Maternal Health Pandemic Response Act of 2020

II 116TH CONGRESS 2D SESSION S. 4769 To improve the public health response to addressing maternal mortality and morbidity during the COVID–19 public health emergency. IN THE SENATE OF THE UNITED STATES SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2020 Ms. WARREN (for herself, Mr. BOOKER, Ms. HARRIS, Mrs. GILLIBRAND, and Ms. SMITH) introduced the following bill; which was read twice and re- ferred to the Committee on Health, Education, Labor, and Pensions 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 SEC. 2. FINDINGS. 6 Congress finds as follows: 7 (1) The World Health Organization declared 8 COVID–19 a ‘‘Public Health Emergency of Inter- 9 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4769 IS national Concern’’ on January 30, 2020. By the be- 1 ginning of August 2020, there have been over 2 18,000,000 confirmed cases of, and over 700,000 3 deaths associated with, COVID–19 worldwide. 4 (2) In the United States, the number of cases 5 of COVID–19 has quickly surpassed the number of 6 such cases in every other nation, and as of August 7 5, 2020, over 4,000,000 cases and 156,000 deaths 8 have been reported by the United States alone. 9 (3) Longstanding systemic health and social in- 10 equities have put communities of color at increased 11 risk of contracting COVID–19 or experiencing se- 12 vere illness; age-adjusted hospitalization rates from 13 COVID–19 are highest for American Indian and 14 Alaska Native, Black, and Latinx people. 15 (4) Prior to the start of the COVID–19 pan- 16 demic, the United States was facing a maternal mor- 17 tality and morbidity crisis, in which the United 18 States has the highest maternal mortality rate in the 19 developed world, and that rate is not improving. 20 (5) More than 50,000 women in the United 21 States annually experience severe maternal mor- 22 bidity, and much larger numbers experience more 23 common harmful challenges, such as prenatal and 24 VerDate Sep 11 2014 00:19 Oct 21, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4769 IS postpartum anxiety and depression and lack of sup- 1 port for meeting breastfeeding goals. 2 (6) Compared to White women, Black and 3 American Indian and Alaska Native women in the 4 United States are significantly more likely to die 5 from pregnancy-related complications, and Black 6 and American Indian and Alaska Native women suf- 7 fer disproportionately high rates of maternal mor- 8 bidity. 9 (7) The causes of maternal mortality and mor- 10 bidity are complex and include racial, ethnic, and so- 11 cioeconomic inequities; racism, bias, and discrimina- 12 tion; comorbidities; and inadequate access to the 13 health care system, including behavioral health care, 14 which are factors that have similarly contributed to 15 the racial disparities seen in COVID–19 outcomes. 16 (8) The burden of morbidity and mortality in 17 the United States for both COVID–19 and maternal 18 health outcomes has also fallen disproportionately on 19 Black, Latinx, and American Indian and Alaska Na- 20 tive communities, who suffer the most from great 21 public health needs and are the most medically un- 22 derserved. 23 (9) According to the Centers for Disease Con- 24 trol and Prevention, ‘‘pregnant people have changes 25 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4769 IS in their bodies that may increase their risk of some 1 infections’’ and ‘‘pregnant people have had a higher 2 risk of severe illness when infected with viruses from 3 the same family as COVID–19 and other viral res- 4 piratory infections, such as influenza’’. 5 (10) As of June 25, 2020, the latest informa- 6 tion from the Centers for Disease Control and Pre- 7 vention indicates that pregnant women are more 8 likely to be hospitalized and are at higher risk for 9 intensive care unit admissions than nonpregnant 10 women due to COVID–19, and Latinx and Black 11 pregnant people have been disproportionately in- 12 fected by COVID–19. 13 (11) Our understanding of the specific impact 14 of COVID–19 on pregnant people is limited, in part 15 due to a lack of robust data collection, but the 16 COVID–19 pandemic has further strained the health 17 care system and added another layer of fear and vul- 18 nerability for pregnant people, with disproportionate 19 effects on people of color. 20 (12) As of July 30, 2020, over 14,000 pregnant 21 people in the United States have tested positive for 22 COVID–19 and 35 pregnant people have died as a 23 result of COVID–19. 