113 HR 2286 IH: Maximizing Optimal Maternity Services for the 21st Century
U.S. House of Representatives
2013-06-06
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Maximizing Optimal Maternity
Services for the 21st Century
or the MOMS for the 21st Century
Act
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Title I—HHS Focus on the Promotion of Optimal Maternity
Care
Sec. 101. Additional focus area for the Office on Women’s
Health.
Sec. 102. Interagency Coordinating Committee on the Promotion
of Optimal Maternity Outcomes.
Sec. 103. Consumer education campaign.
Sec. 104. Bibliographic database of systematic reviews for care
of childbearing women and newborns.
Title II—Research and data collection on Maternity
Care
Sec. 201. Maternity care health professional shortage
areas.
Sec. 202. Expansion of CDC Prevention Research Centers program
to include Centers on Optimal Maternity Outcomes.
Sec. 203. Expanding models to be tested by Center for Medicare
and Medicaid Innovation to include maternity care models.
Title III—Enhancement of a Geographically, Racially, and
Ethnically Diverse Interprofessional Maternity Workforce
Sec. 301. Development of interprofessional maternity care
educational models and tools.
Sec. 302. Interprofessional training of medical students,
residents, and student midwives in academic health centers and freestanding
birth centers.
Sec. 303. Grants to professional organizations to increase
diversity in maternity care professionals.
2.Congress finds the following:
(1)Maternity
expenditures in the United States surpass all other developed countries, but
childbirth continues to carry significant risks for mothers in the United
States, as demonstrated by the following:
(A)More than two women die every day in the
United States from pregnancy-related causes and the maternal mortality rate in
the United States has roughly doubled in the past 25 years. According to data
released in 2010, the maternal mortality ratio was 12.7 percent as compared to
6.6 percent in 1987.
(B)More than
one-third of all women who give birth in the United States (1,700,000 women
each year) experience some type of complication that has an adverse effect on
their health.
(C)Severe
complications that result in women nearly dying, known as a near
miss
or severe morbidity, increased by 25 percent between 1998 and
2005, to approximately 34,000 cases a year.
(D)African-American
women have nearly a four times greater risk of dying from pregnancy-related
complications than White women, and these disparities have not improved in 50
years.
(2)In spite of the
considerable investment of the United States in maternity care, the United
States is failing to ensure that all infants have a healthy start in life, as
demonstrated by the following:
(A)Despite five years
of modest reduction in pre-term births between 2006 and 2011, the United States
continues to lag behind most other countries in pre-term birth rates, ranking
131 out of 184 countries, according to a 2011 report by the March of Dimes and
the World Health Organization.
(B)The proportion of
low birth weight babies increased by 21 percent between 1981 and 2008.
(C)Non-Hispanic Black
infants continue to experience significantly higher rates of both pre-term
birth and low birthweight, two of the leading causes of infant mortality in
this country.
(3)Despite
shortcomings in the United States statewide data collections systems, which
make international comparisons more challenging, international health
organizations have ranked the United States far behind almost all developed
countries in important perinatal and maternal outcomes, as demonstrated by the
following:
(A)The World Health
Organization identified 49 nations with lower rates of maternal deaths than the
United States in 2008.
(B)In the World
Health Report 2005, the World Health Organization identified 35 nations with
lower early neonatal mortality rates (4/1,000 live births) and 33 with lower
neonatal mortality rates (5/1,000 live births) than the United States.
(C)According to data
from the Organisation for Economic Co-operation and Development (OECD), 26
countries (out of 29 reporting) had low birthweight rates lower than that of
the United States.
(D)21 OECD countries
(out of 27 reporting) had lower cesarean section rates than the United
States.
(4)Maternity care is
a major component of the escalating health care costs in the United States, as
demonstrated by the following:
(A)With 4,000,000
deliveries yearly, the vast majority of which occur in hospitals, maternity
care for mothers and their newborns is the number one reason for
hospitalization in the United States, exceeding such prevalent conditions as
pneumonia, cancer, fracture, and heart disease. Of those discharged from
hospitals in the United States in 2009, nearly one in four were childbearing
women and newborns.
(B)Combined mother
and baby charges for hospitalization, which was $98,000,000,000 in 2008, far
exceeded charges for any other hospital condition in the United States.
(5)Maternity care
also accounts for a significant proportion of expenditures under the Medicaid
program, which covers 42 percent of births in this country, as demonstrated by
the following:
(A)In 2008, 26
percent of all hospital charges for which payment was made under the Medicaid
program (totaling $41,000,000,000) was for birthing women and newborns.
(B)The two most
common conditions for which payments were made under the Medicaid program in
2007 were pregnancy and childbirth (constituting 28 percent of such payments)
and newborns (constituting 26 percent of such payments), which together
accounted for 53 percent of hospital discharges billed to Medicaid.
(C)The two most
costly conditions for which payment was made under the Medicaid program in 2008
were mother’s pregnancy and delivery
and care for newborn
infants
, which together accounted for 26 percent of all Medicaid
expenditures.
(6)Maternity care
facility charges vary significantly by setting and type of birth. Part of the
charge differentials between facilities are attributable to high overhead of
hospitals—
(A)in 2008, the
average charge for a hospital cesarean birth with complications was $20,080,
and without complications was $14,900;
(B)in 2008, the
average charge for a hospital vaginal birth with complications was $11,410, and
without complications was $8,920; and
(C)in 2010, the
average charge for a birth center vaginal birth was $2,277.
(7)The
procedure-intensity of birth-related hospital stays also helps to explain the
high costs of such hospital stays. In 2008, 6 of the 10 most commonly performed
hospital procedures for all patients with all diagnoses involved childbirth and
newborn care. Cesarean section was the most common operating room
procedure.
(8)Two non-invasive
maternity practices, smoking cessation programs during pregnancy and external
version to turn breech babies at term, have strong proven correlation with
considerable improvement in outcomes with no detrimental side effects, but are
significantly underused in the United States.
(9)There is a growing
body of evidence that other non-invasive practices which are underused in
current practice may also be associated with improved outcomes. These
non-invasive practices include group model prenatal care (such as the
CenteringPregnancy model), continuous labor support, and non-supine positions
for birth.
(10)The growing shortage of maternity health
care professionals and childbirth facilities is creating a serious obstacle to
timely and adequate maternity health care for women, particularly in rural
areas and the inner cities.
(11)There are
significant racial and ethnic disparities across the maternity care workforce
creating additional access barriers to culturally and linguistically competent
maternity services.
