Florida Senate - 2021 SB 1556 By Senator Gibson 6-01874-21 20211556__ 1 A bill to be entitled 2 An act relating to maternal health care services; 3 creating s. 383.52, F.S.; defining terms; requiring 4 the Department of Health to develop and implement the 5 Prevention of Maternal Mortality Grant Program by a 6 specified date; providing eligibility criteria; 7 requiring the department to conduct certain outreach 8 and technical assistance to eligible entities; 9 requiring the department to give special consideration 10 to certain eligible entities; requiring the department 11 to provide certain technical assistance to grant 12 recipients; requiring the department to submit a 13 report to the Governor and Legislature by a specified 14 date; requiring the department to adopt rules; 15 creating s. 383.53, F.S.; requiring the department to 16 award grants to certain training programs; providing 17 for an application; providing reporting requirements 18 for grant recipients and the department; requiring the 19 department, in consultation with the Office of Program 20 Policy Analysis and Government Accountability 21 (OPPAGA), to conduct a certain study and submit a 22 report to the Governor and Legislature by a specified 23 date; requiring the department to adopt rules; 24 creating s. 383.54, F.S.; defining terms; requiring 25 the department to award grants to certain eligible 26 entities by a specified date; requiring that grant 27 funds be used for specified activities; providing 28 limitations on the award of such grants; providing 29 requirements for such grants and grant applications; 30 authorizing the department to coordinate with other 31 state agencies to ensure that grant recipients have 32 access to reliable broadband technology; requiring the 33 department to provide certain technical assistance to 34 eligible entities and grant recipients; requiring the 35 department, in coordination with certain stakeholders, 36 to develop a strategic plan to research and evaluate 37 certain models; providing reporting requirements for 38 grant recipients and the department; requiring the 39 department to adopt rules; creating s. 383.55, F.S.; 40 defining the terms “department” and “eligible entity”; 41 requiring the department to develop and implement the 42 Investments in Digital Tools to Promote Equity in 43 Maternal Health Outcomes Program by a specified date; 44 providing eligibility criteria; providing for an 45 application; providing limitations on the award of 46 such grants; requiring the department to provide 47 certain technical assistance to eligible entities; 48 providing reporting requirements for grant recipients 49 and the department; requiring the department, in 50 consultation with OPPAGA, to conduct a certain study 51 and submit a report to the Governor and Legislature by 52 a specified date; requiring the department to adopt 53 rules; providing an effective date. 54 55 Be It Enacted by the Legislature of the State of Florida: 56 57 Section 1. Section 383.52, Florida Statutes, is created to 58 read: 59 383.52 Prevention of Maternal Mortality Grant Program.— 60 (1) DEFINITIONS.—As used in this section, the term: 61 (a) “Culturally congruent” means in agreement with the 62 preferred cultural values, beliefs, worldview, and practices of 63 the health care consumer and other stakeholders. 64 (b) “Department” means the Department of Health. 65 (c) “Postpartum” means the 1-year period beginning on the 66 last day of a woman’s pregnancy. 67 (2) PROGRAM.—By July 1, 2022, the department shall develop 68 and implement the Prevention of Maternal Mortality Grant Program 69 to award grants to eligible entities to establish or expand 70 programs to prevent maternal mortality and severe maternal 71 morbidity among black women. 72 (3) ELIGIBILITY.—To be eligible to seek a grant under this 73 section, an entity must be a community-based organization 74 offering programs and resources aligned with evidence-based 75 practices for improving maternal health outcomes for black 76 women. 77 (4) OUTREACH AND TECHNICAL ASSISTANCE.— 78 (a) Beginning July 1, 2021, the department shall: 79 1. Conduct outreach to encourage eligible entities to apply 80 for grants under this section; and 81 2. Provide technical assistance to eligible entities on 82 best practices for applying for grants under this section. 83 (b) In conducting outreach, the department shall give 84 special consideration to eligible entities that: 85 1. Are based in, and provide support for, communities with 86 high rates of adverse maternal health outcomes and significant 87 racial and ethnic disparities in maternal health outcomes; 88 2. Are led by black women; and 89 3. Offer programs and resources that are aligned with 90 evidence-based practices for improving maternal health outcomes 91 for black women. 92 (5) AWARDS.