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Title V — Addressing COVID–19 Health Disparities

H.R. 14 · 116th Congress · Oct 30, 2020 · Lineage

V Addressing COVID–19 Health Disparities

A Tribal Health Data Improvement

Sec. 5001 Collection and availability of health data with respect to Indian Tribes

(a)
Data collection— Section 3101(a)(1) of the Public Health Service Act (42 U.S.C. 300kk(a)(1)) is amended—
(1)
by striking “, by not later than 2 years after the date of enactment of this title,”; and
(2)
in subparagraph (B), by inserting “Tribal,” after “State,”.
(b)
Data reporting and dissemination— Section 3101(c) of the Public Health Service Act (42 U.S.C. 300kk(c)) is amended—
(1)
by amending subparagraph (F) of paragraph (1) to read as follows:

“(F) the Indian Health Service, Indian Tribes, Tribal organizations, and epidemiology centers authorized under the Indian Health Care Improvement Act;”

(2)
in paragraph (3), by inserting “Indian Tribes, Tribal organizations, and epidemiology centers,” after “Federal agencies,”.
(c)
Protection and sharing of data— Section 3101(e) of the Public Health Service Act (42 U.S.C. 300kk(e)) is amended by adding at the end the following new paragraphs:

“(3) Data sharing strategy—With respect to data access for Tribal epidemiology centers and Tribes, the Secretary shall create a data sharing strategy that takes into consideration recommendations by the Secretary’s Tribal Advisory Committee for—

“(A) ensuring that Tribal epidemiology centers and Indian Tribes have access to the data sources necessary to accomplish their public health responsibilities; and

“(B) protecting the privacy and security of such data.

“(4) Tribal public health authority

“(A) Availability—Beginning not later than 180 days after the date of the enactment of the Commitment to Defeat the Virus and Keep America Healthy Act, the Secretary shall make available to the entities listed in subparagraph (B) all data that is collected pursuant to this title with respect to health care and public health surveillance programs and activities, including such programs and activities that are federally supported or conducted, so long as—

“(i) such entities request the data pursuant to statute; and

“(ii) the data is requested for use—

“(I) consistent with Federal law and obligations; and

“(II) to satisfy a particular purpose or carry out a specific function consistent with the purpose for which the data was collected.

“(B) Entities—The entities listed in this subparagraph are—

“(i) the Indian Health Service;

“(ii) Indian Tribes and Tribal organizations; and

“(iii) epidemiology centers.”

(d)
Technical updates— Section 3101 of the Public Health Service Act (42 U.S.C. 300kk) is amended—
(1)
by striking subsections (g) and (h); and
(2)
by redesignating subsection (i) as subsection (h).
(e)
Definitions— After executing the amendments made by subsection (d), section 3101 of the Public Health Service Act (42 U.S.C. 300kk) is amended by inserting after subsection (f) the following new subsection:

“(g) Definitions—In this section:

“(1) The term epidemiology center means an epidemiology center established under section 214 of the Indian Health Care Improvement Act, including such Tribal epidemiology centers serving Indian Tribes regionally and any Tribal epidemiology center serving Urban Indian organizations nationally.

“(2) The term Indian Tribe has the meaning given to the term Indian tribe in section 4 of the Indian Self-Determination and Education Assistance Act.

“(3) The term Tribal organization has the meaning given to the term tribal organization in section 4 of the of the Indian Self-Determination and Education Assistance Act.

“(4) The term Urban Indian organization has the meaning given to that term in section 4 of the Indian Health Care Improvement Act.”

(f)
Technical correction— Section 3101(b) of the Public Health Service Act (42 U.S.C. 300kk(b)) is amended by striking “Data analysis.—” and all that follows through “For each federally” and inserting “Data analysis.—For each federally”.

