Perinatal Workforce Act
This bill establishes programs and requires research to diversify the perinatal workforce and advance respectful maternal care delivery models.
Specifically, the Department of Health and Human Services (HHS) must award grants to education and training programs to grow and diversify the professions that make up the perinatal workforce. HHS must also disseminate guidance on respectful maternal care delivery. This guidance must cover, among other topics, recruiting and retaining maternity care providers from diverse backgrounds and incorporating trained midwives and other perinatal health workers into maternity care teams.
In addition, the National Institutes of Health must study best practices for culturally and linguistically congruent maternity care. This is care that is in agreement with the preferred cultural values, beliefs, languages, worldview, and practices of health care consumers and other stakeholders.
The Government Accountability Office must also report on certain aspects of perinatal health care professions. The report must focus on barriers to entering those professions for low-income and minority women.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3523 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 3523
To grow and diversify the perinatal workforce, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 18, 2023
Ms. Moore of Wisconsin (for herself, Ms. Underwood, Ms. Adams, Mr.
Allred, Ms. Barragan, Mrs. Beatty, Mr. Bishop of Georgia, Mr.
Blumenauer, Ms. Blunt Rochester, Ms. Brownley, Ms. Budzinski, Ms. Bush,
Ms. Caraveo, Mr. Carbajal, Mr. Carson, Mr. Carter of Louisiana, Mrs.
Cherfilus-McCormick, Ms. Clarke of New York, Mr. Cleaver, Mr. Cohen,
Ms. Craig, Ms. Crockett, Mr. Davis of Illinois, Ms. Dean of
Pennsylvania, Ms. Escobar, Mr. Espaillat, Mr. Evans, Mrs. Foushee, Mr.
Garamendi, Ms. Garcia of Texas, Mr. Garcia of Illinois, Mr. Green of
Texas, Mrs. Hayes, Mr. Horsford, Mr. Huffman, Mr. Ivey, Mr. Jackson of
Illinois, Ms. Jackson Lee, Ms. Jacobs, Ms. Jayapal, Mr. Johnson of
Georgia, Ms. Kamlager-Dove, Mr. Krishnamoorthi, Ms. Kuster, Ms. Lee of
California, Mr. Lieu, Ms. Lofgren, Mrs. McBath, Mrs. McClellan, Ms.
McCollum, Mr. McGovern, Mr. Meeks, Ms. Meng, Mr. Mfume, Mr. Morelle,
Mr. Moulton, Mr. Mrvan, Mr. Mullin, Mrs. Napolitano, Mr. Neguse, Ms.
Ocasio-Cortez, Mr. Pappas, Mr. Payne, Mr. Phillips, Ms. Porter, Ms.
Pressley, Mr. Ruppersberger, Ms. Salinas, Ms. Scanlon, Mr. Schiff, Mr.
Schneider, Ms. Scholten, Mr. David Scott of Georgia, Ms. Sewell, Mr.
Soto, Ms. Spanberger, Ms. Stansbury, Ms. Strickland, Mrs. Sykes, Mr.
Takano, Ms. Tlaib, Ms. Tokuda, Mr. Tonko, Mrs. Torres of California,
Mrs. Trahan, Mr. Trone, Mr. Vargas, Mr. Veasey, Ms. Velazquez, Ms.
Wasserman Schultz, Mrs. Watson Coleman, Ms. Wexton, Ms. Williams of
Georgia, Mr. Pascrell, Ms. DelBene, and Mr. Lynch) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To grow and diversify the perinatal workforce, 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 ``Perinatal Workforce Act''.
SEC. 2. HHS AGENCY DIRECTIVES.
(a) Guidance to States.--
(1) In general.--Not later than 2 years after the date of
enactment of this Act, the Secretary of Health and Human
Services shall issue and disseminate guidance to States to
educate providers, managed care entities, and other insurers
about the value and process of delivering respectful maternal
health care through diverse and multidisciplinary care provider
models.