<enum>I</enum><header>HHS
Focus on the Promotion of Optimal Maternity Care</header>
<section id="HFC8B3ED0114440E1AF64F9497CF8C3A7"><enum>101.</enum><header>Additional
focus area for the Office on Women’s Health</header><text display-inline="no-display-inline">Section 229(b) of the Public Health Service
Act (<external-xref legal-doc="usc" parsable-cite="usc/42/237a">42 U.S.C. 237a(b)</external-xref>) is amended—</text>
<paragraph id="H5B0FD760396C49A098908A428CFF9BEE"><enum>(1)</enum><text>in paragraph (6),
at the end, by striking <quote>and</quote>;</text>
</paragraph><paragraph id="HF7CDF6D5699448F8BFA1CCD1EC005A0E"><enum>(2)</enum><text>in paragraph (7),
at the end, by striking the period and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="HB101EB54EC0D42FE8266EDCBB9929D3F"><enum>(3)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H337C67D236C54D24986BADDD3EDF7FE5" style="OLC">
<paragraph id="H62AF238FE1384B67A7D43A47FD40EAAA"><enum>(8)</enum><text display-inline="yes-display-inline">facilitate policy makers, health system
leaders and providers, consumers, and other stakeholders in their understanding
optimal maternity care and support for the provision of such care, including
the priorities of—</text>
<subparagraph id="H8C85EE2317234084B27D3B1D3C785C7A"><enum>(A)</enum><text>protecting,
promoting, and supporting the innate capacities of childbearing women and their
newborns for childbirth, breast-feeding, and attachment;</text>
</subparagraph><subparagraph id="HF500C28FB1DF4B1C9E86D3957257913C"><enum>(B)</enum><text>using obstetric
interventions only when such interventions are supported by strong,
high-quality evidence, and minimizing overuse of maternity practices that have
been shown to have benefit in limited situations and that can expose women,
infants, or both to risk of harm if used routinely and indiscriminately,
including continuous electronic fetal monitoring, labor induction, epidural
analgesia, primary cesarean section, and routine repeat cesarean birth;</text>
</subparagraph><subparagraph id="H7526F6B63AAF4D08AC7FEEF406827FB0"><enum>(C)</enum><text display-inline="yes-display-inline">reliably incorporating non-invasive,
evidence-based practices that have documented correlation with considerable
improvement in outcomes with no detrimental side effects, such as smoking
cessation programs in pregnancy and proven models of group prenatal care that
integrate health assessment, education, and support into a unified
program;</text>
</subparagraph><subparagraph id="H3FFF6A6A02B74404B0231209A2116133"><enum>(D)</enum><text>a shared
understanding of the qualifications of licensed providers of maternity care and
the best evidence about the safety, satisfaction, outcomes, and costs of their
care, and appropriate deployment of such caregivers within the maternity care
workforce to address the needs of childbearing women and newborns and the
growing shortage of maternity caregivers;</text>
</subparagraph><subparagraph id="H2009C9F133C74CCBA3B78597B343B1ED"><enum>(E)</enum><text>a shared
understanding of the results of the best available research comparing hospital,
birth center, and planned home births, including information about each
setting’s safety, satisfaction, outcomes, and costs; and</text>
</subparagraph><subparagraph id="HA43940F5C0A34B4A8F4C09B8D9698727"><enum>(F)</enum><text display-inline="yes-display-inline">high-quality, evidence-based childbirth
education that promotes a natural, healthy, and safe approach to pregnancy,
childbirth, and early parenting; is taught by certified educators, peer
counselors, and health professionals; and promotes informed decisionmaking by
childbearing
women.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="HF1DF1022C87F4FD4BAE780700BD617B5"><enum>102.</enum><header>Interagency
Coordinating Committee on the Promotion of Optimal Maternity Outcomes</header>
<subsection id="H6B768CC58E974896A1C042875DA1E673"><enum>(a)</enum><header>In
general</header><text>Part A of title II of the Public Health Service Act (42
U.S.C. 202 et seq.) is amended by adding at the end the following new
section:</text>
<quoted-block display-inline="no-display-inline" id="HDF4658BDFE804F48BD285767110D7F21" style="OLC">
<section id="HFCB1EA238A024D969B10741CF3266A9F"><enum>229A.</enum><header>Interagency
Coordinating Committee on the Promotion of Optimal Maternity Outcomes</header>
<subsection id="H4F47A590E527446CA45F2CB4B5DE3793"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services, acting through the Deputy Assistant Secretary for
Women’s Health under section 229 and in collaboration with the Federal
officials specified in subsection (b), shall establish the Interagency
Coordinating Committee on the Promotion of Optimal Maternity Outcomes (referred
to in this subsection as the <term>ICCPOM</term>).</text>
</subsection><subsection id="H8E8EC333C7EF4AD9BDA168D17EC850A2"><enum>(b)</enum><header>Other
agencies</header><text>The officials specified in this subsection are the
Secretary of Labor, the Secretary of Defense, the Secretary of Veterans
Affairs, the Surgeon General, the Director of the Centers for Disease Control
and Prevention, the Administrator of the Health Resources and Services Agency,
the Administrator of the Centers for Medicare & Medicaid Services, the
Director of the Indian Health Service, the Administrator of the Substance Abuse
and Mental Health Services Administration, the Director of the National
Institute on Child Health and Development, the Director of the Agency for
Healthcare Research and Quality, the Assistant Secretary for Children and
Families, the Deputy Assistant Secretary for Minority Health, the Director of
the Office of Personnel Management, and such other Federal officials as the
Secretary of Health and Human Services determines to be appropriate.</text>
</subsection><subsection id="HAB9A7A14F72B40CD90116419A32673D8"><enum>(c)</enum><header>Chair</header><text display-inline="yes-display-inline">The Deputy Assistant Secretary for Women’s
Health shall serve as the chair of the ICCPOM.</text>
