S. 5283 — Momnibus Act

This section establishes a task force, chaired by the Secretary of Health and Human Services and comprising 17 specified federal officials plus appointed patient representatives, community leaders, perinatal workers, and maternity care providers, to coordinate federal and nonfederal efforts addressing clinical and nonclinical causes of maternal mortality, severe maternal morbidity, and racial disparities. It requires the task force to submit public annual reports to Congress beginning two years after enactment.

This section authorizes the Secretary of Health and Human Services to award grants to community-based organizations, Indian Tribes, Tribal organizations, Urban Indian organizations, and certain public health departments or nonprofits to address social determinants of maternal health, including housing, transportation, nutrition, employment, environmental conditions, and intimate partner violence. It prioritizes areas with high rates of maternal mortality, severe maternal morbidity, or poverty; requires annual grantee reports with data disaggregated by race, ethnicity, and other factors; directs the Secretary to submit a summary report to Congress by the end of FY2031; and authorizes $100 million annually for FY2027 through FY2031.

This section extends WIC eligibility for postpartum women to 24 months (from 6 months) and for breastfeeding women to 24 months (from 1 year). It requires the Secretary to submit a report to Congress within 2 years evaluating effects on maternal and infant health outcomes, including racial and ethnic disparities, breastfeeding rates, and family experiences under the program.

This section directs the Secretary of Health and Human Services to award grants to community-based organizations to establish or expand programs advancing maternal health equity for demographic groups with elevated rates of maternal mortality, severe maternal morbidity, or related disparities. It requires a one-year outreach and technical assistance period before grant awards begin, mandates special consideration for entities based in, led by, and serving affected communities, and lists eligible activities including maternal mental health and substance use supports, social determinants of health, perinatal health worker training, group prenatal and postpartum care, mutual aid during infant formula shortages, pregnancy loss support, and midwifery practice expansion. The section also requires the Secretary to provide technical assistance to recipients and submit an evaluation of the program to Congress by the end of FY2031.

This section establishes a grant program to reduce bias, racism, and discrimination in maternity care settings and advance respectful, culturally and linguistically congruent, trauma-informed care. It requires the Secretary to give special consideration to programs that apply to all maternity care employees, emphasize periodic training, address implicit bias and antiracism, integrate with obstetric emergency simulations, and meet other specified criteria; mandates annual reports on patient outcomes for racial and ethnic minority groups; and authorizes $5 million annually for fiscal years 2027 through 2031.

This section directs the Secretary of Health and Human Services to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine within 90 days of enactment to conduct a study on the design and implementation of programs that reduce bias, racism, and discrimination in maternity care settings and advance respectful, culturally and linguistically congruent, trauma-informed care. The Academies must complete the study and transmit a report to Congress within 24 months of enactment.

This section directs the Secretary of Health and Human Services to award grants to accredited hospitals, health systems, and other maternity care settings to establish respectful maternity care compliance programs. The programs must enable reporting of racism or bias, provide timely follow-up with patients and families, develop and publicly release hospital-wide strategies to reduce bias (including employee training and routine assessments), collect and publicly report patient experience data, and submit annual case reports to the Secretary containing deidentified demographics and institutional responses. The Secretary must establish dissemination, coordination, and evaluation processes within 180 days, contract for an independent study on addressing racism and bias in maternity care within 2 years that includes recommendations for accountability mechanisms, and submit the study results to Congress. The section authorizes such sums as may be necessary for fiscal years 2027 through 2032.

This section requires the Comptroller General to submit to Congress and make publicly available, beginning two years after enactment and annually thereafter, a report on the establishment of respectful maternity care compliance programs in hospitals, health systems, and other maternity care settings. The report must address adoption rates and timing, effects on maternal health outcomes and patient experiences (particularly for racial and ethnic minority groups), geographic and facility-type gaps with contributing factors, funding sufficiency, and recommendations for expansion.

This section requires the Secretary of Veterans Affairs to submit annual reports to Congress, through September 30, 2031, summarizing maternity health care and coordination programs, data on maternal health outcomes for veterans (including those dually eligible with the Indian Health Service), and recommendations to improve outcomes for demographic groups with elevated rates of maternal mortality or morbidity. It authorizes $15 million per year for fiscal years 2027 through 2031 for such programs, in addition to existing funding.

This section directs the Secretary of Health and Human Services to issue guidance to states within 2 years on educating providers and insurers about respectful maternal health care. The guidance must address recruiting and retaining diverse maternity, mental health, and nutrition providers; incorporating midwives, perinatal health workers, physician assistants, advanced practice nurses, and certified lactation consultants into care teams; and delivering culturally and linguistically congruent care. It also requires the National Institutes of Health to complete a study on best practices in such care and submit a public report to Congress within 2 years that includes examples of effective providers and recommendations for reducing maternal health disparities.

