[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1599 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 1599
To amend the Public Health Service Act to provide for grants to promote
representative community engagement in maternal mortality review
committees, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 15, 2023
Ms. Smith (for herself and Mr. Booker) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide for grants to promote
representative community engagement in maternal mortality review
committees, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Data to Save Moms Act''.
SEC. 2. DEFINITIONS.
In this Act:
(1) Maternity care provider.--The term ``maternity care
provider'' means a health care provider who--
(A) is a physician, a physician assistant, a
midwife who meets, at a minimum, the international
definition of a midwife and global standards for
midwifery education as established by the International
Confederation of Midwives, an advanced practice
registered nurse, or a lactation consultant certified
by the International Board of Lactation Consultant
Examiners; and
(B) has a focus on maternal or perinatal health.
(2) Maternal mortality.--The term ``maternal mortality''
means a death occurring during or within a 1-year period after
pregnancy, caused by pregnancy-related or childbirth
complications, including a suicide, overdose, or other death
resulting from a mental health or substance use disorder
attributed to or aggravated by pregnancy-related or childbirth
complications.
(3) Perinatal health worker.--The term ``perinatal health
worker'' means a nonclinical health worker focused on maternal
or perinatal health, such as a doula, community health worker,
peer supporter, lactation educator or counselor, nutritionist
or dietitian, childbirth educator, social worker, home visitor,
patient navigator or coordinator, or language interpreter.
(4) Postpartum.--The term ``postpartum'' means the 1-year
period beginning on the last day of the pregnancy of an
individual.
(5) Pregnancy-associated death.--The term ``pregnancy-
associated death'' means a death of a pregnant or postpartum
individual, by any cause, that occurs during, or within 1 year
following, the individual's pregnancy, regardless of the
outcome, duration, or site of the pregnancy.
(6) Pregnancy-related death.--The term ``pregnancy-related
death'' means a death of a pregnant or postpartum individual
that occurs during, or within 1 year following, the
individual's pregnancy, from a pregnancy complication, a chain
of events initiated by pregnancy, or the aggravation of an
unrelated condition by the physiologic effects of pregnancy.
(7) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term in
section 1707(g)(1) of the Public Health Service Act (42 U.S.C.
300u-6(g)(1)).
(8) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(9) Severe maternal morbidity.--The term ``severe maternal
morbidity'' means a health condition, including mental health
conditions and substance use disorders, attributed to or
aggravated by pregnancy or childbirth that results in
significant short-term or long-term consequences to the health
of the individual who was pregnant.
(10) Social determinants of maternal health.--The term
``social determinants of maternal health'' means nonclinical
factors that impact maternal health outcomes.
SEC. 3. FUNDING FOR MATERNAL MORTALITY REVIEW COMMITTEES TO PROMOTE
REPRESENTATIVE COMMUNITY ENGAGEMENT.
(a) In General.--Section 317K(d) of the Public Health Service Act
(42 U.S.C. 247b-12(d)) is amended by adding at the end the following:
``(9) Grants to promote representative community engagement
in maternal mortality review committees.--
``(A) In general.--The Secretary may, using funds
made available pursuant to subparagraph (C), provide
assistance to an applicable maternal mortality review
committee of a State, Indian tribe, tribal
organization, or Urban Indian organization (as such
term is defined in section 4 of the Indian Health Care
Improvement Act)--
``(i) to select for inclusion in the
membership of such a committee community
members from the State, Indian tribe, tribal
organization, or Urban Indian organization by--
``(I) prioritizing community
members who can increase the diversity
of the committee's membership with
respect to race and ethnicity,
location, personal or family
experiences of maternal mortality or
severe maternal morbidity, and
professional background, including
members with nonclinical experiences;
and
``(II) to the extent applicable,
using funds reserved under subsection
(f), to address barriers to maternal
mortality review committee
participation for community members,
including required training,
transportation barriers, compensation,
and other supports as may be necessary;
``(ii) to establish initiatives to conduct
outreach and community engagement efforts
within communities throughout the State or
Indian tribe to seek input from community
members on the work of such maternal mortality
review committee, with a particular focus on
outreach to women from racial and ethnic
minority groups (as such term is defined in
section 1707(g)(1)); and
``(iii) to release public reports
assessing--
``(I) the pregnancy-related death
and pregnancy-associated death review
processes of the maternal mortality
review committee, with a particular
focus on the maternal mortality review
committee's sensitivity to the unique
circumstances of pregnant and
postpartum individuals from racial and
ethnic minority groups (as such term is
defined in section 1707(g)(1)) who have
suffered pregnancy-related deaths; and
``(II) the impact of the use of
funds made available pursuant to
subparagraph (C) on increasing the
diversity of the maternal mortality
review committee membership and
promoting community engagement efforts
throughout the State or Indian tribe.
