Maternal Health Pandemic Response Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8027 To improve the public health response to addressing maternal mortality and morbidity during the COVID–19 public health emergency. IN THE HOUSE OF REPRESENTATIVES AUGUST 11, 2020 Ms. UNDERWOOD (for herself, Ms. WILD, Mr. KHANNA, Ms. MOORE, Ms. NORTON, Ms. ROYBAL-ALLARD, Mr. CARSON of Indiana, Mr. FOSTER, Mr. TRONE, Mr. LAWSON of Florida, Mrs. MCBATH, Mr. BUTTERFIELD, Ms. OMAR, Ms. JUDY CHU of California, Mr. COHEN, and Mr. KEN- NEDY) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Edu- cation and Labor, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provi- sions as fall within the jurisdiction of the committee concerned A BILL To improve the public health response to addressing maternal mortality and morbidity during the COVID–19 public health emergency. 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 ‘‘Maternal Health Pan- 4 demic Response Act of 2020’’. 5 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 8027 IH SEC. 2. FINDINGS. 1 Congress finds as follows: 2 (1) The World Health Organization declared 3 COVID–19 a ‘‘Public Health Emergency of Inter- 4 national Concern’’ on January 30, 2020. By the be- 5 ginning of August 2020, there have been over 6 18,000,000 confirmed cases of, and over 700,000 7 deaths associated with, COVID–19 worldwide. 8 (2) In the United States, the number of cases 9 of COVID–19 has quickly surpassed the number of 10 such cases in every other nation, and as of August 11 5, 2020, over 4,000,000 cases and 156,000 deaths 12 have been reported by the United States alone. 13 (3) Long-standing systemic health and social 14 inequities have put communities of color at increased 15 risk of contracting COVID–19 or experiencing se- 16 vere illness; age-adjusted hospitalization rates from 17 COVID–19 are highest for American Indian and 18 Alaska Native, Black, and Latinx people. 19 (4) Prior to the start of the COVID–19 pan- 20 demic, the United States was facing a maternal mor- 21 tality and morbidity crisis, in which the United 22 States has the highest maternal mortality rate in the 23 developed world, and that rate is not improving. 24 (5) More than 50,000 women in the United 25 States annually experience severe maternal mor- 26 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 8027 IH bidity, and much larger numbers experience more 1 common harmful challenges, such as prenatal and 2 postpartum anxiety and depression and lack of sup- 3 port for meeting breastfeeding goals. 4 (6) Compared to White women, Black and 5 American Indian and Alaska Native women in the 6 United States are significantly more likely to die 7 from pregnancy-related complications, and Black 8 and American Indian and Alaska Native women suf- 9 fer disproportionately high rates of maternal mor- 10 bidity. 11 (7) The causes of maternal mortality and mor- 12 bidity are complex and include racial, ethnic, and so- 13 cioeconomic inequities; racism, bias, and discrimina- 14 tion; comorbidities; and inadequate access to the 15 health care system, including behavioral health care, 16 which are factors that have similarly contributed to 17 the racial disparities seen in COVID–19 outcomes. 18 (8) The burden of morbidity and mortality in 19 the United States for both COVID–19 and maternal 20 health outcomes has also fallen disproportionately on 21 Black, Latinx, and American Indian and Alaska Na- 22 tive communities, who suffer the most from great 23 public health needs and are the most medically un- 24 derserved. 25 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 8027 IH (9) According to the Centers for Disease Con- 1 trol and Prevention, ‘‘pregnant people have changes 2 in their bodies that may increase their risk of some 3 infections’’ and ‘‘pregnant people have had a higher 4 risk of severe illness when infected with viruses from 5 the same family as COVID–19 and other viral res- 6 piratory infections, such as influenza’’. 7 (10) As of June 25, 2020, the latest informa- 8 tion from the Centers for Disease Control and Pre- 9 vention indicates that pregnant women are more 10 likely to be hospitalized and are at higher risk for 11 intensive care unit admissions than nonpregnant 12 women due to COVID–19, and Latinx and Black 13 pregnant people have been disproportionately in- 14 fected by COVID–19. 