Sec. 5002 Improving health statistics reporting with respect to Indian Tribes

(a)
Technical aid to States and localities— Section 306(d) of the Public Health Service Act (42 U.S.C. 242k(d)) is amended by inserting “, Indian Tribes, Tribal organizations, and epidemiology centers” after “jurisdictions”.
(b)
Cooperative health statistics system— Section 306(e)(3) of the Public Health Service Act (42 U.S.C. 242k(e)(3)) is amended by inserting “, Indian Tribes, Tribal organizations, and epidemiology centers” after “health agencies”.
(c)
Federal-State-Tribal cooperation— Section 306(f) of the Public Health Service Act (42 U.S.C. 242k(f)) is amended—
(1)
by inserting “the Indian Health Service,” before “the Departments of Commerce”;
(2)
by inserting a comma after “the Departments of Commerce and Labor”;
(3)
by inserting “, Indian Tribes, Tribal organizations, and epidemiology centers” after “State and local health departments and agencies”; and
(4)
by striking “he shall” and inserting “the Secretary shall”.
(d)
Registration area records— Section 306(h)(1) of the Public Health Service Act (42 U.S.C. 242k(h)(1)) is amended—
(1)
by striking “in his discretion” and inserting “in the discretion of the Secretary”; and
(2)
by striking “Hispanics, Asian Americans, and Pacific Islanders” and inserting “American Indians and Alaska Natives, Hispanics, Asian Americans, and Native Hawaiian and other Pacific Islanders”.
(e)
National Committee on Vital and Health Statistics— Section 306(k) of the Public Health Service Act (42 U.S.C. 242k(k)) is amended—
(1)
in paragraph (3), by striking “, not later than 60 days after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996,” each place it appears; and
(2)
in paragraph (7), by striking “Not later than 1 year after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996, and annually thereafter, the Committee shall” and inserting “The Committee shall, on an biennial basis,”.
(f)
Grants for assembly and analysis of data on ethnic and racial populations— Section 306(m)(4) of the Public Health Service Act (42 U.S.C. 242k(m)(4)) is amended—
(1)
in subparagraph (A)—
(A)
by striking “Subject to subparagraph (B), the” and inserting “The”; and
(B)
by striking “and major Hispanic subpopulation groups and American Indians” and inserting “, major Hispanic subgroups, and American Indians and Alaska Natives”; and
(2)
by amending subparagraph (B) to read as follows:

“(B) In carrying out subparagraph (A), with respect to American Indians and Alaska Natives, the Secretary shall—

“(i) consult with Indian Tribes, Tribal organizations, the Tribal Technical Advisory Group of the Centers for Medicare & Medicaid Services maintained under section 5006(e) of the American Recovery and Reinvestment Act of 2009, and the Tribal Advisory Committee established by the Centers for Disease Control and Prevention, in coordination with epidemiology centers, to develop guidelines for State and local health agencies to improve the quality and accuracy of data with respect to the birth and death records of American Indians and Alaska Natives;

“(ii) confer with Urban Indian organizations to develop guidelines for State and local health agencies to improve the quality and accuracy of data with respect to the birth and death records of American Indians and Alaska Natives;

“(iii) enter into cooperative agreements with Indian Tribes, Tribal organizations, Urban Indian organizations, and epidemiology centers to address misclassification and undersampling of American Indians and Alaska Natives with respect to—

“(I) birth and death records; and

“(II) health care and public health surveillance systems, including, but not limited to, data with respect to chronic and infectious diseases, unintentional injuries, environmental health, child and adolescent health, maternal health and mortality, foodborne and waterborne illness, reproductive health, and any other notifiable disease or condition;

“(iv) encourage States to enter into data sharing agreements with Indian Tribes, Tribal organizations, and epidemiology centers to improve the quality and accuracy of public health data; and

“(v) not later than 180 days after the date of enactment of the Commitment to Defeat the Virus and Keep America Healthy Act, and biennially thereafter, issue a report on the following:

“(I) Which States have data sharing agreements with Indian Tribes, Tribal organizations, Urban Indian organizations, and Tribal epidemiology centers to improve the quality and accuracy of health data.

“(II) What the Centers for Disease Control and Prevention is doing to encourage States to enter into data sharing agreements with Indian Tribes, Tribal organizations, Urban Indian organizations, and Tribal epidemiology centers to improve the quality and accuracy of health data.

“(III) Best practices and guidance for States, Indian Tribes, Tribal organizations, Urban Indian organizations, and Tribal epidemiology centers that wish to enter into data sharing agreements.

“(IV) Best practices and guidance for local, State, Tribal, and Federal uniform standards for the collection of data on race and ethnicity.”

