conduct outreach and community engagement efforts within communities throughout the ,state or ,tribe to seek input from community members on the work of such maternal mortality review committee1 with a particular focus on outreach to minority women2 and 7iii7 to release public reports assessing-- 7,i7 the pregnancy-related death and pregnancy-associated death review processes of the maternal mortality review committee1 with a particular focus on the maternal mortality review committee's sensitivity to the unique circumstances of pregnant and postpartum individuals from racial and ethnic minority groups 7as such term is defined in section #agjg7;g77#a77 who have suffered pregnancy-related deaths2 and 7,,ii7 the impact of the use of funds made available pursuant to subparagraph 7,c7 on increasing the diversity of the maternal mortality review committee membership and promoting community engagement efforts throughout the ,state or ,tribe4 7,b7 ,technical assistance ,the ,secretary shall provide 7either directly through the ,department of ,health and ,human ,services or by contract7 technical assistance to any maternal mortality review committee receiving a grant under this paragraph on best practices for increasing the diversity of the maternal mortality review committee's membership and for conducting effective community engagement throughout the ,state or ,tribe4 7,c7 ,authorization of appropriations ,in addition to any funds made available under subsection 7f71 there are authorized to be appropriated to carry out this paragraph #aj1jjj1jjj for each of fiscal years #bjbb through #bjbf4 4 7b7 ,definitions ,section #cag,k7e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;e77 is amended-- 7#a7 in paragraph 7#b71 by striking and at the end2 7#b7 in paragraph 7#c77;,b71 by striking the period and inserting 2 and2 and 7#c7 by adding at the end the following3 7#d7 the term urban ,indian organization has the meaning given such term in section #d of the ,indian ,health ,care ,improvement ,act4 4 7c7 ,reservation of funds ,section #cag,k7f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;f77 is amended by adding at the end the following3 ,of the amount made available under the preceding sentence for a fiscal year1 not less than #a1ejj1jjj shall be reserved for grants to ,indian tribes1 tribal organizations1 or urban ,indian organizations44 #d4 ,data collection and review ,section #cag,k7d77#c77;,a77i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#c77;,a77i77 is amended-- 7#a7 by redesignating subclauses 7,,ii7 and 7,,iii7 as subclauses 7,v7 and 7,,vi71 respectively2 and 7#b7 by inserting after subclause 7,i7 the following3 7,,ii7 to the extent practicable1 reviewing cases of severe maternal morbidity1 according to the most up-to-date indicators2 7,,iii7 to the extent practicable1 reviewing deaths during pregnancy or up to #a year after the end of a pregnancy from suicide1 overdose1 or other death from a mental health condition or substance use disorder attributed to or aggravated by pregnancy or childbirth complications2 7,,iv7 to the extent practicable1 consulting with local community-based organizations representing pregnant and postpartum individuals from demographic groups disproportionately impacted by poor maternal health outcomes to ensure that1 in addition to clinical factors1 non-clinical factors that might have contributed to a pregnancy-related death are appropriately considered2 4 #e4 ,review of maternal health data collection processes and quality measures 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator for ,centers for ,medicare ,medicaid ,serves and the ,director of the ,agency for ,healthcare ,research and ,quality1 shall consult with relevant stakeholders-- 7#a7 to review existing maternal health data collection processes and quality measures2 and 7#b7 make recommendations to improve such processes and measures1 including topics described in subsection 7c74 7b7 ,collaboration ,in carrying out this section1 the ,secretary shall consult with a diverse group of maternal health stakeholders1 which may include-- 7#a7 pregnant and postpartum individuals and their family members1 and nonprofit organizations representing such individuals1 with a particular focus on patients from racial and ethnic minority groups2 7#b7 community-based organizations that provide support for pregnant and postpartum individuals1 with a particular focus on patients from racial and ethnic minority groups2 7#c7 membership organizations for maternity care providers2 7#d7 organizations representing perinatal health workers2 7#e7 organizations that focus on maternal mental or behavioral health2 7#f7 organizations that focus on intimate partner violence2 7#g7 institutions of higher education1 with a particular focus on minority-serving institutions2 7#h7 licensed and accredited hospitals1 birth centers1 midwifery practices1 or other medical practices that provide maternal health care services to pregnant and postpartum patients2 7#i7 relevant ,state and local public agencies1 including ,state maternal mortality review committees2 and 7#aj7 the ,national ,quality ,forum1 or such other standard-setting organizations specified by the ,secretary4 7c7 ,topics ,the review of maternal health data collection processes and recommendations to improve such processes and measures required under subsection 7a7 shall assess all available relevant information1 including information from ,state-level sources1 and shall consider