—In awarding grants under this section, the 93 department shall give special consideration to eligible entities 94 that meet all of the following criteria: 95 (a) Meet the criteria specified in paragraph (4)(b). 96 (b) Offer programs and resources designed in consultation 97 with and intended for black women. 98 (c) Offer programs and resources in the communities in 99 which they are located which include any of the following 100 activities: 101 1. Promotion of maternal mental health and maternal 102 substance use disorder treatments that are aligned with 103 evidence-based practices for improving maternal mental health 104 outcomes for black women. 105 2. Addressing social determinants of health for women in 106 the prenatal and postpartum periods, including, but not limited 107 to, any of the following: 108 a. Inadequate housing. 109 b. Transportation barriers. 110 c. Poor nutrition. 111 d. Lack of access to healthy foods. 112 e. Need for lactation support. 113 f. Need for lead abatement and other efforts to improve air 114 and water quality. 115 g. Lack of access to child care. 116 h. Need for car seat installation. 117 i. Need for wellness and stress management programs. 118 j. Need for coordination across safety net and social 119 support services and programs. 120 3. Promotion of evidence-based health literacy and 121 pregnancy, childbirth, and parenting education for women in the 122 prenatal and postpartum periods. 123 4. Providing support from doulas and other perinatal health 124 workers to women from pregnancy through the postpartum period. 125 5. Providing culturally congruent training to perinatal 126 health workers such as doulas, community health workers, peer 127 supporters, certified lactation consultants, nutritionists and 128 dietitians, social workers, home visitors, and navigators. 129 6. Conducting or supporting research on issues affecting 130 black maternal health. 131 7. Development of other programs and resources that address 132 community-specific needs for women in the prenatal and 133 postpartum periods and are aligned with evidence-based practices 134 for improving maternal health outcomes for black women. 135 (6) TECHNICAL ASSISTANCE.—The department shall provide to 136 grant recipients under this section technical assistance 137 regarding all of the following: 138 (a) Capacity building to establish or expand programs to 139 prevent adverse maternal health outcomes among black women. 140 (b) Best practices in data collection, measurement, 141 evaluation, and reporting. 142 (c) Planning for sustaining programs to prevent maternal 143 mortality and severe maternal morbidity among black women when 144 the grant expires. 145 (7) REPORT.—By July 1, 2023, and each year thereafter, the 146 department shall submit a report to the Governor, the President 147 of the Senate, and the Speaker of the House of Representatives 148 which includes all of the following: 149 (a) Assessment of the effectiveness of outreach efforts 150 during the application process in diversifying the pool of grant 151 recipients. 152 (b) Recommendations for future outreach efforts to 153 diversify the pool of grant recipients for department grant 154 programs and funding opportunities. 155 (c) Assessment of the effectiveness of programs funded by 156 grants awarded under this section in improving maternal health 157 outcomes for black women. 158 (d) Recommendations for future department grant programs 159 and funding opportunities that deliver funding to community 160 based organizations to improve maternal health outcomes for 161 black women through programs and resources that are aligned with 162 evidence-based practices for improving maternal health outcomes 163 for black women. 164 (8) RULES.—The department shall adopt rules to implement 165 this section. 166 Section 2. Section 383.53, Florida Statutes, is created to 167 read: 168 383.53 Training programs for employees in maternity care 169 settings.— 170 (1) GRANTS.—The Department of Health shall award grants to 171 training programs that reduce and prevent bias, racism, and 172 discrimination in maternity care settings. In awarding grants 173 under this section, the department shall give special 174 consideration to programs that would: 175 (a) Apply to all birthing professionals and any employees 176 who interact with pregnant and postpartum women, as the term 177 “postpartum” is defined in s. 383.52(1), in the provider 178 setting, including front desk employees, technicians, 179 schedulers, health care professionals, hospital or health system 180 administrators, and security staff; 181 (b) Emphasize periodic, as opposed to one-time, trainings 182 for all birthing professionals and employees described in 183 paragraph (a); 184 (c) Address implicit bias and explicit bias; 185 (d) Be delivered in continuing education settings for 186 providers maintaining their licenses, with a preference for 187 training programs that provide continuing education units and 188 continuing medical education; 189 (e) Include