</subsection><subsection id="H24E977AB730D4EDEB639A48330F86768"><enum>(d)</enum><header>Duties</header><text>The
ICCPOM shall guide policy and program development across the Federal Government
with respect to promotion of optimal maternity care, provided, however, that
nothing in this section shall be construed as transferring regulatory or
program authority from an Agency to the Coordinating Committee.</text>
</subsection><subsection id="H53D26BB1DB1E466FBD04BDD13EB3CBBE"><enum>(e)</enum><header>Consultations</header><text>The
ICCPOM shall actively seek the input of, and shall consult with, all
appropriate and interested stakeholders, including State Health Departments,
public health research and interest groups, foundations, childbearing women and
their advocates, and maternity care professional associations and
organizations, reflecting racially, ethnically, demographically, and
geographically diverse communities.</text>
</subsection><subsection id="H957C22F6F50444F192986F83035CBCE7"><enum>(f)</enum><header>Annual
report</header>
<paragraph id="HFF891EBBA7AD4E1D85625F7F9F6BC344"><enum>(1)</enum><header>In
general</header><text>The Secretary, on behalf of the ICCPOM, shall annually
submit to Congress a report that summarizes—</text>
<subparagraph id="HC14A67E6C86B45289EDE55137F999B48"><enum>(A)</enum><text>all programs and
policies of Federal agencies (including the Medicare program under title XVIII
of the Social Security Act and the Medicaid program under title XIX of such
Act) designed to promote optimal maternity care, focusing particularly on
programs and policies that support the adoption of evidence based maternity
care, as defined by timely, scientifically sound systematic reviews;</text>
</subparagraph><subparagraph id="H31F9444AC6044478A0841C8E4E746A06"><enum>(B)</enum><text display-inline="yes-display-inline">all programs and policies of Federal
agencies (including the Medicare program under title XVIII of the Social
Security Act and the Medicaid program under title XIX of such Act) designed to
address the problems of maternal mortality and morbidity, infant mortality,
prematurity, and low birth weight, including such programs and policies
designed to address racial and ethnic disparities with respect to each of such
problems;</text>
</subparagraph><subparagraph id="HBE9E9DE85BFE44ACB48A17882510530F"><enum>(C)</enum><text>the extent of
progress in reducing maternal mortality and infant mortality, low birth weight,
and prematurity at State and national levels; and</text>
</subparagraph><subparagraph id="H64BA13F12A9C42BD808529B3CF87FFE7"><enum>(D)</enum><text>such other
information regarding optimal maternity care as the Secretary determines to be
appropriate.</text>
</subparagraph><continuation-text continuation-text-level="paragraph">The
information specified in subparagraph (C) shall be included in each such report
in a manner that disaggregates such information by race, ethnicity, and
indigenous status in order to determine the extent of progress in reducing
racial and ethnic disparities and disparities related to indigenous
status.</continuation-text></paragraph><paragraph id="H55A3FACBDF3B4FC4984A35B54CFEFB46"><enum>(2)</enum><header>Certain
information</header><text>Each report under paragraph (1) shall include
information (disaggregated by race, ethnicity, and indigenous status, as
applicable) on the following rates and costs by State:</text>
<subparagraph id="H0F5371E21B9F44A68AC08E0A09F5FA56"><enum>(A)</enum><text>The rate of
primary cesarean deliveries and repeat cesarean deliveries.</text>
</subparagraph><subparagraph id="H2B313E8AEEBE42C9AC145FAF602D1D16"><enum>(B)</enum><text>The rate of
vaginal births after cesarean.</text>
</subparagraph><subparagraph id="HB092EA7CF47C4803B7E2A0C9CCC553BC"><enum>(C)</enum><text>The rate of
vaginal breech births.</text>
</subparagraph><subparagraph id="H6A0801BA23CE48CBA3B4AD6C339C8D2F"><enum>(D)</enum><text>The rate of
induction of labor.</text>
</subparagraph><subparagraph id="HD28A745C354E4197BECEB019E1154A59"><enum>(E)</enum><text>The rate of
freestanding birth center births.</text>
</subparagraph><subparagraph id="HF3B4C20CDC8A4F9491886ED7EF65C3D0"><enum>(F)</enum><text>The rate of
planned and unplanned home birth.</text>
</subparagraph><subparagraph id="HBC3CDDAFC3D2405EAF4642C0A8DFA7C3"><enum>(G)</enum><text display-inline="yes-display-inline">The rate of attended births by provider,
including by an obstetrician-gynecologist, family practice physician,
obstetrician-gynecologist physician assistant, certified nurse-midwife,
certified midwife, and certified professional midwife.</text>
</subparagraph><subparagraph id="H7CFF5065155C483FB14B0A828553E7D7"><enum>(H)</enum><text display-inline="yes-display-inline">The cost of maternity care disaggregated by
place of birth and provider of care, including—</text>
<clause id="H7AC3134E9C264EDB818E12631C9B98F0"><enum>(i)</enum><text>uncomplicated
vaginal birth;</text>
</clause><clause id="H0BA904E99F38434D97083D67130AA15B"><enum>(ii)</enum><text>complicated
vaginal birth;</text>
</clause><clause id="H249CF25DA78743D19CA00E8FFD61AD3A"><enum>(iii)</enum><text>uncomplicated
cesarean birth; and</text>
</clause><clause id="H5A37677A439441F19251D1631B8C3DDD"><enum>(iv)</enum><text>complicated
cesarean birth.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H5394682D50154A0C8829322F81C539BA"><enum>(g)</enum><header>Authorization of
appropriations</header><text display-inline="yes-display-inline">There is
authorized to be appropriated, in addition to such amounts authorized to be
appropriated under section 229(e), to carry out this section $1,000,000 for
each of the fiscal years 2014 through
2018.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H2D03E42F5960435C9D9202D4D6D8074A"><enum>(b)</enum><header>Conforming
amendments</header>
<paragraph id="H6AB6E9FF28DA4B97A2F264EAE0E95981"><enum>(1)</enum><header>Inclusion as
duty of HHS Office on Women’s Health</header><text display-inline="yes-display-inline">Section 229(b) of such Act (42 U.S.C.
