[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5807 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5807

    To promote optimal maternity outcomes by making evidence-based 
      maternity care a national priority, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 21, 2010

Ms. Roybal-Allard (for herself, Ms. Baldwin, Mrs. Capps, Ms. Castor of 
   Florida, Mrs. Christensen, Mr. Cohen, Mr. Conyers, Mrs. Davis of 
California, Ms. DeGette, Ms. DeLauro, Mr. Engel, Mr. Hinojosa, Ms. Lee 
of California, Ms. Zoe Lofgren of California, Mrs. Lowey, Mr. McGovern, 
Mrs. Maloney, Mr. Michaud, Ms. Moore of Wisconsin, Mrs. Napolitano, Ms. 
 Norton, Mr. Reyes, Ms. Velazquez, Ms. Wasserman Schultz, Ms. Woolsey, 
 and Ms. Schakowsky) introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
Committee on Ways and Means, for a period to be subsequently determined 
 by the Speaker, in each case for consideration of such provisions as 
        fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
    To promote optimal maternity outcomes by making evidence-based 
      maternity care a national priority, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Maximizing Optimal 
Maternity Services for the 21st Century'' or the ``MOMS for the 21st 
Century Act''.
    (b) Table of Contents.--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. 229A. 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 INTERDISCIPLINARY MATERNITY WORKFORCE

