Excellence in Maternal Health Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4215 To improve maternal health care quality, to improve the training of health care professionals to reduce or prevent discrimination in certain health care services, to improve perinatal care, and for other purposes. IN THE HOUSE OF REPRESENTATIVES AUGUST 30, 2019 Mr. BUCSHON (for himself, Mr. CARSON of Indiana, Mr. BURGESS, Mr. BILI- RAKIS, Mrs. BROOKS of Indiana, Ms. HERRERA BEUTLER, Mr. LONG, Mrs. MCBATH, and Mr. WALDEN) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To improve maternal health care quality, to improve the training of health care professionals to reduce or prevent discrimination in certain health care services, to improve perinatal care, 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Excellence in Maternal 4 Health Act of 2019’’. 5 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 2 •HR 4215 IH SEC. 2. INNOVATION FOR MATERNAL HEALTH. 1 The Public Health Service Act is amended by insert- 2 ing after section 330M of such Act (42 U.S.C. 254c–19) 3 the following: 4 ‘‘SEC. 330N. INNOVATION FOR MATERNAL HEALTH. 5 ‘‘(a) IN GENERAL.—The Secretary, in consultation 6 with experts representing a variety of clinical specialties, 7 State, tribal, or local public health officials, researchers, 8 epidemiologists, statisticians, and community organiza- 9 tions, shall establish or continue a program to award com- 10 petitive grants to eligible entities for the purpose of— 11 ‘‘(1) identifying, developing, or disseminating 12 best practices to improve maternal health care qual- 13 ity and outcomes, eliminate preventable maternal 14 mortality and severe maternal morbidity, and im- 15 prove infant health outcomes, which may include— 16 ‘‘(A) information on evidence-based prac- 17 tices to improve the quality and safety of ma- 18 ternal health care in hospitals and other health 19 care settings of a State or health care system, 20 including by addressing topics commonly associ- 21 ated with health complications or risks related 22 to prenatal care, labor care, birthing, and 23 postpartum care; 24 ‘‘(B) best practices for improving maternal 25 health care based on data findings and reviews 26 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 3 •HR 4215 IH conducted by a State maternal mortality review 1 committee that address topics of relevance to 2 common complications or health risks related to 3 prenatal care, labor care, birthing, and postpar- 4 tum care; and 5 ‘‘(C) information on addressing deter- 6 minants of health that impact maternal health 7 outcomes for women before, during, and after 8 pregnancy; 9 ‘‘(2) collaborating with State maternal mor- 10 tality review committees to identify issues for the de- 11 velopment and implementation of evidence-based 12 practices to improve maternal health outcomes and 13 reduce preventable maternal mortality and severe 14 maternal morbidity; 15 ‘‘(3) providing technical assistance and sup- 16 porting the implementation of best practices identi- 17 fied in paragraph (1) to entities providing health 18 care services to pregnant and postpartum women; 19 and 20 ‘‘(4) identifying, developing, and evaluating new 21 models of care that improve maternal and infant 22 health outcomes, which may include the integration 23 of community-based services and clinical care. 24 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 4 •HR 4215 IH ‘‘(b) ELIGIBLE ENTITIES.—To be eligible for a grant 1 under subsection (a), an entity shall— 2 ‘‘(1) submit to the Secretary an application at 3 such time, in such manner, and containing such in- 4 formation as the Secretary may require; and 5 ‘‘(2) demonstrate in such application that the 6 entity is capable of carrying out data-driven mater- 7 nal safety and quality improvement initiatives in the 8 areas of obstetrics and gynecology or maternal 9 health. 10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 11 carry out this section, there is authorized to be appro- 12 priated $10,000,000 for each of fiscal years 2020 through 13 2024.’’. 14 SEC. 3. TRAINING FOR HEALTH CARE PROVIDERS. 15 Title VII of the Public Health Service Act is amended 16 by striking section 763 (42 U.S.C. 294p) and inserting 17 the following: 18 ‘‘SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS. 19 ‘‘(a) GRANT PROGRAM.