This section establishes a perinatal workforce grant program under which the Secretary awards funds to create or expand accredited training programs for physician assistants specializing in maternal and perinatal health, perinatal health workers, and midwives meeting international standards. It authorizes $15 million annually for fiscal years 2027 through 2031, prioritizes applicants with strategies to recruit diverse students and those committed to practicing in shortage areas or areas with maternal health disparities, requires annual grantee reports on student demographics and outcomes, and directs the Secretary to report to Congress on program effectiveness after four years.

This section establishes a perinatal nursing workforce grant program under which the Secretary awards grants to schools of nursing to provide scholarships for students pursuing careers as nurse practitioners or clinical nurse specialists with a maternal and perinatal health focus, or as certified nurse-midwives. Grants last up to five years, with priority given to schools that recruit diverse students, partner with health professional shortage areas, target areas with maternal health disparities, and include bias training in the curriculum; the program is authorized at $15 million annually for fiscal years 2027 through 2031.

This section requires the Comptroller General to submit a report to Congress not later than 2 years after enactment and every 5 years thereafter on barriers to maternal health education and access to care. The report must assess barriers to accredited midwifery and maternity-related education programs, barriers to meeting international midwifery standards, disparities in access to maternity care providers and perinatal health workers, and recommendations to address such barriers and promote compensation equity, particularly for low-income women and women from racial and ethnic minority groups.

This section authorizes $10 million annually for fiscal years 2027 through 2031 for grants to state, tribal, and urban Indian maternal mortality review committees to increase membership diversity with respect to race, ethnicity, location, and personal or professional background; address participation barriers such as training, transportation, and compensation; conduct outreach focused on racial and ethnic minority groups; and issue public reports assessing review processes and fund impacts. It reserves at least $1.5 million annually for tribal grants and requires technical assistance on best practices.

This section expands the required activities of maternal mortality review committees to include, to the extent practicable, reviewing cases of severe maternal morbidity using the most current indicators; reviewing deaths during pregnancy or within one year after from suicide, overdose, or other mental health or substance use conditions attributed to or aggravated by pregnancy or childbirth; and consulting local community-based organizations representing groups with elevated rates of maternal mortality or disparities to consider nonclinical contributing factors.

This section directs the Secretary of Health and Human Services, acting through the Centers for Medicare & Medicaid Services Administrator and the Agency for Healthcare Research and Quality Director, to consult with specified stakeholders—including pregnant and postpartum individuals from racial and ethnic minority groups, community organizations, maternity care providers, and state maternal mortality review committees—to review existing maternal health data collection processes and quality measures and make recommendations to improve them. The review must assess state and tribal data practices on maternal mortality and severe maternal morbidity, barriers to demographic data linkage, funding adequacy, and the sufficiency of current prenatal, labor and delivery, and postpartum quality measures.

This section directs the Secretary of Health and Human Services to enter into a contract within 90 days with an independent research organization or Tribal Epidemiology Center to study maternal mortality, severe maternal morbidity, and adverse perinatal outcomes among American Indian and Alaska Native individuals. It requires a report with policy recommendations to Congress within 3 years, incorporates input from 12 tribal representatives across all Indian Health Service areas, and authorizes $2 million annually for fiscal years 2027 through 2029.

This section establishes a grant program under which the Secretary of Health and Human Services awards funds to research centers, health professions schools, and other entities at minority-serving institutions to study maternal mortality, severe maternal morbidity, and related adverse outcomes among pregnant and postpartum individuals from racial and ethnic minority groups. It authorizes $10 million annually for fiscal years 2027 through 2031.

This section establishes a grant program administered by the Secretary of Health and Human Services, through the Assistant Secretary for Mental Health and Substance Use, to award funds to eligible entities such as community-based organizations for addressing maternal mental health conditions and substance use disorders. It prioritizes entities partnering with community organizations or operating in areas with elevated maternal mortality, severe maternal morbidity, or health professional shortages, and requires grantees to use funds for integration of behavioral health into maternity care, group prenatal and postpartum programs, suicide prevention, provider training, hotlines, and stigma reduction, with annual public reports from recipients and a comprehensive evaluation report to Congress by the end of FY2030.

This section authorizes the Secretary to award grants to entities to establish or expand schools or programs that train mental and behavioral health providers specializing in maternal mental health conditions or substance use disorders, including through scholarships. It requires grantees to submit annual reports on student demographics, practice locations in health professional shortage areas or areas with maternal health disparities, and bias training; directs the Secretary to provide technical assistance and submit a report to Congress after four years on program effectiveness; prioritizes entities with strategies to recruit from racial and ethnic minority groups and underserved populations; and authorizes $15 million annually for fiscal years 2027 through 2031.