Sec. 301. Development of interdisciplinary maternity care provider core 
                            curricula.
Sec. 302. Interdisciplinary training of medical students, residents, 
                            and student midwives in academic health 
                            centers.
Sec. 303. Loan repayments for maternal care professionals.
Sec. 304. Grants to professional organizations to increase diversity in 
                            maternity care professionals.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The United States spends more than double per capita on 
        health care than other industrialized countries, but ranks far 
        behind almost all developed countries in important perinatal 
        outcomes. In the World Health Report 2005--
                    (A) the World Health Organization identified 29 
                nations with lower estimated maternal mortality ratios 
                than the United States (14/100,000 live births);
                    (B) the World Health Organization identified 35 
                nations with lower early neonatal mortality rates (5/
                1,000 live births) and 33 with lower neonatal mortality 
                rates (5/1,000 live births) than the United States;
                    (C) 23 countries (out of 30 reporting) had superior 
                low birth weight rates than the United States; and
                    (D) 19 member countries (out of 23 reporting) had 
                lower cesarean section rates than the United States.
            (2) Despite maternity expenditures in the United States, 
        childbirth continues to carry significant risks for mothers in 
        this country, as demonstrated by the following:
                    (A) More than two women die every day in the United 
                States from pregnancy-related causes.
                    (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) African-American women having nearly a four 
                times greater risk of dying from pregnancy-related 
                complications than White women, and these disparities 
                have not improved in 20 years.
            (3) In spite of the Nation's considerable investment 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) The national rate of pre-term birth increased 
                by 36 percent in the quarter-century from 1981 to 2006.
                    (B) The proportion of low birth weight babies 
                increased by 22 percent between 1981 and 2006.
                    (C) Non-Hispanic Black infants continue to 
                experience significantly higher rates of both pre-term 
                birth and low birth weight, two of the leading causes 
                of infant mortality in this country.
            (4) Maternity Care is a major component of the escalating 
        health care costs in this country, as demonstrated by the 
        following:
                    (A) 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 
                2007, 25 percent were childbearing women and newborns.
                    (B) Combined mother and baby charges for 
                hospitalization, which was $86,000,000,000 in 2006, 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, as 
        demonstrated by the following:
                    (A) In 2006, 29 percent of all hospital charges 
                under Medicaid ($39,000,000,000) were for birthing 
                women and children.
                    (B) Six of the 10 most common procedures reimbursed 
                under the Medicaid program were maternity related, 
                making ``mother's pregnancy and delivery'' the most 
                costly Medicaid expenditure.
            (6) Maternity care charges vary significantly by setting 
        and type of birth. In 2005--
                    (A) the average charge for a hospital cesarean 
                birth with complications was $15,900, and without 
                complications was $12,500;
                    (B) the average charge for a hospital vaginal birth 
                with complications was $8,960, and without 
                complications was $6,970; and
                    (C) the average charge for a birth center vaginal 
                birth was $1,600.
            (7) The procedure-intensity of birth-related hospital stays 
        helps to explain their high costs. In 2005, 6 of the 15 most 
        commonly performed hospital procedures for all patients with 
        all diagnoses involved childbirth. Cesarean section was the 
        most common operating room procedure for Medicaid, for private 
        payers, and for all payers combined.
            (8) There is a vast body of knowledge regarding best 
        evidence-based practices in maternity care, but current 
        practice is not following the research, as demonstrated by the 
        following:
                    (A) A recent analysis of American College of 
                Obstetrics and Gynecology obstetrical practice 
                bulletins 1998 through 2004 found that only 23 percent 
                of their practice recommendations were based on good, 
                consistent scientific evidence, while 42 percent of 
                recommendations were based on consensus and opinion.
                    (B) There is widespread overuse of maternity 
                practices that have been shown to have benefit only in 
                limited situations, 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.
                    (C) There are multiple non-invasive maternity 
                practices that have been associated with considerable 
                improvement in outcomes with no detrimental side 
                effects, and are significantly underused in this 
                country, 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.
            (9) 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.
            (10) There are significant racial and ethnic disparities 
        across the maternity care workforce creating additional access 
        barriers to culturally and linguistically competent maternity 
        services.
            (11) Although most women in the United States are healthy 
        and at low risk for complications, Obstetrician-Gynecologist 
        Surgeons are the lead caregivers for about 79 percent of women 
        during pregnancy and labor, as compared to midwives who care 
        for 8 percent to 9 percent of women, and Family Practice 
        Physicians who care for 6 percent to 7 percent of women. Among 
        developed nations, only the United States and Canada rely to 
        this degree on specialists rather than midwives or family 
        physicians to provide care to healthy birthing women.
            (12) There is a growing shortage of Obstetrician-
        Gynecologists in the United States who provide maternity 
        services. Data from the 2006 American College of Obstetricians 
        and Gynecologists (ACOG) Survey on Professional Liability 
        showed a negative trend in length of obstetrical practice, with 
        the average age at which physicians stopped practicing 
        obstetrics being 48 years. At one point this was the near 
        midpoint of an Obstetrician-Gynecologist's professional career.
            (13) There is extensive research demonstrating that 
        certified nurse midwives, when compared to Obstetrician-
        Gynecologists, provide high quality of care with comparable or 
        better outcomes, high levels of patient satisfaction, and at 
        lower costs due to fewer unnecessary, invasive, and expensive 
        technologic interventions.
            (14) Approximately 1 percent of births in the United States 
        take place in non-hospital settings. Of such births, 27 percent 
        occur in birth centers and 65 percent are home births. 
        Hospitals remain the setting of delivery for 99 percent of all 
        births despite the following findings:
                    (A) Multiple studies have demonstrated that for 
                women who meet criteria to be considered at low risk 
                for obstetrical complications, labor and delivery at a 
                birth center can result in higher patient satisfaction 
                and equivalent or better outcomes than in-hospital 
                birth.
                    (B) Studies have consistently found that for low-
                risk mothers, planned home birth had the same outcomes 
                as hospital births for similar risk women, but with 
                fewer costly and often preventable interventions.
                    (C) In a nationwide comparison of birth center 
                costs to hospital costs, it is estimated that if 
                100,000 births were attended in birth centers, access 
                to care would be greatly improved, and annual savings 
                would total more than $314,000,000.
            (15) Midwives serve as faculty at many of the Nation's most 
        prominent academic health centers, however, the time they spend 
        training medical students, residents, and midwifery students is 
        not reimbursed as it is for physicians. As a result, medical 
        students, residents, and midwifery students often fail to 
        benefit from the practice experience and physiologic birth 
        expertise of midwives.

     TITLE I--HHS FOCUS ON THE PROMOTION OF OPTIMAL MATERNITY CARE

SEC. 101. ADDITIONAL FOCUS AREA FOR THE OFFICE ON WOMEN'S HEALTH.