(g)
Definitions— Section 306 of the Public Health Service Act (42 U.S.C. 242k) is amended—
(1)
by redesignating subsection (n) as subsection (o); and
(2)
by inserting after subsection (m) the following:

“(n) In this section:

“(1) The term epidemiology center means an epidemiology center established under section 214 of the Indian Health Care Improvement Act, including such Tribal epidemiology centers serving Indian Tribes regionally and any Tribal epidemiology center serving Urban Indian organizations nationally.

“(2) The term Indian Tribe has the meaning given to the term Indian tribe in section 4 of the Indian Self-Determination and Education Assistance Act.

“(3) The term Tribal organization has the meaning given to the term tribal organization in section 4 of the Indian Self-Determination and Education Assistance Act.

“(4) The term Urban Indian organization has the meaning given to that term in section 4 of the Indian Health Care Improvement Act.”

(h)
Authorization of appropriations— Section 306(o) of the Public Health Service Act, as redesignated by subsection (g), is amended to read as follows:

“(o)

“(1) To carry out this section, there is authorized to be appropriated $185,000,000 for each of the fiscal years 2021 through 2025.

“(2) Of the amount authorized to be appropriated to carry out this section for a fiscal year, the Secretary shall not use more than 10 percent for the combined costs of—

“(A) administration of this section; and

“(B) carrying out subsection (m)(2).”

B Tribal Medical Supplies Stockpile Access

Sec. 5011 Provision of items to Indian programs and facilities

(a)
Strategic national stockpile— Section 319F–2(a)(3)(G) of the Public Health Service Act (42 U.S.C. 247d–6b(a)(3)(G)) is amended by inserting “, and, in the case that the Secretary deploys the stockpile under this subparagraph, ensure that appropriate drugs, vaccines and other biological products, medical devices, and other supplies are deployed by the Secretary directly to health programs or facilities operated by the Indian Health Service, an Indian tribe, a tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)), or an inter-tribal consortium (as defined in section 501 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5381)) or through an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act), while avoiding duplicative distributions to such programs or facilities” before the semicolon.
(b)
Distribution of qualified pandemic or epidemic products to IHS facilities— Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), as amended by section 3015, is further amended by inserting after section 319F–5 the following:

“319F–6. Distribution of qualified pandemic or epidemic products to Indian programs and facilities

“In the case that the Secretary distributes qualified pandemic or epidemic products (as defined in section 319F–3(i)(7)) to States or other entities, the Secretary shall ensure that, as appropriate, such products are distributed directly to health programs or facilities operated by the Indian Health Service, an Indian tribe, a tribal organization (as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)), or an inter-tribal consortium (as defined in section 501 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5381)) or through an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act), while avoiding duplicative distributions to such programs or facilities.”

C Native American Suicide Prevention

Sec. 5021 Native American suicide prevention

Section 520E(b) of the Public Health Service Act (42 U.S.C. 290bb–36(b)) is amended by inserting after paragraph (3) the following:

“(4) Consultation—A State applying for a grant or cooperative agreement under this section shall, in the development and implementation of a statewide early intervention strategy, consult or confer with entities described in paragraph (1)(C) in such State.”

D Pursuing Equity in Mental Health

1 Health Equity and Accountability

Sec. 5031 Integrated Health Care Demonstration Program

Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following:

“554. Interprofessional health care teams for provision of behavioral health care in primary care settings

“(a) Grants—The Secretary shall award grants to eligible entities for the purpose of establishing interprofessional health care teams that provide behavioral health care.

“(b) Eligible entities—To be eligible to receive a grant under this section, an entity shall be a federally qualified health center (as defined in section 1861(aa) of the Social Security Act), rural health clinic, or behavioral health program, serving a high proportion of individuals from racial and ethnic minority groups (as defined in section 1707(g)).

“(c) Scientifically based—Integrated health care funded through this section shall be scientifically based, taking into consideration the results of the most recent peer-reviewed research available.

“(d) Authorization of appropriations—To carry out this section, there is authorized to be appropriated $20,000,000 for each of the first 5 fiscal years following the date of enactment of the Commitment to Defeat the Virus and Keep America Healthy Act.”