``(B) Technical assistance.--The Secretary shall
provide (either directly through the Department of
Health and Human Services or by contract) technical
assistance to any maternal mortality review committee
receiving a grant under this paragraph on best
practices for increasing the diversity of the maternal
mortality review committee's membership and for
conducting effective community engagement throughout
the State or Indian tribe.
``(C) Authorization of appropriations.--In addition
to any funds made available under subsection (f), there
is authorized to be appropriated to carry out this
paragraph $10,000,000 for each of fiscal years 2024
through 2028.''.
(b) Reservation of Funds.--Section 317K(f) of the Public Health
Service Act (42 U.S.C. 247b-12(f)) is amended by adding at the end the
following: ``Of the amount made available under the preceding sentence
for a fiscal year, not less than $1,500,000 shall be reserved for
grants to Indian tribes, tribal organizations, or Urban Indian
organizations (as such term is defined in section 4 of the Indian
Health Care Improvement Act)''.
SEC. 4. DATA COLLECTION AND REVIEW.
Section 317K(d)(3)(A)(i) of the Public Health Service Act (42
U.S.C. 247b-12(d)(3)(A)(i)) is amended--
(1) by redesignating subclauses (II) and (III) as
subclauses (V) and (VI), respectively; and
(2) by inserting after subclause (I) the following:
``(II) to the extent practicable,
reviewing cases of severe maternal
morbidity, according to the most up-to-
date indicators;
``(III) to the extent practicable,
reviewing deaths during pregnancy or up
to 1 year after the end of a pregnancy
from suicide, overdose, or other death
from a mental health condition or
substance use disorder attributed to or
aggravated by pregnancy or childbirth
complications;
``(IV) to the extent practicable,
consulting with local community-based
organizations representing pregnant and
postpartum individuals from demographic
groups with elevated rates of maternal
mortality, severe maternal morbidity,
maternal health disparities, or other
adverse perinatal or childbirth
outcomes to ensure that, in addition to
clinical factors, nonclinical factors
that might have contributed to a
pregnancy-related death are
appropriately considered;''.
SEC. 5. REVIEW OF MATERNAL HEALTH DATA COLLECTION PROCESSES AND QUALITY
MEASURES.
(a) In General.--The Secretary, acting through the Administrator of
the Centers for Medicare & Medicaid Services and the Director of the
Agency for Healthcare Research and Quality (referred to in this section
as the ``Secretary''), shall consult with relevant stakeholders--
(1) to review existing maternal health data collection
processes and quality measures; and
(2) to make recommendations to improve such processes and
measures, including topics described under subsection (c).
(b) Collaboration.--In carrying out this section, the Secretary
shall consult with a diverse group of maternal health stakeholders,
which may include--
(1) pregnant and postpartum individuals and their family
members, and nonprofit organizations representing such
individuals, with a particular focus on patients from racial
and ethnic minority groups;
(2) community-based organizations that provide support for
pregnant and postpartum individuals, with a particular focus on
patients from demographic groups with elevated rates of
maternal mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth outcomes;
(3) membership organizations for maternity care providers;
(4) organizations representing perinatal health workers;
(5) organizations that focus on maternal mental or
behavioral health;
(6) organizations that focus on intimate partner violence;
(7) institutions of higher education, with a particular
focus on minority-serving institutions;
(8) licensed and accredited hospitals, birth centers,
midwifery practices, or other facilities that provide maternal
health care services;
(9) relevant State and local public agencies, including
State maternal mortality review committees; and
(10) the National Quality Forum, or such other standard-
setting organizations specified by the Secretary.
