,,ii #aagth ,,congress #ast ,session ,s4 #hea ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ah1 #bjba ,mr4 ,blumenthal introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to address social determinants of maternal health4 #a4 ,short title ,this ,act may be cited as the ,social ,determinants for ,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 ,pregnancy-related death ,the term pregnancy-related death 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 7#f7 ,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#g7 ,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#h7 ,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 ,task force to develop a strategy to address social determinants of maternal health 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall convene a task force 7in this section referred to as the ,task ,force7 to develop a strategy to coordinate efforts between ,federal agencies to address social determinants of maternal health with respect to pregnant and postpartum individuals4 7b7 ,ex officio members ,the ex officio members of the ,task ,force shall consist of the following3 7#a7 ,the ,secretary of ,health and ,human ,services 7or a designee thereof74 7#b7 ,the ,secretary of ,housing and ,urban ,development 7or a designee thereof74 7#c7 ,the ,secretary of ,transportation 7or a designee thereof74 7#d7 ,the ,secretary of ,agriculture 7or a designee thereof74 7#e7 ,the ,secretary of ,labor 7or a designee thereof74 7#f7 ,the ,secretary of ,defense 7or a designee thereof74 7#g7 ,the ,secretary of ,veterans ,affairs 7or a designee thereof74 7#h7 ,the ,administrator of the ,environmental ,protection ,agency 7or a designee thereof74 7#i7 ,the ,assistant ,secretary for the ,administration for ,children and ,families 7or a designee thereof74 7#aj7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services 7or a designee thereof74 7#aa7 ,the ,director of the ,indian ,health ,service 7or a designee thereof74 7#ab7 ,the ,director of the ,national ,institutes of ,health 7or a designee thereof74 7#ac7 ,the ,administrator of the ,health ,resources and ,services ,administration 7or a designee thereof74 7#ad7 ,the ,deputy ,assistant ,secretary for ,minority ,health of the ,department of ,health and ,human ,services 7or a designee thereof74 7#ae7 ,the ,deputy ,assistant ,secretary for ,women's ,health of the ,department of ,health and ,human ,services 7or a designee thereof74 7#af7 ,the ,director of the ,centers for ,disease ,control and ,prevention 7or a designee thereof74 7#ag7 ,the ,director of the ,office on ,violence ,against ,women at the ,department of ,justice 7or a designee thereof74 7c7 ,appointed members ,in addition to the ex officio members of the ,task ,force1 the ,secretary of ,health and ,human ,services shall appoint the following members of the ,task ,force3 7#a7 ,at least #b representatives of patients1 to include-- 7,a7 a representative of patients who have suffered from severe maternal morbidity2 or 7,b7 a representative of patients who is a family member of an individual who suffered a pregnancy-related death4 7#b7 ,at least #b leaders of community-based organizations that address maternal mortality and severe maternal morbidity with a specific focus on racial and ethnic disparities4 ,in appointing such leaders under this paragraph1 the ,secretary of ,health and ,human ,services shall give priority to individuals who are leaders of organizations led by individuals from racial and ethnic minority groups4 7#c7 ,at least #b perinatal health workers4 7#d7 ,a professionally diverse panel of maternity care providers4 7d7 ,chair ,the ,secretary of ,health and ,human ,services shall select the chair of the ,task ,force from among the members of the ,task ,force4 7e7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,task ,force shall submit to ,congress a report on-- 7#a7 the strategy developed under subsection 7a72 7#b7 recommendations on funding amounts with respect to implementing such strategy2 and 7#c7 recommendations for how to expand coverage of social services to address social determinants of maternal health under ,medicaid managed care organizations and ,state ,medicaid programs4 7f7 ,termination ,section #ad of the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the ,task ,force with respect to termination4 #d4 ,housing for ,moms grant program 7a7 ,in general ,the ,secretary of ,housing and ,urban ,development shall establish a ,housing for ,moms grant program under this section to make grants to eligible entities to increase access to safe1 stable1 affordable1 and adequate housing for pregnant and postpartum individuals and their families4 7b7 ,application ,to be eligible to receive a grant under this section1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may provide4 7c7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to an eligible entity that-- 7#a7 is a community-based organization or will partner with a community-based organization to implement initiatives to increase access to safe1 stable1 affordable1 and adequate housing for pregnant and postpartum individuals and their families2 7#b7 is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic disparities in maternal health outcomes1 to the extent such data are available2 and 7#c7 is operating in an area with a high poverty rate or significant number of individuals who lack consistent access to safe1 stable1 affordable1 and adequate housing4 7d7 ,use of funds ,an eligible entity that receives a grant under this section shall use funds under the grant for the purposes of-- 7#a7 identifying and conducting outreach to pregnant