Sec. 5032 Addressing racial and ethnic minority mental health disparities research gaps

Not later than 6 months after the date of the enactment of this Act, the Director of the National Institutes of Health shall enter into an arrangement with the National Academies of Sciences, Engineering, and Medicine (or, if the National Academies of Sciences, Engineering, and Medicine decline to enter into such an arrangement, the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, or another appropriate entity)—
(1)
to conduct a study with respect to mental health disparities in racial and ethnic minority groups (as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g))); and
(2)
to submit to the Congress a report on the results of such study, including—
(A)
a compilation of information on the dynamics of mental disorders in such racial and ethnic minority groups; and
(B)
a compilation of information on the impact of exposure to community violence, adverse childhood experiences, structural racism, and other psychological traumas on mental disorders in such racial and minority groups.

Sec. 5033 Health professions competencies to address racial and ethnic minority mental health disparities

(a)
In general— The Secretary of Health and Human Services shall award grants to qualified national organizations for the purposes of—
(1)
developing, and disseminating to health professional educational programs best practices or core competencies addressing mental health disparities among racial and ethnic minority groups for use in the training of students in the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, and substance misuse counseling; and
(2)
certifying community health workers and peer wellness specialists with respect to such best practices and core competencies and integrating and expanding the use of such workers and specialists into health care to address mental health disparities among racial and ethnic minority groups.
(b)
Best practices; core competencies— Organizations receiving funds under subsection (a) may use the funds to engage in the following activities related to the development and dissemination of best practices or core competencies described in subsection (a)(1):
(1)
Formation of committees or working groups comprised of experts from accredited health professions schools to identify best practices and core competencies relating to mental health disparities among racial and ethnic minority groups.
(2)
Planning of workshops in national fora to allow for public input into the educational needs associated with mental health disparities among racial and ethnic minority groups.
(3)
Dissemination and promotion of the use of best practices or core competencies in undergraduate and graduate health professions training programs nationwide.
(4)
Establishing external stakeholder advisory boards to provide meaningful input into policy and program development and best practices to reduce mental health disparities among racial and ethnic minority groups.
(c)
Definitions— In this section:
(1)
Qualified national organization— The term qualified national organization means a national organization that focuses on the education of students in one or more of the professions of social work, psychology, psychiatry, marriage and family therapy, mental health counseling, and substance misuse counseling.
(2)
Racial and ethnic minority group— The term racial and ethnic minority group has the meaning given to such term in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).

Sec. 5034 Racial and ethnic minority behavioral and mental health outreach and education strategy

Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.), as amended by section 5031, is further amended by adding at the end the following new section:

“555. Behavioral and mental health outreach and education strategy

“(a) In general—The Secretary shall, in consultation with advocacy and behavioral and mental health organizations serving racial and ethnic minority groups, develop and implement an outreach and education strategy to promote behavioral and mental health and reduce stigma associated with mental health conditions and substance abuse among racial and ethnic minority groups. Such strategy shall—

“(1) be designed to—

“(A) meet the diverse cultural and language needs of the various racial and ethnic minority groups; and

“(B) be developmentally and age-appropriate;

“(2) increase awareness of symptoms of mental illnesses common among such groups, taking into account differences within at-risk subgroups;

“(3) provide information on evidence-based, culturally and linguistically appropriate and adapted interventions and treatments;

“(4) ensure full participation of, and engage, both consumers and community members in the development and implementation of materials; and

“(5) seek to broaden the perspective among both individuals in these groups and stakeholders serving these groups to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health.

“(b) Reports—Beginning not later than 1 year after the date of the enactment of this section and annually thereafter, the Secretary shall submit to Congress, and make publicly available, a report on the extent to which the strategy developed and implemented under subsection (a) increased behavioral and mental health outcomes associated with mental health conditions and substance abuse among racial and ethnic minority groups.

“(c) Definition—In this section, the term racial and ethnic minority group has the meaning given to that term in section 1707(g).

“(d) Authorization of appropriations—There is authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2021 through 2025.”

Sec. 5035 Additional funds for National Institutes of Health

(a)
In general— In addition to amounts otherwise authorized to be appropriated to the National Institutes of Health, there is authorized to be appropriated to such Institutes $100,000,000 for each of fiscal years 2021 through 2025 to build relations with communities and conduct or support clinical research, including clinical research on racial or ethnic disparities in physical and mental health.
(b)
Definition— In this section, the term clinical research has the meaning given to such term in section 409 of the Public Health Service Act (42 U.S.C. 284d).