(c) Topics.--The review of maternal health data collection
processes and recommendations to improve such processes and measures
required under subsection (a) shall assess all available relevant
information, including information from State-level sources, and shall
consider at least the following:
(1) Current State and Tribal practices for maternal health,
maternal mortality, and severe maternal morbidity data
collection and dissemination, including consideration of--
(A) the timeliness of processes for amending a
death certificate when new information pertaining to
the death becomes available to reflect whether the
death was a pregnancy-related death;
(B) relevant data collected with electronic health
records, including data on race, ethnicity, primary
language, socioeconomic status, geography, insurance
type, and other relevant demographic information;
(C) maternal health data collected and publicly
reported by hospitals, health systems, midwifery
practices, and birth centers;
(D) the barriers preventing States from correlating
maternal outcome data with data on race, ethnicity, and
other demographic characteristics;
(E) processes for determining the cause of a
pregnancy-associated death in States that do not have a
maternal mortality review committee;
(F) whether maternal mortality review committees
include multidisciplinary and diverse membership (as
described in section 317K(d)(1)(A) of the Public Health
Service Act (42 U.S.C. 247b-12(d)(1)(A)));
(G) whether members of maternal mortality review
committees participate in trainings on bias, racism, or
discrimination, and the quality of such trainings;
(H) the extent to which States have implemented
systematic processes of listening to the stories of
pregnant and postpartum individuals and their family
members, with a particular focus on pregnant and
postpartum individuals from demographic groups with
elevated rates of maternal mortality, severe maternal
morbidity, maternal health disparities, or other
adverse perinatal or childbirth outcomes, and their
family members, to fully understand the causes of, and
inform potential solutions to, the maternal mortality
and severe maternal morbidity crisis within their
respective States;
(I) the extent to which maternal mortality review
committees are considering social determinants of
maternal health when examining the causes of pregnancy-
associated and pregnancy-related deaths;
(J) the extent to which maternal mortality review
committees are making actionable recommendations based
on their reviews of adverse maternal health outcomes
and the extent to which such recommendations are being
implemented by appropriate stakeholders;
(K) the legal and administrative barriers
preventing the collection, collation, and dissemination
of State maternity care data;
(L) the effectiveness of data collection and
reporting processes in separating pregnancy-associated
deaths from pregnancy-related deaths; and
(M) the current Federal, State, local, and Tribal
funding support for the activities referred to in
subparagraphs (A) through (L).
(2) Whether the funding support referred to in paragraph
(1)(M) is adequate for States to carry out optimal data
collection and dissemination processes with respect to maternal
health, maternal mortality, and severe maternal morbidity.
(3) Current quality measures for maternity care, including
prenatal measures, labor and delivery measures, and postpartum
measures, including topics such as--
(A) effective quality measures for maternity care
used by hospitals, health systems, midwifery practices,
birth centers, health plans, and other relevant
entities;
(B) the sufficiency of current outcome measures
used to evaluate maternity care for driving improved
care, experiences, and outcomes in maternity care
payment and delivery system models;
(C) maternal health quality measures that other
countries effectively use;
(D) validated measures that have been used for
research purposes that could be tested, refined, and
submitted for national endorsement;
(E) barriers preventing maternity care providers
and insurers from implementing quality measures that
are aligned with best practices;
(F) the frequency with which maternity care quality
measures are reviewed and revised;
(G) the strengths and weaknesses of the Prenatal
and Postpartum Care measures of the Health Plan
Employer Data and Information Set measures established
by the National Committee for Quality Assurance;
(H) the strengths and weaknesses of maternity care
quality measures under the Medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
and the Children's Health Insurance Program under title
XXI of such Act (42 U.S.C. 1397 et seq.), including the
extent to which States voluntarily report relevant
measures;
(I) the extent to which maternity care quality
measures are informed by patient experiences that
include measures of patient-reported experience of
care;
(J) the current processes for collecting and making
publicly available, to the extent practicable,
stratified data on race, ethnicity, and other
demographic characteristics of pregnant and postpartum
individuals in hospitals, health systems, midwifery
practices, and birth centers, and for incorporating
such demographically stratified data in maternity care
quality measures;
(K) the extent to which maternity care quality
measures account for the unique experiences of pregnant
and postpartum individuals from racial and ethnic
minority groups; and
(L) the extent to which hospitals, health systems,
midwifery practices, and birth centers are implementing
existing maternity care quality measures.
