Data to Save Moms Act

II 117TH CONGRESS 1ST SESSION S. 347 To improve the collection and review of maternal health data to address maternal mortality, severe maternal morbidity, and other adverse mater- nal health outcomes. IN THE SENATE OF THE UNITED STATES FEBRUARY 22, 2021 Ms. SMITH (for herself, Mr. BLUMENTHAL, Ms. KLOBUCHAR, and Mr. MAR- KEY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To improve the collection and review of maternal health data to address maternal mortality, severe maternal mor- bidity, and other adverse maternal health outcomes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Data to Save Moms 4 Act’’. 5 SEC. 2. DEFINITIONS. 6 In this Act: 7 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 347 IS (1) MATERNITY CARE PROVIDER.—The term 1 ‘‘maternity care provider’’ means a health care pro- 2 vider who— 3 (A) is a physician, physician assistant, 4 midwife who meets at a minimum the inter- 5 national definition of the midwife and global 6 standards for midwifery education as estab- 7 lished by the International Confederation of 8 Midwives, nurse practitioner, or clinical nurse 9 specialist; and 10 (B) has a focus on maternal or perinatal 11 health. 12 (2) MATERNAL MORTALITY.—The term ‘‘mater- 13 nal mortality’’ means a death occurring during or 14 within a one-year period after pregnancy, caused by 15 pregnancy-related or childbirth complications, in- 16 cluding a suicide, overdose, or other death resulting 17 from a mental health or substance use disorder at- 18 tributed to or aggravated by pregnancy-related or 19 childbirth complications. 20 (3) PERINATAL HEALTH WORKER.—The term 21 ‘‘perinatal health worker’’ means a doula, commu- 22 nity health worker, peer supporter, breastfeeding 23 and lactation educator or counselor, nutritionist or 24 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 347 IS dietitian, childbirth educator, social worker, home 1 visitor, language interpreter, or navigator. 2 (4) POSTPARTUM AND POSTPARTUM PERIOD.— 3 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 4 refer to the 1-year period beginning on the last day 5 of the pregnancy of an individual. 6 (5) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘‘racial and ethnic minority group’’ has the 8 meaning given such term in section 1707(g)(1) of 9 the Public Health Service Act (42 U.S.C. 300u– 10 6(g)(1)). 11 (6) SEVERE MATERNAL MORBIDITY.—The term 12 ‘‘severe maternal morbidity’’ means a health condi- 13 tion, including mental health conditions and sub- 14 stance use disorders, attributed to or aggravated by 15 pregnancy or childbirth that results in significant 16 short-term or long-term consequences to the health 17 of the individual who was pregnant. 18 (7) SOCIAL DETERMINANTS OF MATERNAL 19 HEALTH.—The term ‘‘social determinants of mater- 20 nal health’’ means non-clinical factors that impact 21 maternal health outcomes, including— 22 (A) economic factors, which may include 23 poverty, employment, food security, support for 24 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 347 IS and access to lactation and other infant feeding 1 options, housing stability, and related factors; 2 (B) neighborhood factors, which may in- 3 clude quality of housing, access to transpor- 4 tation, access to child care, availability of 5 healthy foods and nutrition counseling, avail- 6 ability of clean water, air and water quality, 7 ambient temperatures, neighborhood crime and 8 violence, access to broadband, and related fac- 9 tors; 10 (C) social and community factors, which 11 may include systemic racism, gender discrimi- 12 nation or discrimination based on other pro- 13 tected classes, workplace conditions, incarcer- 14 ation, and related factors; 15 (D) household factors, which may include 16 ability to conduct lead testing and abatement, 17 car seat installation, indoor air temperatures, 18 and related factors; 19 (E) education access and quality factors, 20 which may include educational attainment, lan- 21 guage and literacy, and related factors; and 22 (F) health care access factors, including 23 health insurance coverage, access to culturally 24 congruent health care services, providers, and 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 347 IS non-clinical support, access to home visiting 1 services, access to wellness and stress manage- 2 ment programs, health literacy, access to tele- 3 health and items required to receive telehealth 4 services, and related factors. 