Mothers and Newborns Success Act

II 116TH CONGRESS 2D SESSION S. 4269 To amend the Public Health Service Act to improve maternal health and promote safe motherhood. IN THE SENATE OF THE UNITED STATES JULY 22, 2020 Mr. KAINE (for himself and Ms. MURKOWSKI) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To amend the Public Health Service Act to improve maternal health and promote safe motherhood. 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 ‘‘Mothers and Newborns 4 Success Act’’. 5 SEC. 2. FINDINGS AND SENSE OF THE SENATE. 6 (a) FINDINGS.—Congress finds the following: 7 (1) Among developed nations, the United States 8 has disturbingly high rates of maternal and infant 9 mortality. 10 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4269 IS (2) The United States published an official ma- 1 ternal mortality rate from vital statistics for the first 2 time since 2007 in 2018. The United States mater- 3 nal mortality rate of 17.4 per 100,000 live births, is 4 significantly higher than the Organisation for Eco- 5 nomic Co-operation and Development (referred to in 6 this section as the ‘‘OECD’’) average of 14.0 in 7 2017, according to modeling by the World Bank. 8 (3) The United States infant mortality rate in 9 2017 was 5.8 per 1,000 live births, while the OECD 10 average was 3.8 per 1,000 live births. 11 (4) In the United States, there are significant 12 maternal mortality and infant mortality inequities. 13 (5) The maternal mortality rate for non-His- 14 panic Black women in 2018 was 37.1 per 100,000 15 live births. This rate is more than 2.5 times higher 16 than the maternal mortality rate of 14.7 for non- 17 Hispanic White women and more than 3.1 times 18 higher than the maternal mortality rate of 11.8 for 19 Hispanic women of any race. 20 (6) The Centers for Disease Control and Pre- 21 vention data from 2007 through 2016 shows that 22 American Indian/Alaska Native women also have 23 significantly higher rates of pregnancy-related 24 deaths than White, Hispanic, and Asian/Pacific Is- 25 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4269 IS lander women. American Indian/Alaska Native 1 women had a rate of 29.7 pregnancy-related deaths 2 per 100,000 live births from 2007 through 2016, 3 which is 2.3 times higher than the rate of 12.7 4 deaths per 100,000 live births for White women dur- 5 ing the same time period. 6 (7) The mortality rate for infants of non-His- 7 panic Black women is 11.0 per 1,000 live births and 8 9.2 per 1,000 live births for infants of American In- 9 dian or Alaska Native women. This rate is more 10 than 2.3 times higher than the infant mortality rate 11 of non-Hispanic White infants at 4.7 and more than 12 2.1 times higher than the infant mortality rate of 13 Hispanic infants of any race at 5.1 per 1,000 live 14 births. 15 (b) SENSE OF THE SENATE.—It is the sense of the 16 Senate that the following should apply: 17 (1) The United States should dramatically re- 18 duce maternal and infant mortality, ensure that all 19 infants can grow up healthy and safe, and protect 20 women’s health before, during, and after pregnancy. 21 (2) Any pregnant woman choosing to have a 22 child should be able to do so safely without regard 23 to income, race, ethnicity, employment status, geo- 24 graphic location, ability, or any other socio-economic 25 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4269 IS factor. United States policy should support women’s 1 health so that women thrive and newborns have the 2 maximum chance for a healthy life. 3 (3) The evidence of serious racial inequities in 4 maternal and infant mortality, especially between 5 Black women and White women demonstrates the 6 persistence of racism and racial bias in our society 7 and health care system. A 2015 study funded by the 8 National Institute for Biomedical and Bioengi- 9 neering of the National Institutes of Health found 10 that most health care providers appear to harbor 11 negative implicit biases towards people of color. 12 These biases were found to impact patient-provider 13 interactions, treatment decisions, treatment adher- 14 ence, and patient health outcomes. Therefore, the 15 programs authorized by this Act should be specifi- 16 cally deployed in ways to counter such inequities. 17 (4) In the next 5 years, the United States 18 should aim to reduce its overall maternal and infant 19 mortality rates such that they are no higher than 20 the OECD average. The United States should dra- 21 matically reduce the maternal mortality and infant 22 mortality inequities between Black and American In- 23 dian/Alaskan Native women and White women. 