(4) Recommendations on authorizing additional funds and
providing additional technical assistance to improve maternal
mortality review committees and State and Tribal maternal
health data collection and reporting processes.
(5) Recommendations for new authorities that may be granted
to maternal mortality review committees to be able to--
(A) access records from other Federal and State
agencies and departments that may be necessary to
identify causes of pregnancy-associated and pregnancy-
related deaths that are unique to pregnant and
postpartum individuals from specific populations, such
as veterans and individuals who are incarcerated; and
(B) work with relevant experts who are not members
of the maternal mortality review committee to assist in
the review of pregnancy-associated deaths of pregnant
and postpartum individuals from specific populations,
such as veterans and individuals who are incarcerated.
(6) Recommendations to improve and standardize current
quality measures for maternity care, with a particular focus on
maternal health disparities.
(7) Recommendations to improve the coordination by the
Department of Health and Human Services of the efforts
undertaken by the agencies and organizations within the
Department related to maternal health data and quality
measures.
(d) Report.--Not later than 1 year after the date of enactment of
this Act, the Secretary shall submit to the Congress and make publicly
available a report on the results of the review of maternal health data
collection processes and quality measures and recommendations to
improve such processes and measures required under subsection (a).
(e) Definition.--In this section, the term ``maternal mortality
review committee'' means a maternal mortality review committee duly
authorized by a State and receiving funding under section 317K(a)(2)(D)
of the Public Health Service Act (42 U.S.C. 247b-12(a)(2)(D)).
(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal years 2024 through 2027.
SEC. 6. STUDY ON MATERNAL HEALTH AMONG AMERICAN INDIAN AND ALASKA
NATIVE INDIVIDUALS.
(a) In General.--The Secretary shall, in coordination with entities
described in subsection (b)--
(1) not later than 90 days after the date of enactment of
this Act, enter into a contract with an independent research
organization or Tribal Epidemiology Center to conduct a
comprehensive study on maternal mortality, severe maternal
morbidity, and other adverse perinatal or childbirth outcomes
in the populations of American Indian and Alaska Native
individuals; and
(2) not later than 3 years after the date of enactment of
this Act, submit to Congress a report on such study that
contains recommendations for policies and practices that can be
adopted to improve maternal health outcomes for American Indian
and Alaska Native individuals.
(b) Participating Entities.--The entities described in this
subsection shall consist of 12 members, selected by the Secretary from
among individuals nominated by Indian Tribes and Tribal organizations
(as such terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304)), and Urban
Indian organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)). In selecting such
members, the Secretary shall ensure that each of the 12 service areas
of the Indian Health Service is represented.