(2) Contents.--The guidance required by paragraph (1) shall
address how States can encourage and incentivize hospitals,
health systems, midwifery practices, freestanding birth
centers, other maternity care provider groups, managed care
entities, and other insurers--
(A) to recruit and retain maternity care providers,
mental and behavioral health care providers acting in
accordance with State law, and registered dietitians or
nutrition professionals (as such term is defined in
section 1861(vv)(2) of the Social Security Act (42
U.S.C. 1395x(vv)(2)))--
(i) from racially, ethnically, and
linguistically diverse backgrounds;
(ii) with experience practicing in racially
and ethnically diverse communities; and
(iii) who have undergone training on
implicit bias and racism;
(B) to incorporate into maternity care teams--
(i) midwives who meet, at a minimum, the
international definition of a midwife and
global standards for midwifery education as
established by the International Confederation
of Midwives;
(ii) perinatal health workers;
(iii) physician assistants;
(iv) advanced practice registered nurses;
and
(v) lactation consultants certified by the
International Board of Lactation Consultant
Examiners;
(C) to provide collaborative, culturally and
linguistically congruent care; and
(D) to provide opportunities for individuals
enrolled in accredited midwifery education programs to
participate in job shadowing with maternity care teams
in hospitals, health systems, midwifery practices, and
freestanding birth centers.
(b) Study on Respectful and Culturally and Linguistically Congruent
Maternity Care.--
(1) Study.--The Secretary of Health and Human Services
acting through the Director of the National Institutes of
Health (in this subsection referred to as the ``Secretary'')
shall conduct a study on best practices in respectful and
culturally and linguistically congruent maternity care.
(2) Report.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall--
(A) complete the study required by paragraph (1);
(B) submit to the Congress and make publicly
available a report on the results of such study; and
(C) include in such report--
(i) a compendium of examples of hospitals,
health systems, midwifery practices,
freestanding birth centers, other maternity
care provider groups, managed care entities,
and other insurers that are delivering
respectful and culturally and linguistically
congruent maternal health care;
(ii) a compendium of examples of hospitals,
health systems, midwifery practices,
freestanding birth centers, other maternity
care provider groups, managed care entities,
and other insurers that have made progress in
reducing disparities in maternal health
outcomes and improving birthing experiences for
pregnant and postpartum individuals from racial
and ethnic minority groups; and
(iii) recommendations to hospitals, health
systems, midwifery practices, freestanding
birth centers, other maternity care provider
groups, managed care entities, and other
insurers, for best practices in respectful and
culturally and linguistically congruent
maternity care.
SEC. 3. GRANTS TO GROW AND DIVERSIFY THE PERINATAL WORKFORCE.
Title VII of the Public Health Service Act is amended by inserting
after section 757 (42 U.S.C. 294f) the following new section:
``SEC. 758. PERINATAL WORKFORCE GRANTS.
``(a) In General.--The Secretary shall award grants to entities to
establish or expand programs described in subsection (b) to grow and
diversify the perinatal workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the perinatal workforce by--
``(1) establishing accredited schools or programs that
provide education and training to individuals seeking
appropriate licensing and certification as--
``(A) physician assistants who will complete
clinical training in the field of maternal and
perinatal health;
``(B) perinatal health workers; or
``(C) midwives who meet, at a minimum, the
international definition of a midwife and global
standards for midwifery education as established by the
International Confederation of Midwives; and
``(2) expanding the capacity of existing accredited schools
or programs described in paragraph (1), for the purposes of
increasing the number of students enrolled in such accredited
schools or programs, such as by awarding scholarships for
students (including students from racially, ethnically, and
linguistically diverse backgrounds).