237a(b)), as amended by section 101, is amended—</text>
<subparagraph id="H4FEE32EBAB85453494ED41AE3CE48057"><enum>(A)</enum><text>in paragraph (7),
at the end, by striking <quote>and</quote>;</text>
</subparagraph><subparagraph id="H428EA453A57747608A46B359633FF439"><enum>(B)</enum><text>in paragraph (8),
at the end, by striking the period and inserting <quote>; and</quote>;
and</text>
</subparagraph><subparagraph id="HF496BF5F4A2E4F43AB274918AFEB2B63"><enum>(C)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H99EBC8963EBC4463B4E139655F75A30E" style="OLC">
<paragraph id="H3E6CE376D21C4B079EC26FD4232A0165"><enum>(9)</enum><text display-inline="yes-display-inline">establish the Interagency Coordinating
Committee on the Promotion of Optimal Maternity Outcomes in accordance with
section
229A.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H4B5FFA44833549B89A9A96967436903B"><enum>(2)</enum><header>Treatment of
biennial reports</header><text display-inline="yes-display-inline">Section
229(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/237a">42 U.S.C. 237a(d)</external-xref>) is amended by inserting <quote>(other
than under subsection (b)(9))</quote> after <quote>under this
section</quote>.</text>
</paragraph></subsection></section><section commented="no" id="H47B33A1E65DB4F1DB9F5470092AE5FCF"><enum>103.</enum><header>Consumer
education campaign</header><text display-inline="no-display-inline">Section 229
of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/237a">42 U.S.C. 237a</external-xref>), as amended by sections 101
and 102, is further amended—</text>
<paragraph id="H917CB2AA75C7413EA68B0AADD7E299DB"><enum>(1)</enum><text>in subsection
(b)—</text>
<subparagraph id="HFB8C0BB4D53B4010B0AD36FBD19AB47B"><enum>(A)</enum><text>in paragraph (8),
at the end, by striking <quote>and</quote>;</text>
</subparagraph><subparagraph id="H67D9D7D67F9649C0951D0AA51E5C30C5"><enum>(B)</enum><text>in paragraph (9),
at the end, by striking the period and inserting <quote>; and</quote>;
and</text>
</subparagraph><subparagraph id="HA9CC41E4266642E8B5B77C919AAAD867"><enum>(C)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H85E1127798C04D33B3744A314F694A83" style="OLC">
<paragraph id="H3F1B0B313B204DB4800F49E6D0917514"><enum>(10)</enum><text display-inline="yes-display-inline">not later than one year after the date of
the enactment of the MOMS for the 21st Century Act, develop and implement a
4-year culturally and linguistically appropriate multi-media consumer education
campaign to promote understanding and acceptance of evidence based maternity
practices and models of care for optimal maternity outcomes among women of
childbearing ages and families of such women and that—</text>
<subparagraph id="HEFABD8356ACF4820B3FD65B35FCF8625"><enum>(A)</enum><text display-inline="yes-display-inline">highlights the importance of protecting,
promoting, and supporting the innate capacities of childbearing women and their
newborns for childbirth, breast-feeding, and attachment;</text>
</subparagraph><subparagraph id="HD810288527DB4FA581D23BA8A8CC8CF1"><enum>(B)</enum><text display-inline="yes-display-inline">promotes understanding of the importance of
using obstetric interventions when medically necessary and when supported by
strong, high-quality evidence;</text>
</subparagraph><subparagraph id="H44D3685697E8436EB2A7367D86655185"><enum>(C)</enum><text>highlights the
widespread overuse of maternity practices that have been shown to have benefit
when used appropriately in situations of medical necessity, but which can
expose women, infants, or both to risk of harm if used routinely and
indiscriminately, including continuous fetal monitoring, labor induction,
epidural anesthesia, elective primary cesarean section, and repeat cesarean
delivery;</text>
</subparagraph><subparagraph id="H36C66121427D4A63ADEDB4BED2C58FFD"><enum>(D)</enum><text display-inline="yes-display-inline">emphasizes the non-invasive maternity
practices that have strong proven correlation or may be associated with
considerable improvement in outcomes with no detrimental side effects, and are
significantly underused in the United States, including smoking cessation
programs in pregnancy, group model prenatal care, continuous labor support,
non-supine positions for birth, and external version to turn breech babies at
term;</text>
</subparagraph><subparagraph id="HF7C38AD940BB4D908396918A6A2DA919"><enum>(E)</enum><text display-inline="yes-display-inline">educates consumers about the qualifications
of licensed providers of maternity care and the best evidence about their
safety, satisfaction, outcomes, and costs;</text>
</subparagraph><subparagraph id="HEBF8193A1B924EC2B6310A3AEAC6174F"><enum>(F)</enum><text display-inline="yes-display-inline">informs consumers about the best available
research comparing birth center births, planned home births, and hospital
births, including information about each setting’s safety, satisfaction,
outcomes, and costs;</text>
</subparagraph><subparagraph id="H8E80A4CA24B34AFEBADD71E0E1712755"><enum>(G)</enum><text display-inline="yes-display-inline">fosters participation in high-quality,
evidence-based childbirth education that promotes a natural, healthy, and safe
approach to pregnancy, childbirth, and early parenting; is taught by certified
educators, peer counselors, and health professionals; and promotes informed
decisionmaking by childbearing women; and</text>
</subparagraph><subparagraph id="HEBBFC337970A40A7BB297E2E2A393556"><enum>(H)</enum><text display-inline="yes-display-inline">is pilot tested for consumer comprehension,
cultural sensitivity, and acceptance of the messages across geographically,
racially, ethnically, and linguistically diverse
populations.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></section><section id="H7445C3640BBC4332950A4014EE52B5BD"><enum>104.</enum><header>Bibliographic
database of systematic reviews for care of childbearing women and
newborns</header>
<subsection id="HB826632D7D954F8EA0B4FCCAE579FFE0"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than one
year after the date of the enactment of this Act, the Secretary of Health and
Human Services, through the Agency for Healthcare Research and Quality,
shall—</text>
<paragraph id="HB7452F4F8C5444279DDD402D299FAAEF"><enum>(1)</enum><text>make publicly
available an online bibliographic database identifying systematic reviews,
including an explanation of the level and quality of evidence, for care of
childbearing women and newborns; and</text>
</paragraph><paragraph id="H95D88A31982C40329874C72A4090A991"><enum>(2)</enum><text>initiate regular
updates that incorporate newly issued and updated systematic reviews.</text>
</paragraph></subsection><subsection id="H327BD2163FCD4E68ABD347C02F3907CC"><enum>(b)</enum><header>Sources</header><text>To
aim for a comprehensive inventory of systematic reviews relevant to maternal
and newborn care, the database shall identify reviews from diverse sources,
including—</text>
<paragraph display-inline="no-display-inline" id="H07C94AA90FAA45E5BA3775DF276787D8"><enum>(1)</enum><text>scientific
peer-reviewed journals;</text>
</paragraph><paragraph id="H29FE9A345CC44EBEA02243F7D198D167"><enum>(2)</enum><text>databases,
including Cochrane Database of Systematic Reviews, Clinical Evidence, and
Database of Abstracts of Reviews of Effects; and</text>
</paragraph><paragraph id="HDCC30EFC87974B158441484DF33527BB"><enum>(3)</enum><text>Internet Web sites
of agencies and organizations throughout the world that produce such systematic
reviews.</text>
</paragraph></subsection><subsection id="H5D226C12FAF142D189322A310C6F5128"><enum>(c)</enum><header>Features</header><text>The
database shall—</text>
<paragraph id="HB229F801331C40D59D8995C54762D7AC"><enum>(1)</enum><text display-inline="yes-display-inline">provide bibliographic citations for each
record within the database, and for each such citation include an explanation
of the level and quality of evidence;</text>
</paragraph><paragraph id="H390D0CF0DA314C308B2059E3FD4098D2"><enum>(2)</enum><text>include abstracts,
as available;</text>
</paragraph><paragraph id="H964BF836DBD4410A86E4DBDCA32B400C"><enum>(3)</enum><text>provide reference
to companion documents as may exist for each review, such as evidence tables
and guidelines or consumer educational materials developed from the
review;</text>
</paragraph><paragraph id="H27FFC963979945AD8CE768FA17DE4CB0"><enum>(4)</enum><text>provide links to
the source of the full review and to any companion documents;</text>
</paragraph><paragraph id="H53FCCB75032344D585D8FD96EC6D9868"><enum>(5)</enum><text>provide links to
the source of a previous version or update of the review;</text>
</paragraph><paragraph id="HB8A70054CEAB45BD82B4E65481B15D91"><enum>(6)</enum><text>be searchable by
intervention or other topic of the review, reported outcomes, author, title,
and source; and</text>
</paragraph><paragraph id="HF2BEEC8DB6B44BCB9F29264B8925B08C"><enum>(7)</enum><text>offer to users
periodic electronic notification of database updates relating to users’ topics
of interest.</text>
</paragraph></subsection><subsection id="H8E1FB03228CB4163B6600BDAB82617D7"><enum>(d)</enum><header>Outreach</header><text display-inline="yes-display-inline">Not later than the first date the database
is made publicly available and periodically thereafter, the Secretary of Health
and Human Services shall publicize the availability, features, and uses of the
database under this section to the stakeholders described in subsection
(e).</text>
</subsection><subsection id="H5AC9A5FFEE084C3A962A5CB7D3F23D45"><enum>(e)</enum><header>Consultation</header><text>For
purposes of developing the database under this section and maintaining and
updating such database, the Secretary of Health and Human Services shall
convene and consult with an advisory committee composed of relevant
stakeholders, including—</text>
<paragraph id="H7EFA4A51209D42398ED5E0DE2A0295F9"><enum>(1)</enum><text>Federal Medicaid
administrators and State agencies administrating State plans under title XIX of
the Social Security Act pursuant to section 1902(a)(5) of such Act (42 U.S.C.