Sec. 5036 Additional funds for National Institute on Minority Health and Health Disparities

In addition to amounts otherwise authorized to be appropriated to the National Institute on Minority Health and Health Disparities, there is authorized to be appropriated to such Institute $650,000,000 for each of fiscal years 2021 through 2025.

2 Other provisions

Sec. 5037 Reauthorization of Minority Fellowship Program

Section 597(c) of the Public Health Service Act (42 U.S.C. 297ll(c)) is amended by striking “$12,669,000 for each of fiscal years 2018 through 2022” and inserting “$25,000,000 for each of fiscal years 2021 through 2025”.

Sec. 5038 Study on the Effects of Smartphone and Social Media Use on Adolescents

(a)
In general— Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall conduct or support research on—
(1)
smartphone and social media use by adolescents; and
(2)
the effects of such use on—
(A)
emotional, behavioral, and physical health and development; and
(B)
disparities in minority and underserved populations.
(b)
Report— Not later than 5 years after the date of the enactment of this Act, the Secretary shall submit to the Congress, and make publicly available, a report on the findings of research described in this section.

Sec. 5039 Technical correction

Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) is amended—
(1)
by redesignating the second section 550 of such Act (42 U.S.C. 290ee–10) (relating to Sobriety Treatment And Recovery Teams) as section 553; and
(2)
by moving such section 553, as so redesignated, so as to appear after section 552 of such Act (42 U.S.C. 290ee–7).

E Maternal Health Quality Improvement

Sec. 5041 Innovation for maternal health

Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.), as amended by section 4071, is further amended—
(1)
in the section designation of section 330M of such Act (42 U.S.C. 254c–19) by inserting a period after “330M”; and
(2)
by inserting after section 330N of such Act, as inserted by section 4071, the following:

“330O. Innovation for maternal health

“(a) In general—The Secretary, in consultation with experts representing a variety of clinical specialties, State, Tribal, or local public health officials, researchers, epidemiologists, statisticians, and community organizations, shall establish or continue a program to award competitive grants to eligible entities for the purposes of—

“(1) identifying, developing, or disseminating best practices to improve maternal health care quality and outcomes, eliminate preventable maternal mortality and severe maternal morbidity, and improve infant health outcomes, which may include—

“(A) information on evidence-based practices to improve the quality and safety of maternal health care in hospitals and other health care settings of a State or health care system, including by addressing topics commonly associated with health complications or risks related to prenatal care, labor care, birthing, and postpartum care;

“(B) best practices for improving maternal health care based on data findings and reviews conducted by a State maternal mortality review committee that address topics of relevance to common complications or health risks related to prenatal care, labor care, birthing, and postpartum care; and

“(C) information on addressing determinants of health that impact maternal health outcomes for women before, during, and after pregnancy;

“(2) collaborating with State maternal mortality review committees to identify issues for the development and implementation of evidence-based practices to improve maternal health outcomes and reduce preventable maternal mortality and severe maternal morbidity;

“(3) providing technical assistance and supporting the implementation of best practices identified pursuant to paragraph (1) to entities providing health care services to pregnant and postpartum women; and

“(4) identifying, developing, and evaluating new models of care that improve maternal and infant health outcomes, which may include the integration of community-based services and clinical care.

“(b) Eligible entities—To be eligible for a grant under subsection (a), an entity shall—

“(1) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and

“(2) demonstrate in such application that the entity is capable of carrying out data-driven maternal safety and quality improvement initiatives in the areas of obstetrics and gynecology or maternal health.

“(c) Authorization of appropriations—To carry out this section, there are authorized to be appropriated $5,000,000 for each of fiscal years 2021 through 2025.”

Sec. 5042 Training for health care providers

Title VII of the Public Health Service Act is amended by striking section 763 (42 U.S.C. 294p) and inserting the following:

“763. Training for health care providers

“(a) Grant program—The Secretary shall establish a program to award grants to accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other health professional training programs for the training of health care professionals to reduce and prevent discrimination (including training related to implicit and explicit biases) in the provision of health care services related to prenatal care, labor care, birthing, and postpartum care.

“(b) Eligibility—To be eligible for 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) 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, including a description of the impact of such training on patient outcomes, as applicable.

“(d) Best practices—The Secretary may identify and disseminate best practices for the training of health care professionals to reduce and prevent discrimination (including training related to implicit and explicit biases) in the provision of health care services related to prenatal care, labor care, birthing, and postpartum care.