    Section 229(b) of the Public Health Service Act (42 U.S.C. 237a(b)) 
is amended--
            (1) in paragraph (6), at the end, by striking ``and'';
            (2) in paragraph (7), at the end, by striking the period 
        and inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(8) 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--
                    ``(A) protecting, promoting, and supporting the 
                innate capacities of childbearing women and their 
                newborns for childbirth, breast-feeding, and 
                attachment;
                    ``(B) 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;
                    ``(C) reliably providing beneficial practices with 
                no or minimal evidence of harm that are underused, 
                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;
                    ``(D) 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;
                    ``(E) 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
                    ``(F) informed decisionmaking by childbearing 
                women.''.

SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF 
              OPTIMAL MATERNITY OUTCOMES.

    (a) In General.--Part B of title II of the Public Health Service 
Act is amended by adding at the end the following new section:

``SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF 
              OPTIMAL MATERNITY OUTCOMES.

    ``(a) In General.--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 `ICCPOM').
    ``(b) Other Agencies.--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.
    ``(c) Chair.--The Deputy Assistant Secretary for Women's Health 
shall serve as the chair of the ICCPOM.
    ``(d) Duties.--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.
    ``(e) Consultations.--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 focused primary care professional associations and 
organizations, reflecting racially, ethnically, demographically, and 
geographically diverse communities.
    ``(f) Annual Report.--
            ``(1) In general.--The Secretary, on behalf of the ICCPOM, 
        shall annually submit to Congress a report that summarizes--
                    ``(A) all programs and policies of Federal agencies 
                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;
                    ``(B) all programs and policies of Federal agencies 
                designed to address the problems of maternal mortality 
                and infant mortality, prematurity, and low birth 
                weight;
                    ``(C) the extent of progress in reducing maternal 
                mortality and infant mortality, low birth weight, and 
                prematurity at State and national levels; and
                    ``(D) such other information regarding optimal 
                maternity care as the Secretary determines to be 
                appropriate.
        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.
            ``(2) Certain information.--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:
                    ``(A) The rate of primary cesarean deliveries and 
                repeat cesarean deliveries.
                    ``(B) The rate of vaginal births after cesarean.
                    ``(C) The rate of vaginal breech births.
                    ``(D) The rate of induction of labor.
                    ``(E) The rate of birthing center births.
                    ``(F) The rate of planned and unplanned home birth.
                    ``(G) 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.
                    ``(H) The cost of maternity care disaggregated by 
                place of birth and provider of care, including--
                            ``(i) uncomplicated vaginal birth;
                            ``(ii) complicated vaginal birth;
                            ``(iii) uncomplicated cesarean birth; and
                            ``(iv) complicated cesarean birth.
    ``(g) Authorization of Appropriations.--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 2011 through 2015.''.
    (b) Conforming Amendments.--
            (1) Inclusion as duty of hhs office on women's health.--
        Section 229(b) of such Act (42 U.S.C. 237a(b)), as amended by 
        section 101, is amended--
                    (A) in paragraph (7), at the end, by striking 
                ``and'';
                    (B) in paragraph (8), at the end, by striking the 
                period and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(9) establish the Interagency Coordinating Committee on 
        the Promotion of Optimal Maternity Outcomes in accordance with 
        section 229A.''.
            (2) Treatment of biennial reports.--Section 229(d) of such 
        Act (42 U.S.C. 237a(d)) is amended by inserting ``(other than 
        under subsection (b)(9))'' after ``under this section''.

SEC. 103. CONSUMER EDUCATION CAMPAIGN.