5 SEC. 3. FUNDING FOR MATERNAL MORTALITY REVIEW 6 COMMITTEES TO PROMOTE REPRESENTA- 7 TIVE COMMUNITY ENGAGEMENT. 8 (a) IN GENERAL.—Section 317K(d) of the Public 9 Health Service Act (42 U.S.C. 247b–12(d)) is amended 10 by adding at the end the following: 11 ‘‘(9) GRANTS TO PROMOTE REPRESENTATIVE 12 COMMUNITY ENGAGEMENT IN MATERNAL MOR- 13 TALITY REVIEW COMMITTEES.— 14 ‘‘(A) IN GENERAL.—The Secretary may, 15 using funds made available pursuant to sub- 16 paragraph (C), provide assistance to an applica- 17 ble maternal mortality review committee of a 18 State, Indian tribe, tribal organization, or 19 urban Indian organization— 20 ‘‘(i) to select for inclusion in the mem- 21 bership of such a committee community 22 members from the State, Indian tribe, trib- 23 al organization, or urban Indian organiza- 24 tion by— 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 347 IS ‘‘(I) prioritizing community mem- 1 bers who can increase the diversity of 2 the committee’s membership with re- 3 spect to race and ethnicity, location, 4 and professional background, includ- 5 ing members with non-clinical experi- 6 ences; and 7 ‘‘(II) to the extent applicable, 8 using funds reserved under subsection 9 (f), to address barriers to maternal 10 mortality review committee participa- 11 tion for community members, includ- 12 ing required training, transportation 13 barriers, compensation, and other sup- 14 ports as may be necessary; 15 ‘‘(ii) to establish initiatives to conduct 16 outreach and community engagement ef- 17 forts within communities throughout the 18 State or Tribe to seek input from commu- 19 nity members on the work of such mater- 20 nal mortality review committee, with a par- 21 ticular focus on outreach to minority 22 women; and 23 ‘‘(iii) to release public reports assess- 24 ing— 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 347 IS ‘‘(I) the pregnancy-related death 1 and pregnancy-associated death review 2 processes of the maternal mortality 3 review committee, with a particular 4 focus on the maternal mortality re- 5 view committee’s sensitivity to the 6 unique circumstances of pregnant and 7 postpartum individuals from racial 8 and ethnic minority groups (as such 9 term is defined in section 1707(g)(1)) 10 who have suffered pregnancy-related 11 deaths; and 12 ‘‘(II) the impact of the use of 13 funds made available pursuant to sub- 14 paragraph (C) on increasing the diver- 15 sity of the maternal mortality review 16 committee membership and promoting 17 community engagement efforts 18 throughout the State or Tribe. 19 ‘‘(B) TECHNICAL ASSISTANCE.—The Sec- 20 retary shall provide (either directly through the 21 Department of Health and Human Services or 22 by contract) technical assistance to any mater- 23 nal mortality review committee receiving a 24 grant under this paragraph on best practices 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 347 IS for increasing the diversity of the maternal 1 mortality review committee’s membership and 2 for conducting effective community engagement 3 throughout the State or Tribe. 4 ‘‘(C) AUTHORIZATION OF APPROPRIA- 5 TIONS.—In addition to any funds made avail- 6 able under subsection (f), there are authorized 7 to be appropriated to carry out this paragraph 8 $10,000,000 for each of fiscal years 2022 9 through 2026.’’. 10 (b) DEFINITIONS.—Section 317K(e) of the Public 11 Health Service Act (42 U.S.C. 247b–12(e)) is amended— 12 (1) in paragraph (2), by striking ‘‘and’’ at the 13 end; 14 (2) in paragraph (3)(B), by striking the period 15 and inserting ‘‘; and’’; and 16 (3) by adding at the end the following: 17 ‘‘(4) the term ‘urban Indian organization’ has 18 the meaning given such term in section 4 of the In- 19 dian Health Care Improvement Act.’’. 20 (c) RESERVATION OF FUNDS.—Section 317K(f) of 21 the Public Health Service Act (42 U.S.C. 247b–12(f)) is 22 amended by adding at the end the following: ‘‘Of the 23 amount made available under the preceding sentence for 24 a fiscal year, not less than $1,500,000 shall be reserved 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 347 IS for grants to Indian tribes, tribal organizations, or urban 1 Indian organizations.’’. 2 SEC. 4. DATA COLLECTION AND REVIEW. 