trauma-informed care best practices and an 190 emphasis on shared decisionmaking between providers and 191 patients; 192 (f) Include a service-learning component that sends 193 providers to work in underserved communities to better 194 understand patients’ life experiences; 195 (g) Be delivered in undergraduate degree programs, such as 196 biology and premedicine, which generally lead to enrollment in 197 or are prerequisite programs for medical schools; 198 (h) Be delivered in settings where providers of the federal 199 Special Supplemental Nutrition Program for Women, Infants, and 200 Children would receive the training; 201 (i) Integrate bias training in obstetric emergency 202 simulation trainings; 203 (j) Offer training to all maternity care providers on the 204 value of racially, ethnically, and professionally diverse 205 maternity care teams to provide culturally congruent care as 206 defined in s. 383.52(1), including doulas, community health 207 workers, peer supporters, certified lactation consultants, 208 nutritionists and dietitians, social workers, home visitors, and 209 navigators; or 210 (k) Be based on one or more programs designed by a 211 historically black college or university. 212 (2) APPLICATION.—To seek a grant under this section, an 213 entity shall submit an application at such time, in such manner, 214 and containing such information as the department may require. 215 (3) REPORTING.—Each recipient of a grant under this section 216 shall annually submit to the department a report on the status 217 of activities conducted under the grant, including, as 218 applicable, a description of the impact of training provided 219 through the grant on patient outcomes and patient experiences 220 for minority women and their families. 221 (4) BEST PRACTICES.—Based on the annual reports submitted 222 pursuant to subsection (3), the department: 223 (a) Shall produce an annual report on the findings 224 resulting from programs funded through this section; 225 (b) Shall disseminate such report to all recipients of 226 grants under this section and to the public; and 227 (c) May include in such report findings on best practices 228 for improving patient outcomes and patient experiences for 229 minority women and their families in maternity care settings. 230 (5) STUDY.— 231 (a) The department, in consultation with the Office of 232 Program Policy Analysis and Government Accountability, shall 233 conduct a study on the design and implementation of programs to 234 reduce and prevent bias, racism, and discrimination in maternity 235 care settings. 236 (b) The study may include: 237 1. The development of a scorecard for programs designed to 238 reduce and prevent bias, racism, and discrimination in maternity 239 care settings to assess the effectiveness of such programs in 240 improving patient outcomes and patient experiences for minority 241 women and their families. 242 2. Determination of the types of training to reduce and 243 prevent bias, racism, and discrimination in maternity care 244 settings which are demonstrated to improve patient outcomes or 245 patient experiences for minority women and their families. 246 (c) By December 1, 2022, the department, in coordination 247 with the Office of Program Policy Analysis and Government 248 Accountability, shall submit a report to the Governor, the 249 President of the Senate, and the Speaker of the House of 250 Representatives which includes findings and recommendations 251 based on the study required by this subsection. 252 (6) RULES.—The department shall adopt rules to implement 253 this section. 254 Section 3. Section 383.54, Florida Statutes, is created to 255 read: 256 383.54 Expanding capacity for positive maternal health 257 outcomes.— 258 (1) DEFINITIONS.—As used in this section, the term: 259 (a) “Department” means the Department of Health. 260 (b) “Eligible entity” means an entity that provides, or 261 supports the provision of, maternal health care services or 262 other evidence-based services for pregnant and postpartum women: 263 1. In health professional shortage areas; 264 2. In areas with high rates of adverse maternal health 265 outcomes and significant racial and ethnic disparities in 266 maternal health outcomes; or 267 3. Medically underserved populations. 268 269 The term includes entities leading, or capable of leading, a 270 technology-enabled collaborative learning and capacity-building 271 model or engaging in technology-enabled collaborative training 272 of participants in such model. 273 (c) “Health professional shortage area” means a geographic 274 area designated as such by the Health Resources and Services 275 Administration of the United States Department of Health and 276 Human Services. 