“(e) Authorization of appropriations—To carry out this section, there are authorized to be appropriated $5,000,000 for each of fiscal years 2021 through 2025.”

Sec. 5043 Study on training to reduce and prevent discrimination

Not later than 2 years after date of enactment of this Act, the Secretary of Health and Human Services shall, through a contract with an independent research organization, conduct a study and make recommendations for accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other health professional training programs, on best practices related to training to reduce and prevent discrimination, including training related to implicit and explicit biases, in the provision of health care services related to prenatal care, labor care, birthing, and postpartum care.

Sec. 5044 Perinatal quality collaboratives

Section 317K(a)(2) of the Public Health Service Act (42 U.S.C. 247b–12(a)(2)) is amended by adding at the end the following:

“(E)

“(i) The Secretary, acting through the Director of the Centers for Disease Control and Prevention and in coordination with other offices and agencies, as appropriate, shall establish or continue a competitive grant program for the establishment or support of perinatal quality collaboratives to improve perinatal care and perinatal health outcomes for pregnant and postpartum women and their infants. A State, Indian Tribe, or Tribal organization may use funds received through such grant to—

“(I) support the use of evidence-based or evidence-informed practices to improve outcomes for maternal and infant health;

“(II) work with clinical teams; experts; State, local, and, as appropriate, Tribal public health officials; and stakeholders, including patients and families, to identify, develop, or disseminate best practices to improve perinatal care and outcomes; and

“(III) employ strategies that provide opportunities for health care professionals and clinical teams to collaborate across health care settings and disciplines, including primary care and mental health, as appropriate, to improve maternal and infant health outcomes, which may include the use of data to provide timely feedback across hospital and clinical teams to inform responses, and to provide support and training to hospital and clinical teams for quality improvement, as appropriate.

“(ii) To be eligible for a grant under clause (i), an entity shall submit to the Secretary an application in such form and manner and containing such information as the Secretary may require.”

Sec. 5045 Integrated services for pregnant and postpartum women

(a)
Grants— Title III of the Public Health Service Act is amended by inserting after section 330O of such Act, as added by section 5041, the following:

“330P. Integrated services for pregnant and postpartum women

“(a) In general—The Secretary may award grants to States, Indian Tribes, and Tribal organizations for the purpose of establishing or operating evidence-based or innovative, evidence-informed programs to deliver integrated health care services to pregnant and postpartum women to optimize the health of women and their infants, including to reduce adverse maternal health outcomes, pregnancy-related deaths, and related health disparities (including such disparities associated with racial and ethnic minority populations), and, as appropriate, by addressing issues researched under subsection (b)(2) of section 317K.

“(b) Integrated services for pregnant and postpartum women

“(1) Eligibility—To be eligible to receive a grant under subsection (a), a State, Indian Tribe, or Tribal organization shall work with relevant stakeholders that coordinate care (including coordinating resources and referrals for health care and social services) to develop and carry out the program, including—

“(A) State, Tribal, and local agencies responsible for Medicaid, public health, social services, mental health, and substance use disorder treatment and services;

“(B) health care providers who serve pregnant and postpartum women; and

“(C) community-based health organizations and health workers, including providers of home visiting services and individuals representing communities with disproportionately high rates of maternal mortality and severe maternal morbidity, and including individuals representing racial and ethnic minority populations.

“(2) Terms

“(A) Period—A grant awarded under subsection (a) shall be made for a period of 5 years. Any supplemental award made to a grantee under subsection (a) may be made for a period of less than 5 years.

“(B) Preference—In awarding grants under subsection (a), the Secretary shall—

“(i) give preference to States, Indian Tribes, and Tribal organizations that have the highest rates of maternal mortality and severe maternal morbidity relative to other such States, Indian Tribes, or Tribal organizations, respectively; and

“(ii) shall consider health disparities related to maternal mortality and severe maternal morbidity, including such disparities associated with racial and ethnic minority populations.

“(C) Priority—In awarding grants under subsection (a), the Secretary shall give priority to applications from up to 15 entities described in subparagraph (B)(i).

“(D) Evaluation—The Secretary shall require grantees to evaluate the outcomes of the programs supported under the grant.