15 (11) Our understanding of the specific impact 16 of COVID–19 on pregnant people is limited, in part 17 due to a lack of robust data collection, but the 18 COVID–19 pandemic has further strained the health 19 care system and added another layer of fear and vul- 20 nerability for pregnant people, with disproportionate 21 effects on people of color. 22 (12) As of July 30, 2020, over 14,000 pregnant 23 people in the United States have tested positive for 24 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 8027 IH COVID–19 and 35 pregnant people have died as re- 1 sult of COVID–19. 2 (13) The World Health Organization states 3 that everyone ‘‘has the right to safe and positive 4 childbirth experience, whether or not they have a 5 confirmed COVID–19 infection, this includes the 6 right to respect and dignity, a companion of choice, 7 clear communication by maternity staff, pain relief 8 strategies, and mobility in labor when possible and 9 the position of choice’’. 10 (14) A COVID–19 public health response with- 11 out concerted Federal action and focus on maternal 12 health care access and quality, research, data collec- 13 tion, mitigating negative socioeconomic consequences 14 of the pandemic, and safeguarding the right to safe 15 and positive childbirth experience will risk exacer- 16 bating the maternal mortality and morbidity crisis. 17 SEC. 3. DEFINITIONS. 18 In this Act: 19 (1) COVID–19 PUBLIC HEALTH EMERGENCY.— 20 The term ‘‘COVID–19 public health emergency’’ 21 means the period beginning on the date that the 22 public health emergency declared by the Secretary of 23 Health and Human Services under section 319 of 24 the Public Health Service Act (42 U.S.C. 247d) on 25 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 8027 IH January 31, 2020, with respect to COVID–19 took 1 effect, and ending on the later of the end of such 2 public health emergency or January 1, 2023. 3 (2) CULTURALLY CONGRUENT.—The term ‘‘cul- 4 turally congruent’’, with respect to care or maternity 5 care, means care that is anti-racist and is in agree- 6 ment with the preferred cultural values, beliefs, 7 worldview, and practices of the health care consumer 8 and other stakeholders. 9 (3) INDIAN TRIBE, TRIBAL ORGANIZATION, AND 10 URBAN INDIAN ORGANIZATION.—The terms ‘‘Indian 11 Tribe’’ and ‘‘Tribal organization’’ have the meanings 12 given the terms ‘‘Indian tribe’’ and ‘‘tribal organiza- 13 tion’’, respectively, in section 4 of the Indian Self- 14 Determination and Education Assistance Act (25 15 U.S.C. 5304), and the term ‘‘urban Indian organiza- 16 tion’’ has the meaning given such term in section 4 17 of the Indian Health Care Improvement Act (25 18 U.S.C. 1603). 19 (4) MATERNAL MORTALITY.—The term ‘‘mater- 20 nal mortality’’ means a death occurring during preg- 21 nancy or within one year of the end of pregnancy, 22 from a pregnancy complication, a chain of events 23 initiated by pregnancy, or the aggravation of an un- 24 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 8027 IH related condition by the physiologic effects of preg- 1 nancy. 2 (5) POSTPARTUM.—The term ‘‘postpartum’’ 3 means the 1-year period beginning on the last day 4 of a person’s pregnancy. 5 (6) RESPECTFUL MATERNITY CARE.—The term 6 ‘‘respectful maternity care’’ refers to care organized 7 for, and provided to, all pregnant and postpartum 8 people in a manner that is culturally congruent, 9 maintains their dignity, privacy, and confidentiality, 10 ensures freedom from harm and mistreatment, and 11 enables informed choice and continuous support dur- 12 ing labor, childbirth, and postpartum. 13 (7) SECRETARY.—The term ‘‘Secretary’’ means 14 the Secretary of Health and Human Services. 15 (8) SEVERE MATERNAL MORBIDITY.—The term 16 ‘‘severe maternal morbidity’’ means an unexpected 17 outcome caused by labor and delivery that results in 18 significant short-term or long-term consequences to 19 the health of the pregnant person. 20 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 8027 IH SEC. 4. EMERGENCY FUNDING FOR FEDERAL DATA COL- 1 LECTION, SURVEILLANCE AND RESEARCH ON 2 MATERNAL HEALTH OUTCOMES DURING THE 3 COVID–19 PUBLIC HEALTH EMERGENCY. 