[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4243 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 4243

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 9, 2019

    Ms. Torres Small of New Mexico (for herself, Mr. Newhouse, Ms. 
    Finkenauer, Mr. Latta, Mr. Lujan, and Mr. Cole) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend the 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 (race, ethnicity, language, class, income), including 
among American Indians and Alaska Natives, as such terms are defined in 
section 4 of the Indian Health Care Improvement Act, 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 (L), by striking ``and'' at the end;
            (2) by redesignating subparagraph (M) as subparagraph (N); 
        and
            (3) by inserting after subparagraph (L), the following:
                    ``(M) an examination of the relationship between 
                maternal 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. RURAL OBSTETRIC NETWORK GRANTS.

    The Public Health Service Act is amended by inserting after section 
317L-1 (42 U.S.C. 247b-13a) the following:

``SEC. 317L-2. RURAL OBSTETRIC NETWORK GRANTS.

    ``(a) In General.--For the purpose of enabling the Secretary 
(through grants, contracts, or otherwise), acting through the 
Administrator of the Health Resources and Services Administration, to 
establish collaborative improvement and innovation networks (referred 
to in this section as `rural obstetric networks') to improve 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 2020 through 2024. 
Such amounts shall remain available until expended.
    ``(b) Use of Funds.--Amount appropriated under subsection (a) shall 
be used for the establishment of collaborative improvement and 
innovation networks to improve maternal health in rural areas by 
improving outcomes in birth and maternal morbidity and mortality. Rural 
obstetric networks established in accordance with this section shall--
            ``(1) assist pregnant women and individuals in rural areas 
        connect with prenatal, labor and birth, and postpartum care to 
        improve outcomes in birth and maternal mortality and morbidity;
            ``(2) identify successful prenatal, labor and birth, and 
        postpartum health delivery models for individuals in rural 
        areas, including evidence-based home visiting programs and 
        successful, culturally competent models with positive maternal 
        health outcomes that advance health equity;
            ``(3) 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;
            ``(4) provide training and guidance for health facilities 
        that do not have obstetric health units;
            ``(5) collaborate with academic institutions that can 
        provide regional expertise and research on access, outcomes, 
        needs assessments, and other identified data; and
            ``(6) measure and address inequities in birth outcomes 
        among rural residents, with an emphasis on Black and American 
        Indians and Alaska Native residents, as such terms are defined 
        in section 4 of the Indian Health Care Improvement Act.
    ``(c) Requirements.--
            ``(1) Establishment.--Not later than October 1, 2020, the 
        Secretary shall establish rural obstetric health networks in at 
        least 5 regions.
            ``(2) Definitions.--In this section:
                    ``(A) Frontier area.--The term `frontier area' 
                means a frontier county, as defined in section 
                1886(d)(3)(E)(iii)(III) of the Social Security Act.
                    ``(B) Indian tribe.--The term `Indian tribe' has 
                the meaning given such term in section 4 of the Indian 
                Health Care Improvement Act.
                    ``(C) Native hawaiian health care system.--The term 
                `Native Hawaiian Health Care System' has the meaning 
                given such term in section 12 of the Native Hawaiian 
                Health Care Improvement Act.
                    ``(D) Region.--The term `region' means a State, 
                Indian tribe, rural area, or frontier area.
                    ``(E) Rural area.--The term `rural area' has the 
                meaning given that term in section 1886(d)(2)(D) of the 
                Social Security Act.
                    ``(F) Tribal organization.--The term `tribal 
                organization' has the meaning given such term in the 
                Indian Self-Determination Act.
                    ``(G) State.--The term `State' has the meaning 
                given that term for purposes of title V of the Social 
                Security Act.''.