    Section 229 of the Public Health Service Act (42 U.S.C. 237a), as 
amended by sections 101 and 102, is further amended--
            (1) in subsection (b)--
                    (A) in paragraph (8), at the end, by striking 
                ``and'';
                    (B) in paragraph (9), at the end, by striking the 
                period and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(10) 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--
                    ``(A) highlights the importance of protecting, 
                promoting, and supporting the innate capacities of 
                childbearing women and their newborns for childbirth, 
                breast-feeding, and attachment;
                    ``(B) promotes understanding of the importance of 
                using obstetric interventions only when supported by 
                strong, high-quality evidence;
                    ``(C) highlights the widespread overuse of 
                maternity practices that have been shown to have 
                benefit only in limited situations, and 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;
                    ``(D) emphasizes the multiple non-invasive 
                maternity practices that have been 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;
                    ``(E) educates consumers about the qualifications 
                of licensed providers of maternity care and the best 
                evidence about their safety, satisfaction, outcomes, 
                and costs;
                    ``(F) informs consumers about the best available 
                research comparing birth center births and planned home 
                births with hospital births, including information 
                about each setting's safety, satisfaction, outcomes, 
                and costs;
                    ``(G) fosters involvement in informed 
                decisionmaking among childbirth consumers; and
                    ``(H) is pilot tested for consumer comprehension, 
                cultural sensitivity, and acceptance of the messages 
                across geographically, racially, ethnically, and 
                linguistically diverse populations.''.

SEC. 104. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC REVIEWS FOR CARE OF 
              CHILDBEARING WOMEN AND NEWBORNS.

    (a) In General.--Not later than January 1, 2014, the Secretary of 
Health and Human Services, through the Agency for Healthcare Research 
and Quality, shall--
            (1) make publicly available an online bibliographic 
        database identifying systematic reviews for care of 
        childbearing women and newborns; and
            (2) initiate regular updates that incorporate newly issued 
        and updated systematic reviews.
    (b) Sources.--To aim for a comprehensive inventory of systematic 
reviews relevant to maternal and newborn care, the database shall 
identify reviews from diverse sources, including--
            (1) scientific journals;
            (2) databases, including Cochrane Database of Systematic 
        Reviews, Clinical Evidence, and Database of Abstracts of 
        Reviews of Effects; and
            (3) Internet Web sites of agencies and organizations 
        throughout the world that produce such systematic reviews.
    (c) Features.--The database shall--
            (1) provide bibliographic citations for each record within 
        the database;
            (2) include abstracts, as available;
            (3) 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;
            (4) provide links to the source of the full review and to 
        any companion documents;
            (5) provide links to the source of a previous version or 
        update of the review;
            (6) be searchable by intervention or other topic of the 
        review, reported outcomes, author, title, and source; and
            (7) offer to users periodic electronic notification of 
        database updates relating to users' topics of interest.
    (d) Outreach.--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).
    (e) Consultation.--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--
            (1) 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));
            (2) providers of maternity and newborn care from both 
        academic and community-based settings, including obstetrician-
        gynecologists, family physicians, midwives, physician 
        assistants, perinatal nurses, pediatricians, and nurse 
        practitioners;
            (3) maternal-fetal medicine specialists;
            (4) neonatologists;
            (5) childbearing women and their advocates representing 
        communities that are diverse in terms of race, ethnicity, 
        indigenous status, and geographic area;
            (6) employers and purchasers;
            (7) health facility and system leaders, including both 
        hospital and birth center facilities;
            (8) journalists; and
            (9) bibliographic informatics specialists.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated $2,500,000 for each of the fiscal years 2011 through 2013 
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.

        TITLE II--RESEARCH AND DATA COLLECTION ON MATERNITY CARE

SEC. 201. MATERNITY CARE HEALTH PROFESSIONAL SHORTAGE AREAS.

    Section 332 of the Public Health Service Act (42 U.S.C. 254e) is 
amended by adding at the end the following new subsection:
    ``(k)(1) 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.
    ``(2) For purposes of paragraph (1), a complete descriptive list 
shall be published in the Federal Register not later than July 1 of 
2011 and each subsequent year.
    ``(3) 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 `physicians' shall be 
deemed to be a reference to `physicians, obstetricians, family practice 
physicians who practice full-scope maternity care, certified nurse-
midwives, certified midwives, and certified professional midwives'.
    ``(4) For purposes of this subsection, the term `maternity care 
health professional shortage area' means--
            ``(A) 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 
        obstetricians, family practice physicians who practice full-
        scope maternity care, certified nurse-midwives, certified 
        midwives, and certified professional midwives, and shall also 
        include urban or rural areas that have lost a significant 
        number of local hospital labor and delivery units;
            ``(B) 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 birth center labor and delivery units, or areas 
        that lost a significant number of these units in during the 10-
        year period beginning with 2000; or
            ``(C) a population group which the Secretary determines has 
        such a shortage of providers or facilities.''.