24 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4269 IS (5) By advancing evidence-based policies to im- 1 prove maternal and infant health outcomes, the 2 United States can work to reduce and eliminate pre- 3 ventable maternal and infant mortality and severe 4 maternal morbidity. 5 SEC. 3. STATE MATERNAL HEALTH INNOVATION. 6 Title III of the Public Health Service Act is amended 7 by inserting after section 330M (42 U.S.C. 254c–19) the 8 following: 9 ‘‘SEC. 330N. STATE MATERNAL HEALTH INNOVATION. 10 ‘‘(a) IN GENERAL.—The Secretary, acting through 11 the Administrator of the Health Resources and Services 12 Administration, shall continue in effect the State Maternal 13 Health Innovation Program and the Supporting Maternal 14 Health Innovation Program to award competitive grants 15 to eligible entities for the purpose of assisting States to 16 implement State-specific actions that address racial, eth- 17 nic and geographic inequities in maternal health and im- 18 prove maternal health outcomes, including the prevention 19 and reduction of maternal mortality and severe maternal 20 morbidity. 21 ‘‘(b) USE OF FUNDS.—An entity receiving a grant 22 under this section may use such funds— 23 ‘‘(1) to translate recommendations on address- 24 ing maternal mortality and severe maternal mor- 25 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4269 IS bidity into action through activities which may in- 1 clude— 2 ‘‘(A) establishing a State- or regional 3 multi-State-focused Maternal Health Task 4 Force to create and implement a strategic plan; 5 ‘‘(B) improving the collection, analysis, 6 and application of State- or regional multi- 7 State-level data on maternal mortality and se- 8 vere maternal morbidity; and 9 ‘‘(C) promoting and executing innovation 10 in maternal health service delivery, such as im- 11 proving access to maternal health care services, 12 identifying and addressing workforce needs, in- 13 cluding maternal health provider shortages; 14 identifying and addressing implicit and explicit 15 bias based on race or ethnicity; or supporting 16 postpartum and inter-pregnancy care services; 17 or 18 ‘‘(2) to provide support to entities receiving as- 19 sistance under paragraph (1), and other initiatives 20 of the Department of Health and Human Services to 21 improve maternal health outcomes as the Secretary 22 determines appropriate, States, multi-State regions 23 and other stakeholders working to reduce and pre- 24 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4269 IS vent maternal mortality and severe maternal mor- 1 bidity through activities which may include— 2 ‘‘(A) providing capacity-building assistance 3 to such entities to implement innovative and 4 evidence-informed strategies; and 5 ‘‘(B) establishing or continuing the oper- 6 ation of a resource center to provide national 7 guidance to such entities, States, and key stake- 8 holders to improve maternal health. 9 ‘‘(c) ALIGNMENT OF ACTIVITIES.—An entity carrying 10 out activities under subsection (b)(1) shall coordinate and 11 align such activities with the activities to improve mater- 12 nal health outcomes carried out by such entities under title 13 V of the Social Security Act. 14 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible for a grant 15 under subsection (a), a domestic public or non-profit pri- 16 vate entity, Indian Tribe, or Tribal serving organization, 17 such as a Tribal health department or other organization 18 fulfilling similar functions for the Tribe, shall submit to 19 the Secretary an application at such time, in such manner, 20 and containing such information as the Secretary may re- 21 quire. In the case of applicants intending to carry out ac- 22 tivities described in subsection (b)(1), such applicants 23 shall demonstrate in such application that the entity has 24 a commitment from a State or group of States to collabo- 25 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4269 IS rate as part of the project on strengthening State-level ca- 1 pacity in achieving the program aims. 2 ‘‘(e) REPORT TO CONGRESS.—Not later than Janu- 3 ary 1, 2024, the Secretary shall submit to the Committee 4 on Health, Education, Labor, and Pensions of the Senate 5 and the Committee on Energy and Commerce of the 6 House of Representatives, and make publicly available, a 7 report concerning the impact of the programs continued 8 under this section on addressing inequities in maternal 9 health and improving maternal health outcomes, including 10 the prevention and reduction of maternal mortality and 11 severe maternal morbidity, together with recommendations 12 on whether to expand such programs to additional recipi- 13 ents and the estimated amount of funds needed to expand 14 such programs. 