(c) Contents of Study.--The study conducted pursuant to subsection
(a) shall--
(1) examine the causes of maternal mortality and severe
maternal morbidity that are unique to American Indian and
Alaska Native individuals;
(2) include a systematic process of listening to the
stories of American Indian and Alaska Native individuals to
fully understand the causes of, and inform potential solutions
to, the maternal health crisis within their respective
communities;
(3) distinguish between the causes of, landscape of
maternity care at, and recommendations to improve maternal
health outcomes within, the different settings in which
American Indian and Alaska Native individuals receive maternity
care, such as--
(A) facilities operated by the Indian Health
Service;
(B) an Indian health program operated by an Indian
Tribe or Tribal organization pursuant to a contract,
grant, cooperative agreement, or compact with the
Indian Health Service pursuant to the Indian Self-
Determination Act;
(C) an urban Indian health program operated by an
Urban Indian organization pursuant to a grant or
contract with the Indian Health Service pursuant to
title V of the Indian Health Care Improvement Act; and
(D) facilities outside of the Indian Health Service
in which American Indian and Alaska Native individuals
receive maternity care services;
(4) review processes for coordinating programs of the
Indian Health Service with social services provided through
other programs administered by the Secretary (other than the
Medicare Program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), the Medicaid Program under title XIX
of such Act (42 U.S.C. 1396 et seq.), and the Children's Health
Insurance Program under title XXI of such Act (42 U.S.C. 1397
et seq.);
(5) review current data collection and quality measurement
processes and practices;
(6) assess causes and frequency of maternal mental health
conditions and substance use disorders;
(7) consider social determinants of health, including
poverty, lack of health insurance, unemployment, sexual and
domestic violence, and environmental conditions in Tribal
areas;
(8) consider the role that historical mistreatment of
American Indian and Alaska Native women has played in causing
currently elevated rates of maternal mortality, severe maternal
morbidity, and other adverse perinatal or childbirth outcomes;
(9) consider how current funding of the Indian Health
Service affects the ability of the Service to deliver quality
maternity care;
(10) consider the extent to which the delivery of maternity
care services is culturally appropriate for American Indian and
Alaska Native individuals;
(11) make recommendations to reduce misclassification of
American Indian and Alaska Native individuals, including
consideration of best practices in training for maternal
mortality review committee members to be able to correctly
classify American Indian and Alaska Native individuals; and
(12) make recommendations informed by the stories shared by
American Indian and Alaska Native individuals referred to in
paragraph (2) to improve maternal health outcomes for such
individuals.
(d) Report.--The agreement entered into under subsection (a) with
an independent research organization or Tribal Epidemiology Center
shall require that the organization or Center transmit to Congress a
report on the results of the study conducted pursuant to that agreement
not later than 36 months after the date of enactment of this Act.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2024 through 2026.
SEC. 7. GRANTS TO MINORITY-SERVING INSTITUTIONS TO STUDY MATERNAL
MORTALITY, SEVERE MATERNAL MORBIDITY, AND OTHER ADVERSE
MATERNAL HEALTH OUTCOMES.
(a) In General.--The Secretary shall establish a program under
which the Secretary shall award grants to research centers, health
professions schools and programs, and other entities at minority-
serving institutions to study specific aspects of the maternal health
crisis among pregnant and postpartum individuals from racial and ethnic
minority groups. Such research may--
(1) include the development and implementation of
systematic processes of listening to the stories of pregnant
and postpartum individuals from racial and ethnic minority
groups, and perinatal health workers supporting such
individuals, to fully understand the causes of, and inform
potential solutions to, the maternal mortality and severe
maternal morbidity crisis within their respective communities;
(2) assess the potential causes of relatively low rates of
maternal mortality among Hispanic individuals, including
potential racial misclassification and other data collection
and reporting issues that might be misrepresenting maternal
mortality rates among Hispanic individuals in the United
States;
(3) assess differences in rates of adverse maternal health
outcomes among subgroups identifying as Hispanic, including
disparities in access to early prenatal care; and
(4) include lactation education to promote racial and
ethnic diversity within the workforce of health care
professionals with breastfeeding and lactation expertise.
(b) Application.--To be eligible to receive a grant under
subsection (a), an entity described in such subsection shall submit to
the Secretary an application at such time, in such manner, and
containing such information as the Secretary may require.
(c) Technical Assistance.--The Secretary may use not more than 10
percent of the funds made available under subsection (g)--
(1) to conduct outreach to minority-serving institutions to
raise awareness of the availability of grants under subsection
(a);
(2) to provide technical assistance in the application
process for such a grant; and
(3) to promote capacity building as needed to enable
entities described in such subsection to submit such an
application.
(d) Reporting Requirement.--Each entity awarded a grant under this
section shall periodically submit to the Secretary a report on the
status of activities conducted using the grant.
(e) Evaluation.--Beginning 1 year after the date on which the first
grant is awarded under this section, the Secretary shall submit to
Congress an annual report summarizing the findings of research
conducted using funds made available under this section.
(f) Minority-Serving Institutions Defined.--In this section, the
term ``minority-serving institution'' means an institution described in
section 371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)).
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2024 through 2028.
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