“(c) Definitions—In this section, the terms Indian Tribe and Tribal organization have the meanings given the terms Indian tribe and tribal organization, respectively, in section 4 of the Indian Self-Determination and Education Assistance Act.

“(d) Authorization of appropriations—There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2021 through 2025.”

(b)
Report on grant outcomes and dissemination of best practices—
(1)
Report— Not later than February 1, 2026, the Secretary of Health and Human Services shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that describes—
(A)
the outcomes of the activities supported by the grants awarded under the amendment made by this section on maternal and child health;
(B)
best practices and models of care used by recipients of grants under such amendment; and
(C)
obstacles identified by recipients of grants under such amendment, and strategies used by such recipients to deliver care, improve maternal and child health, and reduce health disparities.
(2)
Dissemination of best practices— Not later than August 1, 2026, the Secretary of Health and Human Services shall disseminate information on best practices and models of care used by recipients of grants under the amendment made by this section (including best practices and models of care relating to the reduction of health disparities, including such disparities associated with racial and ethnic minority populations, in rates of maternal mortality and severe maternal morbidity) to relevant stakeholders, which may include health providers, medical schools, nursing schools, relevant State, Tribal, and local agencies, and the general public.

Sec. 5046 Improving rural maternal and obstetric care data

(a)
Maternal mortality and morbidity activities— Section 301(e) of the Public Health Service Act (42 U.S.C. 241(e)) is amended by inserting “, preventable maternal mortality and severe maternal morbidity,” after “delivery”.
(b)
Office of women’s health— Section 310A(b)(1) of the Public Health Service Act (42 U.S.C. 242s(b)(1)) is amended by striking “and sociocultural contexts,” and inserting “sociocultural (including among American Indians, Native Hawaiians, and Alaska Natives), and geographical contexts”.
(c)
Safe motherhood— Section 317K of the Public Health Service Act (42 U.S.C. 247b–12) is amended—
(1)
in subsection (a)(2)(A), by inserting “, including improving collection of data on race, ethnicity, and other demographic information” before the period; and
(2)
in subsection (b)(2)—
(A)
in subparagraph (L), by striking “and” at the end;
(B)
by redesignating subparagraph (M) as subparagraph (N); and
(C)
by inserting after subparagraph (L) the following:

“(M) an examination of the relationship between maternal health and obstetric services in rural areas and outcomes in delivery and postpartum care; and”

(d)
Office of research on women’s health— Section 486 of the Public Health Service Act (42 U.S.C. 287d) is amended—
(1)
in subsection (b), by amending paragraph (3) to read as follows:

“(3) carry out paragraphs (1) and (2) with respect to—

“(A) the aging process in women, with priority given to menopause; and

“(B) pregnancy, with priority given to deaths related to preventable maternal mortality and severe maternal morbidity;”

(2)
in subsection (d)(4)(A)(iv), by inserting “, including preventable maternal morbidity and severe maternal morbidity” before the semicolon.

Sec. 5047 Rural obstetric network grants

The Public Health Service Act is amended by inserting after section 330A–1 (42 U.S.C. 254c–1a) the following:

“330A–2. Rural obstetric network grants

“(a) Program established—The Secretary shall award grants or cooperative agreements to eligible entities to establish collaborative improvement and innovation networks (referred to in this section as “rural obstetric networks”) to improve maternal and infant health outcomes and reduce preventable maternal mortality and severe maternal morbidity by improving maternity care and access to care in rural areas, frontier areas, maternity care health professional target areas, or jurisdictions of Indian Tribes and Tribal organizations.

“(b) Use of funds—Grants or cooperative agreements awarded pursuant to this section shall be used for the establishment or continuation of collaborative improvement and innovation networks to improve maternal health in rural areas by improving infant health and maternal outcomes and reducing preventable maternal mortality and severe maternal morbidity. Rural obstetric networks established in accordance with this section may—

“(1) develop a network to improve coordination and increase access to maternal health care and assist pregnant women in the areas described in subsection (a) with accessing and utilizing maternal and obstetric care, including health care services related to prenatal care, labor care, birthing, and postpartum care to improve outcomes in birth and maternal mortality and morbidity;

“(2) identify and implement evidence-based and sustainable delivery models for maternal and obstetric care (including health care services related to prenatal care, labor care, birthing, and postpartum care for women in the areas described in subsection (a)), including home visiting programs and culturally appropriate care models that reduce health disparities;

“(3) develop a model for maternal health care collaboration between health care settings to improve access to care in areas described in subsection (a), which may include the use of telehealth;

“(4) provide training for professionals in health care settings that do not have specialty maternity care;

“(5) collaborate with academic institutions that can provide regional expertise and help identify barriers to providing maternal health care, including strategies for addressing such barriers; and

“(6) assess and address disparities in infant and maternal health outcomes, including among racial and ethnic minority populations and underserved populations in areas described in subsection (a).

