,,ii #aaith ,,congress #b;d ,session ,s4 #dahg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #be1 #bjbf,ms4 ,smith 7for herself1 ,mr4 ,booker1 and ,mr4 ,murphy7 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 data collection processes and quality measures1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,data to ,save ,moms ,act4 #b4 ,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 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act7-- 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 personal or family experiences of maternal mortality or severe maternal morbidity1 and professional background1 including members with nonclinical 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 women from racial and ethnic minority groups 7as such term is defined in section #agjg7;g77#a772 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 is authorized to be appropriated to carry out this paragraph #aj1jjj1jjj for each of fiscal years #bjbg through #bjca4 4 7b7 ,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 organizations 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act74 #c4 ,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 with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes to ensure that1 in addition to clinical factors1 nonclinical factors that might have contributed to a pregnancy-related death are appropriately considered2 4 #d4 ,review of maternal health data collection processes and quality measures 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services 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 to make recommendations to improve such processes and measures1 including topics described under 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 demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 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 facilities that provide maternal health care services2 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 primary language1 socioeconomic status1 geography1 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 data on race1 ethnicity1 and other demographic characteristics2 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;,a7772 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 demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes1 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 and 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 and making publicly available1 to the extent practicable1 stratified data on race1 ethnicity1 and other demographic characteristics of pregnant and postpartum individuals in hospitals1 health systems1 midwifery practices1 and birth centers1 and for incorporating such demographically 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 groups2 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 maternal health disparities4 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 enactment of this ,act1 the ,secretary shall submit to the ,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 ,definition ,in this section1 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 7f7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal years #bjbg through #bjcj4 #e4 ,study on maternal health among ,american ,indian and ,alaska ,native individuals 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall1 in coordination with entities described in subsection 7b7-- 7#a7 not later than #ij days after the enactment of this ,act1 enter into a contract with an independent research organization or ,tribal ,epidemiology ,center to conduct a comprehensive study on maternal mortality1 severe maternal morbidity1 and other adverse perinatal or childbirth outcomes in the populations of ,american ,indian and ,alaska ,native individuals2 and 7#b7 not later than #c years after the date of the enactment of this ,act1 submit to ,congress a report on such study that contains recommendations for policies and practices that can be adopted to improve maternal health outcomes for ,american ,indian and ,alaska ,native individuals4 7b7 ,participating entities ,the entities described in this subsection shall consist of #ab members1 selected by the ,secretary from among individuals nominated by ,indian ,tribes and ,tribal organizations 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 and ,urban ,indian organizations 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 ,in selecting such members1 the ,secretary shall ensure that each of the #ab service areas of the ,indian ,health ,service is represented4 7c7 ,contents of study ,the study conducted pursuant to subsection 7a7 shall-- 7#a7 examine the causes of maternal mortality and severe maternal morbidity that are unique to ,american ,indian and ,alaska ,native individuals2 7#b7 include a systematic process of listening to the stories of ,american ,indian and ,alaska ,native individuals to fully understand the causes of1 and inform potential solutions to1 the maternal health crisis within their respective communities2 7#c7 distinguish between the causes of1 landscape of maternity care at1 and recommendations to improve maternal health outcomes within1 the different settings in which ,american ,indian and ,alaska ,native individuals receive maternity care1 such as-- 7,a7 facilities operated by the ,indian ,health ,service2 7,b7 an ,indian health program operated by an ,indian ,tribe or ,tribal organization pursuant to a contract1 grant1 cooperative agreement1 or compact with the ,indian ,health ,service pursuant to the ,indian ,self-,determination ,act2 7,c7 an urban ,indian health program operated by an ,urban ,indian organization pursuant to a grant or contract with the ,indian ,health ,service pursuant to title ,v of the ,indian ,health ,care ,improvement ,act2 and 7,d7 facilities outside of the ,indian ,health ,service in which ,american ,indian and ,alaska ,native individuals receive maternity care services2 7#d7 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 such ,act 7#db ,u4,s4,c4 #acif et seq471 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig et seq4772 7#e7 review current data collection and quality measurement processes and practices2 7#f7 assess causes and frequency of maternal mental health conditions and substance use disorders2 7#g7 consider social determinants of health1 including poverty1 lack of health insurance1 unemployment1 sexual and domestic violence1 and environmental conditions in ,tribal areas2 7#h7 consider the role that historical mistreatment of ,american ,indian and ,alaska ,native women has played in causing currently elevated rates of maternal mortality1 severe maternal morbidity1 and other adverse perinatal or childbirth outcomes2 7#i7 consider how current funding of the ,indian ,health ,service affects the ability of the ,service to deliver quality maternity care2 7#aj7 consider the extent to which the delivery of maternity care services is culturally appropriate for ,american ,indian and ,alaska ,native individuals2 7#aa7 make recommendations to reduce misclassification of ,american ,indian and ,alaska ,native individuals1 including consideration of best practices in training for maternal mortality review committee members to be able to correctly classify ,american ,indian and ,alaska ,native individuals2 and 7#ab7 make recommendations informed by the stories shared by ,american ,indian and ,alaska ,native individuals referred to in paragraph 7#b7 to improve maternal health outcomes for such individuals4 7d7 ,report ,the agreement entered into under subsection 7a7 with an independent research organization or ,tribal ,epidemiology ,center shall require that the organization or ,center transmit to ,congress a report on the results of the study conducted pursuant to that agreement not later than #cf months after the date of the enactment of this ,act4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjbg through #bjbi4 #f4 ,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 7#c7 assess differences in rates of adverse maternal health outcomes among subgroups identifying as ,hispanic1 including disparities in access to early prenatal care2 and 7#d7 include lactation education to promote racial and ethnic diversity within the workforce of health care professionals with breastfeeding and lactation expertise4 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 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 #a 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 is authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjbg through #bjca4 #g4 ,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 a physician assistant1 a midwife who meets1 at a minimum1 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#b7 ,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#c7 ,postpartum ,the term postpartum refers to the #a-year period beginning on the last day of the pregnancy of an individual4 7#d7 ,pregnancy-associated death ,the term pregnancy-associated death 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#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 nonclinical factors that impact maternal health outcomes4