277 (d) “Indigenous population” means any Indian tribe, band, 278 nation, tribal organization, urban Indian organization, or other 279 organized group or community of Indians recognized as eligible 280 for services provided to Indians by the United States Secretary 281 of the Interior because of their status as Indians. The term 282 includes any Alaskan native village as defined in 43 U.S.C. s. 283 1602(c), the Alaska Native Claims Settlement Act, as that 284 definition existed on the effective date of this act. 285 (e) “Maternal mortality” means a death occurring during 286 pregnancy or the postpartum period which is caused by pregnancy 287 or childbirth complications. 288 (f) “Medically underserved population” means the population 289 of an urban or rural area designated by the United States 290 Secretary of Health and Human Services as an area with a 291 shortage of personal health care services or a population group 292 designated by the United States Secretary of Health and Human 293 Services as having a shortage of such services. 294 (g) “Postpartum” has the same meaning as provided in s. 295 383.52(1). 296 (h) “Severe maternal morbidity” means an unexpected outcome 297 caused by a woman’s labor and delivery that results in 298 significant short-term or long-term consequences to the woman’s 299 health. 300 (i) “Technology-enabled collaborative learning and capacity 301 building model” means a distance health care education model 302 that connects health care professionals, and particularly 303 specialists, with other health care professionals through 304 simultaneous interactive videoconferencing for the purpose of 305 facilitating case-based learning, disseminating best practices, 306 and evaluating outcomes in the context of maternal health care. 307 (2) PROGRAM ESTABLISHED.—By July 1, 2022, the department 308 shall award grants to eligible entities to evaluate, develop, 309 and, as appropriate: 310 (a) Expand the use of technology-enabled collaborative 311 learning and capacity building models; and 312 (b) Improve maternal health outcomes in health professional 313 shortage areas; in areas with high rates of maternal mortality 314 and severe maternal morbidity and significant racial and ethnic 315 disparities in maternal health outcomes; and for medically 316 underserved populations, including, but not limited to, 317 indigenous populations. 318 (3) USE OF GRANT FUNDS.— 319 (a) Grants awarded under this section must be used for any 320 of the following: 321 1. The development and acquisition of instructional 322 programming and the training of maternal health care providers 323 and other health care professionals that provide or assist in 324 the provision of health care services through models such as: 325 a. Training on adopting and effectively implementing 326 Alliance for Innovation on Maternal Health safety and quality 327 improvement bundles; 328 b. Training on implicit and explicit bias, racism, and 329 discrimination for maternity care providers; 330 c. Training on best practices in screening for and, as 331 needed, evaluating and treating maternal mental health 332 conditions and substance use disorders; 333 d. Training on how to screen for social determinants of 334 health risks in the prenatal and postpartum periods, such as 335 inadequate housing, lack of access to nutrition, environmental 336 risks, and transportation barriers; or 337 e. Training on the use of remote patient monitoring tools 338 for pregnancy-related complications. 339 2. Information collection and evaluation activities that: 340 a. Study the impact of models described in subparagraph 1. 341 on all of the following: 342 (I) Access to and quality of care. 343 (II) Patient outcomes. 344 (III) Subjective measures of patient experiences. 345 (IV) Cost-effectiveness. 346 b. Identify best practices for the expansion and use of 347 such models. 348 3. Information collection and evaluation activities that 349 study the impact of models described in subparagraph 1. on 350 patient outcomes and maternal health care providers and that 351 identify best practices for the expansion and use of such 352 models. 353 4. Any other activity consistent with achieving the 354 objectives of grants awarded under this section, as determined 355 by the department. 356 (b) In addition to any of the uses described under 357 paragraph (a), grants awarded under this section may be used 358 for: 359 1. Equipment to support the use and expansion of 360 technology-enabled collaborative learning and capacity-building 361 models, including hardware and software that enables distance 362 learning, maternal health care provider support, and the secure 363 exchange of electronic health information; and 364 2. Support for maternal health care providers and other 365 health care professionals that provide or assist in the 366 provision of maternity care services through such models. 367 (4) LIMITATIONS.—The department may not award more than one 368 grant under this section to an eligible entity. Each grant under 369 this section must be made for a period not to exceed 5 years. 