S. 4186 — Perinatal Workforce Act

This section directs the Secretary of Health and Human Services (HHS), not later than two years after enactment, to issue guidance to states educating providers, managed care entities, and insurers on delivering respectful maternal health care through diverse multidisciplinary models, including strategies to (1) recruit and retain diverse maternity care providers (i.e., from racially, ethnically, and linguistically diverse backgrounds or with experience and training in such communities), mental/behavioral health providers, and registered dietitians or nutrition professionals (as defined in SSA §1861(vv)); (2) incorporate midwives (meeting International Confederation of Midwives standards), perinatal health workers, physician assistants, advanced practice registered nurses, and certified lactation consultants; (3) provide collaborative culturally and linguistically congruent care; and (4) offer job shadowing for midwifery students. Separately, this section directs the HHS Secretary, acting through the NIH Director and also not later than two years after enactment, to complete a study on best practices in respectful and culturally and linguistically congruent maternity care; submit a report to Congress with public availability; and include in the report compendiums of exemplary providers, health systems, and insurers reducing maternal health disparities among racial/ethnic minorities, plus recommendations for best practices.

This section establishes a grant program under Title VII of the Public Health Service Act to grow and diversify the perinatal workforce by awarding grants to eligible entities to (1) establish accredited schools or programs training physician assistants (with clinical training in maternal and perinatal health), perinatal health workers, or midwives (meeting International Confederation of Midwives standards); or (2) expand the capacity of existing such programs (e.g., via scholarships for racially, ethnically, and linguistically diverse students). In awarding grants (up to 5 years), the Secretary must prioritize applicants with commitments or strategies to recruit/retain diverse students/faculty (especially racial/ethnic minorities and underserved populations), students planning to practice in health professional shortage areas (under section 332) or areas with maternal health disparities, and curricula including bias/racism/discrimination training (covering implicit/explicit bias). Grant recipients must submit annual reports to the Secretary on student numbers/demographics, entry into relevant practice areas, and bias training effectiveness; and the Secretary must provide technical assistance and submit a report to Congress (and post online) four years after enactment evaluating the program's impact on workforce diversity and deployment in shortage/disparity areas. The section authorizes $15 million for each of FY2027 through FY2031.

This section establishes the Perinatal Nursing Workforce Grants program, requiring the Secretary of Health and Human Services to award grants to schools of nursing to provide scholarships for students seeking to become nurse practitioners or clinical nurse specialists with a focus on maternal and perinatal health, or certified nurse-midwives. In awarding grants, which have periods of up to five years, the Secretary must prioritize schools of nursing that (1) recruit and retain diverse students, particularly from racial and ethnic minority groups and other underserved populations, for maternal and perinatal health careers; (2) partner with practice settings in health professional shortage areas (designated under section 332 of the Public Health Service Act) for student clinical placements; (3) recruit students to practice in areas with significant racial and ethnic disparities in maternal health outcomes, to the extent practicable; and (4) include bias, racism, or discrimination training (covering implicit bias and racism) in curricula for such students. Grantees must submit annual reports to the Secretary on student numbers and demographics, career plans in shortage areas or high-disparity regions, and curriculum elements; the Secretary must provide technical assistance and submit a report to Congress (also posted online) four years after enactment evaluating the program's effectiveness in increasing diverse advanced practice registered nurses in maternal and perinatal health, including in shortage areas and disparity regions. The section authorizes $15 million annually for FY2027 through FY2031.

This section directs the Comptroller General of the United States to submit to Congress a report on barriers to maternal health education and access to care in the United States, not later than two years after the date of enactment and every five years thereafter. The report must assess (1) barriers to entering and completing accredited midwifery education programs, with recommendations particularly for low-income women and women from racial and ethnic minority groups; (2) barriers to entering and completing accredited education programs for maternity care providers, mental and behavioral health care providers acting in accordance with state law, and registered dietitians or nutrition professionals (as defined in 42 U.S.C. 1395x(vv)(2)), particularly for low-income women and women from racial and ethnic minority groups; (3) barriers preventing midwives from meeting the international definition of a midwife and global standards for midwifery education as established by the International Confederation of Midwives, with recommendations particularly for low-income women and women from racial and ethnic minority groups; (4) disparities in access to maternity care providers, mental or behavioral health care providers acting in accordance with state law, registered dietitians or nutrition professionals, and perinatal health workers, stratified by race, ethnicity, gender identity, primary language, geographic location, and insurance type, with 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.

This section establishes definitions for purposes of the Act, including "(1) culturally and linguistically congruent," meaning care that is in agreement with the preferred cultural values, beliefs, worldview, language, and practices of the health care consumer and other stakeholders with respect to care or maternity care; "(2) maternity care provider," meaning a physician, physician assistant, midwife meeting international standards, advanced practice registered nurse, State-accredited doula eligible for Medicaid reimbursement, or International Board-certified lactation consultant focused on maternal or perinatal health; "(3) perinatal health worker," meaning a nonclinical health worker focused on maternal or perinatal health (e.g., 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," meaning the one-year period beginning on the last day of pregnancy; and "(5) racial and ethnic minority group," as defined in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u-6(g)(1)).