15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 16 carry out this section, including carrying out the programs 17 referred to in subsection (a) on a national basis (subject 18 to the availability of appropriations), there is authorized 19 to be appropriated $53,000,000 for each of fiscal years 20 2021 through 2024.’’. 21 SEC. 4. SAFE MOTHERHOOD. 22 Section 317K of the Public Health Service Act (42 23 U.S.C. 247b–12) is amended— 24 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4269 IS (1) by redesignating subsections (e) and (f) as 1 subsections (h) and (i), respectively; 2 (2) by inserting after subsection (d) the fol- 3 lowing: 4 ‘‘(e) LEVELS OF MATERNAL AND NEONATAL 5 CARE.— 6 ‘‘(1) IN GENERAL.—The Secretary, acting 7 through the Director of the Centers for Disease 8 Control and Prevention, shall establish or continue 9 in effect a program to award competitive grants to 10 eligible entities to assist with the classification of 11 birthing facilities based on the level of risk-appro- 12 priate maternal and neonatal care such entities can 13 provide in order to strategically improve maternal 14 and infant care delivery and health outcomes. 15 ‘‘(2) USE OF FUNDS.—An eligible entity receiv- 16 ing a grant under this subsection shall use such 17 funds to— 18 ‘‘(A) coordinate an assessment of the risk- 19 appropriate maternal and neonatal care of a 20 State, jurisdiction, or region, based on the most 21 recent guidelines and policy statements issued 22 by the professional associations representing 23 relevant clinical specialties, including obstetrics 24 and gynecology and pediatrics; and 25 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4269 IS ‘‘(B) work with relevant stakeholders, such 1 as hospitals, hospital associations, perinatal 2 quality collaboratives, members of the commu- 3 nities most affected by racial, ethnic, and geo- 4 graphic maternal health inequities, maternal 5 mortality review committees, and maternal and 6 neonatal health care providers and community- 7 based birth workers to review the findings of 8 the assessment made of activities carried out 9 under paragraph (1) and implement changes, as 10 appropriate, based on identified gaps in perina- 11 tal services and differences in maternal and 12 neonatal outcomes in the State, jurisdiction, or 13 region for which such an assessment was con- 14 ducted to support the provision of risk-appro- 15 priate care. 16 ‘‘(3) ELIGIBLE ENTITIES.—To be eligible for a 17 grant under this subsection, a State health depart- 18 ment, Indian Tribe or other Tribal serving organiza- 19 tion, such as a Tribal health department or other or- 20 ganization fulfilling similar functions for the Tribe, 21 shall submit to the Secretary an application at such 22 time, in such manner, and containing such informa- 23 tion as the Secretary may require. 24 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 11 •S 4269 IS ‘‘(4) PERIOD.—A grant awarded under this 1 subsection shall be made for a period of 3 years. 2 Any supplemental award made to a grantee under 3 this subsection may be made for a period of less 4 than 3 years. 5 ‘‘(5) REPORT TO CONGRESS.—Not later than 6 January 1, 2023, the Secretary shall submit to the 7 Committee on Health, Education, Labor, and Pen- 8 sions of the Senate and the Committee on Energy 9 and Commerce of the House of Representatives, and 10 make publicly available, a report concerning the im- 11 pact of the programs established or continued under 12 this subsection. 13 ‘‘(f) PREGNANCY CHECKBOX QUALITY ASSUR- 14 ANCE.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of the Centers for Disease 17 Control and Prevention, may establish or continue a 18 program to award competitive grants and provide 19 technical assistance to eligible entities to implement 20 a quality assurance process to improve the validity 21 of the pregnancy checkbox data from death certifi- 22 cates. 23 ‘‘(2) USE OF FUNDS.—Eligible entities receiv- 24 ing a grant under this subsection shall use grant 25 VerDate Sep 11 2014 05:32 Aug 05, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4269.IS S4269 kjohnson on DSK79L0C42PROD with BILLS 12 • [Text truncated for display. 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