,,ii #aaith ,,congress #b;d ,session ,s4 #dcef ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #ba1 #bjbf,mr4 ,markey 7for himself1 ,mr4 ,blumenthal1 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 protect ,moms and babies against climate change1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,protecting ,moms and ,babies ,against ,climate ,change ,act4 #b4 ,definitions ,in this ,act3 7#a7 ,adverse maternal and infant health outcomes ,the term adverse maternal and infant health outcomes includes the outcomes of preterm birth1 low birth weight1 stillbirth1 infant or maternal mortality1 and severe maternal morbidity4 7#b7 ,institution of higher education ,the term institution of higher education has the meaning given such term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#c7 ,maternal mortality ,the term maternal mortality means a death occurring during or within a #a-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#d7 ,minority-serving institution ,the term minority-serving institution means an entity specified in any of paragraphs 7#a7 through 7#g7 of section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7#e7 ,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#f7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7#g7 ,risks associated with climate change ,the term risks associated with climate change includes risks associated with extreme heat1 air pollution1 extreme weather events1 and other environmental issues associated with climate change that can result in adverse maternal and infant health outcomes4 7#h7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#i7 ,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#aj7 ,stakeholder organization ,the term stakeholder organization means-- 7,a7 a community-based organization with expertise in providing assistance to vulnerable individuals2 7,b7 a nonprofit organization with expertise in-- 7i7 maternal or infant health2 or 7ii7 environmental or climate justice2 and 7,c7 a patient advocacy organization representing vulnerable individuals4 7#aa7 ,vulnerable individual ,the term vulnerable individual means-- 7,a7 an individual who is pregnant2 7,b7 an individual who was pregnant during any portion of the preceding #a-year period2 and 7,c7 an individual under #c years of age4 #c4 ,grant program to protect vulnerable mothers and babies from climate change risks 7a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall establish a grant program to protect vulnerable individuals from risks associated with climate change4 7b7 ,grant authority ,in carrying out the ,program1 the ,secretary may award1 on a competitive basis1 grants to #aj covered entities4 7c7 ,applications ,to be eligible for a grant under the ,program1 a covered entity shall submit to the ,secretary an application at such time1 in such form1 and containing such information as the ,secretary may require1 which shall include1 at a minimum1 a description of the following3 7#a7 ,plans for the use of grant funds awarded under the ,program and how patients and stakeholder organizations were involved in the development of such plans4 7#b7 ,how such grant funds will be targeted to geographic areas that have disproportionately high levels of risks associated with climate change for vulnerable individuals4 7#c7 ,how such grant funds will be used to address racial and ethnic disparities in-- 7,a7 adverse maternal and infant health outcomes2 and 7,b7 exposure to risks associated with climate change for vulnerable individuals4 7#d7 ,strategies to prevent an initiative assisted with such grant funds from causing-- 7,a7 adverse environmental impacts2 7,b7 displacement of residents and businesses2 7,c7 rent and housing price increases2 or 7,d7 disproportionate adverse impacts on racial and ethnic minority groups and other underserved populations4 7d7 ,selection of grant recipients 7#a7 ,timing ,not later than #bgj days after the date of enactment of this ,act1 the ,secretary shall select the recipients of grants under the ,program4 7#b7 ,consultation ,in selecting covered entities for grants under the ,program1 the ,secretary shall consult with-- 7,a7 representatives of stakeholder organizations2 7,b7 the ,administrator of the ,environmental ,protection ,agency2 7,c7 the ,administrator of the ,national ,oceanic and ,atmospheric ,administration2 and 7,d7 from the ,department of ,health and ,human ,services-- 7i7 the ,deputy ,assistant ,secretary for ,minority ,health2 7ii7 the ,administrator of the ,centers for ,medicare ,medicaid ,services2 7iii7 the ,administrator of the ,health ,resources and ,services ,administration2 7iv7 the ,director of the ,national ,institutes of ,health2 and 7v7 the ,director of the ,centers for ,disease ,control and ,prevention4 7#c7 ,priority ,in selecting grantees under the ,program1 the ,secretary shall give priority to covered entities that serve a county or locality-- 7,a7 designated1 or located in an area designated1 as a nonattainment area pursuant to section #ajg of the ,clean ,air ,act 7#db ,u4,s4,c4 #gdjg7 for any air pollutant for which air quality criteria have been issued under section #ajh7;a7 of such ,act 7#db ,u4,s4,c4 #gdjh7;a772 7,b7 with a level of vulnerability of moderate-to-high or higher1 according to the ,social ,vulnerability ,index of the ,centers for ,disease ,control and ,prevention1 or a similar rating of social vulnerability according to related ,federal mapping tools2 7,c7 with temperatures that pose a risk to human health1 as determined by the ,secretary1 in consultation with the ,administrator of the ,national ,oceanic and ,atmospheric ,administration and the ,chair of the ,united ,states ,global ,change ,research ,program1 based on the best available science2 7,d7 with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 7,e7 with a rating of very high or relatively high risk according to the ,national ,risk ,index for ,natural ,hazards of the ,federal ,emergency ,management ,agency2 or 7,f7 with other climate-sensitive hazards with associations to adverse maternal or infant health outcomes1 as determined by the ,secretary4 7#d7 ,limitation ,a recipient of grant funds under the ,program may not use such grant funds to serve a county or locality that is served by any other recipient of a grant under the ,program4 7e7 ,use of funds ,a covered entity awarded grant funds under the ,program may only use such grant funds for the following3 7#a7 ,initiatives to identify risks associated with climate change for vulnerable individuals and to provide services and support to such individuals that address such risks1 which may include-- 7,a7 training for health care providers1 perinatal health workers1 and other employees in hospitals1 birth centers1 midwifery practices1 and other health care practices that provide prenatal or labor and delivery services to vulnerable individuals on the identification of1 and patient counseling relating to1 risks associated with climate change for vulnerable individuals2 7,b7 hiring1 training1 or providing resources to perinatal health workers who can help identify risks associated with climate change for vulnerable individuals1 provide patient counseling about such risks1 and carry out the distribution of relevant services and support2 7,c7 enhancing the monitoring of risks associated with climate change for vulnerable individuals1 including by-- 7i7 collecting data on such risks in specific census tracts1 neighborhoods1 or other geographic areas2 and 7ii7 sharing such data with local health care providers1 perinatal health workers1 and other employees in hospitals1 birth centers1 midwifery practices1 and other health care practices that provide prenatal or labor and delivery services to local vulnerable individuals2 and 7,d7 providing vulnerable individuals-- 7i7 air conditioning units1 residential weatherization support1 filtration systems1 household appliances1 or related items2 7ii7 direct financial assistance2 and 7iii7 services and support1 including housing assistance1 evacuation assistance1 transportation assistance1 access to cooling shelters1 and mental health counseling1 to prepare for or recover from extreme weather events1 which may include floods1 hurricanes1 wildfires1 droughts1 and related events4 7#b7 ,initiatives to mitigate levels of and exposure to risks associated with climate change for vulnerable individuals1 which shall be based on the best available science and which may include initiatives to-- 7,a7 develop1 maintain1 or expand urban or community forestry initiatives and tree canopy coverage initiatives2 7,b7 improve infrastructure1 such as buildings and paved surfaces2 7,c7 develop or improve community outreach networks to provide culturally and linguistically appropriate information and notifications about risks associated with climate change for vulnerable individuals2 and 7,d7 provide enhanced services to racial and ethnic minority groups and other underserved populations4 7f7 ,length of award ,a grant under this section shall be disbursed over #d fiscal years4 7g7 ,technical assistance ,the ,secretary shall provide technical assistance to a covered entity awarded a grant under the ,program to support the development1 implementation1 and evaluation of activities funded with such grant4 7h7 ,reports to ,secretary 7#a7 ,annual report ,for each fiscal year during which a covered entity is disbursed grant funds under the ,program1 such covered entity shall submit to the ,secretary a report that summarizes the activities carried out by such covered entity with such grant funds during such fiscal year1 which shall include a description of the following3 7,a7 ,the involvement of stakeholder organizations in the implementation of initiatives assisted with such grant funds4 7,b7 ,relevant health and environmental data1 disaggregated1 to the extent practicable1 by race1 ethnicity1 primary language1 socioeconomic status1 geography1 insurance type1 pregnancy status1 and other relevant demographic information4 7,c7 ,qualitative feedback received from vulnerable individuals with respect to initiatives assisted with such grant funds4 7,d7 ,criteria used in selecting the geographic areas assisted with such grant funds4 7,e7 ,efforts to address racial and ethnic disparities in adverse maternal and infant health outcomes and in exposure to risks associated with climate change for vulnerable individuals4 7,f7 ,any negative and unintended impacts of initiatives assisted with such grant funds1 including-- 7i7 adverse environmental impacts2 7ii7 displacement of