at least the following3 7#a7 ,current ,state and ,tribal practices for maternal health1 maternal mortality1 and severe maternal morbidity data collection and dissemination1 including consideration of-- 7,a7 the timeliness of processes for amending a death certificate when new information pertaining to the death becomes available to reflect whether the death was a pregnancy-related death2 7,b7 relevant data collected with electronic health records1 including data on race1 ethnicity1 socioeconomic status1 insurance type1 and other relevant demographic information2 7,c7 maternal health data collected and publicly reported by hospitals1 health systems1 midwifery practices1 and birth centers2 7,d7 the barriers preventing ,states from correlating maternal outcome data with race and ethnicity data2 7,e7 processes for determining the cause of a pregnancy-associated death in ,states that do not have a maternal mortality review committee2 7,f7 whether maternal mortality review committees include multidisciplinary and diverse membership 7as described in section #cag,k7d77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#a77;,a772 7,g7 whether members of maternal mortality review committees participate in trainings on bias1 racism1 or discrimination1 and the quality of such trainings2 7,h7 the extent to which ,states have implemented systematic processes of listening to the stories of pregnant and postpartum individuals and their family members1 with a particular focus on pregnant and postpartum individuals from racial and ethnic minority groups 7as such term is defined in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a777 and their family members1 to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective ,states2 7,i7 the extent to which maternal mortality review committees are considering social determinants of maternal health when examining the causes of pregnancy-associated and pregnancy-related deaths2 7,j7 the extent to which maternal mortality review committees are making actionable recommendations based on their reviews of adverse maternal health outcomes and the extent to which such recommendations are being implemented by appropriate stakeholders2 7,k7 the legal and administrative barriers preventing the collection1 collation1 and dissemination of ,state maternity care data2 7,l7 the effectiveness of data collection and reporting processes in separating pregnancy-associated deaths from pregnancy-related deaths2 7,m7 the current ,federal1 ,state1 local1 and ,tribal funding support for the activities referred to in subparagraphs 7,a7 through 7,l74 7#b7 ,whether the funding support referred to in paragraph 7#a77,m7 is adequate for ,states to carry out optimal data collection and dissemination processes with respect to maternal health1 maternal mortality1 and severe maternal morbidity4 7#c7 ,current quality measures for maternity care1 including prenatal measures1 labor and delivery measures1 and postpartum measures1 including topics such as-- 7,a7 effective quality measures for maternity care used by hospitals1 health systems1 midwifery practices1 birth centers1 health plans1 and other relevant entities2 7,b7 the sufficiency of current outcome measures used to evaluate maternity care for driving improved care1 experiences1 and outcomes in maternity care payment and delivery system models2 7,c7 maternal health quality measures that other countries effectively use2 7,d7 validated measures that have been used for research purposes that could be tested1 refined1 and submitted for national endorsement2 7,e7 barriers preventing maternity care providers and insurers from implementing quality measures that are aligned with best practices2 7,f7 the frequency with which maternity care quality measures are reviewed and revised2 7,g7 the strengths and weaknesses of the ,prenatal and ,postpartum ,care measures of the ,health ,plan ,employer ,data and ,information ,set measures established by the ,national ,committee for ,quality ,assurance2 7,h7 the strengths and weaknesses of maternity care quality measures under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig et seq471 including the extent to which ,states voluntarily report relevant measures2 7,i7 the extent to which maternity care quality measures are informed by patient experiences that include measures of patient-reported experience of care2 7,j7 the current processes for collecting stratified data on the race and ethnicity of pregnant and postpartum individuals in hospitals1 health systems1 midwifery practices1 and birth centers1 and for incorporating such racially and ethnically stratified data in maternity care quality measures2 7,k7 the extent to which maternity care quality measures account for the unique experiences of pregnant and postpartum individuals from racial and ethnic minority groups 7as such term is defined in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a7772 and 7,l7 the extent to which hospitals1 health systems1 midwifery practices1 and birth centers are implementing existing maternity care quality measures4 7#d7 ,recommendations on authorizing additional funds and providing additional technical assistance to improve maternal mortality review committees and ,state and ,tribal maternal health data collection and reporting processes4 7#e7 ,recommendations for new authorities that may be granted to maternal mortality review committees to be able to-- 7,a7 access records from other ,federal and ,state agencies and departments