This section reduces by 25 percent the Edward Byrne Memorial Justice Assistance Grant Program allocation to any state that lacks laws restricting the use of restraints on pregnant individuals in prison substantially similar to the rights, procedures, requirements, effects, and penalties in 18 U.S.C. 4322, beginning 6 months after enactment, and reallocates the withheld amounts to compliant states.

This section directs the Attorney General to establish maternal health programs in at least 6 Bureau of Prisons facilities within 1 year of enactment to optimize outcomes for pregnant and postpartum incarcerated individuals. The 5-year programs may provide perinatal health workers, nutrition counseling, staff training, mental health and trauma services, parenting education, newborn bonding support, reentry assistance, and pretrial diversion partnerships, with results reported at 3 and 6 years after enactment.

This section establishes the Justice for Incarcerated Moms grant program, under which the Attorney General awards 5-year grants to States no later than 1 year after enactment to establish or expand programs in State and local prisons and jails for pregnant and postpartum incarcerated individuals. Programs may provide perinatal health workers, nutrition counseling, officer and medical staff training, mental health and trauma treatment, parenting education, newborn bonding support, reentry assistance, and pretrial diversion partnerships. Grants prioritize States with larger numbers of affected individuals from groups with elevated maternal mortality and morbidity rates.

This section requires the Comptroller General to submit a report to Congress within 2 years on adverse maternal and infant health outcomes among incarcerated individuals, with a focus on racial and ethnic disparities. The report must include data on the number of pregnant individuals in Bureau of Prisons facilities; pregnancy-related deaths, severe maternal morbidity, and preterm or low-birthweight births over the most recent 10 years across Federal, State, and local facilities; effects of Medicaid ineligibility under title XIX of the Social Security Act; detention policies tied to positive drug tests; unique causes of adverse outcomes; and recommendations to reduce maternal mortality, morbidity, and disparities.

This section expands the payment and service delivery models that the Center for Medicare and Medicaid Innovation must test to include one focused on Medicaid that adopts telehealth tools for screening, monitoring, and managing common health complications during pregnancy and for up to one year after pregnancy. The change takes effect one year after enactment.

This section establishes a grant program, administered by the Secretary of Health and Human Services, to evaluate, develop, and expand technology-enabled collaborative learning models that improve maternal health outcomes in health professional shortage areas, rural and underserved areas, areas with high rates of maternal mortality or disparities, and for medically underserved populations and American Indians and Alaska Natives. It limits awards to one 5-year grant, requires training on implicit bias, maternal mental health, substance use disorders, public health emergencies, social determinants, and remote monitoring, mandates evaluations and reporting, provides technical assistance, and authorizes $6 million annually for fiscal years 2027 through 2031.

This section establishes a grant program under which the Secretary of Health and Human Services awards up to one 5-year grant to reduce maternal health disparities by expanding access to digital tools, including provider-facing early warning systems and clinical decision support. It prioritizes entities in areas with elevated maternal mortality or severe morbidity rates, health professional shortage areas, or rural and underserved communities; requires grantee and congressional reports with evaluations and recommendations on telehealth, privacy, data sharing, and related topics; and authorizes $6 million annually for fiscal years 2027 through 2031.

This section directs the Secretary of Health and Human Services to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine within 60 days of enactment to study the use of innovative technology, including artificial intelligence, and patient monitoring devices such as pulse oximeters in maternity care. The study must examine effects on racial and ethnic biases, best practices for reducing those biases, best practices for serving pregnant and postpartum individuals from racial and ethnic minority groups, and privacy and security safeguards, with a report transmitted to Congress within 24 months of enactment.

This section establishes the Perinatal Care Alternative Payment Model Demonstration Project for fiscal years 2027 through 2031. It allows States to test alternative payment models for maternity care provided to pregnant and postpartum individuals under Medicaid and CHIP, requires stakeholder coordination and model considerations focused on risk stratification, quality metrics, nonhospital settings, and maternal mental health, directs an evaluation of health outcomes and spending with data stratified by race, ethnicity, and other factors, and requires a report to Congress with recommendations on continuation after fiscal year 2031.

This section defines "respectful maternity care" as care for pregnant and postpartum individuals that is culturally and linguistically congruent, maintains dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support. It also defines "Secretary" as the Secretary of Health and Human Services.

This section authorizes appropriations of $190 million for CDC and NICHD programs on maternal health data collection, surveillance, and research during public health emergencies, including $100 million for the Surveillance for Emerging Threats to Mothers and Babies program, $30 million for the ERASE MM program, $45 million for the Pregnancy Risk Assessment Monitoring System, and $15 million for the National Institute of Child Health and Human Development.