residents and businesses2 7iii7 rent and housing price increases2 and 7iv7 disproportionate adverse impacts on racial and ethnic minority groups and other underserved populations4 7,g7 ,how the covered entity will address and prevent any impacts described in subparagraph 7,f74 7#b7 ,publication ,not later than #cj days after the date on which a report is submitted under paragraph 7#a71 the ,secretary shall publish such report on a public website of the ,department of ,health and ,human ,services4 7i7 ,report to ,congress ,not later than the date that is #e years after the date on which the ,program is established1 the ,secretary shall submit to ,congress and publish on a public website of the ,department of ,health and ,human ,services a report on the results of the ,program1 including the following3 7#a7 ,summaries of the annual reports submitted under subsection 7h74 7#b7 ,evaluations of the initiatives assisted with grant funds under the ,program4 7#c7 ,an assessment of the effectiveness of the ,program in-- 7,a7 identifying risks associated with climate change for vulnerable individuals2 7,b7 providing services and support to such individuals2 7,c7 mitigating levels of and exposure to such risks2 and 7,d7 addressing racial and ethnic disparities in adverse maternal and infant health outcomes and in exposure to such risks4 7#d7 ,a description of how the ,program could be expanded1 including-- 7,a7 monitoring efforts or data collection that would be required to identify areas with high levels of risks associated with climate change for vulnerable individuals2 7,b7 how such areas could be identified using the strategy developed under section #f2 and 7,c7 recommendations for additional funding4 7j7 ,definitions ,in this section3 7#a7 ,the term covered entity means a consortium of organizations serving a county that-- 7,a7 shall include a community-based organization2 and 7,b7 may include-- 7i7 another stakeholder organization2 7ii7 the government of such county2 7iii7 the governments of #a or more municipalities within such county2 7iv7 a ,state or local public health department or emergency management agency2 7v7 a local health care practice1 which may include a licensed and accredited hospital1 birth center1 midwifery practice1 or other health care practice that provides prenatal or labor and delivery services to vulnerable individuals2 7vi7 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 7vii7 an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 and 7viii7 an institution of higher education4 7#b7 ,the term ,program means the grant program under this section4 7k7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ajj1jjj1jjj for the period of fiscal years #bjbg through #bjcj4 #d4 ,grant program for education and training at health profession schools 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall establish a grant program to provide funds to health profession schools to support the development and integration of education and training programs for identifying and addressing risks associated with climate change for vulnerable individuals4 7b7 ,grant authority ,in carrying out the ,program1 the ,secretary may award1 on a competitive basis1 grants to health profession schools4 7c7 ,application ,to be eligible for a grant under the ,program1 a health profession school shall submit to the ,secretary an application at such time1 in such form1 and containing such information as the ,secretary may require1 which shall include1 at a minimum1 a description of the following3 7#a7 ,how such health profession school will engage with vulnerable individuals1 and stakeholder organizations representing such individuals1 in developing and implementing the education and training programs supported by grant funds awarded under the ,program4 7#b7 ,how such health profession school will ensure that such education and training programs will address racial and ethnic disparities in exposure to1 and the effects of1 risks associated with climate change for vulnerable individuals4 7d7 ,use of funds ,a health profession school awarded a grant under the ,program shall use the grant funds to develop1 and integrate into the curriculum and continuing education of such health profession school1 education and training on each of the following3 7#a7 ,identifying risks associated with climate change for vulnerable individuals and individuals with the intent to become pregnant4 7#b7 ,how risks associated with climate change affect vulnerable individuals and individuals with the intent to become pregnant4 7#c7 ,racial and ethnic disparities in exposure to1 and the effects of1 risks associated with climate change for vulnerable individuals and individuals with the intent to become pregnant4 7#d7 ,patient counseling and mitigation strategies relating to risks associated with climate change for vulnerable individuals4 7#e7 ,relevant services and support for vulnerable individuals relating to risks associated with climate change and strategies for ensuring vulnerable individuals have access to such services and support4 7#f7 ,implicit and explicit bias1 racism1 and discrimination4 7#g7 ,related topics identified by such health profession school based on the engagement of such health profession school with vulnerable