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to a school or program described in
subsection (b) that--
``(1) has demonstrated a commitment to recruiting and
retaining students and faculty from racial and ethnic minority
groups;
``(2) has developed a strategy to recruit and retain a
diverse pool of students into the school or program described
in subsection (b) that is supported by funds received through
the grant, particularly from racial and ethnic minority groups
and other underserved populations;
``(3) has developed a strategy to recruit and retain
students who plan to practice in a health professional shortage
area designated under section 332;
``(4) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(5) includes in the standard curriculum for all students
within the school or program described in subsection (b) a
bias, racism, or discrimination training program that includes
training on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section for a school or program described in subsection (b), an entity
shall agree to submit to the Secretary an annual report on the
activities conducted through the grant, including--
``(1) the number and demographics of students participating
in the school or program;
``(2) the extent to which students in the school or program
are entering careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with elevated rates of maternal
mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth
outcomes, to the extent such data are available; and
``(3) whether the school or program has included in the
standard curriculum for all students a bias, racism, or
discrimination training program that includes explicit and
implicit bias, and if so the effectiveness of such training
program.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to entities seeking or receiving a
grant under this section on the development, use, evaluation, and
postgrant period sustainability of the school or program described in
subsection (b) that is proposed to be, or is being, established or
expanded through the grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups;
``(2) increasing the number of health professionals
described in subparagraphs (A), (B), and (C) of subsection
(b)(1) from racial and ethnic minority groups and other
underserved populations;
``(3) increasing the number of such health professionals
working in health professional shortage areas designated under
section 332; and
``(4) increasing the number of such health professionals
working in areas with significant racial and ethnic disparities
in maternal health outcomes, to the extent such data are
available.
``(i) Definition.--In this section, the term `racial and ethnic
minority group' has the meaning given such term in section 1707(g)(1).
``(j) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2024 through 2028.''.
SEC. 4. GRANTS TO GROW AND DIVERSIFY THE NURSING WORKFORCE IN MATERNAL
AND PERINATAL HEALTH.
Title VIII of the Public Health Service Act is amended by inserting
after section 811 of that Act (42 U.S.C. 296j) the following:
``SEC. 812. PERINATAL NURSING WORKFORCE GRANTS.
``(a) In General.--The Secretary shall award grants to schools of
nursing to grow and diversify the perinatal nursing workforce.
``(b) Use of Funds.--Recipients of grants under this section shall
use the grants to grow and diversify the perinatal nursing workforce by
providing scholarships to students seeking to become--
``(1) nurse practitioners whose education includes a focus
on maternal and perinatal health;
``(2) certified nurse-midwives; or
``(3) clinical nurse specialists whose education includes a
focus on maternal and perinatal health.
``(c) Prioritization.--In awarding grants under this section, the
Secretary shall give priority to any school of nursing that--
``(1) has developed a strategy to recruit and retain a
diverse pool of students seeking to enter careers focused on
maternal and perinatal health, particularly students from
racial and ethnic minority groups and other underserved
populations;
``(2) has developed a partnership with a practice setting
in a health professional shortage area designated under section
332 for the clinical placements of the school's students;
``(3) has developed a strategy to recruit and retain
students who plan to practice in an area with significant
racial and ethnic disparities in maternal health outcomes, to
the extent practicable; and
``(4) includes in the standard curriculum for all students
seeking to enter careers focused on maternal and perinatal
health a bias, racism, or discrimination training program that
includes education on implicit bias and racism.
``(d) Reporting.--As a condition on receipt of a grant under this
section, a school of nursing shall agree to submit to the Secretary an
annual report on the activities conducted through the grant, including,
to the extent practicable--
``(1) the number and demographics of students in the school
of nursing seeking to enter careers focused on maternal and
perinatal health;
``(2) the extent to which such students are preparing to
enter careers in--
``(A) health professional shortage areas designated
under section 332; and
``(B) areas with elevated rates of maternal
mortality, severe maternal morbidity, maternal health
disparities, or other adverse perinatal or childbirth
outcomes, to the extent such data are available; and
``(3) whether the standard curriculum for all students
seeking to enter careers focused on maternal and perinatal
health includes a bias, racism, or discrimination training
program that includes education on implicit bias and racism.