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, labor and birth, 
                                and postpartum care services and 
                                entities operation obstetric care 
                                units.'';
            (2) in subsection (i)(1)(B), by inserting ``labor and 
        birth, postpartum,'' before ``or prenatal''; and
            (3) in subsection (k)(1)(B), by inserting ``equipment 
        useful for caring for pregnant women and individuals, 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 medicine and obstetrics and gynecology residents, and 
        fellows to practice maternal and obstetric medicine in rural 
        community-based settings;
            ``(2) training for licensed and accredited nurse 
        practitioners, physician assistants, certified nurse midwives, 
        certified midwives, certified professional midwives, home 
        visiting nurses, or non-clinical professionals such as doulas 
        and community health workers, to provide maternal 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 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 medical 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 
                        and gynecology residents and fellows; or
                            ``(ii) to train new family practice or 
                        obstetrics and gynecology 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 
                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, the Accreditation 
        Commission for Midwifery Education, or the Accreditation Review 
        Commission on Education for the Physician Assistant) to carry 
        out activities under subsection (a)(3).
            ``(4) Training program requirements.--The recipient of a 
        grant under subsection (a)(1) or (a)(2) shall ensure that 
        training programs carried out under the grant include 
        instruction on--
                    ``(A) maternal mental health, including perinatal 
                depression and anxiety and postpartum depression;
                    ``(B) maternal substance use disorder;
                    ``(C) social determinants of health that impact 
                individuals living in rural communities, including 
                poverty, social isolation, access to nutrition, 
                education, transportation, and housing; and
                    ``(D) implicit bias.
    ``(c) Eligible Entities.--
            ``(1) Training for medical 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; 
                        or
                            ``(ii) the sponsoring institution (or 
                        parent institution of the sponsoring 
                        institution) of--
                                    ``(I) an obstetrics and gynecology 
                                or family medicine 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 medical 
                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 freestanding birth center (as defined in 
                section 1905(l)(3) of the Social Security Act);
                    ``(F) a health center operated by the Indian Health 
                Service, an Indian tribe, a tribal organization, or a 
                Native Hawaiian Health Care System (as such terms are 
                defined in section 4 of the Indian Health Care 
                Improvement Act and section 12 of the Native Hawaiian 
                Health Care Improvement Act); or
                    ``(G) an entity with a demonstrated record of 
                success in providing academic training for nurse 
                practitioners, physician assistants, certified nurse-
                midwives, certified midwives, certified professional 
                midwives, home visiting nurses, or non-clinical 
                professionals, such as doulas and community health 
                workers.
            ``(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, a school accredited by the Midwifery Education and 
        Accreditation Council, or a public or private nonprofit entity 
        which the Secretary has determined is capable of carrying out 
        such grant.
            ``(4) Application.--To be eligible to receive a grant under 
        subsection (a), an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require, including an estimate 
        of the amount to be expended to conduct training activities 
        under the grant (including ancillary and administrative costs).
    ``(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 for the duration of 
                the grant, 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, labor and birth, and postpartum 
                care services and the demographics of the recipients of 
                those services;
                    ``(B) an analysis of maternal and infant health 
                outcomes (including quality of care, morbidity, and 
                mortality) before and after implementation of the 
                program in the communities served by entities 
                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 2020 through 2024.''.

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, labor and birth, and postpartum care in rural areas. Such 
report shall include the following:
            (1) The location of gaps in maternal and obstetric 
        clinicians and health professionals, including non-clinical 
        professionals such as doulas and community health workers.
            (2) The location of gaps in facilities able to provide 
        maternal, including prenatal, labor and birth, and postpartum 
        care in rural areas, including care for high-risk pregnancies.
            (3) The gaps in data on maternal mortality and 
        recommendations to standardize the format on collecting data 
        related to maternal mortality and morbidity.
            (4) The gaps in maternal health by race and ethnicity in 
        rural communities, with a focus on racial inequities for Black 
        residents and among Indian Tribes and American Indian/Alaska 
        Native rural residents (as such terms are defined in section 4 
        of the Indian Health Care Improvement Act).
            (5) A list of specific activities that the Secretary of 
        Health and Human Services plans to conduct on maternal, 
        including prenatal, labor and birth, and postpartum care.
            (6) A plan for completing such activities.
            (7) An explanation of Federal agency involvement and 
        coordination needed to conduct such activities.
            (8) A budget for conducting such activities.
            (9) Other information that the Comptroller General 
        determines appropriate.
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