[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2286 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 2286

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 6, 2013

 Ms. Roybal-Allard (for herself, Mrs. Capps, Mrs. Christensen, Ms. Lee 
  of California, Ms. McCollum, Ms. Pingree of Maine, and Mr. Rangel) 
 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. 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.

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 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.

     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 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;
                    ``(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) 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.''.

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

    (a) In General.--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:

``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 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;
                    ``(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 freestanding birth 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 2014 through 2018.''.
    (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 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
                    ``(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 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--
            (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, and for each such citation include an explanation 
        of the level and quality of evidence;
            (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, certified nurse midwives, 
        certified midwives, certified professional midwives, physician 
        assistants, perinatal nurses, pediatricians, and nurse 
        practitioners;
            (3) maternal-fetal medicine specialists;
            (4) neonatologists;
            (5) 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;
            (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 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.

        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 one year 
after the date of the enactment of the MOMS for the 21st Century Act 
and annually thereafter.
    ``(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 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.
    ``(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 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;
            ``(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 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
            ``(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 freestanding 
        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) Nurse practitioners.
                    (C) 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 2014 through 2018.

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 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.''.

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

SEC. 301. DEVELOPMENT OF INTERPROFESSIONAL MATERNITY CARE EDUCATIONAL 
              MODELS AND TOOLS.

    (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, an 
Interprofessional Maternity Provider Education Commission to discuss 
and make recommendations for--
            (1) 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;
            (2) suggestions for multi-disciplinary use of the consensus 
        physiologic curriculum;
            (3) 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
            (4) pilot demonstrations of interprofessional 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 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.
    (c) Curriculum.--The consensus standard physiologic maternity care 
curriculum described in subsection (a)(1) shall--
            (1) have a public health focus with a foundation in health 
        promotion and disease prevention;
            (2) foster physiologic childbearing and woman and family 
        centered care;
            (3) integrate strategies to reduce maternal and infant 
        morbidity and mortality;
            (4) incorporate recommendations to ensure respectful, safe, 
        and seamless consultation, referral, transport, and transfer of 
        care when necessary; and
            (5) 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 2014 and 2015, and such sums as are necessary for each of 
the fiscal years 2016 through 2018.

SEC. 302. INTERPROFESSIONAL TRAINING OF MEDICAL STUDENTS, RESIDENTS, 
              AND STUDENT MIDWIVES IN ACADEMIC HEALTH CENTERS AND 
              FREESTANDING BIRTH 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. 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 2014, 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, nurse practitioners whose scope 
of practice includes maternity care, physician assistants whose scope 
of practice includes obstetrical care, 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 2014 
and $3,000,000 for each of the fiscal years 2015 through 2018.
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