42 U.S.C. § 254c–8 — Healthy start for infants

(a) In general. (1) Continuation and expansion of program. The Secretary, acting through the Administrator of the Health Resources and Services Administration's Maternal and Child Health Bureau, must continue the Healthy Start Initiative under this section, and may carry it out on a national basis. (2) Definition. The "Healthy Start Initiative" is a program that makes grants for project areas with infant mortality rates that are high, or rising faster than the national average, to reduce infant mortality and improve outcomes around birth. Before this section took effect, it was a demonstration program carried out under section 241 of this title. (b) Considerations in making grants. (1) Requirements. Besides meeting all the Secretary's eligibility criteria, applicants must establish, for their project areas, community-based groups of individuals and organizations — such as agencies that administer Title V Social Security Act block grant programs, current and former program participants, public health departments, hospitals, section 254b health centers, State substance abuse agencies, and other significant sources of health care — appropriate for taking part in the project. (2) Other considerations. In making grants, the Secretary must consider: (A) factors that contribute to infant mortality, including poor birth outcomes such as low birthweight and preterm birth, and social determinants of health; (B) communities with (i) high rates of infant mortality or poor perinatal outcomes, or (ii) high rates of those in specific subpopulations within the community; and (C) how much applicants facilitate (i) collaboration with the local community in developing the project, (ii) a community-based approach to delivering services, (iii) a comprehensive approach to women's health care that improves perinatal outcomes, and (iv) using and collecting data showing the program's effect on infant mortality and perinatal outcomes — or, for new applicants, their plan for collecting that data. (3) Special projects. Nothing in (2) stops the Secretary from awarding grants for special projects addressing significant disparities in perinatal health measures in communities along the United States-Mexico border or in Alaska or Hawaii. (c) Coordination. (1) In general. Grant recipients must coordinate their services and activities with the State agency or agencies that administer Title V Social Security Act block grant programs, to promote cooperation, integration, and information sharing with statewide systems and with other community services funded under the Maternal and Child Health Block Grant. (2) Other programs. The Secretary must make sure this program is coordinated with the Department's other programs and activities aimed at reducing infant mortality and improving perinatal and infant health outcomes. (d) Rule of construction. Except to the extent this section says otherwise, nothing here limits the Secretary's authority to modify the program carried out under subsection (a). (e) Funding. (1) Authorization of appropriations. Congress authorized $125,500,000 for each fiscal year from 2021 through 2025. (2) Allocation. (A) Program administration. Of the amount appropriated for a fiscal year, the Secretary may reserve up to 5 percent for coordination, information sharing, technical assistance, and data activities the Secretary decides are appropriate for running the program. (B) Evaluation. The Secretary may reserve up to 1 percent of the amount appropriated for a fiscal year to evaluate projects carried out under subsection (a). Each evaluation must determine whether the project was effective at reducing the disparity in health status between the general population and racial or ethnic minority groups. Evaluations may also cover, as practical: (i) progress toward grant goals for reducing infant mortality rates, improving perinatal outcomes, or reducing health-status disparities; (ii) recommendations for improvements that could help close gaps; and (iii) how much the grantee coordinated with its community in developing the project and delivering services, including through technical assistance and mentorship programs. (f) GAO report. (1) In general. By 4 years after March 27, 2020, the Comptroller General of the United States must conduct an independent evaluation of, and submit to the relevant congressional committees a report on, the Healthy Start program under this section. (2) Evaluation. In conducting the evaluation, the Comptroller General must consider, as practical and appropriate, information from the evaluations under subsection (e)(2)(B). (3) Report. The report must review, assess, and give recommendations on: (A) how the Health Resources and Services Administration allocates Healthy Start program grants, including what it considers about disparities in infant mortality or perinatal outcomes between urban and rural areas; (B) trends toward meeting the evaluation criteria under subsection (e)(2)(B), including programs that did reduce infant mortality rates and improve perinatal outcomes, programs that did not, and programs that affected disparities in infant mortality or perinatal outcomes; (C) how well grantees improve health outcomes for participants, promote awareness of Healthy Start services, involve families, coordinate with their community, and increase accountability through quality improvement, performance monitoring, and evaluation, and how those things affect infant mortality rates and perinatal outcomes; and (D) how well these federal programs are coordinated across agencies, and where coordination could improve.