[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2141 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 2141
To promote optimal maternity outcomes by making evidence-based
maternity care a national priority, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 3, 2011
Ms. Roybal-Allard 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) 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.
(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) The national rate of pre-term birth increased
by 36 percent in the quarter-century from 1981 to 2006.
Despite a very modest reduction in pre-term births
between 2006 and 2008, rates remain 31 percent higher
than in 1981.
(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 2008, 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 in 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.
Other non-invasive practices which are underused in current
practice and may be associated with improved outcomes include
group model prenatal care, continuous labor support, and non-
supine positions for birth.
(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.
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 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
(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;
``(B) 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 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 2012 through 2016.''.
(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 when medically necessary
and when supported by strong, high-quality evidence;
``(C) 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;
``(D) 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;
``(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, planned home
births, and 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, including an
explanation of the level and quality of evidence, 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 peer-reviewed 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 2012 through 2014
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
2012 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, 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;
(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.
(7) Substance abuse services.
(8) Home visiting.
(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 2012 through 2016.
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 that takes into
account the core competencies for basic midwifery practice as
developed by the American College of Nurse Midwives, and the
educational objectives in obstetrics and gynecology as
determined by the Council on Resident Education in Obstetrics
and Gynecology;
(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;
(3) incorporate strategies to reduce maternal mortality and
infant mortality; and
(4) 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 2012 and 2013, and such sums as are necessary for each of
the fiscal years 2014 through 2016.
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 2012, 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 2012
and $3,000,000 for each of the fiscal years 2013 through 2016.
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