This section requires the Secretary of Health and Human Services, through the CDC and CMS, to publicly post on the CDC website data on infectious disease testing, confirmed cases, hospitalizations, deaths, and maternal and infant health outcomes among pregnant and postpartum individuals during public health emergencies. It mandates monthly updates during emergencies and for at least one month afterward, disaggregation by race, ethnicity, gender, primary language, geography, and socioeconomic status, privacy protections including de-identification, consultation with Indian Tribes and Urban Indian organizations, and issuance of guidance to states and localities within 30 days of a public health emergency declaration.

This section directs the Director of the Centers for Disease Control and Prevention to conduct public health education campaigns during public health emergencies. The campaigns must deliver accurate, evidence-based information on maternal and infant health risks to pregnant and postpartum individuals, their employers, and their health care providers, with particular focus on underserved communities.

This section establishes a Department of Health and Human Services task force, in consultation with the CDC and HRSA, to develop, publicly post, and update Federal recommendations in multiple languages on respectful, responsive, and empowering maternity care during public health emergencies. The recommendations focus on equitable outcomes for demographic groups with elevated maternal mortality and morbidity rates and address 21 specific topics including telehealth access, midwifery licensure and Medicaid reimbursement, doula coverage, newborn separation, breast milk feeding, mental health screening, intimate partner violence, hospital capacity, implicit bias training, and care for undocumented and uninsured individuals.

This section defines terms used throughout the title, including adverse maternal and infant health outcomes such as preterm birth, low birth weight, stillbirth, and maternal mortality; risks associated with climate change such as extreme heat, air pollution, and extreme weather events; vulnerable individuals as those who are pregnant, were pregnant in the prior year, or are under age 3; and stakeholder organizations such as community-based groups and nonprofits focused on maternal health or climate justice.

This section establishes a grant program, administered by the Secretary of Health and Human Services, that awards competitive grants to 10 covered entities to protect vulnerable individuals from climate change risks. It requires selection of recipients within 270 days after enactment after consultation with the EPA, NOAA, and specified HHS officials, with priority for counties or localities designated as nonattainment areas, rated moderate-to-high or higher on the Social Vulnerability Index, experiencing temperatures that pose health risks, or showing elevated maternal mortality, severe morbidity, or natural hazard risks. Grant funds may be used only for training health care providers and perinatal workers, data collection and sharing on risks, distribution of air conditioning units and weatherization support, direct financial assistance, evacuation and housing services, and initiatives to reduce exposure to such risks.

This section establishes a grant program, administered by the Secretary of Health and Human Services, to award competitive grants to accredited health profession schools for developing curricula on identifying and addressing climate change risks for vulnerable individuals, including those intending to become pregnant, with required focus on racial and ethnic disparities, patient counseling, and access to services. It authorizes $5 million for fiscal years 2027 through 2030 and requires annual grantee reports plus a Secretary's report to Congress six years after establishment.

This section establishes the Consortium on Birth and Climate Change Research at the National Institutes of Health not later than one year after enactment. The Consortium coordinates research across NIH institutes and centers on climate change risks to vulnerable individuals, with priorities on identifying disparities and reduction strategies among racial and ethnic minority groups and other underserved populations; identifies data, collaboration, and funding gaps; increases public awareness; publishes annual reports; and consults with the Environmental Protection Agency, National Oceanic and Atmospheric Administration, Occupational Safety and Health Administration, and specified Department of Health and Human Services agencies plus maternal health and environmental justice stakeholders.

This section directs the Secretary of Health and Human Services, acting through the CDC Director, to develop and publish within 18 months a strategy for designating areas at high risk of adverse maternal and infant health outcomes for vulnerable individuals due to climate change. The strategy must incorporate data on air pollution, extreme heat, health care access, insurance status, English proficiency, racial and ethnic disparities, socioeconomic factors, and housing, transportation, and nutrition access; identify existing mapping tools, monitoring networks, and gaps; estimate required funding; and outline data uses for grant programs. The Secretary must coordinate with the EPA and NOAA Administrators, consult specified stakeholders, and provide 90 days for public comment before publication.

This section establishes the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) Initiative at the National Institutes of Health. The Initiative advances research to reduce preventable maternal mortality and severe maternal morbidity, reduce related health disparities, and improve outcomes for pregnant and postpartum women; it authorizes appropriations of $73,400,000 for each of fiscal years 2027 through 2032.

This section expands the national evidence-based vaccine awareness campaign to target pregnant and postpartum individuals in addition to communities with low vaccination rates. It requires dissemination of resources to obstetric care providers and includes information on vaccinations for pregnant and postpartum individuals. It increases annual funding for the campaign to $17 million for fiscal years 2027 through 2031 (from $15 million for fiscal years 2021 through 2025). It also directs activities to increase vaccination rates among pregnant and postpartum individuals, including from racial and ethnic minority groups, and their children.