4 To conduct or support data collection, surveillance, 5 and research on maternal health as a result of the 6 COVID–19 public health emergency, including support to 7 assist in the capacity building for State, Tribal, territorial, 8 and local public health departments to collect and trans- 9 mit racial, ethnic, and other demographic data related to 10 maternal health, there are authorized to be appro- 11 priated— 12 (1) $100,000,000 for the Surveillance for 13 Emerging Threats to Mothers and Babies program 14 of the Centers for Disease Control and Prevention, 15 to support the Centers for Disease Control and Pre- 16 vention in its efforts to— 17 (A) work with public health, clinical, and 18 community-based organizations to provide time- 19 ly, continually updated guidance to families and 20 health care providers on ways to reduce risk to 21 mothers and babies and tailor interventions to 22 improve their long-term health; 23 (B) partner with more State, Tribal, terri- 24 torial, and local public health programs in the 25 collection and analysis of clinical data on the 26 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 8027 IH impact of COVID–19 on pregnant and 1 postpartum patients and their newborns, includ- 2 ing among pregnant people of color; and 3 (C) establish regionally based centers of 4 excellence to offer medical, public health, and 5 other knowledge to ensure communities, espe- 6 cially communities of color, can help pregnant 7 and postpartum patients and infants get the 8 care they need; 9 (2) $30,000,000 for the Enhancing Reviews 10 and Surveillance to Eliminate Maternal Mortality 11 program (commonly known as the ‘‘ERASE MM 12 program’’) of the Centers for Disease Control and 13 Prevention, to support the Centers for Disease Con- 14 trol and Prevention in expanding its partnerships 15 with States and Indian Tribes and provide technical 16 assistance to existing Maternal Mortality Review 17 Committees; 18 (3) $45,000,000 for the Pregnancy Risk As- 19 sessment Monitoring System (commonly known as 20 the ‘‘PRAMS’’) of the Centers for Disease Control 21 and Prevention, to support the Centers for Disease 22 Control and Prevention in its efforts to— 23 (A) create a COVID–19 supplement to its 24 PRAMS questionnaire; 25 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 8027 IH (B) add questions around experiences of 1 respectful maternity care in prenatal, 2 intrapartum, and postpartum care; 3 (C) conduct a rapid assessment of 4 COVID–19 awareness, impact on care and ex- 5 periences, and use of preventive measures 6 among pregnant, laboring and birthing, and 7 postpartum people during the COVID–19 pub- 8 lic health emergency; and 9 (D) work to transition the survey to an 10 electronic platform and expand the survey to a 11 larger population, with a special focus on reach- 12 ing underrepresented communities; and 13 (4) $15,000,000 for the National Institute of 14 Child Health and Human Development, to conduct 15 or support research for interventions to mitigate the 16 effects of the COVID–19 public health emergency on 17 pregnant and postpartum people, including Black, 18 Latinx, Asian American and Pacific Islander, and 19 American Indian and Alaska Native people. 20 SEC. 5. COVID–19 MATERNAL HEALTH DATA COLLECTION 21 AND DISCLOSURE. 22 (a) DATA COLLECTION.—The Secretary, acting 23 through the Director of the Centers for Disease Control 24 and Prevention and the Administrator of the Centers for 25 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 8027 IH Medicare & Medicaid Services, shall make publicly avail- 1 able, on the website of the Centers for Disease Control 2 and Prevention, pregnancy and postpartum data collected 3 across all surveillance systems relating to COVID–19, 4 disaggregated by race, ethnicity, State, and Tribal location 5 including the following: 6 (1) Data related to all COVID–19 diagnostic 7 testing, including the number of pregnant people 8 and postpartum people tested and the number of 9 positive cases. 10 (2) Data related to all suspected cases of 11 COVID–19 in pregnant, birthing, and postpartum 12 people who did not undergo testing. 13 (3) Data related to all COVID–19 serologic 14 testing, including the number of pregnant and 15 postpartum people tested and the number of such 16 serologic tests that were positive. 17 (4) Data related to treatment for COVID–19, 18 including hospitalizations, emergency room, and in- 19 tensive care unit admissions of pregnant, birthing, 20 and postpartum people related to COVID–19. 21 (5) Data related to COVID–19 outcomes, in- 22 cluding total fatalities and case fatality (expressed 23 as the proportion of people who were infected with 24 VerDate Sep 11 2014 23:11 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8027.IH H8027 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 8027 IH COVID–19 and died from the virus) of pregnant 1 and postpartum people. 2 (6) Data r [Text truncated for display. Full text available on Congress.gov.]