[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3568 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3568

   To amend the Social Security Act and Public Health Service Act to 
                 improve obstetric care in rural areas.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 10, 2018

 Ms. Heitkamp introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To amend the Social Security Act and Public Health Service Act to 
                 improve obstetric care in rural areas.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Maternal and Obstetric 
Modernization of Services Act'' or the ``Rural MOMS Act''.

SEC. 2. IMPROVING RURAL MATERNAL AND OBSTETRIC CARE DATA.

    (a) Maternal Mortality and Morbidity Activities.--Section 301 of 
the Public Health Service Act (42 U.S.C. 241) is amended--
            (1) by redesignating subsections (e) through (h) as 
        subsections (f) through (i), respectively; and
            (2) by inserting after subsection (d), the following:
    ``(e) The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, shall expand, intensify, and coordinate 
the activities of the Centers for Disease Control and Prevention with 
respect to maternal mortality and morbidity.''.
    (b) Office of Women's Health.--Section 310A(b)(1) of the Public 
Health Service Act (42 U.S.C. 242s(b)(1)) is amended by inserting 
``sociocultural, and geographic contexts,'' after ``biological,''.
    (c) Safe Motherhood.--Section 317K(b)(2) of the Public Health 
Service Act (42 U.S.C. 247b-12(b)(2)) is amended--
            (1) in subparagraph (K), by striking ``and'' at the end;
            (2) by redesignating subparagraph (L) as subparagraph (M); 
        and
            (3) by inserting after subparagraph (K), the following:
                    ``(L) an examination of the relationship between 
                maternal and obstetric health services in rural areas 
                and outcomes in delivery and postpartum care; and''.
    (d) Office of Research on Women's Health.--Section 486 of the 
Public Health Service Act (42 U.S.C. 287d) is amended--
            (1) in subsection (b)--
                    (A) by redesignating paragraphs (4) through (9) as 
                paragraphs (5) through (10), respectively;
                    (B) by inserting after paragraph (3) the following:
            ``(4) carry out paragraphs (1) and (2) with respect to 
        pregnancy, with priority given to deaths related to 
        pregnancy;''; and
                    (C) in paragraph (5) (as so redesignated), by 
                striking ``through (3)'' and inserting ``through (4)''; 
                and
            (2) in subsection (d)(4)(A)(iv), by inserting ``, including 
        maternal mortality and other maternal morbidity outcomes'' 
        before the semicolon.

SEC. 3. COLLABORATIVE IMPROVEMENT AND INNOVATION NETWORKS TO IMPROVE 
              OBSTETRIC HEALTH IN RURAL AREAS.

    Section 501 of the Social Security Act (42 U.S.C. 701) is amended--
            (1) in subsection (a)(2), by inserting ``and the 
        establishment of collaborative improvement and innovation 
        networks to improve obstetric health in rural areas by 
        improving outcomes in birth and maternal morbidity and 
        mortality'' after ``services development''; and
            (2) by adding at the end the following:
    ``(d)(1)(A) For the purpose of enabling the Secretary (through 
grants, contracts, or otherwise) to establish, as special projects of 
regional and national significance, collaborative improvement and 
innovation networks (referred to in this subsection as `rural obstetric 
health CoIINs') to improve obstetric health in rural areas by improving 
outcomes in birth and maternal morbidity and mortality, there is 
appropriated to the Secretary, out of any money in the Treasury not 
otherwise appropriated, $3,000,000 for each of fiscal years 2019 
through 2023.
    ``(B) Funds appropriated under subparagraph (A) shall--
            ``(i) be in addition to amounts appropriated under 
        subsection (a) and retained under section 502(a)(1) for the 
        purpose of carrying out activities described in subsection 
        (a)(2); and
            ``(ii) remain available until expended.
    ``(2) Rural obstetric health CoIINs established in accordance with 
this subsection shall--
            ``(A) assist pregnant women in rural areas connect with 
        maternal, prenatal and postnatal, and obstetric care to improve 
        outcomes in birth and maternal mortality and morbidity;
            ``(B) identify successful maternal, prenatal and postnatal, 
        and obstetric health delivery models for women in rural areas;
            ``(C) develop a model for collaboration between health 
        facilities that have an obstetric health unit and health 
        facilities that do not have an obstetric health unit;
            ``(D) provide training and guidance for health facilities 
        that do not have obstetric health units; and
            ``(E) collaborate with academic institutions that can 
        provide regional expertise and research on access, outcomes, 
        needs assessments, and other identified data.
    ``(3)(A) Not later than October 1, 2019, the Secretary shall 
establish rural obstetric health CoIINs in at least 5 regions.
    ``(B) In this subsection:
            ``(i) The term `frontier area' means a frontier county, as 
        defined in section 1886(d)(3)(E)(iii)(III).
            ``(ii) The term `Indian tribe' has the meaning given such 
        term in section 4 of the Indian Health Care Improvement Act (25 
        U.S.C. 1603).
            ``(iii) The term `region' means a State, Indian tribe, 
        rural area, or frontier area.
            ``(iv) The term `rural area' has the meaning given that 
        term in section 1886(d)(2)(D).
            ``(v) The term `State' has the meaning given that term for 
        purposes of this title in section 1101.
    ``(4) The provisions of this title that are applicable to the funds 
made available to the Secretary under section 502(a)(1) apply in the 
same manner to funds made available to the Secretary under paragraph 
(1)(A).''.