3 Section 317K(d)(3)(A)(i) of the Public Health Serv- 4 ice Act (42 U.S.C. 247b–12(d)(3)(A)(i)) is amended— 5 (1) by redesignating subclauses (II) and (III) 6 as subclauses (V) and (VI), respectively; and 7 (2) by inserting after subclause (I) the fol- 8 lowing: 9 ‘‘(II) to the extent practicable, 10 reviewing cases of severe maternal 11 morbidity, according to the most up- 12 to-date indicators; 13 ‘‘(III) to the extent practicable, 14 reviewing deaths during pregnancy or 15 up to 1 year after the end of a preg- 16 nancy from suicide, overdose, or other 17 death from a mental health condition 18 or substance use disorder attributed 19 to or aggravated by pregnancy or 20 childbirth complications; 21 ‘‘(IV) to the extent practicable, 22 consulting with local community-based 23 organizations representing pregnant 24 and postpartum individuals from de- 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 347 IS mographic groups disproportionately 1 impacted by poor maternal health out- 2 comes to ensure that, in addition to 3 clinical factors, non-clinical factors 4 that might have contributed to a preg- 5 nancy-related death are appropriately 6 considered;’’. 7 SEC. 5. REVIEW OF MATERNAL HEALTH DATA COLLECTION 8 PROCESSES AND QUALITY MEASURES. 9 (a) IN GENERAL.—The Secretary of Health and 10 Human Services, acting through the Administrator for 11 Centers for Medicare & Medicaid Serves and the Director 12 of the Agency for Healthcare Research and Quality, shall 13 consult with relevant stakeholders— 14 (1) to review existing maternal health data col- 15 lection processes and quality measures; and 16 (2) make recommendations to improve such 17 processes and measures, including topics described 18 in subsection (c). 19 (b) COLLABORATION.—In carrying out this section, 20 the Secretary shall consult with a diverse group of mater- 21 nal health stakeholders, which may include— 22 (1) pregnant and postpartum individuals and 23 their family members, and nonprofit organizations 24 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 347 IS representing such individuals, with a particular focus 1 on patients from racial and ethnic minority groups; 2 (2) community-based organizations that provide 3 support for pregnant and postpartum individuals, 4 with a particular focus on patients from racial and 5 ethnic minority groups; 6 (3) membership organizations for maternity 7 care providers; 8 (4) organizations representing perinatal health 9 workers; 10 (5) organizations that focus on maternal mental 11 or behavioral health; 12 (6) organizations that focus on intimate partner 13 violence; 14 (7) institutions of higher education, with a par- 15 ticular focus on minority-serving institutions; 16 (8) licensed and accredited hospitals, birth cen- 17 ters, midwifery practices, or other medical practices 18 that provide maternal health care services to preg- 19 nant and postpartum patients; 20 (9) relevant State and local public agencies, in- 21 cluding State maternal mortality review committees; 22 and 23 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 347 IS (10) the National Quality Forum, or such other 1 standard-setting organizations specified by the Sec- 2 retary. 3 (c) TOPICS.—The review of maternal health data col- 4 lection processes and recommendations to improve such 5 processes and measures required under subsection (a) 6 shall assess all available relevant information, including 7 information from State-level sources, and shall consider at 8 least the following: 9 (1) Current State and Tribal practices for ma- 10 ternal health, maternal mortality, and severe mater- 11 nal morbidity data collection and dissemination, in- 12 cluding consideration of— 13 (A) the timeliness of processes for amend- 14 ing a death certificate when new information 15 pertaining to the death becomes available to re- 16 flect whether the death was a pregnancy-related 17 death; 18 (B) relevant data collected with electronic 19 health records, including data on race, eth- 20 nicity, socioeconomic status, insurance type, 21 and other relevant demographic information; 22 (C) maternal health data collected and 23 publicly reported by hospitals, health systems, 24 midwifery practices, and birth centers; 25 VerDate Sep 11 2014 22:59 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S347.IS S347 pamtmann on DSKBC07HB2PROD with BILLS 13 •S 347 IS (D) the barriers preventing States from 1 correlating maternal outcome data with race 2 and ethnicity data; 3 (E) processes for determining the cause of 4 a pregnancy-associated death in States that do 5 not have a maternal mortality review com- 6 mittee; 7 (F) whether maternal mortality review 8 committees include multidiscipl [Text truncated for display. 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