—The Secretary shall estab- 20 lish a program to award grants to accredited schools of 21 allopathic medicine, osteopathic medicine, and nursing, 22 and other health professional training programs for the 23 training of health care professionals to reduce and prevent 24 discrimination (including training related to implicit bi- 25 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 5 •HR 4215 IH ases) in the provision of health care services related to 1 prenatal care, labor care, birthing, and postpartum care. 2 ‘‘(b) ELIGIBILITY.—To be eligible for a grant under 3 subsection (a), an entity described in such subsection shall 4 submit to the Secretary an application at such time, in 5 such manner, and containing such information as the Sec- 6 retary may require. 7 ‘‘(c) REPORTING REQUIREMENT.—Each entity 8 awarded a grant under this section shall periodically sub- 9 mit to the Secretary a report on the status of activities 10 conducted using the grant, including a description of the 11 impact of such training on patient outcomes, as applicable. 12 ‘‘(d) BEST PRACTICES.—The Secretary may identify 13 and disseminate best practices for the training of health 14 care professionals to reduce and prevent discrimination 15 (including training related to implicit biases) in the provi- 16 sion of health care services related to prenatal care, labor 17 care, birthing, and postpartum care. 18 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 19 carry out this section, there is authorized to be appro- 20 priated $5,000,000 for each of fiscal years 2020 through 21 2024.’’. 22 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 6 •HR 4215 IH SEC. 4. STUDY ON TRAINING TO REDUCE AND PREVENT 1 DISCRIMINATION. 2 Not later than 2 years after date of enactment of this 3 Act, the Secretary of Health and Human Services (re- 4 ferred to in this section as the ‘‘Secretary’’) shall, through 5 a contract with an independent research organization, con- 6 duct a study and make recommendations for accredited 7 schools of allopathic medicine, osteopathic medicine, and 8 nursing, and other health professional training programs 9 on best practices related to training to reduce and prevent 10 discrimination, including training related to implicit bi- 11 ases, in the provision of health care services related to pre- 12 natal care, labor care, birthing, and postpartum care. 13 SEC. 5. PERINATAL QUALITY COLLABORATIVES. 14 (a) GRANTS.—Section 317K(a)(2) of the Public 15 Health Service Act (42 U.S.C. 247b–12(a)(2)) is amended 16 by adding at the end the following: 17 ‘‘(E)(i) The Secretary, acting through the 18 Director of the Centers for Disease Control and 19 Prevention and in coordination with other of- 20 fices and agencies, as appropriate, shall estab- 21 lish or continue a competitive grant program 22 for the establishment or support of perinatal 23 quality collaboratives to improve perinatal care 24 and perinatal health outcomes for pregnant and 25 postpartum women and their infants. A State, 26 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 7 •HR 4215 IH Indian Tribe, or Tribal organization may use 1 funds received through such grant to— 2 ‘‘(I) support the use of evidence- 3 based or evidence-informed practices 4 to improve outcomes for maternal and 5 infant health; 6 ‘‘(II) work with clinical teams; 7 experts; State, local, and, as appro- 8 priate, tribal public health officials; 9 and stakeholders, including patients 10 and families, to identify, develop, or 11 disseminate best practices to improve 12 perinatal care and outcomes; and 13 ‘‘(III) employ strategies that pro- 14 vide opportunities for health care pro- 15 fessionals and clinical teams to col- 16 laborate across health care settings 17 and disciplines, including primary 18 care and mental health, as appro- 19 priate, to improve maternal and infant 20 health outcomes, which may include 21 the use of data to provide timely feed- 22 back across hospital and clinical 23 teams to inform responses, and to 24 provide support and training to hos- 25 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 8 •HR 4215 IH pital and clinical teams for quality im- 1 provement, as appropriate. 2 ‘‘(ii) To be eligible for a grant under 3 clause (i), an entity shall submit to the 4 Secretary an application in such form and 5 manner and containing such information 6 as the Secretary may require.’’. 7 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 8 317K(f) of the Public Health Service Act (42 U.S.C. 9 247b–12(f)) is amended by striking ‘‘$58,000,000 for 10 each of fiscal years 2019 through 2023’’ and inserting 11 ‘‘$65,000,000 for each of fiscal years 2020 through 12 2024’’. 13 SEC. 6. INTEGRATED SERVICES FOR PREGNANT AND 14 POSTPARTUM WOMEN. 15 (a) GRANTS.