1396a(a)(5));</text>
</paragraph><paragraph id="H93EFA7C6D1E9488886E25125F67569F6"><enum>(2)</enum><text display-inline="yes-display-inline">providers of maternity and newborn care
from both academic and community-based settings, including
obstetrician-gynecologists, family physicians, certified nurse midwives,
certified midwives, certified professional midwives, physician assistants,
perinatal nurses, pediatricians, and nurse practitioners;</text>
</paragraph><paragraph id="HE904E55E251D43078910661CDE7D30FD"><enum>(3)</enum><text>maternal-fetal
medicine specialists;</text>
</paragraph><paragraph id="HDCF4D8BC668441879A34BCD05AB180A8"><enum>(4)</enum><text>neonatologists;</text>
</paragraph><paragraph id="H8A02499F35DB41EB9F7CCE90D386E2D1"><enum>(5)</enum><text display-inline="yes-display-inline">childbearing women and advocates for such
women, including childbirth educators certified by a nationally accredited
program, representing communities that are diverse in terms of race, ethnicity,
indigenous status, and geographic area;</text>
</paragraph><paragraph id="H0B1ABA9DE8834E6DBDFD770C996C3020"><enum>(6)</enum><text>employers and
purchasers;</text>
</paragraph><paragraph id="HA640F960F19144B392AEA9A248CE1617"><enum>(7)</enum><text>health facility
and system leaders, including both hospital and birth center facilities;</text>
</paragraph><paragraph id="H4ABAC283534746D0989C74614A9199A7"><enum>(8)</enum><text>journalists;
and</text>
</paragraph><paragraph id="HC0A6DB2B68204000ABF74DE40AD22551"><enum>(9)</enum><text>bibliographic
informatics specialists.</text>
</paragraph></subsection><subsection id="HD120C6DCBD8C4262A2A16A7D04D8C184"><enum>(f)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated $2,500,000
for each of the fiscal years 2014 through 2016 for the purpose of developing
the database and such sums as may be necessary for each subsequent fiscal year
for updating the database and providing outreach and notification to users, as
described in this section.</text>
</subsection></section><enum>II</enum><header>Research and data
collection on Maternity Care</header>
<section id="HE251C99EAE4B48DD9634F6975177448E"><enum>201.</enum><header>Maternity care
health professional shortage areas</header><text display-inline="no-display-inline">Section 332 of the Public Health Service Act
(<external-xref legal-doc="usc" parsable-cite="usc/42/254e">42 U.S.C. 254e</external-xref>) is amended by adding at the end the following new
subsection:</text>
<quoted-block display-inline="no-display-inline" id="H84CF21C4DEF64B628491E83F6A07434C" style="OLC">
<subsection id="H1A9216D6ACD74D6EAF91E265D46DE650"><enum>(k)</enum><paragraph commented="no" display-inline="yes-display-inline" id="H9120B58116CA4FBDAD1FE1B4271B6624"><enum>(1)</enum><text>The Secretary, acting
through the Administrator of the Health Resources and Services Administration,
shall designate maternity care health professional shortage areas in the
States, publish a descriptive list of the area’s population groups, medical
facilities, and other public facilities so designated, and at least annually
review and, as necessary, revise such designations.</text>
</paragraph><paragraph id="H188E440C53954C3C80B09165269AFC79" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1), a
complete descriptive list shall be published in the Federal Register not later
than one year after the date of the enactment of the
<short-title>MOMS for the 21st Century Act</short-title>
and annually thereafter.</text>
</paragraph><paragraph commented="no" id="H051D41CC1EA64AE7BFAAA7A312F2F574" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The provisions of subsections (b), (c),
(e), (f), (g), (h), (i), and (j) (other than (j)(1)(B)) of this section shall
apply to the designation of a maternity care health professional shortage area
in a similar manner and extent as such provisions apply to the designation of
health professional shortage areas, except in applying subsection (b)(3), the
reference in such subsection to <term>physicians</term> shall be deemed to be a
reference to nationally certified and State licensed obstetricians, family
practice physicians who practice full-scope maternity care, certified
nurse-midwives, certified midwives, certified professional midwives, and
physician’s assistants who practice full scope maternity care.</text>
</paragraph><paragraph id="HFF86DCFA82874318B42F5FD5E97190F9" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For purposes of this subsection, the term
<term>maternity care health professional shortage area</term> means—</text>
<subparagraph id="H8C279AFB9DEC483998A703BF625BF0D4"><enum>(A)</enum><text display-inline="yes-display-inline">an
area in an urban or rural area (which need not conform to the geographic
boundaries of a political subdivision and which is a rational area for the
delivery of health services) which the Secretary determines has a shortage of
providers of maternity care health services including those referenced in
paragraph (3) or an urban or rural area that the Secretary determines has lost
a significant number of such providers during the 10-year period beginning with
2004 or has no obstetrical providers licensed to provide operative obstetrical
services;</text>
</subparagraph><subparagraph id="H859559BF564D4FD0AE0226D264A8EDFE"><enum>(B)</enum><text display-inline="yes-display-inline">an
area in an urban or rural area (which need not conform to the geographic
boundaries of a political subdivision and which is a rational area for the
delivery of health services) which the Secretary determines has a shortage of
hospital or labor and delivery units, hospital birth center units, or
