,,ii #aaith ,,congress #b;d ,session ,s4 #dahf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #be1 #bjbf,ms4 ,baldwin 7for herself1 ,mr4 ,merkley1 and ,mr4 ,booker7 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 grow and diversify the perinatal workforce1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,perinatal ,workforce ,act4 #b4 ,,hhs agency directives 7a7 ,guidance to ,states 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue and disseminate guidance to ,states to educate providers1 managed care entities1 and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models4 7#b7 ,contents ,the guidance required by paragraph 7#a7 shall address how ,states can encourage and incentivize hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers-- 7,a7 to recruit and retain maternity care providers1 mental and behavioral health care providers acting in accordance with ,state law1 and registered dietitians or nutrition professionals 7as such term is defined in section #ahfa7vv77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b777-- 7i7 from racially1 ethnically1 and linguistically diverse backgrounds2 7ii7 with experience practicing in racially and ethnically diverse communities2 and 7iii7 who have undergone training on implicit bias and racism2 7,b7 to incorporate into maternity care teams-- 7i7 midwives who meet1 at a minimum1 the international definition of a midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives2 7ii7 perinatal health workers2 7iii7 physician assistants2 7iv7 advanced practice registered nurses2 and 7v7 lactation consultants certified by the ,international ,board of ,lactation ,consultant ,examiners2 7,c7 to provide collaborative1 culturally and linguistically congruent care2 and 7,d7 to provide opportunities for individuals enrolled in accredited midwifery education programs to participate in job shadowing with maternity care teams in hospitals1 health systems1 midwifery practices1 and freestanding birth centers4 7b7 ,study on respectful and culturally and linguistically congruent maternity care 7#a7 ,study ,the ,secretary of ,health and ,human ,services acting through the ,director of the ,national ,institutes of ,health 7in this subsection referred to as the ,secretary7 shall conduct a study on best practices in respectful and culturally and linguistically congruent maternity care4 7#b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall-- 7,a7 complete the study required by paragraph 7#a72 7,b7 submit to the ,congress and make publicly available a report on the results of such study2 and 7,c7 include in such report-- 7i7 a compendium of examples of hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers that are delivering respectful and culturally and linguistically congruent maternal health care2 7ii7 a compendium of examples of hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers that have made progress in reducing disparities in maternal health outcomes and improving birthing experiences for pregnant and postpartum individuals from racial and ethnic minority groups2 and 7iii7 recommendations to hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers1 for best practices in respectful and culturally and linguistically congruent maternity care4 #c4 ,grants to grow and diversify the perinatal workforce ,title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #geg 7#db ,u4,s4,c4 #bid;f7 the following3 #geh4 ,perinatal workforce grants 7a7 ,in general ,the ,secretary shall award grants to entities to establish or expand programs described in subsection 7b7 to grow and diversify the perinatal workforce4 7b7 ,use of funds ,recipients of grants under this section shall use the grants to grow and diversify the perinatal workforce by-- 7#a7 establishing accredited schools or programs that provide education and training to individuals seeking appropriate licensing and certification as-- 7,a7 physician assistants who will complete clinical training in the field of maternal and perinatal health2 7,b7 perinatal health workers2 or 7,c7 midwives who meet1 at a minimum1 the international definition of a midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives2 and 7#b7 expanding the capacity of existing accredited schools or programs described in paragraph 7#a71 for the purposes of increasing the number of students enrolled in such accredited schools or programs1 such as by awarding scholarships for students 7including students from racially1 ethnically1 and linguistically diverse backgrounds74 7c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to a school or program described in subsection 7b7 that-- 7#a7 has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups2 7#b7 has developed a strategy to recruit and retain a diverse pool of students into the school or program described in subsection 7b7 that is supported by funds received through the grant1 particularly from racial and ethnic minority groups and other underserved populations2 7#c7 has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section #ccb2 7#d7 has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic disparities in maternal health outcomes1 to the extent practicable2 and 7#e7 includes in the standard curriculum for all students within the school or program described in subsection 7b7 a bias1 racism1 or discrimination training program that includes training on implicit bias and racism4 7d7 ,reporting ,as a condition on receipt of a grant under this section for a school or program described in subsection 7b71 an entity shall agree to submit to the ,secretary an annual report on the activities conducted through the grant1 including-- 7#a7 the number and demographics of students participating in the school or program2 7#b7 the extent to which students in the school or program are entering careers in-- 7,a7 health professional shortage areas designated under section #ccb2 and 7,b7 areas with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes1 to the extent such data are available2 and 7#c7 whether the school or program has included in the standard curriculum for all students a bias1 racism1 or discrimination training program that includes explicit and implicit bias1 and if so the effectiveness of such training program4 7e7 ,period of grants ,the period of a grant under this section shall be up to #e years4 7f7 ,application ,to seek a grant under this section1 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including any information necessary for prioritization under subsection 7c74 7g7 ,technical assistance ,the ,secretary shall provide1 directly or by contract1 technical assistance to entities seeking or receiving a grant under this section on the development1 use1 evaluation1 and postgrant period sustainability of the school or program described in subsection 7b7 that is proposed to be1 or is being1 established or expanded through the grant4 7h7 ,report by the ,secretary ,not later than #d years after the date of enactment of this section1 the ,secretary shall prepare and submit to the ,congress1 and post on the internet website of the ,department of ,health and ,human ,services1 a report on the effectiveness of the grant program under this section at-- 7#a7 recruiting students from racial and ethnic minority groups2 7#b7 increasing the number of health professionals described in subparagraphs 7,a71 7,b71 and 7,c7 of subsection 7b77#a7 from racial and ethnic minority groups and other underserved populations2 7#c7 increasing the number of such health professionals working in health professional shortage areas designated under section #ccb2 and 7#d7 increasing the number of such health professionals working in areas with significant racial and ethnic disparities in maternal health