SEC. 202. EXPANSION OF CDC PREVENTION RESEARCH CENTERS PROGRAM TO 
              INCLUDE CENTERS ON OPTIMAL MATERNITY OUTCOMES.

    (a) In General.--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.
    (b) Research.--Each Center for Excellence on Optimal Maternity 
Outcomes shall--
            (1) conduct at least one focused program of research to 
        improve maternity outcomes, including the reduction of cesarean 
        birth rates, 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, cesarean section rates, 
        infant mortality, prematurity, or low birth weight;
            (2) 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
            (3) involve a minimum of two distinct birth setting models, 
        such as a hospital labor and delivery model and birth center 
        model; or a hospital labor and delivery model and planned home 
        birth model.
    (c) Interdisciplinary Providers.--Each Center for Excellence on 
Optimal Maternity Outcomes shall include the following 
interdisciplinary providers of maternity care:
            (1) Obstetrician-gynecologists.
            (2) Certified nurse midwives or certified midwives.
            (3) At least two of the following providers:
                    (A) Family practice physicians.
                    (B) Women's health nurse practitioners.
                    (C) Obstetrician-gynecologists physician 
                assistants.
                    (D) Certified professional midwives.
    (d) Services.--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:
            (1) Mental health.
            (2) Doula labor support.
            (3) Nutrition education.
            (4) Childbirth education.
            (5) Social work.
            (6) Physical therapy or occupation therapy.
    (e) Coordination.--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.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,000,000 for each of the 
fiscal years 2011 through 2015.

SEC. 203. EXPANDING MODELS TO BE TESTED BY CENTER FOR MEDICARE AND 
              MEDICAID INNOVATION TO INCLUDE MATERNITY CARE MODELS.

    Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 
1315a(b)(2)(B)) is amended by adding at the end the following new 
clause:
                            ``(xxi) Promoting evidence-based group 
                        prenatal care models, doula support, and out-
                        of-hospital births, including births at home or 
                        a birthing center.''.

 TITLE III--ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, AND ETHNICALLY 
             DIVERSE INTERDISCIPLINARY MATERNITY WORKFORCE

SEC. 301. DEVELOPMENT OF INTERDISCIPLINARY MATERNITY CARE PROVIDER CORE 
              CURRICULA.

    (a) In General.--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, a 
Maternity Curriculum Commission to discuss and make recommendations 
for--
            (1) a shared core maternity care curriculum;
            (2) strategies to integrate and coordinate education across 
        maternity care disciplines, including suggestions for multi-
        disciplinary use of the shared core curriculum; and
            (3) pilot demonstrations of interdisciplinary educational 
        models.
    (b) Participants.--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, certified 
midwives, family practice physicians, women's health nurse 
practitioners, obstetrician-gynecologists physician assistants, 
certified professional midwives, and perinatal nurses.
    (c) Curriculum.--The shared core maternity care curriculum 
described in subsection (A) shall--
            (1) have a public health focus with a foundation in health 
        promotion and disease prevention;
            (2) foster physiologic childbearing and patient and family 
        centered care; and
            (3) include cultural sensitivity and strategies to decrease 
        disparities in maternity outcomes.
    (d) Report.--Not later than 6 months after the final day of the 
summit, the Secretary of Health and Human Services shall--
            (1) submit to Congress a report containing the 
        recommendations made by the summit under this section; and
            (2) make such report publicly available.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,000,000 for each of the 
fiscal years 2011 and 2012, and such sums as are necessary for each of 
the fiscal years 2013 through 2015.

SEC. 302. INTERDISCIPLINARY TRAINING OF MEDICAL STUDENTS, RESIDENTS, 
              AND STUDENT MIDWIVES IN ACADEMIC HEALTH CENTERS.

    (a) Including Within Inpatient Hospital Services Under Medicare 
Services Furnished by Certain Students, Interns, and Residents 
Supervised by Certified Nurse Midwives.--Section 1861(b) of the Social 
Security Act (42 U.S.C. 1395x(b)) is amended--
            (1) in paragraph (6), by striking ``; or'' and inserting 
        ``, 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;'';
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``; or''; and
            (3) by adding at the end the following new paragraph:
            ``(8) 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.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to services furnished on or after the date of the enactment of 
this Act.

