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