and postpartum individuals who are low income and lack consistent access to safe1 stable1 affordable1 and adequate housing2 7#b7 providing safe1 stable1 affordable1 and adequate housing options to such individuals2 7#c7 connecting such individuals with local organizations offering safe1 stable1 affordable1 and adequate housing options2 7#d7 providing application assistance to such individuals seeking to enroll in programs offering safe1 stable1 affordable1 and adequate housing options2 7#e7 providing direct financial assistance to such individuals for the purposes of maintaining safe1 stable1 and adequate housing for the duration of the individual's pregnancy and postpartum periods2 and 7#f7 working with relevant stakeholders to ensure that local housing and homeless shelter infrastructure is supportive to pregnant and postpartum individuals1 including through-- 7,a7 health-promoting housing codes2 7,b7 enforcement of housing codes2 7,c7 proactive rental inspection programs2 7,d7 code enforcement officer training2 and 7,e7 partnerships between regional offices of the ,department of ,housing and ,urban ,development and community-based organizations to ensure housing laws are understood and violations are discovered4 7e7 ,reporting 7#a7 ,eligible entities ,the ,secretary shall require each eligible entity receiving a grant under this section to annually submit to the ,secretary and make publicly available a report on the status of activities conducted using the grant4 7#b7 ,secretary ,not later than the end of each fiscal year in which grants are made under this section1 the ,secretary shall submit to ,congress and make publicly available a report that-- 7,a7 summarizes the reports received under paragraph 7#a72 7,b7 evaluates the effectiveness of grants awarded under this section in increasing access to safe1 stable1 affordable1 and adequate housing for pregnant and postpartum individuals and their families2 and 7,c7 makes recommendations with respect to ensuring activities described in subsection 7d7 continue after grant amounts made available under this section are expended4 7f7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means-- 7,a7 a community-based organization2 7,b7 a ,state or local governmental entity1 including a ,state or local public health department2 7,c7 an ,indian tribe or tribal organization 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd772 or 7,d7 an ,urban ,indian organization 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7#b7 ,secretary ,the term ,secretary means the ,secretary of ,housing and ,urban ,development4 7g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #aj1jjj1jjj for fiscal year #bjbb1 which shall remain available until expended4 #e4 ,department of ,transportation 7a7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,transportation shall submit to ,congress and make publicly available a report that contains-- 7#a7 an assessment of transportation barriers preventing individuals from attending prenatal and postpartum appointments1 accessing maternal health care services1 or accessing services and resources related to social determinants of maternal health2 7#b7 recommendations on how to overcome the barriers described in paragraph 7#a72 7#c7 an assessment of transportation safety risks for pregnant individuals and recommendations on how to mitigate those risks2 and 7#d7 an assessment of the impact of disabilities1 including service-related disabilities1 on pregnant and postpartum women's mobility and access to appropriate care4 7b7 ,considerations ,in carrying out subsection 7a71 the ,secretary of ,transportation shall give special consideration to solutions for-- 7#a7 pregnant and postpartum individuals living in a health professional shortage area designated under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e72 7#b7 pregnant and postpartum individuals living in areas with high maternal mortality or severe morbidity rates or significant racial or ethnic disparities in maternal health outcomes2 and 7#c7 pregnant and postpartum individuals with a disability that impacts mobility4 #f4 ,department of ,agriculture 7a7 ,special supplemental nutrition program for women1 infants1 and children 7#a7 ,breastfeeding women 7,a7 ,definition of breastfeeding woman ,section #ag7;b7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;b77 is amended by striking paragraph 7#a7 and inserting the following3 7#a7 ,breastfeeding woman ,the term breastfeeding woman means-- 7,a7 a woman who is not more than #a year postpartum and is breastfeeding the infant of the woman2 and 7,b7 for purposes of subsection 7d71 a woman who is not more than #b years postpartum and is breastfeeding the infant of the woman4 4 7,b7 ,extension of breastfeeding period ,section #ag7;d77#c77;,a77ii7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is amended by striking #a year and inserting #b years4 7#b7 ,postpartum women 7,a7 ,definition of postpartum women ,section #ag7;b77#aj7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;b77#aj77 is amended by striking six months and inserting #b years4 7,b7 ,certification ,section #ag7;d77#c77;,a7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77 is amended by adding at the end the following3 7iv7 ,postpartum women ,a ,state may elect to certify a postpartum woman for a period of up to #b years after the termination of pregnancy of the postpartum woman4 4 7#c7 ,report ,not later than #b years after the date of enactment of this section1 the ,secretary of ,agriculture shall submit to ,congress a report that includes an evaluation of the effect of each of the amendments