370 The department shall determine the maximum amount of each grant 371 awarded under this section. 372 (5) GRANT REQUIREMENTS.—The department shall require 373 entities awarded a grant under this section to collect 374 information on the effect of the use of technology-enabled 375 collaborative learning and capacity-building models, such as the 376 effect of the use of such models on maternal health outcomes, 377 access to maternal health care services, quality of maternal 378 health care, and maternal health care provider retention in 379 areas and populations described in subsection (1). The 380 department may award a grant or contract to assist in the 381 coordination of such models, including to assess outcomes 382 associated with the use of such models in grants awarded under 383 this section, including for the purposes described in 384 subparagraph (3)(a)2. 385 (6) APPLICATION.— 386 (a) An eligible entity that seeks to receive a grant under 387 this section shall submit to the department an application at 388 such time, in such manner, and containing such information as 389 the department may require. 390 (b) The application must include plans to assess the effect 391 of technology-enabled collaborative learning and capacity 392 building models on indicators, including access to and quality 393 of care, patient outcomes, subjective measures of patient 394 experiences, and cost-effectiveness. Such indicators may focus 395 on: 396 1. Health professional shortage areas; 397 2. Areas with high rates of maternal mortality and severe 398 maternal morbidity and significant racial and ethnic disparities 399 in maternal health outcomes; and 400 3. Medically underserved populations or American Indians 401 and Alaska Natives, including Indian tribes, tribal 402 organizations, and urban Indian organizations. 403 (7) ACCESS TO BROADBAND.—In administering grants under this 404 section, the department may coordinate with other state agencies 405 to ensure that funding opportunities are available to support 406 access to reliable, high-speed Internet for grantees. 407 (8) TECHNICAL ASSISTANCE.—The department shall provide, 408 directly or by contract, technical assistance to eligible 409 entities, including recipients of grants under this section, 410 with the development, use, and post-grant sustainability of 411 technology-enabled collaborative learning and capacity-building 412 models in order to expand access to maternal health care 413 services provided by such entities in health professional 414 shortage areas and areas with high rates of maternal mortality 415 and severe maternal morbidity and significant racial and ethnic 416 disparities in maternal health outcomes; and for medically 417 underserved populations, including, but not limited to, 418 indigenous populations. 419 (9) RESEARCH AND EVALUATION.—The department, in 420 consultation with stakeholders with appropriate expertise in the 421 models described in subsection (8), shall develop a strategic 422 plan to research and evaluate the evidence for such models. The 423 department shall use such plan to implement this section. 424 (10) REPORTING.— 425 (a) An eligible entity that receives a grant under this 426 section shall submit to the department a report at such time, in 427 such manner, and containing such information as the department 428 may require. 429 (b) By July 1, 2023, the department shall submit to the 430 Governor, the President of the Senate, and the Speaker of the 431 House of Representatives, and post on its Internet website, a 432 report that includes, at a minimum: 433 1. A description of any new and continuing grants awarded 434 under this section and the specific purposes and amounts of such 435 grants; 436 2. An overview of: 437 a. Evaluations conducted under subsection (3); 438 b. Technical assistance provided under subsection (8); and 439 c. Activities conducted by entities awarded grants under 440 this section; and 441 3. A description of any significant findings related to 442 patient outcomes or maternal health care providers and best 443 practices for eligible entities that are expanding, using, or 444 evaluating technology-enabled collaborative learning and 445 capacity-building models. 446 (11) RULES.—The department shall adopt rules to implement 447 this section. 448 Section 4. Section 383.55, Florida Statutes, is created to 449 read: 450 383.55 Grants to promote equity in maternal health outcomes 451 by increasing access to digital tools.— 452 (1) DEFINITIONS.—As used in this section, the term: 453 (a) “Department” means the Department of Health. 454 (b) “Eligible entity” has the same meaning as provided in 455 s. 383.54(1). The term includes domestic faith-based and 456 community-based organizations. 457 (2) PROGRAM.