Maternal CARE Act

II 116TH CONGRESS 1ST SESSION S. 1600 To support States in their work to end preventable morbidity and mortality in maternity care by using evidence-based quality improvement to protect the health of mothers during pregnancy, childbirth, and in the postpartum period and to reduce neonatal and infant mortality, to elimi- nate racial disparities in maternal health outcomes, and for other pur- poses. IN THE SENATE OF THE UNITED STATES MAY 22, 2019 Ms. HARRIS (for herself, Ms. HIRONO, Mr. MERKLEY, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. JONES, Mr. DURBIN, Mr. KAINE, Mr. BROWN, Mr. MARKEY, Ms. WARREN, Mr. BOOKER, Mr. CASEY, Mr. SANDERS, Mr. CARDIN, Ms. KLOBUCHAR, Mr. WYDEN, Ms. DUCKWORTH, Ms. STABE- NOW, and Mrs. GILLIBRAND) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To support States in their work to end preventable morbidity and mortality in maternity care by using evidence-based quality improvement to protect the health of mothers during pregnancy, childbirth, and in the postpartum pe- riod and to reduce neonatal and infant mortality, to eliminate racial disparities in maternal health outcomes, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 2 •S 1600 IS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Maternal Care Access 2 and Reducing Emergencies Act’’ or the ‘‘Maternal CARE 3 Act’’. 4 SEC. 2. FINDINGS. 5 Congress finds the following: 6 (1) In the United States, maternal mortality 7 rates are among the highest in the developed world 8 and increased by 26.6 percent between 2000 and 9 2014. 10 (2) Of the 4,000,000 American women who give 11 birth each year, about 700 suffer fatal complications 12 during pregnancy, while giving birth, or during the 13 postpartum period, and an additional 50,000 are se- 14 verely injured. 15 (3) It is estimated that about 60 percent of the 16 maternal mortalities in the United States could be 17 prevented and half of the maternal injuries in the 18 United States could be reduced or eliminated with 19 better care. 20 (4) Data from the Centers for Disease Control 21 and Prevention show that Black women are 3 to 4 22 times more likely to die from pregnancy-related 23 causes than White women. There are 42.8 deaths 24 per 100,000 live births for Black women, compared 25 to 13 deaths per 100,000 live births for White 26 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 3 •S 1600 IS women and 17.2 deaths per 100,000 live births for 1 women nationally. 2 (5) Black women’s risk of maternal mortality 3 has remained higher than White women’s risk for 4 the past 6 decades. 5 (6) Black women in the United States suffer 6 from life-threatening pregnancy complications twice 7 as often as their White counterparts. 8 (7) High rates of maternal mortality among 9 Black women span income and education levels, as 10 well as socioeconomic status; moreover, risk factors 11 such as a lack of access to prenatal care and phys- 12 ical health conditions do not fully explain the racial 13 disparity in maternal mortality. 14 (8) A growing body of evidence indicates that 15 stress from racism and racial discrimination results 16 in conditions—including hypertension and pre-ec- 17 lampsia—that contribute to poor maternal health 18 outcomes among Black women. 19 (9) Pervasive racial bias against Black women 20 and unequal treatment of Black women exist in the 21 health care system, often resulting in inadequate 22 treatment for pain and dismissal of cultural norms 23 with respect to health. A 2016 study by University 24 of Virginia researchers found that White medical 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 4 •S 1600 IS students and residents often believed biological 1 myths about racial differences in patients, including 2 that Black patients have less-sensitive nerve endings 3 and thicker skin than their White counterparts. Pro- 4 viders, however, are not consistently required to un- 5 dergo implicit bias, cultural competency, or empathy 6 training. 7 (10) North Carolina has established a statewide 8 Pregnancy Medical Home (PMH) program, which 9 aims to reduce adverse maternal health outcomes 10 and maternal deaths by incentivizing maternal 11 health care providers to provide integral health care 12 services to pregnant women and new mothers. Ac- 13 cording to the North Carolina Department of Health 14 and Human Services Center for Health Statistics, 15 the pregnancy-related mortality rate for Black 16 women was approximately 5.1 times higher than 17 that of White women in 2004. Almost a decade 18 later, in 2013, the pregnancy-related mortality rates 19 for Black women and White women were 24.3 and 20 24.2 deaths per 100,000 live births, respectively. 