[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4995 Referred in Senate (RFS)]

<DOC>
116th CONGRESS
  2d Session
                                H. R. 4995


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 22, 2020

     Received; read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 AN ACT


 
 To amend the Public Health Service Act to improve obstetric care and 
           maternal health outcomes, 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.

    This Act may be cited as the ``Maternal Health Quality Improvement 
Act of 2020''.

SEC. 2. INNOVATION FOR MATERNAL HEALTH.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended--
            (1) in the section designation of section 330M of such Act 
        (42 U.S.C. 254c-19) by inserting a period after ``330M''; and
            (2) by inserting after section 330M of such Act (42 U.S.C. 
        254c-19) the following:

``SEC. 330N. INNOVATION FOR MATERNAL HEALTH.

    ``(a) In General.--The Secretary, in consultation with experts 
representing a variety of clinical specialties, State, Tribal, or local 
public health officials, researchers, epidemiologists, statisticians, 
and community organizations, shall establish or continue a program to 
award competitive grants to eligible entities for the purposes of--
            ``(1) identifying, developing, or disseminating best 
        practices to improve maternal health care quality and outcomes, 
        eliminate preventable maternal mortality and severe maternal 
        morbidity, and improve infant health outcomes, which may 
        include--
                    ``(A) information on evidence-based practices to 
                improve the quality and safety of maternal health care 
                in hospitals and other health care settings of a State 
                or health care system, including by addressing topics 
                commonly associated with health complications or risks 
                related to prenatal care, labor care, birthing, and 
                postpartum care;
                    ``(B) best practices for improving maternal health 
                care based on data findings and reviews conducted by a 
                State maternal mortality review committee that address 
                topics of relevance to common complications or health 
                risks related to prenatal care, labor care, birthing, 
                and postpartum care; and
                    ``(C) information on addressing determinants of 
                health that impact maternal health outcomes for women 
                before, during, and after pregnancy;
            ``(2) collaborating with State maternal mortality review 
        committees to identify issues for the development and 
        implementation of evidence-based practices to improve maternal 
        health outcomes and reduce preventable maternal mortality and 
        severe maternal morbidity;
            ``(3) providing technical assistance and supporting the 
        implementation of best practices identified pursuant to 
        paragraph (1) to entities providing health care services to 
        pregnant and postpartum women; and
            ``(4) identifying, developing, and evaluating new models of 
        care that improve maternal and infant health outcomes, which 
        may include the integration of community-based services and 
        clinical care.
    ``(b) Eligible Entities.--To be eligible for a grant under 
subsection (a), an entity shall--
            ``(1) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require; and
            ``(2) demonstrate in such application that the entity is 
        capable of carrying out data-driven maternal safety and quality 
        improvement initiatives in the areas of obstetrics and 
        gynecology or maternal health.
    ``(c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $5,000,000 for each of fiscal 
years 2021 through 2025.''.

SEC. 3. TRAINING FOR HEALTH CARE PROVIDERS.

    Title VII of the Public Health Service Act is amended by striking 
section 763 (42 U.S.C. 294p) and inserting the following:

``SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS.

    ``(a) Grant Program.--The Secretary shall establish a program to 
award grants to accredited schools of allopathic medicine, osteopathic 
medicine, and nursing, and other health professional training programs 
for the training of health care professionals to reduce and prevent 
discrimination (including training related to implicit and explicit 
biases) in the provision of health care services related to prenatal 
care, labor care, birthing, and postpartum care.
    ``(b) Eligibility.--To be eligible for a grant under subsection 
(a), an entity described in such subsection shall submit to the 
Secretary an application at such time, in such manner, and containing 
such information as the Secretary may require.
    ``(c) Reporting Requirement.--Each entity awarded a grant under 
this section shall periodically submit to the Secretary a report on the 
status of activities conducted using the grant, including a description 
of the impact of such training on patient outcomes, as applicable.
    ``(d) Best Practices.--The Secretary may identify and disseminate 
best practices for the training of health care professionals to reduce 
and prevent discrimination (including training related to implicit and 
explicit biases) in the provision of health care services related to 
prenatal care, labor care, birthing, and postpartum care.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $5,000,000 for each of fiscal 
years 2021 through 2025.''.