made by this subsection on-- 7,a7 maternal and infant health outcomes1 including racial and ethnic disparities with respect to those outcomes2 7,b7 breastfeeding rates among postpartum individuals2 7,c7 qualitative evaluations of family experiences under the special supplemental nutrition program for women1 infants1 and children established under section #ag of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf72 and 7,d7 other relevant information as determined by the ,secretary of ,agriculture4 7b7 ,grant program for healthy food and clean water for pregnant and postpartum individuals 7#a7 ,definitions ,in this subsection3 7,a7 ,eligible entity ,the term eligible entity means-- 7i7 a community-based organization2 7ii7 a ,state or local governmental entity1 including a ,state or local public health department2 7iii7 an ,indian tribe or tribal organization 7as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd772 and 7iv7 an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7,b7 ,secretary ,the term ,secretary means the ,secretary of ,agriculture4 7#b7 ,establishment ,the ,secretary shall establish a program to award grants1 on a competitive basis1 to eligible entities to carry out the activities described in paragraph 7#e74 7#c7 ,application ,to be eligible for a grant under this subsection1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary determines appropriate4 7#d7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to an eligible entity that-- 7,a7 is1 or will partner with1 a community-based organization2 and 7,b7 is operating in an area with high rates of-- 7i7 adverse maternal health outcomes2 or 7ii7 significant racial or ethnic disparities in maternal health outcomes4 7#e7 ,use of funds ,an eligible entity shall use grant funds awarded under this subsection to deliver healthy food1 infant formula1 clean water1 or diapers to pregnant women 7as defined in section #ag7;b7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;b777 and postpartum individuals located in areas that are food deserts1 as determined by the ,secretary using data from the ,food ,access ,research ,atlas of the ,department of ,agriculture4 7#f7 ,reports 7,a7 ,eligible entity ,each eligible entity that receives a grant under this subsection shall1 not later than #a year after receiving the grant1 and annually thereafter1 submit to the ,secretary a report on the status of activities conducted using the grant1 which shall contain such information as the ,secretary may require4 7,b7 ,secretary 7i7 ,in general ,not later than #b years after the date on which the first grant is awarded under this subsection1 the ,secretary shall submit to ,congress a report that includes-- 7,i7 a summary of the reports submitted by eligible entities under subparagraph 7,a72 7,,ii7 an assessment of the extent to which food distributed through the grant program under this subsection was purchased from local and regional food systems2 7,,iii7 an evaluation of the effect of the grant program under this subsection on maternal and infant health outcomes1 including racial and ethnic disparities and disparities impacting other underserved mothers1 such as mothers living in rural areas1 with respect to those outcomes2 and 7,,iv7 recommendations with respect to ensuring the activities described in paragraph 7#e7 continue after the grant funding for those activities expires4 7ii7 ,publication ,the ,secretary shall make the report submitted under clause 7i7 publicly available on the website of the ,department of ,agriculture4 7#g7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary #e1jjj1jjj to carry out this subsection for the period of fiscal years #bjbb through #bjbd4 #g4 ,environmental study through ,national ,academies 7a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 the ,administrator of the ,environmental ,protection ,agency shall seek to enter into an agreement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7referred to in this section as the ,national ,academies7 under which the ,national ,academies agree to conduct a study on the impacts of water and air quality1 exposure to extreme temperatures1 exposure to environmental chemicals1 environmental risks in the workplace and the home1 and pollution levels on maternal and infant health outcomes4 7b7 ,study requirements ,the agreement under subsection 7a7 shall direct the ,national ,academies to make recommendations for-- 7#a7 improving the environmental conditions described in that subsection to improve maternal and infant health outcomes2 and 7#b7 reducing or eliminating racial and ethnic disparities in those outcomes4 7c7 ,report ,the agreement under subsection 7a7 shall require the ,national ,academies-- 7#a7 to complete the study described in that subsection2 and 7#b7 not later than #a year after the date of enactment of this ,act1 to transmit to ,congress and make publicly available a report that-- 7,a7 describes the results of the study2 and 7,b7 includes the recommendations described in subsection 7b74 #h4 ,child care access 7a7 ,grant program ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall award grants to eligible organizations to provide pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments1 including for mental health care1 prenatal and childbirth classes1 and labor and delivery4 ,the ,secretary shall coordinate with the ,secretary of ,defense to disseminate information regarding such services and to expand on-installation drop-in child care services for military parents4 7b7 ,application ,to be eligible to receive a grant under this section1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,eligible