freestanding birth centers or an area that lost a significant number of these
units during the 10-year period beginning with 2003; or</text>
</subparagraph><subparagraph id="H1C9BBDDD0E4F46E7A6AC3D9E812983F4"><enum>(C)</enum><text>a population group which the Secretary
determines has such a shortage of providers or
facilities.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="HAE400A4C5536422FA237D1EE2DC803B0"><enum>202.</enum><header>Expansion of
CDC Prevention Research Centers program to include Centers on Optimal Maternity
Outcomes</header>
<subsection id="H861B6A2088904399A0EEBE284B0A1C3A"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Not later than one
year after the date of the enactment of this Act, the Secretary of Health and
Human Services, shall support the establishment of 2 additional Prevention
Research Centers under the Prevention Research Center Program administered by
the Centers for Disease Control and Prevention. Such additional centers shall
each be known as a Center for Excellence on Optimal Maternity Outcomes.</text>
</subsection><subsection id="H009F2511A301472AAAAEE0A023CEC9B4"><enum>(b)</enum><header>Research</header><text display-inline="yes-display-inline">Each Center for Excellence on Optimal
Maternity Outcomes shall—</text>
<paragraph id="HE2A8C31E628E4396A7CF720EBF18AFFD"><enum>(1)</enum><text display-inline="yes-display-inline">conduct at least one focused program of
research to improve maternity outcomes, including the reduction of cesarean
birth rates, elective inductions, prematurity rates, and low birth weight rates
within an underserved population that has a disproportionately large burden of
suboptimal maternity outcomes, including maternal mortality and morbidity,
infant mortality, prematurity, or low birth weight;</text>
</paragraph><paragraph id="H47515F1D3AA140D2AE6B9F26DFFCDBBD"><enum>(2)</enum><text>work with partners
on special interest projects, as specified by the Centers for Disease Control
and Prevention and other relevant agencies within the Department of Health and
Human Services, and on projects funded by other sources; and</text>
</paragraph><paragraph id="H9B025DDA632C4CF8AB112F51DB3AD5C7"><enum>(3)</enum><text display-inline="yes-display-inline">involve a minimum of two distinct birth
setting models, such as a hospital labor and delivery model and freestanding
birth center model; or a hospital labor and delivery model and planned home
birth model.</text>
</paragraph></subsection><subsection id="HE400834DD333431EAC158EF37FB95347"><enum>(c)</enum><header>Interdisciplinary
providers</header><text>Each Center for Excellence on Optimal Maternity
Outcomes shall include the following interdisciplinary providers of maternity
care:</text>
<paragraph id="HC2F9D6D3E2DE4E31A32789E180803E65"><enum>(1)</enum><text>Obstetrician-gynecologists.</text>
</paragraph><paragraph id="H5544DE1CEFC54467B731E1E62DD322E1"><enum>(2)</enum><text>Certified nurse
midwives or certified midwives.</text>
</paragraph><paragraph id="H42DFA5AF9DC44C01A547CA86BE5F2194"><enum>(3)</enum><text>At least two of
the following providers:</text>
<subparagraph id="H9B25D58A36344889BF3B6DAB16ED8860"><enum>(A)</enum><text>Family practice
physicians.</text>
</subparagraph><subparagraph id="HA37EF174664C438087C55A70904CAB2E"><enum>(B)</enum><text display-inline="yes-display-inline">Nurse practitioners.</text>
</subparagraph><subparagraph id="H1BB7E4D1B8C64B7F83FC55FFAF250AA4"><enum>(C)</enum><text display-inline="yes-display-inline">Physician assistants.</text>
</subparagraph><subparagraph id="H5B2B6EEBC73A464C8F227694380C184D"><enum>(D)</enum><text>Certified
professional midwives.</text>
</subparagraph></paragraph></subsection><subsection id="H0BBEA6893D7A4E34A806ADC1BE0701BE"><enum>(d)</enum><header>Services</header><text display-inline="yes-display-inline">Research conducted by each Center for
Excellence on Optimal Maternity Outcomes shall include at least 2 (and
preferably more) of the following supportive provider services:</text>
<paragraph id="H51489845BB5A49229F805A5EF9FE8628"><enum>(1)</enum><text>Mental
health.</text>
</paragraph><paragraph id="H3FC7D1C71EDD4DF2BDFEE6C18220BC80"><enum>(2)</enum><text>Doula labor
support.</text>
</paragraph><paragraph id="H170F554DDE9548CDAA710E05D4FB8F03"><enum>(3)</enum><text>Nutrition
education.</text>
</paragraph><paragraph id="H42E71FBC5BAD484886BD09192A0E82BC"><enum>(4)</enum><text>Childbirth
education.</text>
</paragraph><paragraph id="H35D538AC9F5049D288AB36A972015E43"><enum>(5)</enum><text>Social
work.</text>
</paragraph><paragraph id="H5EEBE26FAE3E41F6AE9F8ABD6BF3A76C"><enum>(6)</enum><text>Physical therapy
or occupation therapy.</text>
</paragraph><paragraph id="H3621A07FF7954351889B2083F9D6396C"><enum>(7)</enum><text>Substance abuse
services.</text>
</paragraph><paragraph id="H44FBFD889DB34F5F98B1BC4A717629EB"><enum>(8)</enum><text>Home
visiting.</text>
</paragraph></subsection><subsection id="H51B83B47637244348834EEE1AAA27DF0"><enum>(e)</enum><header>Coordination</header><text display-inline="yes-display-inline">The programs of research at each of the two
Centers of Excellence on Optimal Maternity Outcomes shall compliment and not
replicate the work of the other.</text>
</subsection><subsection id="H30215FAD49CE40978E6F3E23B825516D"><enum>(f)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this section $2,000,000 for each of the fiscal years 2014 through
2018.</text>
</subsection></section><section id="H1604BC248C7D41F181FCDA1A11168F04"><enum>203.</enum><header>Expanding
models to be tested by Center for Medicare and Medicaid Innovation to include
maternity care models</header><text display-inline="no-display-inline">Section