outcomes1 to the extent such data are available4 7i7 ,definition ,in this section1 the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a74 7j7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjbg through #bjca4 4 #d4 ,grants to grow and diversify the nursing workforce in maternal and perinatal health ,title ,,viii of the ,public ,health ,service ,act is amended by inserting after section #haa 7#db ,u4,s4,c4 #bif;j7 the following3 #hab4 ,perinatal nursing workforce grants 7a7 ,in general ,the ,secretary shall award grants to schools of nursing to grow and diversify the perinatal nursing workforce4 7b7 ,use of funds ,recipients of grants under this section shall use the grants to grow and diversify the perinatal nursing workforce by providing scholarships to students seeking to become-- 7#a7 nurse practitioners whose education includes a focus on maternal and perinatal health2 7#b7 certified nurse-midwives2 or 7#c7 clinical nurse specialists whose education includes a focus on maternal and perinatal health4 7c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to any school of nursing that-- 7#a7 has developed a strategy to recruit and retain a diverse pool of students seeking to enter careers focused on maternal and perinatal health1 particularly students from racial and ethnic minority groups and other underserved populations2 7#b7 has developed a partnership with a practice setting in a health professional shortage area designated under section #ccb for the clinical placements of the school's students2 7#c7 has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic disparities in maternal health outcomes1 to the extent practicable2 and 7#d7 includes in the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health a bias1 racism1 or discrimination training program that includes education on implicit bias and racism4 7d7 ,reporting ,as a condition on receipt of a grant under this section1 a school of nursing shall agree to submit to the ,secretary an annual report on the activities conducted through the grant1 including1 to the extent practicable-- 7#a7 the number and demographics of students in the school of nursing seeking to enter careers focused on maternal and perinatal health2 7#b7 the extent to which such students are preparing to enter careers in-- 7,a7 health professional shortage areas designated under section #ccb2 and 7,b7 areas with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes1 to the extent such data are available2 and 7#c7 whether the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health includes a bias1 racism1 or discrimination training program that includes education on implicit bias and racism4 7e7 ,period of grants ,the period of a grant under this section shall be up to #e years4 7f7 ,application ,to seek a grant under this section1 an entity shall submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 including any information necessary for prioritization under subsection 7c74 7g7 ,technical assistance ,the ,secretary shall provide1 directly or by contract1 technical assistance to schools of nursing seeking or receiving a grant under this section on the processes of awarding and evaluating scholarships through the grant4 7h7 ,report by the ,secretary ,not later than #d years after the date of enactment of this section1 the ,secretary shall prepare and submit to the ,congress1 and post on the internet website of the ,department of ,health and ,human ,services1 a report on the effectiveness of the grant program under this section at-- 7#a7 recruiting students from racial and ethnic minority groups and other underserved populations2 7#b7 increasing the number of advanced practice registered nurses entering careers focused on maternal and perinatal health from racial and ethnic minority groups and other underserved populations2 7#c7 increasing the number of advanced practice registered nurses entering careers focused on maternal and perinatal health working in health professional shortage areas designated under section #ccb2 and 7#d7 increasing the number of advanced practice registered nurses entering careers focused on maternal and perinatal health working in areas with significant racial and ethnic disparities in maternal health outcomes1 to the extent such data are available4 7i7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjbg through #bjca4 4 #e4 ,,gao report 7a7 ,in general ,not later than #b years after the date of enactment of this ,act and every #e years thereafter1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on barriers to maternal health education and access to care in the ,united ,states4 ,such report shall include the information and recommendations described in subsection 7b74 7b7 ,content of report ,the report under subsection 7a7 shall include-- 7#a7 an assessment of current barriers to entering and successfully completing accredited midwifery education programs1 and recommendations for addressing such barriers1 particularly for low-income women and women from racial and ethnic minority groups2 7#b7 an assessment of current barriers to entering and successfully completing accredited education programs for other health professional careers related to maternity care1 including maternity care providers1 mental and behavioral health care providers acting in accordance with ,state law1 and registered dietitians or nutrition professionals 7as such term is defined in section #ahfa7vv77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 particularly for low-income women and women from racial and ethnic minority groups2 7#c7 an assessment of current barriers that prevent midwives from meeting the international definition of a midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 and recommendations for addressing such barriers1 particularly for low-income women and women from racial and ethnic minority groups2 7#d7 an assessment of disparities in access to maternity care providers1 mental or behavioral health care providers acting in accordance with ,state law1 and registered dietitians or nutrition professionals 7as such term is defined in section #ahfa7vv77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 and perinatal health workers1 stratified by race1 ethnicity1 gender identity1 primary language1 geographic location1 and insurance type and recommendations to promote greater access equity2 and 7#e7 recommendations to promote greater equity in compensation for perinatal health workers under public and private insurers1 particularly for such individuals from racially and ethnically diverse backgrounds4 #f4 ,definitions ,in this ,act3 7#a7 ,culturally and linguistically congruent ,the term culturally and linguistically congruent1 with respect to care or maternity care1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 7#b7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 a physician assistant1 a midwife who meets at a minimum the international definition of a midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 an advanced practice registered nurse1 a doula accredited by a ,state to receive reimbursement for doula services under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a lactation consultant certified by the ,international ,board of ,lactation ,consultant ,examiners2 and 7,b7 has a focus on maternal or perinatal health4 7#c7 ,perinatal health worker ,the term perinatal health worker means a nonclinical health worker focused on maternal or perinatal health1 such as a doula1 community health worker1 peer supporter1 lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 patient navigator or coordinator1 or language interpreter4 7#d7 ,postpartum ,the term postpartum refers 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