SEC. 4. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT 
              PROGRAMS.

    Section 330I of the Public Health Service Act (42 U.S.C. 254c-14) 
is amended--
            (1) in subsection (f)(1)(B)(iii), by adding at the end the 
        following:
                                    ``(XIII) Providers of maternal, 
                                including prenatal and postnatal, and 
                                obstetric care services and entities 
                                operation obstetric care units.'';
            (2) in subsection (i)(1)(B), by inserting ``maternal, 
        including prenatal and postnatal care, obstetric care,'' before 
        ``or prenatal''; and
            (3) in subsection (k)(1)(B), by inserting ``equipment 
        useful for caring for pregnant women, including ultrasound 
        machines and fetal monitoring equipment,'' before ``and other 
        equipment''.

SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

    Part D of title VII of the Public Health Service Act is amended by 
inserting after section 760 (42 U.S.C. 294k) the following:

SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

    (a) In General.--The Secretary shall establish a training 
demonstration program to award grants to eligible entities to support--
            (1) training for physicians, medical residents, including 
        family practice residents, and fellows to practice maternal and 
        obstetric medicine in rural, community-based settings;
            (2) training for nurse practitioners, physician assistants, 
        nurse midwives, and doulas to provide maternal and obstetric 
        care services in rural community-based settings; and
            (3) establishing, maintaining, or improving academic units 
        or programs that--
                    (A) provide training for students or faculty, 
                including through clinical experiences and research, to 
                improve maternal and obstetric care in rural areas; or
                    (B) develop evidence-based practices or 
                recommendations for the design of the units or programs 
                described in subparagraph (A), including curriculum 
                content standards.
    (b) Activities.--
            (1) Training for residents and fellows.--A recipient of a 
        grant under subsection (a)(1)--
                    (A) shall use the grant funds--
                            (i) to plan, develop, and operate a 
                        training program to provide obstetric care in 
                        rural areas for family practice or obstetrics 
                        residents and fellows; or
                            (ii) to train new family practice or 
                        obstetrics residents and fellows in maternal 
                        and obstetric health care to provide and expand 
                        access to maternal and obstetric health care in 
                        rural areas; and
                    (B) may use the grant funds to provide additional 
                support for the administration of the program or to 
                meet the costs of projects to establish, maintain, or 
                improve faculty development, or departments, divisions, 
                or other units necessary to implement such training.
            (2) Training for other providers.--A recipient of a grant 
        under subsection (a)(2)--
                    (A) shall use the grant funds to plan, develop, or 
                operate a training program to provide maternal and 
                obstetric health care services in rural, community-
                based settings; and
                    (B) may use the grant funds to provide additional 
                support for the administration of the program or to 
                meet the costs of projects to establish, maintain, or 
                improve faculty development, or departments, divisions, 
                or other units necessary to implement such program.
            (3) Academic units or programs.--A recipient of a grant 
        under subsection (a)(3) shall enter into a partnership with 
        organizations such as an education accrediting organization 
        (such as the Liaison Committee on Medical Education, the 
        Accreditation Council for Graduate Medical Education, the 
        Commission on Osteopathic College Accreditation, the 
        Accreditation Commission for Education in Nursing, the 
        Commission on Collegiate Nursing Education, or the 
        Accreditation Review Commission on Education for the Physician 
        Assistant) to carry out activities under subsection (a)(3).
    (c) Eligible Entities.--
            (1) Training for residents and fellows.--To be eligible to 
        receive a grant under subsection (a)(1), an entity shall--
                    (A) be a consortium consisting of--
                            (i) at least one teaching health center; 
                        and
                            (ii) the sponsoring institution (or parent 
                        institution of the sponsoring institution) of--
