Maternal Care Access and Reducing Emergencies Act or the Maternal CARE Act
This bill requires the Department of Health and Human Services (HHS) to award grants to health-professional training programs for training that addresses implicit bias (e.g., racial bias) in the practice of obstetrics and gynecology.
HHS must also award grants to up to 10 states for pregnancy medical-home programs that reduce adverse maternal-health outcomes and racial disparities. Among other requirements, such programs must prioritize the care of uninsured individuals or Medicaid enrollees.
The National Academy of Medicine must make recommendations for incorporating bias recognition in clinical-skills tests at medical schools.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1600 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 1600
To support States in their work to end preventable morbidity and
mortality in maternity care by using evidence-based quality improvement
to protect the health of mothers during pregnancy, childbirth, and in
the postpartum period and to reduce neonatal and infant mortality, to
eliminate racial disparities in maternal health outcomes, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 22, 2019
Ms. Harris (for herself, Ms. Hirono, Mr. Merkley, Ms. Baldwin, Mr.
Blumenthal, Mr. Jones, Mr. Durbin, Mr. Kaine, Mr. Brown, Mr. Markey,
Ms. Warren, Mr. Booker, Mr. Casey, Mr. Sanders, Mr. Cardin, Ms.
Klobuchar, Mr. Wyden, Ms. Duckworth, Ms. Stabenow, and Mrs. Gillibrand)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To support States in their work to end preventable morbidity and
mortality in maternity care by using evidence-based quality improvement
to protect the health of mothers during pregnancy, childbirth, and in
the postpartum period and to reduce neonatal and infant mortality, to
eliminate racial disparities in maternal health outcomes, 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 ``Maternal Care Access and Reducing
Emergencies Act'' or the ``Maternal CARE Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) In the United States, maternal mortality rates are
among the highest in the developed world and increased by 26.6
percent between 2000 and 2014.
(2) Of the 4,000,000 American women who give birth each
year, about 700 suffer fatal complications during pregnancy,
while giving birth, or during the postpartum period, and an
additional 50,000 are severely injured.
(3) It is estimated that about 60 percent of the maternal
mortalities in the United States could be prevented and half of
the maternal injuries in the United States could be reduced or
eliminated with better care.
(4) Data from the Centers for Disease Control and
Prevention show that Black women are 3 to 4 times more likely
to die from pregnancy-related causes than White women. There
are 42.8 deaths per 100,000 live births for Black women,
compared to 13 deaths per 100,000 live births for White women
and 17.2 deaths per 100,000 live births for women nationally.
(5) Black women's risk of maternal mortality has remained
higher than White women's risk for the past 6 decades.
(6) Black women in the United States suffer from life-
threatening pregnancy complications twice as often as their
White counterparts.
(7) High rates of maternal mortality among Black women span
income and education levels, as well as socioeconomic status;
moreover, risk factors such as a lack of access to prenatal
care and physical health conditions do not fully explain the
racial disparity in maternal mortality.
(8) A growing body of evidence indicates that stress from
racism and racial discrimination results in conditions--
including hypertension and pre-eclampsia--that contribute to
poor maternal health outcomes among Black women.
(9) Pervasive racial bias against Black women and unequal
treatment of Black women exist in the health care system, often
resulting in inadequate treatment for pain and dismissal of
cultural norms with respect to health. A 2016 study by
University of Virginia researchers found that White medical
students and residents often believed biological myths about
racial differences in patients, including that Black patients
have less-sensitive nerve endings and thicker skin than their
White counterparts. Providers, however, are not consistently
required to undergo implicit bias, cultural competency, or
empathy training.
(10) North Carolina has established a statewide Pregnancy
Medical Home (PMH) program, which aims to reduce adverse
maternal health outcomes and maternal deaths by incentivizing
maternal health care providers to provide integral health care
services to pregnant women and new mothers. According to the
North Carolina Department of Health and Human Services Center
for Health Statistics, the pregnancy-related mortality rate for
Black women was approximately 5.1 times higher than that of
White women in 2004. Almost a decade later, in 2013, the
pregnancy-related mortality rates for Black women and White
women were 24.3 and 24.2 deaths per 100,000 live births,
respectively. The PMH program has been credited with the
convergence in pregnancy-related mortality rates because the
program partners each high-risk pregnant and postpartum woman
that is covered under Medicaid with a pregnancy care manager.
SEC. 3. DEFINITIONS.
In this Act:
(1) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(2) State.--The term ``State'' has the meaning given that
term in section 1101 of the Social Security Act (42 U.S.C.
1301) for purposes of title XIX of that Act (42 U.S.C. 1396 et
seq.).
SEC. 4. IMPLICIT BIAS TRAINING FOR HEALTH CARE PROVIDERS.
(a) Grant Program.--The Secretary shall establish a grant program
under which such Secretary awards grants to accredited schools of
allopathic medicine, accredited schools of osteopathic medicine,
accredited nursing schools, other health professional training
programs, and other entities for the purpose of supporting implicit
bias training, with priority given to such training with respect to
obstetrics and gynecology.