24 VerDate Sep 11 2014 00:19 Oct 21, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4769 IS (13) The World Health Organization states 1 that everyone ‘‘has the right to safe and positive 2 childbirth experience, whether or not they have a 3 confirmed COVID–19 infection, this includes the 4 right to respect and dignity, a companion of choice, 5 clear communication by maternity staff, pain relief 6 strategies, and mobility in labor when possible and 7 the position of choice’’. 8 (14) A COVID–19 public health response with- 9 out concerted Federal action and focus on maternal 10 health care access and quality, research, data collec- 11 tion, mitigating negative socioeconomic consequences 12 of the pandemic, and safeguarding the right to safe 13 and positive childbirth experience will risk exacer- 14 bating the maternal mortality and morbidity crisis. 15 SEC. 3. DEFINITIONS. 16 In this Act: 17 (1) COVID–19 PUBLIC HEALTH EMERGENCY.— 18 The term ‘‘COVID–19 public health emergency’’ 19 means the period beginning on the date that the 20 public health emergency declared by the Secretary of 21 Health and Human Services under section 319 of 22 the Public Health Service Act (42 U.S.C. 247d) on 23 January 31, 2020, with respect to COVID–19 took 24 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4769 IS effect, and ending on the later of the end of such 1 public health emergency or January 1, 2023. 2 (2) CULTURALLY CONGRUENT.—The term ‘‘cul- 3 turally congruent’’, with respect to care or maternity 4 care, means care that is anti-racist and is in agree- 5 ment with the preferred cultural values, beliefs, 6 worldview, and practices of the health care consumer 7 and other stakeholders. 8 (3) INDIAN TRIBE, TRIBAL ORGANIZATION, AND 9 URBAN INDIAN ORGANIZATION.—The terms ‘‘Indian 10 Tribe’’ and ‘‘Tribal organization’’ have the meanings 11 given the terms ‘‘Indian tribe’’ and ‘‘tribal organiza- 12 tion’’, respectively, in section 4 of the Indian Self- 13 Determination and Education Assistance Act (25 14 U.S.C. 5304), and the term ‘‘urban Indian organiza- 15 tion’’ has the meaning given such term in section 4 16 of the Indian Health Care Improvement Act (25 17 U.S.C. 1603). 18 (4) MATERNAL MORTALITY.—The term ‘‘mater- 19 nal mortality’’ means a death occurring during preg- 20 nancy or within one year of the end of pregnancy, 21 from a pregnancy complication, a chain of events 22 initiated by pregnancy, or the aggravation of an un- 23 related condition by the physiologic effects of preg- 24 nancy. 25 VerDate Sep 11 2014 00:19 Oct 21, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4769 IS (5) POSTPARTUM.—The term ‘‘postpartum’’ 1 means the 1-year period beginning on the last day 2 of a person’s pregnancy. 3 (6) RESPECTFUL MATERNITY CARE.—The term 4 ‘‘respectful maternity care’’ refers to care organized 5 for, and provided to, all pregnant and postpartum 6 people in a manner that is culturally congruent, 7 maintains their dignity, privacy, and confidentiality, 8 ensures freedom from harm and mistreatment, and 9 enables informed choice and continuous support dur- 10 ing labor, childbirth, and postpartum. 11 (7) SECRETARY.—The term ‘‘Secretary’’ means 12 the Secretary of Health and Human Services. 13 (8) SEVERE MATERNAL MORBIDITY.—The term 14 ‘‘severe maternal morbidity’’ means an unexpected 15 outcome caused by labor and delivery that results in 16 significant short-term or long-term consequences to 17 the health of the pregnant person. 18 SEC. 4. EMERGENCY FUNDING FOR FEDERAL DATA COL- 19 LECTION, SURVEILLANCE, AND RESEARCH 20 ON MATERNAL HEALTH OUTCOMES DURING 21 THE COVID–19 PUBLIC HEALTH EMERGENCY. 22 To conduct or support data collection, surveillance, 23 and research on maternal health as a result of the 24 COVID–19 public health emergency, including support to 25 VerDate Sep 11 2014 00:19 Oct 21, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4769 IS assist in the capacity building for State, Tribal, territorial, 1 and local public health departments to collect and trans- 2 mit racial, ethnic, and other demographic data related to 3 maternal health, there are authorized to be appro- 4 priated— 5 (1) $100,000,000 for the Surveillance for 6 Emerging Threats to Mothers and Babies program 7 of the Centers for Disease Control and Prevention, 8 to support the Centers for Disease Control and Pre- 9 vention in its efforts to— 10 (A) work with public health, clinical, and 11 community-based organizations to provide time- 12 ly, continually updated guidance to families and 13 health care