individuals and stakeholder organizations representing such individuals4 7e7 ,partnerships ,in carrying out activities with grant funds1 a health profession school awarded a grant under the ,program may partner with #a or more of the following3 7#a7 ,a ,state or local public health department4 7#b7 ,a health care professional membership organization4 7#c7 ,a stakeholder organization4 7#d7 ,a health profession school4 7#e7 ,an institution of higher education4 7f7 ,reports to ,secretary 7#a7 ,annual report ,for each fiscal year during which a health profession school is disbursed grant funds under the ,program1 such health profession school shall submit to the ,secretary a report that describes the activities carried out with such grant funds during such fiscal year4 7#b7 ,final report ,not later than the date that is #a year after the end of the last fiscal year during which a health profession school is disbursed grant funds under the ,program1 the health profession school shall submit to the ,secretary a final report that summarizes the activities carried out with such grant funds4 7g7 ,report to ,congress ,not later than the date that is #f years after the date on which the ,program is established1 the ,secretary shall submit to ,congress and publish on a public website of the ,department of ,health and ,human ,services a report that includes the following3 7#a7 ,a summary of the reports submitted under subsection 7f74 7#b7 ,recommendations to improve education and training programs at health profession schools with respect to identifying and addressing risks associated with climate change for vulnerable individuals4 7h7 ,definitions ,in this section3 7#a7 ,the term health profession school means an accredited-- 7,a7 medical school2 7,b7 school of nursing2 7,c7 midwifery program2 7,d7 physician assistant education program2 7,e7 teaching hospital2 7,f7 residency or fellowship program2 or 7,g7 other school or program determined appropriate by the ,secretary4 7#b7 ,the term ,program means the grant program under this section4 7i7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this section #e1jjj1jjj for the period of fiscal years #bjbg through #bjcj4 #e4 ,,nih ,consortium on ,birth and ,climate ,change ,research 7a7 ,establishment ,not later than #a year after the date of enactment of this ,act1 the ,director of the ,national ,institutes of ,health shall establish the ,consortium on ,birth and ,climate ,change ,research 7in this section referred to as the ,consortium74 7b7 ,duties 7#a7 ,in general ,the ,consortium shall coordinate1 across the institutes1 centers1 and offices of the ,national ,institutes of ,health1 research on the risks associated with climate change for vulnerable individuals4 7#b7 ,required activities ,in carrying out paragraph 7#a71 the ,consortium shall-- 7,a7 establish research priorities1 including by prioritizing research that-- 7i7 identifies the risks associated with climate change for vulnerable individuals with a particular focus on disparities in such risks among racial and ethnic minority groups and other underserved populations2 and 7ii7 identifies strategies to reduce levels of1 and exposure to1 such risks1 with a particular focus on risks among racial and ethnic minority groups and other underserved populations2 7,b7 identify gaps in available data related to such risks2 7,c7 identify gaps in1 and opportunities for1 research collaborations2 7,d7 identify funding opportunities for community-based organizations and researchers from racially1 ethnically1 and geographically diverse backgrounds2 7,e7 identify opportunities to increase public awareness related to risks associated with climate change for vulnerable individuals2 and 7,f7 publish annual reports on the work and findings of the ,consortium on a public website of the ,national ,institutes of ,health4 7c7 ,membership ,the ,director shall appoint to the ,consortium representatives of such institutes1 centers1 and offices of the ,national ,institutes of ,health as the ,director considers appropriate1 including1 at a minimum1 representatives of-- 7#a7 the ,national ,institute of ,environmental ,health ,sciences2 7#b7 the ,national ,institute on ,minority ,health and ,health ,disparities2 7#c7 the ,eunice ,kennedy ,shriver ,national ,institute of ,child ,health and ,human ,development2 7#d7 the ,national ,institute of ,mental ,health2 7#e7 the ,national ,institute of ,nursing ,research2 and 7#f7 the ,office of ,research on ,women's ,health4 7d7 ,chairperson ,the ,chairperson of the ,consortium shall be designated by the ,director and selected from among the representatives appointed under subsection 7c74 7e7 ,consultation ,in carrying out the duties described in subsection 7b71 the ,consortium shall consult with-- 7#a7 the heads of relevant ,federal agencies1 including-- 7,a7 the ,environmental ,protection ,agency2 7,b7 the ,national ,oceanic and ,atmospheric ,administration2 7,c7 the ,occupational ,safety and ,health ,administration2 and 7,d7 from the ,department of ,health and ,human ,services-- 7i7 the ,office of ,minority ,health in the ,office of the ,secretary2 7ii7 the ,centers for ,medicare ,medicaid ,services2 7iii7 the ,health ,resources and ,services ,administration2 7iv7 the ,centers for ,disease ,control and ,prevention2 7v7 the ,indian ,health ,service2 and 7vi7 the ,administration for ,children and ,families2 and 7#b7 representatives of-- 7,a7 stakeholder organizations2 7,b7 health care providers and professional membership organizations with expertise in maternal health or environmental justice2 7,c7 ,state and local public health departments2 7,d7 licensed and accredited hospitals1 birth centers1 midwifery practices1 or other health care practices that provide prenatal or labor and delivery services to vulnerable individuals2 and 7,e7 institutions of higher education1 including such institutions that are minority-serving institutions or have expertise in maternal health or environmental justice4 #f4 ,strategy for identifying climate change risk zones for vulnerable mothers and babies 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a strategy 7in this section referred to as the ,strategy7 for designating areas that the ,secretary determines to have a high risk of adverse maternal and infant health outcomes among vulnerable individuals as a result of risks associated with climate change4 7b7 ,strategy requirements 7#a7 ,in general ,in developing the ,strategy1 the ,secretary shall establish a process to identify areas where vulnerable individuals are exposed to a high risk of adverse maternal and infant health outcomes as a result of risks associated with climate change in conjunction with other factors that can impact such health outcomes1 including-- 7,a7 the incidence of diseases associated with air pollution1 extreme heat1 and other environmental factors2 7,b7 the availability and accessibility of maternal and infant health care providers2 7,c7 ,english-language proficiency among women of reproductive age2 7,d7 the health insurance status of women of reproductive age2 7,e7 the number of women of reproductive age who are members of racial or ethnic groups with disproportionately high rates of adverse maternal and infant health outcomes2 7,f7 the socioeconomic status of women of reproductive age1 including with respect to-- 7i7 poverty2 7ii7 unemployment2 7iii7 household income2 and 7iv7 educational attainment2 and 7,g7 access to quality housing1 transportation1 and nutrition4 7#b7 ,resources ,in developing the ,strategy1 the ,secretary shall identify1 and incorporate a description of1 the following3 7,a7 ,existing mapping tools or ,federal programs that identify-- 7i7 risks associated with climate change for vulnerable individuals2 and 7ii7 other factors that can influence maternal and infant health outcomes1 including the factors described in paragraph 7#a74 7,b7 ,environmental1 health1 socioeconomic1 and demographic data relevant to identifying risks associated with climate change for vulnerable individuals4 7,c7 ,existing monitoring networks that collect data described in subparagraph 7,b71 and any gaps in such networks4 7,d7 ,federal1 ,state1 and local stakeholders involved in maintaining monitoring networks identified under subparagraph 7,c71 and how such stakeholders are coordinating their monitoring efforts4 7,e7 ,additional monitoring networks1 and enhancements to existing monitoring networks1 that would be required to address gaps identified under subparagraph 7,c71 including at the subcounty and census tract level4 7,f7 ,funding amounts required to establish the monitoring networks identified under subparagraph 7,e7 and recommendations for ,federal1 ,state1 and local coordination with respect to such networks4 7,g7 ,potential uses for data collected and generated as a result of the ,strategy1 including how such data may be used in determining recipients of grants under the program established by section #c or other similar programs4 7,h7 ,other information the ,secretary considers relevant for the development of the ,strategy4 7c7 ,coordination and consultation ,in developing the ,strategy1 the ,secretary shall-- 7#a7 coordinate with the ,administrator of the ,environmental ,protection ,agency and the ,administrator of the ,national ,oceanic and ,atmospheric ,administration2 and 7#b7 consult with-- 7,a7 stakeholder organizations2 7,b7 health care providers and professional membership organizations with expertise in maternal health or environmental justice2 7,c7 ,state and local public health departments2 7,d7 licensed and accredited hospitals1 birth centers1 midwifery practices1 or other health care providers that provide prenatal or labor and delivery services to vulnerable individuals2 and 7,e7 institutions of higher education1 including such institutions that are minority-serving institutions or have expertise in maternal health or environmental justice4 7d7 ,notice and comment ,at least #bdj days before the date on which the ,strategy is published in accordance with subsection 7e71 the ,secretary shall provide-- 7#a7 notice of the ,strategy on a public website of the ,department of ,health and ,human ,services2 and 7#b7 an opportunity for public comment of at least #ij days4 7e7 ,publication ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall publish on a public website of the ,department of ,health and ,human ,services-- 7#a7 the ,strategy2 7#b7 the public comments received under subsection 7d72 and 7#c7 the responses of the ,secretary to such public comments4