(b) Collaboration Required.--In developing requirements for
implicit bias training carried out with grant funds awarded under this
section, the Secretary shall collaborate with relevant stakeholders
that specialize in addressing health equity, including--
(1) health care providers who serve pregnant women,
including doctors, nurses, and midwives;
(2) academic institutions, including schools and training
programs described in subsection (a);
(3) community-based health workers, including perinatal
health workers, doulas, and home visitors; and
(4) community-based organizations.
(c) Implicit Bias Training Defined.--In this section, the term
``implicit bias training'' means evidence-based, on-going professional
development and support, with respect to--
(1) bias in judgment or behavior that results from subtle
cognitive processes, including implicit attitudes and implicit
stereotypes, that often operate at a level below conscious
awareness and without intentional control; or
(2) implicit attitudes and stereotypes that result in
beliefs or simple associations that a person makes between an
object and its evaluation that are automatically activated by
the mere presence (actual or symbolic) of the attitude object.
(d) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to awarding grants to schools, programs,
or entities located in or serving areas with the greatest needs, based
such factors as the Secretary may consider, including racial
disparities in maternal mortality and the incidence of severe maternal
morbidity rates.
(e) Authorization of Appropriations.--There are authorized to be
appropriated for purposes of carrying out the grant program under
subsection (a), $5,000,000 for each of fiscal years 2020 through 2024.
SEC. 5. PREGNANCY MEDICAL HOME DEMONSTRATION PROJECT.
(a) Authority To Award Grants.--The Secretary shall award grants to
States for the purpose of establishing or operating State pregnancy
medical home programs that meet the requirements of subsection (b) to
deliver integrated health care services to pregnant women and new
mothers and reduce adverse maternal health outcomes, maternal deaths,
and racial health disparities in maternal mortality and morbidity.
(b) State Pregnancy Medical Home Program Requirements.--A State
pregnancy medical home program meets the requirements of this
subsection if--
(1) the State works with relevant stakeholders to develop
and carry out the program, including--
(A) State and local agencies responsible for
Medicaid, public health, social services, mental
health, and substance abuse treatment and support;
(B) health care providers who serve pregnant women,
including doctors, nurses, and midwives;
(C) community-based health workers, including
perinatal health workers, doulas, and home visitors;
and
(D) community-based organizations and individuals
representing the communities with--
(i) the highest overall rates of maternal
mortality and morbidity; and
(ii) the greatest racial disparities in
rates of maternal mortality and morbidity;
(2) the State selects health care providers who serve
pregnant women, including doctors, nurses, and midwives, to
participate in the program as pregnancy medical homes, and
requires that any provider that wishes to participate in the
program as a pregnancy medical home--
(A) commits to following evidence-based practices
for maternity care, as developed by the State in
consultation with relevant stakeholders; and
(B) completes training to provide culturally and
linguistically competent care;
(3) under the program, each pregnancy medical home is
required to conduct a standardized medical, obstetric, and
psychosocial risk assessment for every patient of the medical
home who is pregnant at the patient's first prenatal
appointment with the medical home;
(4) under the program, a care manager--
(A) is assigned to each pregnancy medical home; and
(B) coordinates care (including coordinating
resources and referrals for health care and social
services that are not available from the pregnancy
medical home) for each patient of a pregnancy medical
home who is eligible for services under the program;
and
(5) the program prioritizes pregnant and postpartum women
who are uninsured or enrolled in the State Medicaid plan under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.),
or a waiver of such plan.
(c) Grants.--
(1) Limitation.--The Secretary may award a grant under this
section to up to 10 States.
(2) Period.--Grants under this section shall be for a 5-
year period.
(3) Prioritization.--In awarding grants under this section,
the Secretary shall give priority to the States with the
greatest racial disparities in maternal mortality and severe
morbidity rates.
(d) Report on Grant Impact and Dissemination of Best Practices.--
Not later than 1 year after all the grant periods awarded under this
section have ended, the Secretary shall--
(1) submit a report to Congress that describes--
(A) the impact of the grants awarded under this
section on maternal and child health;
(B) best practices and models of care used by
recipients of grants under this section; and
(C) obstacles faced by recipients of grants under
this section in delivering care, improving maternal and
child health, and reducing racial disparities in rates
of maternal and infant mortality and morbidity; and
(2) disseminate information on best practices and models of
care used by recipients of grants under this section (including
best practices and models of care relating to the reduction of
racial disparities in rates of maternal and infant mortality
and morbidity) to interested parties, including health
providers, medical schools, relevant State and local agencies,
and the general public.
(e) Authorization.--There are authorized to be appropriated to
carry out this section, $25,000,000 for each of fiscal years 2020
through 2024, to remain available until expended.
SEC. 6. NATIONAL ACADEMY OF MEDICINE STUDY.
(a) In General.--The Secretary shall enter into an arrangement with
the National Academy of Medicine under which the National Academy
agrees to study and make recommendations for incorporating bias
recognition in clinical skills testing for accredited schools of
allopathic medicine and accredited schools of osteopathic medicine.
(b) Report.--The arrangement under subsection (a) shall provide for
submission by the National Academy of Medicine to the Secretary and
Congress, not later than 3 years after the date of enactment of this
Act, of a report on the results of the study that includes such
recommendations.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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