21 The PMH program has been credited with the con- 22 vergence in pregnancy-related mortality rates be- 23 cause the program partners each high-risk pregnant 24 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 5 •S 1600 IS and postpartum woman that is covered under Med- 1 icaid with a pregnancy care manager. 2 SEC. 3. DEFINITIONS. 3 In this Act: 4 (1) SECRETARY.—The term ‘‘Secretary’’ means 5 the Secretary of Health and Human Services. 6 (2) STATE.—The term ‘‘State’’ has the mean- 7 ing given that term in section 1101 of the Social Se- 8 curity Act (42 U.S.C. 1301) for purposes of title 9 XIX of that Act (42 U.S.C. 1396 et seq.). 10 SEC. 4. IMPLICIT BIAS TRAINING FOR HEALTH CARE PRO- 11 VIDERS. 12 (a) GRANT PROGRAM.—The Secretary shall establish 13 a grant program under which such Secretary awards 14 grants to accredited schools of allopathic medicine, accred- 15 ited schools of osteopathic medicine, accredited nursing 16 schools, other health professional training programs, and 17 other entities for the purpose of supporting implicit bias 18 training, with priority given to such training with respect 19 to obstetrics and gynecology. 20 (b) COLLABORATION REQUIRED.—In developing re- 21 quirements for implicit bias training carried out with 22 grant funds awarded under this section, the Secretary 23 shall collaborate with relevant stakeholders that specialize 24 in addressing health equity, including— 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 6 •S 1600 IS (1) health care providers who serve pregnant 1 women, including doctors, nurses, and midwives; 2 (2) academic institutions, including schools and 3 training programs described in subsection (a); 4 (3) community-based health workers, including 5 perinatal health workers, doulas, and home visitors; 6 and 7 (4) community-based organizations. 8 (c) IMPLICIT BIAS TRAINING DEFINED.—In this sec- 9 tion, the term ‘‘implicit bias training’’ means evidence- 10 based, on-going professional development and support, 11 with respect to— 12 (1) bias in judgment or behavior that results 13 from subtle cognitive processes, including implicit at- 14 titudes and implicit stereotypes, that often operate 15 at a level below conscious awareness and without in- 16 tentional control; or 17 (2) implicit attitudes and stereotypes that result 18 in beliefs or simple associations that a person makes 19 between an object and its evaluation that are auto- 20 matically activated by the mere presence (actual or 21 symbolic) of the attitude object. 22 (d) PRIORITIZATION.—In awarding grants under this 23 section, the Secretary shall give priority to awarding 24 grants to schools, programs, or entities located in or serv- 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 7 •S 1600 IS ing areas with the greatest needs, based such factors as 1 the Secretary may consider, including racial disparities in 2 maternal mortality and the incidence of severe maternal 3 morbidity rates. 4 (e) AUTHORIZATION OF APPROPRIATIONS.—There 5 are authorized to be appropriated for purposes of carrying 6 out the grant program under subsection (a), $5,000,000 7 for each of fiscal years 2020 through 2024. 8 SEC. 5. PREGNANCY MEDICAL HOME DEMONSTRATION 9 PROJECT. 10 (a) AUTHORITY TO AWARD GRANTS.—The Secretary 11 shall award grants to States for the purpose of estab- 12 lishing or operating State pregnancy medical home pro- 13 grams that meet the requirements of subsection (b) to de- 14 liver integrated health care services to pregnant women 15 and new mothers and reduce adverse maternal health out- 16 comes, maternal deaths, and racial health disparities in 17 maternal mortality and morbidity. 18 (b) STATE PREGNANCY MEDICAL HOME PROGRAM 19 REQUIREMENTS.