providers on ways to reduce risk to 14 mothers and babies and tailor interventions to 15 improve their long-term health; 16 (B) partner with more State, Tribal, terri- 17 torial, and local public health programs in the 18 collection and analysis of clinical data on the 19 impact of COVID–19 on pregnant and 20 postpartum patients and their newborns, includ- 21 ing among pregnant people of color; and 22 (C) establish regionally based centers of 23 excellence to offer medical, public health, and 24 other knowledge to ensure communities, espe- 25 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4769 IS cially communities of color, can help pregnant 1 and postpartum patients and infants get the 2 care they need; 3 (2) $30,000,000 for the Enhancing Reviews 4 and Surveillance to Eliminate Maternal Mortality 5 program (commonly known as the ‘‘ERASE MM 6 program’’) of the Centers for Disease Control and 7 Prevention, to support the Centers for Disease Con- 8 trol and Prevention in expanding its partnerships 9 with States and Indian Tribes and provide technical 10 assistance to existing Maternal Mortality Review 11 Committees; and 12 (3) $45,000,000 for the Pregnancy Risk As- 13 sessment Monitoring System (commonly known as 14 the ‘‘PRAMS’’) of the Centers for Disease Control 15 and Prevention, to support the Centers for Disease 16 Control and Prevention in its efforts to— 17 (A) create a COVID–19 supplement to its 18 PRAMS questionnaire; 19 (B) add questions around experiences of 20 respectful maternity care in prenatal, 21 intrapartum, and postpartum care; 22 (C) conduct a rapid assessment of 23 COVID–19 awareness, impact on care and ex- 24 periences, and use of preventive measures 25 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4769 IS among pregnant, laboring and birthing, and 1 postpartum people during the COVID–19 pub- 2 lic health emergency; and 3 (D) work to transition the survey to an 4 electronic platform and expand the survey to a 5 larger population, with a special focus on reach- 6 ing underrepresented communities; 7 (4) $15,000,000 for the National Institute of 8 Child Health and Human Development, to conduct 9 or support research for interventions to mitigate the 10 effects of the COVID–19 public health emergency on 11 pregnant and postpartum people, including Black, 12 Latinx, Asian-American and Pacific Islander, and 13 American Indian and Alaska Native people. 14 SEC. 5. COVID–19 MATERNAL HEALTH DATA COLLECTION 15 AND DISCLOSURE. 16 (a) DATA COLLECTION.—The Secretary, acting 17 through the Director of the Centers for Disease Control 18 and Prevention and the Administrator of the Centers for 19 Medicare & Medicaid Services, shall make publicly avail- 20 able, on the website of the Centers for Disease Control 21 and Prevention, pregnancy and postpartum data collected 22 across all surveillance systems relating to COVID–19, 23 disaggregated by race, ethnicity, State, and Tribal location 24 including the following: 25 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 11 •S 4769 IS (1) Data related to all COVID–19 diagnostic 1 testing, including the number of pregnant people 2 and postpartum people tested and the number of 3 positive cases. 4 (2) Data related to all suspected cases of 5 COVID–19 in pregnant, birthing, and postpartum 6 people who did not undergo testing. 7 (3) Data related to all COVID–19 serologic 8 testing, including the number of pregnant and 9 postpartum people tested and the number of such 10 serologic tests that were positive. 11 (4) Data related to treatment for COVID–19, 12 including hospitalizations, emergency room, and in- 13 tensive care unit admissions of pregnant, birthing, 14 and postpartum people related to COVID–19. 15 (5) Data related to COVID–19 outcomes, in- 16 cluding total fatalities and case fatality (expressed 17 as the proportion of people who were infected with 18 COVID–19 and died from the virus) of pregnant 19 and postpartum people. 20 (6) Data related to pregnancy and infant health 21 outcomes for pregnant people with confirmed or sus- 22 pected COVID–19, which may include stillbirths, 23 maternal mortality and morbidity, infant mortality, 24 VerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769 kjohnson on DSK79L0C42PROD with BILLS 12 •S 4769 IS preterm births, low-birth weight infants, and cesar- 1 ean section births. 2 (b) TIMELINE.—The Secretary shall update the data 3 made available under this section not l [Text truncated for display. 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