1115A(b)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315a">42 U.S.C. 1315a(b)(2)(B)</external-xref>) is amended
by adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H9D0384F158BA490CB330603AC4D9F688" style="OLC">
<clause id="H0F7DC660C2454260AA0C335D7267D982"><enum>(xxi)</enum><text display-inline="yes-display-inline">Promoting evidence-based models of prenatal
care that have been associated with reductions in maternal and infant health
disparities; incorporating the use of doula and promotoras support; and
advancing out-of-hospital births, including births at home and in freestanding
birth
centers.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>III</enum><header>Enhancement of a
Geographically, Racially, and Ethnically Diverse Interprofessional Maternity
Workforce</header>
<section id="H9E18E407449A45D1B3DDF1C80BE0800F"><enum>301.</enum><header>Development of
interprofessional maternity care educational models and tools</header>
<subsection id="HD1FC6E22DD834172A5016253CED07496"><enum>(a)</enum><header>In
general</header><text>Not later than 6 months after the date of the enactment
of this Act, the Secretary of Health and Human Services, acting in conjunction
with the Administrator of Health Resources and Services Administration, shall
convene, for a 1-year period, an Interprofessional Maternity Provider Education
Commission to discuss and make recommendations for—</text>
<paragraph id="HA91B4FA54C73496BBBC38C4B17AC2C0B"><enum>(1)</enum><text>a
consensus standard physiologic maternity care curriculum that takes into
account the core competencies for basic midwifery practice such as those
developed by the American College of Nurse Midwives and the North American
Registry of Midwives, and the educational objectives for physicians practicing
in obstetrics and gynecology as determined by the Council on Resident Education
in Obstetrics and Gynecology;</text>
</paragraph><paragraph id="HA092819DE7E2434EB6CDD3C74892558B"><enum>(2)</enum><text>suggestions for
multi-disciplinary use of the consensus physiologic curriculum;</text>
</paragraph><paragraph id="H61121481E4474B76A5E5D903D761F8BE"><enum>(3)</enum><text>strategies to
integrate and coordinate education across maternity care disciplines, including
recommendations to increase medical and midwifery student exposure to
out-of-hospital birth; and</text>
</paragraph><paragraph id="H4D1BBBDAD3244D748800F67F6AB827F1"><enum>(4)</enum><text>pilot
demonstrations of interprofessional educational models.</text>
</paragraph></subsection><subsection id="H89E2745D475E42EBA7465C4A2F2F848D"><enum>(b)</enum><header>Participants</header><text>The
Commission shall include maternity care educators, curriculum developers,
service leaders, certification leaders, and accreditation leaders from the
various professions that provide maternity care in this country. Such
professions shall include obstetrician-gynecologists, certified nurse midwives
or certified midwives, family practice physicians, nurse practitioners,
physician assistants, certified professional midwives, and perinatal nurses.
Additionally, the Commission shall include representation from maternity care
consumer advocates.</text>
</subsection><subsection id="H8ACA90692DE94F87958CF8D46EC0C6C5"><enum>(c)</enum><header>Curriculum</header><text>The
consensus standard physiologic maternity care curriculum described in
subsection (a)(1) shall—</text>
<paragraph id="H8122372A3D674571A09CFAB4EC424173"><enum>(1)</enum><text>have a public
health focus with a foundation in health promotion and disease
prevention;</text>
</paragraph><paragraph id="H9A0E647B5410412BB1754CFA3CB17CC1"><enum>(2)</enum><text>foster physiologic
childbearing and woman and family centered care;</text>
</paragraph><paragraph id="HB7BF38239A914F8DA59B1E861DA1A15A"><enum>(3)</enum><text>integrate
strategies to reduce maternal and infant morbidity and mortality;</text>
</paragraph><paragraph id="H8409C6227C71430D8A33C2809DF10CC2"><enum>(4)</enum><text>incorporate
recommendations to ensure respectful, safe, and seamless consultation,
referral, transport, and transfer of care when necessary; and</text>
</paragraph><paragraph id="HF0C88E4CC361492FAC2C89B35613F661"><enum>(5)</enum><text>include cultural
sensitivity and strategies to decrease disparities in maternity
outcomes.</text>
</paragraph></subsection><subsection id="H7742716DF9E7485AA9D4782F3243B77C"><enum>(d)</enum><header>Report</header><text>Not
later than 6 months after the final day of the summit, the Secretary of Health
and Human Services shall—</text>
<paragraph id="H8E38A572A7824F0DBA4584DDE7B8EDA0"><enum>(1)</enum><text>submit to Congress
a report containing the recommendations made by the summit under this section;
and</text>
</paragraph><paragraph id="HBD5C9C00BAE342A6926D4E8B50A38DB3"><enum>(2)</enum><text>make such report
publicly available.</text>
</paragraph></subsection><subsection id="HE7BA6A3A3D4A474ABEC61B6D1EE45A1E"><enum>(e)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this section $1,000,000 for each of the fiscal years 2014 and 2015, and
such sums as are necessary for each of the fiscal years 2016 through
2018.</text>
</subsection></section><section commented="no" id="H5C00101ACA524C2DB23734321B7DF900"><enum>302.</enum><header>Interprofessional
training of medical students, residents, and student midwives in academic
health centers and freestanding birth centers</header>
<subsection commented="no" id="H4EC2306B2A4C4854A4D659A4E81FE704"><enum>(a)</enum><header>Including within
inpatient hospital services under Medicare services furnished by certain
students, interns, and residents supervised by certified nurse
midwives</header><text>Section 1861(b) of the Social Security Act (42 U.S.C.
