Sec. 504. Indian Health Service study and report on maternal mortality and severe maternal morbidity

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In this section: The term Director means the Director of the Indian Health Service. The term Indian Tribe has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5304 ). The term maternal mortality review committee means a maternal mortality review committee duly authorized by a State and receiving funding under section 317k(a)(2)(D) of the Public Health Service Act ( 42 U.S.C. 247b–12(a)(2)(D) ). The term Tribal epidemiology center means a Tribal epidemiology center established under section 214 of the Indian Health Care Improvement Act ( 25 U.S.C. 1621m ).

The term tribal organization has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5304 ). The term urban Indian organization has the meaning given the term in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 ). Not later than 90 days after the date of enactment of this Act, the Director, in coordination with the individuals selected under subsection (c), shall enter into an agreement with an independent research organization or a Tribal epidemiology center to conduct a comprehensive study on maternal mortality and severe maternal morbidity in Indian and Alaska Native populations.

The agreement entered into under subparagraph

(A)shall require that the independent research organization or Tribal epidemiology center submit to the Director a report describing the results of the study conducted pursuant to that agreement by not later than 2 years after the date of enactment of this Act. The study conducted under paragraph

(1)shall— examine the causes of maternal mortality and severe maternal morbidity that are unique to Indians and Alaska Natives; include a systematic process of listening to the stories of pregnant and postpartum Indians and Alaska Natives to fully understand the causes of, and inform potential solutions to, the maternal mortality and severe maternal morbidity crisis within the Indian and Alaska Native communities; identify the different settings in which pregnant and postpartum Indians and Alaska Natives receive maternity care, such as— facilities operated by the Indian Health Service; an Indian health program operated by an Indian Tribe or tribal organization pursuant to a grant from, or contract, cooperative agreement, or compact with, the Indian Health Service pursuant to the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5301 et seq.); and an urban Indian health program operated by an urban Indian organization pursuant to a grant from or contract with the Indian Health Service pursuant to title V of the Indian Health Care Improvement Act ( 25 U.S.C. 1651 et seq.); determine the different landscapes of maternity care received by pregnant and postpartum Indians and Alaska Natives at the different settings identified under subparagraph (C); review processes for coordinating programs of the Indian Health Service with social services provided through other programs administered by the Secretary of Health and Human Services (other than the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of that Act ( 42 U.S.C. 1396 et seq.), and the State Children’s Health Insurance Program established under title XXI of that Act ( 42 U.S.C. 1397aa et seq.)); review current data collection and quality measurement processes and practices with respect to pregnant and postpartum Indians and Alaska Natives; assess causes and frequency of maternal mental health conditions and substance use disorders with respect to Indians and Alaska Natives; consider social determinants of health, including poverty, lack of health insurance, unemployment, sexual violence, and environmental conditions in Tribal areas; consider the role that historical mistreatment of Indian and Alaska Native women has played in causing currently high rates of maternal mortality and severe maternal morbidity; consider how current funding of the Indian Health Service affects the ability of the Indian Health Service to deliver quality maternity care; and consider the extent to which the delivery of maternity care services is culturally appropriate for pregnant and postpartum Indians and Alaska Natives. Not later than 3 years after the date of enactment of this Act, the Director shall submit to Congress a report describing the results of the study conducted under paragraph (1), including recommendations for policies and practices that can be adopted to improve maternal health outcomes for pregnant and postpartum Indians and Alaska Natives, including recommendations— on how to improve maternal health outcomes for Indians and Alaska Natives receiving care at the different settings identified under paragraph (2)(C); on how to reduce misclassification of pregnant and postpartum Indians and Alaska Natives, including consideration of best practices in training for members of maternal mortality review committees to be able to correctly classify Indians and Alaska Natives; and informed by the stories shared by pregnant and postpartum Indians and Alaska Natives under paragraph (2)(B) to improve maternal health outcomes for those individuals. The Director shall select from among individuals nominated by Indian Tribes, tribal organizations, and urban Indian organizations 12 individuals for participation in the study conducted under subsection (b)(1). In selecting members under paragraph (1), the Director shall ensure that each of the 12 service areas of the Indian Health Service is represented. There is authorized to be appropriated to carry out this section $2,000,000 for each of fiscal years 2022 through 2024.

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