—A State pregnancy medical home pro- 20 gram meets the requirements of this subsection if— 21 (1) the State works with relevant stakeholders 22 to develop and carry out the program, including— 23 (A) State and local agencies responsible for 24 Medicaid, public health, social services, mental 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 8 •S 1600 IS health, and substance abuse treatment and sup- 1 port; 2 (B) health care providers who serve preg- 3 nant women, including doctors, nurses, and 4 midwives; 5 (C) community-based health workers, in- 6 cluding perinatal health workers, doulas, and 7 home visitors; and 8 (D) community-based organizations and 9 individuals representing the communities 10 with— 11 (i) the highest overall rates of mater- 12 nal mortality and morbidity; and 13 (ii) the greatest racial disparities in 14 rates of maternal mortality and morbidity; 15 (2) the State selects health care providers who 16 serve pregnant women, including doctors, nurses, 17 and midwives, to participate in the program as preg- 18 nancy medical homes, and requires that any provider 19 that wishes to participate in the program as a preg- 20 nancy medical home— 21 (A) commits to following evidence-based 22 practices for maternity care, as developed by 23 the State in consultation with relevant stake- 24 holders; and 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 9 •S 1600 IS (B) completes training to provide culturally 1 and linguistically competent care; 2 (3) under the program, each pregnancy medical 3 home is required to conduct a standardized medical, 4 obstetric, and psychosocial risk assessment for every 5 patient of the medical home who is pregnant at the 6 patient’s first prenatal appointment with the medical 7 home; 8 (4) under the program, a care manager— 9 (A) is assigned to each pregnancy medical 10 home; and 11 (B) coordinates care (including coordi- 12 nating resources and referrals for health care 13 and social services that are not available from 14 the pregnancy medical home) for each patient 15 of a pregnancy medical home who is eligible for 16 services under the program; and 17 (5) the program prioritizes pregnant and 18 postpartum women who are uninsured or enrolled in 19 the State Medicaid plan under title XIX of the So- 20 cial Security Act (42 U.S.C. 1396 et seq.), or a 21 waiver of such plan. 22 (c) GRANTS.— 23 (1) LIMITATION.—The Secretary may award a 24 grant under this section to up to 10 States. 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 10 •S 1600 IS (2) PERIOD.—Grants under this section shall 1 be for a 5-year period. 2 (3) PRIORITIZATION.—In awarding grants 3 under this section, the Secretary shall give priority 4 to the States with the greatest racial disparities in 5 maternal mortality and severe morbidity rates. 6 (d) REPORT ON GRANT IMPACT AND DISSEMINATION 7 OF BEST PRACTICES.—Not later than 1 year after all the 8 grant periods awarded under this section have ended, the 9 Secretary shall— 10 (1) submit a report to Congress that de- 11 scribes— 12 (A) the impact of the grants awarded 13 under this section on maternal and child health; 14 (B) best practices and models of care used 15 by recipients of grants under this section; and 16 (C) obstacles faced by recipients of grants 17 under this section in delivering care, improving 18 maternal and child health, and reducing racial 19 disparities in rates of maternal and infant mor- 20 tality and morbidity; and 21 (2) disseminate information on best practices 22 and models of care used by recipients of grants 23 under this section (including best practices and mod- 24 els of care relating to the reduction of racial dispari- 25 VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS 11 •S 1600 IS ties in rates of maternal and infant mortality and 1 morbidity) to interested parties, including health 2 providers, medical schools, relevant State and local 3 agencies, and the general public. 4 (e) AUTHORIZATION.—There are authorized to be ap- 5 propriated to carry out this section, $25,000,000 for each 6 of fiscal years 2020 through 2024, to remain available 7 until expended. 8 SEC. 6. NATIONAL ACADEMY OF MEDICINE STUDY. 9 (a) IN GENERAL.—The Secretary shall enter into an 10 arrangement with the National Academy of Medicine 11 under which the National Academy agrees to study and 12 make recommendations for incorporating bias recognition 13 in clinical skills testing for accredited schools of allopathic 14 medicine and accredited schools of osteopathic medicine. 15 (b) REPORT.—The arrangement under subsection (a) 16 shall provide for submission by the National Academy of 17 Medicine to the Secretary and Congress, not later than 18 3 years after the date of enactment of this Act, of a report 19 on the results of the study that includes such rec- 20 ommendations. 21 Æ VerDate Sep 11 2014 03:48 May 31, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S1600.IS S1600 kjohnson on DSK79L0C42 with BILLS