                                    (I) an obstetric residency program 
                                that is accredited by the Accreditation 
                                Council of Graduate Medical Education 
                                (or the parent institution of such a 
                                program); or
                                    (II) a fellowship in maternal or 
                                obstetric medicine, as determined 
                                appropriate by the Secretary; or
                    (B) be an entity described in subparagraph (A)(ii) 
                that provides opportunities for residents or fellows to 
                train in rural community-based settings.
            (2) Training for other providers.--To be eligible to 
        receive a grant under subsection (a)(2), an entity shall be--
                    (A) a teaching health center (as defined in section 
                749A(f));
                    (B) a Federally qualified health center (as defined 
                in section 1905(l)(2)(B) of the Social Security Act);
                    (C) a community mental health center (as defined in 
                section 1861(ff)(3)(B) of the Social Security Act);
                    (D) a rural health clinic (as defined in section 
                1861(aa) of the Social Security Act);
                    (E) a health center operated by the Indian Health 
                Service, an Indian tribe, a tribal organization, or an 
                urban Indian organization (as defined in section 4 of 
                the Indian Health Care Improvement Act); or
                    (F) an entity with a demonstrated record of success 
                in providing training for nurse practitioners, 
                physician assistants, nurse midwives, or doulas.
            (3) Academic units or programs.--To be eligible to receive 
        a grant under subsection (a)(3), an entity shall be a school of 
        medicine or osteopathic medicine, a nursing school, a physician 
        assistant training program, an accredited public or nonprofit 
        private hospital, an accredited medical residency program, or a 
        public or private nonprofit entity which the Secretary has 
        determined is capable of carrying out such grant.
    (d) Duration.--Grants awarded under this section shall be for a 
minimum of 5 years.
    (e) Study and Report.--
            (1) Study.--
                    (A) In general.--The Secretary, acting through the 
                Administrator of the Health Resources and Services 
                Administration, shall conduct a study on the results of 
                the demonstration program under this section.
                    (B) Data submission.--Not later than 90 days after 
                the completion of the first year of the training 
                program, and each subsequent year that the program is 
                in effect, each recipient of a grant under subsection 
                (a) shall submit to the Secretary such data as the 
                Secretary may require for analysis for the report 
                described in paragraph (2).
            (2) Report to congress.--Not later than 1 year after 
        receipt of the data described in paragraph (1)(B), the 
        Secretary shall submit to Congress a report that includes--
                    (A) an analysis of the effect of the demonstration 
                program under this section on the quality, quantity, 
                and distribution of maternal, including prenatal and 
                postnatal, and obstetric care services;
                    (B) an analysis of the effect of the demonstration 
                program on the prevalence of maternal mortality in the 
                surrounding communities of health centers participating 
                in the demonstration; and
                    (C) recommendations on whether the demonstration 
                program should be expanded.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2019 through 2023.

SEC. 6. GAO REPORT.

    Not later than 1 year after the date of enactment of this Act, the 
Comptroller General of the United States shall submit to the 
appropriate committees of Congress a report on the maternal, including 
prenatal and postnatal, care and obstetric care in rural areas. Such 
report shall include the following:
            (1) The location of gaps in maternal and obstetric health 
        care workers, including non-physicians such as doulas and 
        community health workers.
            (2) A list of specific activities that the Comptroller 
        General plans to conduct on maternal, including prenatal and 
        postnatal, and obstetric care.
            (3) A plan for completing such activities.
            (4) An explanation of Federal agency involvement and 
        coordination needed to conduct such activities.
            (5) A budget for conducting such activities.
            (6) Other information that the Comptroller General 
        determines appropriate.
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