that may be necessary to identify causes of pregnancy-associated and pregnancy-related deaths that are unique to pregnant and postpartum individuals from specific populations1 such as veterans and individuals who are incarcerated2 and 7,b7 work with relevant experts who are not members of the maternal mortality review committee to assist in the review of pregnancy-associated deaths of pregnant and postpartum individuals from specific populations1 such as veterans and individuals who are incarcerated4 7#f7 ,recommendations to improve and standardize current quality measures for maternity care1 with a particular focus on racial and ethnic disparities in maternal health outcomes4 7#g7 ,recommendations to improve the coordination by the ,department of ,health and ,human ,services of the efforts undertaken by the agencies and organizations within the ,department related to maternal health data and quality measures4 7d7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress and make publicly available a report on the results of the review of maternal health data collection processes and quality measures and recommendations to improve such processes and measures required under subsection 7a74 7e7 ,definitions ,in this section3 7#a7 ,maternal mortality review committee ,the term maternal mortality review committee means a maternal mortality review committee duly authorized by a ,state and receiving funding under section #cag,k7a77#b77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77#b77;,d774 7#b7 ,pregnancy-associated death ,the term pregnancy-associated1 with respect to a death1 means a death of a pregnant or postpartum individual1 by any cause1 that occurs during1 or within #a year following1 the individual's pregnancy1 regardless of the outcome1 duration1 or site of the pregnancy4 7#c7 ,pregnancy-related death ,the term pregnancy-related1 with respect to a death1 means a death of a pregnant or postpartum individual that occurs during1 or within #a year following1 the individual's pregnancy1 from a pregnancy complication1 a chain of events initiated by pregnancy1 or the aggravation of an unrelated condition by the physiologic effects of pregnancy4 7f7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal years #bjbb through #bjbe4 #f4 ,indian ,health ,service study and report on maternal mortality and severe maternal morbidity 7a7 ,definitions ,in this section3 7#a7 ,director ,the term ,director means the ,director of the ,indian ,health ,service4 7#b7 ,indian tribe ,the term ,indian ,tribe has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#c7 ,maternal mortality review committee ,the term maternal mortality review committee means a maternal mortality review committee duly authorized by a ,state and receiving funding under section #cagk7a77#b77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77#b77;,d774 7#d7 ,tribal epidemiology center ,the term ,tribal epidemiology center means a ,tribal epidemiology center established under section #bad of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afbam74 7#e7 ,tribal organization ,the term tribal organization has the meaning given the term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#f7 ,urban ,indian organization ,the term urban ,indian organization has the meaning given the term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7b7 ,study and report 7#a7 ,study 7,a7 ,in general ,not later than #ij days after the date of enactment of this ,act1 the ,director1 in coordination with the individuals selected under subsection 7c71 shall enter into an agreement with an independent research organization or a ,tribal epidemiology center to conduct a comprehensive study on maternal mortality and severe maternal morbidity in ,indian and ,alaska ,native populations4 7,b7 ,report ,the agreement entered into under subparagraph 7,a7 shall require that the independent research organization or ,tribal epidemiology center submit to the ,director a report describing the results of the study conducted pursuant to that agreement by not later than #b years after the date of enactment of this ,act4 7#b7 ,contents of study ,the study conducted under paragraph 7#a7 shall-- 7,a7 examine the causes of maternal mortality and severe maternal morbidity that are unique to ,indians and ,alaska ,natives2 7,b7 include a systematic process of listening to the stories of pregnant and postpartum ,indians and ,alaska ,natives to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within the ,indian and ,alaska ,native communities2 7,c7 identify the different settings in which pregnant and postpartum ,indians and ,alaska ,natives receive maternity care1 such as-- 7i7 facilities operated by the ,indian ,health ,service2 7ii7 an ,indian health program operated by an ,indian ,tribe or tribal organization pursuant to a grant from1 or contract1 cooperative agreement1 or compact with1 the ,indian ,health ,service pursuant to the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecja et seq472 and 7iii7 an urban ,indian health program operated by an urban ,indian organization pursuant to a grant from or contract with the ,indian ,health ,service pursuant to title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq472 7,d7 determine the different landscapes of maternity care received by pregnant and postpartum ,indians and ,alaska ,natives at the different settings identified under subparagraph 7,c72 7,e7 review processes for coordinating programs of the ,indian ,health ,service with social services provided through other programs administered by the ,secretary of ,health and ,human ,services 7other than the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,medicaid program under title ,,xix of that ,act 7#db ,u4,s4,c4 #acif et seq471 and the ,state ,children's ,health ,insurance ,program established under title ,,xxi of that ,act 7#db ,u4,s4,c4 #acig;aa et seq4772 7,f7 review current data collection and quality measurement processes and practices with respect to pregnant and postpartum ,indians and ,alaska ,natives2 7,g7 assess causes and frequency of maternal mental health conditions and substance use disorders with respect to ,indians and ,alaska ,natives2 7,h7 consider social determinants of health1 including poverty1 lack of health insurance1 unemployment1 sexual violence1 and environmental conditions in ,tribal areas2 7,i7 consider the role that historical mistreatment of ,indian and ,alaska ,native women has played in causing currently high rates of maternal mortality and severe maternal morbidity2 7,j7 consider how current funding of the ,indian ,health ,service affects the ability of the ,indian ,health ,service to deliver quality maternity care2 and 7,k7 consider the extent to which the delivery of maternity care services is culturally appropriate for pregnant and postpartum ,indians and ,alaska ,natives4 7#c7 ,report ,not later than #c years after the date of enactment of this ,act1 the ,director shall submit to ,congress a report describing the results of the study conducted under paragraph 7#a71 including recommendations for policies and practices that can be adopted to improve maternal health outcomes for pregnant and postpartum ,indians and ,alaska ,natives1 including recommendations-- 7,a7 on how to improve maternal health outcomes for ,indians and ,alaska ,natives receiving care at the different settings identified under paragraph 7#b77;,c72 7,b7 on how to reduce misclassification of pregnant and postpartum ,indians and ,alaska ,natives1 including consideration of best practices in training for members of maternal mortality review committees to be able to correctly classify ,indians and ,alaska ,natives2 and 7,c7 informed by the stories shared by pregnant and postpartum ,indians and ,alaska ,natives under paragraph 7#b77;,b7 to improve maternal health outcomes for those individuals4 7c7 ,participating individuals 7#a7 ,in general ,the ,director shall select from among individuals nominated by ,indian ,tribes1 tribal organizations1 and urban ,indian organizations #ab individuals for participation in the study conducted under subsection 7b77#a74 7#b7 ,requirement ,in selecting members under paragraph 7#a71 the ,director shall ensure that each of the #ab service areas of the ,indian ,health ,service is represented4 7d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjbb through #bjbd4 #g4 ,grants to minority-serving institutions to study maternal mortality1 severe maternal morbidity1 and other adverse maternal health outcomes 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall establish a program under which the ,secretary shall award grants to research centers1 health professions schools and programs1 and other entities at minority-serving institutions to study specific aspects of the maternal health crisis among pregnant and postpartum individuals from racial and ethnic minority groups4 ,such research may-- 7#a7 include the development and implementation of systematic processes of listening to the stories of pregnant and postpartum individuals from racial and ethnic minority groups1 and perinatal health workers supporting such individuals1 to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective communities2 7#b7 assess the potential causes of relatively low rates of maternal mortality among ,hispanic individuals1 including potential racial misclassification and other data collection and reporting issues that might be misrepresenting maternal mortality rates among ,hispanic individuals in the ,united ,states2 and 7#c7 assess differences in rates of adverse maternal health outcomes among subgroups identifying as ,hispanic4 7b7 ,application ,to be eligible to receive a grant under subsection 7a71 an entity described in such subsection shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,technical assistance ,the ,secretary may use not more than #aj percent of the funds made available under subsection 7g7-- 7#a7 to conduct outreach to minority-serving institutions to raise awareness of the availability of grants under this subsection 7a72 7#b7 to provide technical assistance in the application process for such a grant2 and 7#c7 to promote capacity building as needed to enable entities described in such subsection to submit such an application4 7d7 ,reporting requirement ,each entity awarded a grant under this section shall periodically submit to the ,secretary a report on the status of activities conducted using the grant4 7e7 ,evaluation ,beginning one year after the date on which the first grant is awarded under this section1 the ,secretary shall submit to ,congress an annual report summarizing the findings of research conducted using funds made available under this section4 7f7 ,minority-,serving institutions defined ,in this section1 the term minority-serving institution has the meaning given the term in section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7g7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjbb through #bjbf4