organizations 7#a7 ,eligibility ,to be eligible to receive a grant under this section1 an organization shall be an organization that provides child care services and can carry out programs providing pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments4 7#b7 ,prioritization ,in selecting grant recipients under this section1 the ,secretary shall give priority to eligible organizations that operate in an area with high rates of adverse maternal health outcomes or significant racial or ethnic disparities in maternal health outcomes1 to the extent such data are available4 7d7 ,timing ,the ,secretary shall commence the grant program under subsection 7a7 not later than #a year after the date of enactment of this ,act4 7e7 ,reporting 7#a7 ,grantees ,each recipient of a grant under this section shall annually submit to the ,secretary and make publicly available a report on the status of activities conducted using the grant4 ,each such report shall include-- 7,a7 an analysis of the effect of the funded program on prenatal and postpartum appointment attendance rates2 7,b7 summaries of qualitative assessments of the funded program from-- 7i7 pregnant and postpartum individuals participating in the program2 and 7ii7 the families of such individuals2 and 7,c7 such additional information as the ,secretary may require4 7#b7 ,secretary ,not later than the end of fiscal year #bjbd1 the ,secretary shall submit to ,congress and make publicly available a report containing the following3 7,a7 ,a summary of the reports under paragraph 7#a74 7,b7 ,an assessment of the effects1 if any1 of the funded programs on maternal health outcomes1 with a specific focus on racial and ethnic disparities in such outcomes4 7,c7 ,a description of actions the ,secretary can take to ensure that pregnant and postpartum individuals eligible for medical assistance under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #aicf et seq47 have access to free and accessible drop-in child care services during prenatal and postpartum appointments1 including identification of the funding necessary to carry out such actions4 7f7 ,drop-,in child care services defined ,in this section1 the term drop-in child care services means child care and early childhood education services that are-- 7#a7 delivered at a facility that meets the requirements of all applicable laws and regulations of the ,state or local government in which it is located1 including the licensing of the facility as a child care facility2 and 7#b7 provided in single encounters without requiring full-time enrollment of a person in a child care program4 7g7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #e1jjj1jjj for the period of fiscal years #bjbb through #bjbd4 #i4 ,grants to local entities addressing social determinants of maternal health 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall award grants to eligible entities to-- 7#a7 address social determinants of maternal health for pregnant and postpartum individuals2 and 7#b7 eliminate racial and ethnic disparities in maternal health outcomes4 7b7 ,application ,to be eligible to receive a grant under this subsection an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may provide4 7c7 ,prioritization ,in awarding grants under subsection 7a71 the ,secretary shall give priority to an eligible entity that-- 7#a7 is1 or will partner with1 a community-based organization to carrying out the activities under subsection 7d72 7#b7 is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic disparities in maternal health outcomes2 and 7#c7 is operating in an area with a high poverty rate4 7d7 ,activities ,an eligible entity that receives a grant under this section may-- 7#a7 hire and retain staff2 7#b7 develop and distribute a culturally and linguistically appropriate list of available resources with respect to social service programs in a community1 including housing supports1 child care access1 nutrition counseling1 and resources for pregnant women facing intimate partner violence2 7#c7 establish a culturally appropriate resource center that provides multiple social service programs in a single location2 7#d7 offer programs and resources in the communities in which the respective eligible entities are located to address social determinants of health for pregnant and postpartum individuals2 and 7#e7 consult with such pregnant and postpartum individuals1 pregnant women who are unauthorized aliens1 to conduct an assessment of the activities under this subsection4 7e7 ,technical assistance ,the ,secretary shall provide to grant recipients under this section technical assistance to plan for sustaining programs to address social determinants of maternal health among pregnant and postpartum individuals after the period of the grant4 7f7 ,reporting 7#a7 ,grantees ,not later than #a year after an eligible entity first receives a grant under this section1 and annually thereafter1 an eligible entity shall submit to the ,secretary1 and make publicly available1 a report on the status of activities conducted using the grant4 ,each such report shall include data on the effects of such activities1 disaggregated by race1 ethnicity1 gender1 and other relevant factors4 7#b7 ,secretary ,not later than the end of fiscal year #bjbf1 the ,secretary shall submit to ,congress a report that includes-- 7,a7 a summary of the reports under paragraph 7#a72 and 7,b7 recommendations for-- 7i7 improving maternal health outcomes2 and 7ii7 reducing or eliminating racial and ethnic disparities in maternal health outcomes4 7g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjbb through #bjbf4