1395x(b)) is amended—</text>
<paragraph commented="no" id="HA9A9500685404620B4B1FEDA39A63B80"><enum>(1)</enum><text>in paragraph (6),
by striking <quote>; or</quote> and inserting <quote>, or in the case of
services in a hospital or osteopathic hospital by a student midwife or an
intern or resident-in-training under a teaching program previously described in
this paragraph who is in the field of obstetrics and gynecology, if such
student midwife, intern, or resident-in-training is supervised by a certified
nurse-midwife to the extent permitted under applicable State law and as may be
authorized by the hospital;</quote>;</text>
</paragraph><paragraph commented="no" id="H71745B66EAB04A7EA01151E79C0C8E32"><enum>(2)</enum><text>in paragraph (7),
by striking the period at the end and inserting <quote>; or</quote>; and</text>
</paragraph><paragraph commented="no" id="H64CA1DEA27ED4464A375A2C466AFD47C"><enum>(3)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block id="HE4E5FFED41114F818188FB082D92EAFB" style="OLC">
<paragraph commented="no" id="H4259922522274B08B9FB5CDC961C6D03"><enum>(8)</enum><text>a certified
nurse-midwife where the hospital has a teaching program approved as specified
in paragraph (6), if (A) the hospital elects to receive any payment due under
this title for reasonable costs of such services, and (B) all certified
nurse-midwives in such hospital agree not to bill charges for professional
services rendered in such hospital to individuals covered under the insurance
program established by this
title.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H3520F2957C3846B1B6206F6070018BBC"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall apply to
services furnished on or after the date of the enactment of this Act.</text>
</subsection></section><section commented="no" id="H99CE6A8E00664ED9B3530479B8C55F66"><enum>303.</enum><header>Grants to
professional organizations to increase diversity in maternity care
professionals</header>
<subsection id="H348A66047DF548E580AF05D1312A83D6"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Health and Human Services, through the Administrator of the Health Resources
and Services Administration, shall carry out a grant program under which the
Secretary may make to eligible health professional organizations—</text>
<paragraph id="H6B7B65EDC7144A78B9FC7BB068AE04BF"><enum>(1)</enum><text>for fiscal year
2014, planning grants described in subsection (b); and</text>
</paragraph><paragraph id="H743EF38C176C4D63A3B211674146D49B"><enum>(2)</enum><text>for the subsequent
4-year period, implementation grants described in subsection (c).</text>
</paragraph></subsection><subsection id="H23BEDCA09FB84C78AD419EED37B72C92"><enum>(b)</enum><header>Planning
grants</header>
<paragraph id="H101A329C5F9946A691E4C41CAC67F868"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Planning grants
described in this subsection are grants for the following purposes:</text>
<subparagraph id="HC47F6AE1E13B473EBC836E8D8D3BF9CD"><enum>(A)</enum><text>To collect data
and identify any workforce disparities, with respect to a health profession, at
each of the following areas along the health professional continuum:</text>
<clause id="HDAA2167FA810416EB4C2C57F794ED880"><enum>(i)</enum><text>Pipeline
availability with respect to students at the high school and college or
university levels considering and working toward entrance in the
profession.</text>
</clause><clause id="H761E9DD86D6F4F5BA86C27E82166C3A5"><enum>(ii)</enum><text>Entrance into the
training program for the profession.</text>
</clause><clause id="H19D30C5F69E34CE6970F4016CECA2EB0"><enum>(iii)</enum><text>Graduation from
such training program.</text>
</clause><clause id="H8E1E6AF629954A3BBE13AF4AFF3CC508"><enum>(iv)</enum><text>Entrance into
practice.</text>
</clause><clause id="H0931B88284FC44BFBF108A6D55C09D47"><enum>(v)</enum><text>Retention in
practice for more than a 5-year period.</text>
</clause></subparagraph><subparagraph id="HCBD0081C339148FFBCDCFD942C00857B"><enum>(B)</enum><text>To develop one or
more strategies to address the workforce disparities within the health
profession, as identified under (and in response to the findings pursuant to)
subparagraph (A).</text>
</subparagraph></paragraph><paragraph id="HF9E62C3AAE90490B90566402B0361B06"><enum>(2)</enum><header>Application</header><text>To
be eligible to receive a grant under this subsection, an eligible health
professional organization shall submit to the Secretary of Health and Human
Services an application in such form and manner and containing such information
as specified by the Secretary.</text>
</paragraph><paragraph id="H66CAF2A398064BED8FB178AB60053FE3"><enum>(3)</enum><header>Amount</header><text>Each
grant awarded under this subsection shall be for an amount not to exceed
$300,000.</text>
</paragraph><paragraph id="H75062CD8057D4680B646F484AEBF676A"><enum>(4)</enum><header>Report</header><text>Each
recipient of a grant under this subsection shall submit to the Secretary of
Health and Human Services a report containing—</text>
<subparagraph id="H3E4B730EC70C41EDBBA3D493873F6D6F"><enum>(A)</enum><text>information on the
extent and distribution of workforce disparities identified through the grant;
and</text>
</subparagraph><subparagraph id="H59B41F533F294CE69CC5A735D70DF948"><enum>(B)</enum><text>reasonable
objectives and strategies developed to address such disparities within a 5-,
10-, and 25-year period.</text>
</subparagraph></paragraph></subsection><subsection id="HBB5D429D0976479B9C2169C100B4E114"><enum>(c)</enum><header>Implementation
grants</header>
<paragraph id="H5A7BD748ECCA44B9AE3D7CF6F0967617"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">Implementation grants
described in this subsection are grants to implement one or more of the
strategies developed pursuant to a planning grant awarded under subsection
(b).</text>
</paragraph><paragraph id="H22ACC210C4E64E5E8E3F7F957589E5B2"><enum>(2)</enum><header>Application</header><text display-inline="yes-display-inline">To be eligible to receive a grant under
this subsection, an eligible health professional organization shall submit to
the Secretary of Health and Human Services an application in such form and
manner as specified by the Secretary. Each such application shall contain
information on the capability of the organization to carry out a strategy
described in paragraph (1), involvement of partners or coalitions, plans for
developing sustainability of the efforts after the culmination of the grant
cycle, and any other information specified by the Secretary.</text>
</paragraph><paragraph display-inline="no-display-inline" id="HC3B0C6EC91CA4DE08FC5A21A9CDC4D83"><enum>(3)</enum><header>Amount</header><text>Each
grant awarded under this subsection shall be for an amount not to exceed
$500,000 each year during the 4-year period of the grant.</text>
</paragraph><paragraph id="H2452014E060D46E48C7EEE7BAB25168C"><enum>(4)</enum><header>Reports</header><text>For
each of the first 3 years for which an eligible health professional
organization is awarded a grant under this subsection, the organization shall
submit to the Secretary of Health and Human Services a report on the activities
carried out by such organization through the grant during such year and
objectives for the subsequent year. For the fourth year for which an eligible
health professional organization is awarded a grant under this subsection, the
organization shall submit to the Secretary a report that includes an analysis
of all the activities carried out by the organization through the grant and a
detailed plan for continuation of outreach efforts.</text>
</paragraph></subsection><subsection id="HFDB1359709514324B8C911DD5FE9EE5F"><enum>(d)</enum><header>Eligible health
professional organization defined</header><text display-inline="yes-display-inline">For purposes of this section, the term
<term>eligible health professional organization</term> means a professional
organization representing obstetrician-gynecologists, certified nurse midwives,
certified midwives, family practice physicians, nurse practitioners whose scope
of practice includes maternity care, physician assistants whose scope of
practice includes obstetrical care, or certified professional midwives.</text>
</subsection><subsection id="H32E381D6549C4AD1AE83CF753E89C50D"><enum>(e)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to carry
out this section $2,000,000 for fiscal year 2014 and $3,000,000 for each of the
fiscal years 2015 through 2018.</text>
</subsection></section>