“(c) Definitions—In this section:

“(1) Eligible entities—The term eligible entities means entities providing maternal health care services in rural areas, frontier areas, or medically underserved areas, or to medically underserved populations or Indian Tribes or Tribal organizations.

“(2) Frontier area—The term frontier area means a frontier county, as defined in section 1886(d)(3)(E)(iii)(III) of the Social Security Act.

“(3) Indian Tribes; Tribal organization—The terms Indian Tribe and Tribal organization have the meanings given the terms Indian tribe and tribal organization, respectively, in section 4 of the Indian Self-Determination and Education Assistance Act.

“(4) Maternity care health professional target area—The term maternity care health professional target area has the meaning described in section 332(k)(2).

“(d) Authorization of appropriations—There are authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2021 through 2025.”

Sec. 5048 Telehealth network and telehealth resource centers grant programs

Section 330I of the Public Health Service Act (42 U.S.C. 254c–14) is amended—
(1)
in subsection (f)(3), by adding at the end the following:

“(M) Providers of maternal care, including prenatal, labor care, birthing, and postpartum care services and entities operating obstetric care units.”

(2)
in subsection (h)(1)(B), by inserting “labor care, birthing care, postpartum care,” before “or prenatal”.

Sec. 5049 Rural maternal and obstetric care training demonstration

Subpart 1 of part E of title VII of the Public Health Service Act (42 U.S.C. 294n et seq.) is amended by adding at the end the following:

“764. Rural maternal and obstetric care training demonstration

“(a) In general—The Secretary shall award grants to accredited schools of allopathic medicine, osteopathic medicine, and nursing, and other appropriate health professional training programs, to establish a training demonstration program to support—

“(1) training for physicians, medical residents, fellows, nurse practitioners, physician assistants, nurses, certified nurse midwives, relevant home visiting workforce professionals and paraprofessionals, or other professionals who meet relevant State training and licensing requirements, as applicable, to provide maternal health care services in rural community-based settings; and

“(2) developing recommendations for such training programs.

“(b) Application—To be eligible to receive a grant under subsection (a), an entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

“(c) Activities

“(1) Training for health care professionals—A recipient of a grant under subsection (a)—

“(A) shall use the grant funds to plan, develop, and operate a training program to provide maternal health care in rural areas; and

“(B) may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish, maintain, or improve faculty development, or departments, divisions, or other units necessary to implement such training.

“(2) Training program requirements—The recipient of a grant under subsection (a) shall ensure that training programs carried out under the grant are evidence-based and address improving maternal health care in rural areas, and such programs may include training on topics such as—

“(A) maternal mental health, including perinatal depression and anxiety;

“(B) substance use disorders;

“(C) social determinants of health that affect individuals living in rural areas; and

“(D) implicit and explicit bias.

“(d) Evaluation and report

“(1) Evaluation

“(A) In general—The Secretary shall evaluate the outcomes of the demonstration program under this section.

“(B) Data submission—Recipients of a grant under subsection (a) shall submit to the Secretary performance metrics and other related data in order to evaluate the program for the report described in paragraph (2).

“(2) Report to Congress—Not later than January 1, 2025, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that includes—

“(A) an analysis of the effects of the demonstration program under this section on the quality, quantity, and distribution of maternal health care services, including health care services related to prenatal care, labor care, birthing, and postpartum care, and the demographics of the recipients of those services;

“(B) an analysis of maternal and infant health outcomes (including quality of care, morbidity, and mortality) before and after implementation of the program in the communities served by entities participating in the demonstration program; and

“(C) recommendations on whether the demonstration program should be continued.

“(e) Authorization of appropriations—There are authorized to be appropriated to carry out this section $5,000,000 for each of fiscal years 2021 through 2025.”