``(e) Period of Grants.--The period of a grant under this section
shall be up to 5 years.
``(f) Application.--To seek a grant under this section, an entity
shall submit to the Secretary an application, at such time, in such
manner, and containing such information as the Secretary may require,
including any information necessary for prioritization under subsection
(c).
``(g) Technical Assistance.--The Secretary shall provide, directly
or by contract, technical assistance to schools of nursing seeking or
receiving a grant under this section on the processes of awarding and
evaluating scholarships through the grant.
``(h) Report by the Secretary.--Not later than 4 years after the
date of enactment of this section, the Secretary shall prepare and
submit to the Congress, and post on the internet website of the
Department of Health and Human Services, a report on the effectiveness
of the grant program under this section at--
``(1) recruiting students from racial and ethnic minority
groups and other underserved populations;
``(2) increasing the number of advanced practice registered
nurses entering careers focused on maternal and perinatal
health from racial and ethnic minority groups and other
underserved populations;
``(3) increasing the number of advanced practice registered
nurses entering careers focused on maternal and perinatal
health working in health professional shortage areas designated
under section 332; and
``(4) increasing the number of advanced practice registered
nurses entering careers focused on maternal and perinatal
health working in areas with significant racial and ethnic
disparities in maternal health outcomes, to the extent such
data are available.
``(i) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2024 through 2028.''.
SEC. 5. GAO REPORT.
(a) In General.--Not later than 2 years after the date of enactment
of this Act and every 5 years thereafter, the Comptroller General of
the United States shall submit to Congress a report on barriers to
maternal health education and access to care in the United States. Such
report shall include the information and recommendations described in
subsection (b).
(b) Content of Report.--The report under subsection (a) shall
include--
(1) an assessment of current barriers to entering and
successfully completing accredited midwifery education
programs, and recommendations for addressing such barriers,
particularly for low-income women and women from racial and
ethnic minority groups;
(2) an assessment of current barriers to entering and
successfully completing accredited education programs for other
health professional careers related to maternity care,
including maternity care providers, mental and behavioral
health care providers acting in accordance with State law, and
registered dietitians or nutrition professionals (as such term
is defined in section 1861(vv)(2) of the Social Security Act
(42 U.S.C. 1395x(vv)(2))), particularly for low-income women
and women from racial and ethnic minority groups;
(3) an assessment of current barriers that prevent midwives
from meeting the international definition of a midwife and
global standards for midwifery education as established by the
International Confederation of Midwives, and recommendations
for addressing such barriers, particularly for low-income women
and women from racial and ethnic minority groups;
(4) an assessment of disparities in access to maternity
care providers, mental or behavioral health care providers
acting in accordance with State law, and registered dietitians
or nutrition professionals (as such term is defined in section
1861(vv)(2) of the Social Security Act (42 U.S.C.
1395x(vv)(2))), and perinatal health workers, stratified by
race, ethnicity, gender identity, primary language, geographic
location, and insurance type and recommendations to promote
greater access equity; and
(5) recommendations to promote greater equity in
compensation for perinatal health workers under public and
private insurers, particularly for such individuals from
racially and ethnically diverse backgrounds.
SEC. 6. DEFINITIONS.
In this Act:
(1) Culturally and linguistically congruent.--The term
``culturally and linguistically congruent'', with respect to
care or maternity care, means care that is in agreement with
the preferred cultural values, beliefs, worldview, language,
and practices of the health care consumer and other
stakeholders.
(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) Maternity care provider.--The term ``maternity care
provider'' means a health care provider who--
(A) is a physician, physician assistant, 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, 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.
(4) 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.
(5) Postpartum.--The term ``postpartum'' refers to the 1-
year period beginning on the last day of the pregnancy of an
individual.
(6) 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)).
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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