SEC. 303. LOAN REPAYMENTS FOR MATERNAL CARE PROFESSIONALS.

    (a) Purpose.--It is the purpose of this section to alleviate 
critical shortages of maternal care professionals.
    (b) Loan Repayments.--The Secretary of Health and Human Services, 
acting through the Administrator of the Health Resources and Services 
Administration, shall establish a program of entering into contracts 
with eligible individuals under which--
            (1) the individual agrees to serve full-time--
                    (A) as a physician in the field of obstetrics and 
                gynecology; as a certified nurse midwife, certified 
                midwife or certified professional midwife; or as a 
                family practice physician who agrees to practice full-
                scope maternity care; and
                    (B) in an area that is either a health professional 
                shortage area (as designated under section 332 of the 
                Public Health Service Act) or a maternity care health 
                professional shortage area (as designated under 
                subsection (k) of such section, as added by section 201 
                of this Act); and
            (2) the Secretary agrees to pay, for each year of such 
        full-time service, not more than $50,000 of the principal and 
        interest of the undergraduate or graduate educational loans of 
        the individual.
    (c) Service Requirement.--A contract entered into under this 
section shall allow the individual receiving the loan repayment to 
satisfy the service requirement described in subsection (a)(1) through 
employment in a solo or group practice, a clinic, a public or private 
nonprofit hospital, a freestanding birth center, or any other 
appropriate health care entity.
    (d) Application of Certain Provisions.--The provisions of subpart 
III of part D of title III of the Public Health Service Act shall, 
except as inconsistent with this section, apply to the program 
established in subsection (a) in the same manner and to the same extent 
as such provisions apply to the National Health Service Corps 
Scholarship Program established in such subpart.
    (e) Definition.--In this section, the term ``eligible individual'' 
means--
            (1) a physician in the field of obstetrics and gynecology; 
        or
            (2) a certified nurse-midwife or certified midwife;
            (3) a family practice physician who practices full scope 
        maternity care; or
            (4) a certified professional midwife who has graduated from 
        an accredited midwifery education program.

SEC. 304. GRANTS TO PROFESSIONAL ORGANIZATIONS TO INCREASE DIVERSITY IN 
              MATERNITY CARE PROFESSIONALS.

    (a) In General.--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--
            (1) for fiscal year 2011, planning grants described in 
        subsection (b); and
            (2) for the subsequent 4-year period, implementation grants 
        described in subsection (c).
    (b) Planning Grants.--
            (1) In general.--Planning grants described in this 
        subsection are grants for the following purposes:
                    (A) 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:
                            (i) Pipeline availability with respect to 
                        students at the high school and college or 
                        university levels considering and working 
                        toward entrance in the profession.
                            (ii) Entrance into the training program for 
                        the profession.
                            (iii) Graduation from such training 
                        program.
                            (iv) Entrance into practice.
                            (v) Retention in practice for more than a 
                        5-year period.
                    (B) 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).
            (2) Application.--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.
            (3) Amount.--Each grant awarded under this subsection shall 
        be for an amount not to exceed $300,000.
            (4) Report.--Each recipient of a grant under this 
        subsection shall submit to the Secretary of Health and Human 
        Services a report containing--
                    (A) information on the extent and distribution of 
                workforce disparities identified through the grant; and
                    (B) reasonable objectives and strategies developed 
                to address such disparities within a 5-, 10-, and 25-
                year period.
    (c) Implementation Grants.--
            (1) In general.--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).
            (2) Application.--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.
            (3) Amount.--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.
            (4) Reports.--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.
    (d) Eligible Health Professional Organization Defined.--For 
purposes of this section, the term ``eligible health professional 
organization'' means a professional organization representing 
obstetrician-gynecologists, certified nurse midwives, certified 
midwives, family practice physicians, women's health nurse 
practitioners, obstetrician-gynecologist physician assistants, or 
certified professional midwives.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,000,000 for fiscal year 2011 
and $3,000,000 for each of the fiscal years 2012 through 2015.
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