—By July 1, 2022, the department shall develop 458 and implement the Investments in Digital Tools to Promote Equity 459 in Maternal Health Outcomes Program under which the department 460 shall award grants to eligible entities to reduce racial and 461 ethnic disparities in maternal health outcomes by increasing 462 access to digital tools related to maternal health care. 463 (3) APPLICATIONS.—To be eligible to receive a grant under 464 this section, an eligible entity shall submit to the department 465 an application at such time, in such manner, and containing such 466 information as the department may require. 467 (4) LIMITATIONS.— 468 (a) The department may not award more than one grant under 469 this section to an eligible entity. Each grant under this 470 section shall be for a period of not more than 5 years. The 471 department shall determine the maximum amount of each grant 472 awarded under this section. 473 (b) In awarding grants under this section, the department 474 shall prioritize the selection of an eligible entity that: 475 1. Operates in an area with high rates of adverse maternal 476 health outcomes and significant racial and ethnic disparities in 477 maternal health outcomes; and 478 2. Promotes technology that addresses racial and ethnic 479 disparities in maternal health outcomes. 480 (5) TECHNICAL ASSISTANCE.—The department shall provide 481 technical assistance to an eligible entity on the development, 482 use, evaluation, and post-grant sustainability of digital tools 483 for purposes of promoting equity in maternal health outcomes. 484 (6) REPORTING.— 485 (a) An eligible entity that receives a grant under this 486 section shall submit to the department a report at such time, in 487 such manner, and containing such information as the department 488 may require. 489 (b) By July 1, 2023, the department shall submit to the 490 Governor, the President of the Senate, and the Speaker of the 491 House of Representatives a report that includes all of the 492 following: 493 1. Evaluation of the effectiveness of grants awarded under 494 this section in improving maternal health outcomes for minority 495 women. 496 2. Recommendations for future grant programs that promote 497 the use of technology to improve maternal health outcomes for 498 minority women. 499 3. Recommendations that address: 500 a. Privacy and security safeguards that should be 501 implemented in the use of technology in maternal health care. 502 b. Reimbursement rates for maternal telehealth services. 503 c. The use of digital tools to analyze large data sets for 504 the purpose of identifying potential pregnancy-related 505 complications as early as possible. 506 d. Barriers that prevent maternal health care providers 507 from providing telehealth services across state lines and 508 recommendations from the Centers for Medicare and Medicaid 509 Services for addressing such barriers in the state Medicaid 510 program. 511 e. The use of consumer digital tools, such as mobile 512 telephone applications, patient portals, and wearable 513 technologies to improve maternal health outcomes. 514 f. Barriers that prevent consumers from accessing 515 telehealth services or other digital technologies to improve 516 maternal health outcomes, including a lack of access to 517 reliable, high-speed Internet or a lack of access to electronic 518 devices needed to use such services and technologies. 519 g. Any other related issues as determined by the 520 department. 521 (7)(a) STUDY.—The department, in consultation with the 522 Office of Program Policy Analysis and Government Accountability, 523 shall conduct a study on the use of technology to reduce 524 preventable maternal mortality and severe maternal morbidity and 525 eliminate racial and ethnic disparities in maternal health 526 outcomes in this state. The study must assess current and future 527 uses of artificial intelligence technologies in maternal health 528 care, including all of the following: 529 1. The extent to which artificial intelligence technologies 530 are currently being used in maternal health care. 531 2. The extent to which artificial intelligence technologies 532 have exacerbated racial or ethnic biases in maternal health 533 care. 534 3. Recommendations for reducing racial or ethnic biases in 535 artificial intelligence technologies used in maternal health 536 care. 537 4. Recommendations for potential applications of artificial 538 intelligence technologies that could improve maternal health 539 outcomes, particularly for minority women. 540 5. Recommendations for privacy and security safeguards that 541 should be implemented in the development of artificial 542 intelligence technologies in maternal health care. 543 (b) By July 1, 2023, the department shall submit to the 544 Governor, the President of the Senate, and the Speaker of the 545 House of Representatives a report that includes its findings and 546 recommendations based on the study required in paragraph (a). 547 (8) RULES.—The department shall adopt rules to implement 548 this section. 549 Section 5. This act shall take effect upon becoming a law. 550