—The Public Health Service Act is 16 amended by inserting after section 330N of such Act, as 17 added by section 2, the following: 18 ‘‘SEC. 330O. INTEGRATED SERVICES FOR PREGNANT AND 19 POSTPARTUM WOMEN. 20 ‘‘(a) IN GENERAL.—The Secretary may award grants 21 for the purpose of establishing or operating evidence-based 22 or innovative, evidence-informed programs to deliver inte- 23 grated health care services to pregnant and postpartum 24 women to optimize the health of women and their infants, 25 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 9 •HR 4215 IH including to reduce adverse maternal health outcomes, 1 pregnancy-related deaths, and related health disparities 2 (including such disparities associated with racial and eth- 3 nic minority populations), and, as appropriate, by address- 4 ing issues researched under subsection (b)(2) of section 5 317K. 6 ‘‘(b) INTEGRATED SERVICES FOR PREGNANT AND 7 POSTPARTUM WOMEN.— 8 ‘‘(1) ELIGIBILITY.—To be eligible to receive a 9 grant under subsection (a), a State, Indian Tribe, or 10 Tribal organization (as such terms are defined in 11 section 4 of the Indian Self-Determination and Edu- 12 cation Assistance Act) shall work with relevant 13 stakeholders that coordinate care (including coordi- 14 nating resources and referrals for health care and 15 social services) to develop and carry out the pro- 16 gram, including— 17 ‘‘(A) State, Tribal, and local agencies re- 18 sponsible for Medicaid, public health, social 19 services, mental health, and substance use dis- 20 order treatment and services; 21 ‘‘(B) health care providers who serve preg- 22 nant and postpartum women; and 23 ‘‘(C) community-based health organiza- 24 tions and health workers, including providers of 25 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 10 •HR 4215 IH home visiting services and individuals rep- 1 resenting communities with disproportionately 2 high rates of maternal mortality and severe ma- 3 ternal morbidity, and including those rep- 4 resenting racial and ethnicity minority popu- 5 lations. 6 ‘‘(2) TERMS.— 7 ‘‘(A) PERIOD.—A grant awarded under 8 subsection (a) shall be made for a period of 5 9 years. Any supplemental award made to a 10 grantee under subsection (a) may be made for 11 a period of less than 5 years. 12 ‘‘(B) PREFERENCE.—In awarding grants 13 under subsection (a), the Secretary shall— 14 ‘‘(i) give preference to States, Indian 15 Tribes, and Tribal organizations that have 16 the highest rates of maternal mortality and 17 severe maternal morbidity relative to other 18 such States, Indian Tribes, or Tribal orga- 19 nizations, respectively; and 20 ‘‘(ii) shall consider health disparities 21 related to maternal mortality and severe 22 maternal morbidity, including such dispari- 23 ties associated with racial and ethnic mi- 24 nority populations. 25 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 11 •HR 4215 IH ‘‘(C) PRIORITY.—In awarding grants 1 under subsection (a), the Secretary shall give 2 priority to applications from up to 15 entities 3 described in subparagraph (B)(i). 4 ‘‘(D) EVALUATION.—The Secretary shall 5 require grantees to evaluate the outcomes of the 6 programs supported under the grant. 7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this section, there is authorized to be appro- 9 priated $15,000,000 for each of fiscal years 2020 through 10 2024.’’. 11 (b) REPORT ON GRANT OUTCOMES AND DISSEMINA- 12 TION OF BEST PRACTICES.— 13 (1) REPORT.—Not later than February 1, 14 2026, the Secretary of Health and Human Services 15 shall submit to the Committee on Health, Edu- 16 cation, Labor, and Pensions of the Senate and the 17 Committee on Energy and Commerce of the House 18 of Representatives a report that describes— 19 (A) the outcomes of the activities sup- 20 ported by the grants awarded under the amend- 21 ments made by this section on maternal and 22 child health; 23 VerDate Sep 11 2014 22:24 Aug 30, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4215.IH H4215 kjohnson on DSK79L0C42 with BILLS 12 •HR 4215 IH (B) best practices and models of care used 1 by recipients of grants under such amendments; 2 and 3 (C) obstacles identified by recipients of 4 grants under such amendments, and strategies 5 used by such recipients to deliver care, improve 6 maternal and child health, and reduce health 7 disparities. 8 (2) DISSEMINATION OF BEST PRACTICES.—Not 9 later than August 1, 2026, the Secretary of Health 10 and Human Services shall disseminate information 11 on best practices and models of care used by recipi- 12 ents of grants und [Text truncated for display. 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