SEC. 4. STUDY ON TRAINING TO REDUCE AND PREVENT DISCRIMINATION.

    Not later than 2 years after date of enactment of this Act, the 
Secretary of Health and Human Services shall, through a contract with 
an independent research organization, conduct a study and make 
recommendations for accredited schools of allopathic medicine, 
osteopathic medicine, and nursing, and other health professional 
training programs, on best practices related to training to reduce and 
prevent discrimination, including training related to implicit and 
explicit biases, in the provision of health care services related to 
prenatal care, labor care, birthing, and postpartum care.

SEC. 5. PERINATAL QUALITY COLLABORATIVES.

    Section 317K(a)(2) of the Public Health Service Act (42 U.S.C. 
247b-12(a)(2)) is amended by adding at the end the following:
                    ``(E)(i) The Secretary, acting through the Director 
                of the Centers for Disease Control and Prevention and 
                in coordination with other offices and agencies, as 
                appropriate, shall establish or continue a competitive 
                grant program for the establishment or support of 
                perinatal quality collaboratives to improve perinatal 
                care and perinatal health outcomes for pregnant and 
                postpartum women and their infants. A State, Indian 
                Tribe, or Tribal organization may use funds received 
                through such grant to--
                            ``(I) support the use of evidence-based or 
                        evidence-informed practices to improve outcomes 
                        for maternal and infant health;
                            ``(II) work with clinical teams; experts; 
                        State, local, and, as appropriate, Tribal 
                        public health officials; and stakeholders, 
                        including patients and families, to identify, 
                        develop, or disseminate best practices to 
                        improve perinatal care and outcomes; and
                            ``(III) employ strategies that provide 
                        opportunities for health care professionals and 
                        clinical teams to collaborate across health 
                        care settings and disciplines, including 
                        primary care and mental health, as appropriate, 
                        to improve maternal and infant health outcomes, 
                        which may include the use of data to provide 
                        timely feedback across hospital and clinical 
                        teams to inform responses, and to provide 
                        support and training to hospital and clinical 
                        teams for quality improvement, as appropriate.
                    ``(ii) To be eligible for a grant under clause (i), 
                an entity shall submit to the Secretary an application 
                in such form and manner and containing such information 
                as the Secretary may require.''.

SEC. 6. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

    (a) Grants.--Title III of the Public Health Service Act is amended 
by inserting after section 330N of such Act, as added by section 2, the 
following:

``SEC. 330O. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

    ``(a) In General.--The Secretary may award grants to States, Indian 
Tribes, and Tribal organizations for the purpose of establishing or 
operating evidence-based or innovative, evidence-informed programs to 
deliver integrated health care services to pregnant and postpartum 
women to optimize the health of women and their infants, including to 
reduce adverse maternal health outcomes, pregnancy-related deaths, and 
related health disparities (including such disparities associated with 
racial and ethnic minority populations), and, as appropriate, by 
addressing issues researched under subsection (b)(2) of section 317K.
    ``(b) Integrated Services for Pregnant and Postpartum Women.--
            ``(1) Eligibility.--To be eligible to receive a grant under 
        subsection (a), a State, Indian Tribe, or Tribal organization 
        shall work with relevant stakeholders that coordinate care 
        (including coordinating resources and referrals for health care 
        and social services) to develop and carry out the program, 
        including--
                    ``(A) State, Tribal, and local agencies responsible 
                for Medicaid, public health, social services, mental 
                health, and substance use disorder treatment and 
                services;
                    ``(B) health care providers who serve pregnant and 
                postpartum women; and
                    ``(C) community-based health organizations and 
                health workers, including providers of home visiting 
                services and individuals representing communities with 
                disproportionately high rates of maternal mortality and 
                severe maternal morbidity, and including individuals 
                representing racial and ethnic minority populations.
            ``(2) Terms.--
                    ``(A) Period.--A grant awarded under subsection (a) 
                shall be made for a period of 5 years. Any supplemental 
                award made to a grantee under subsection (a) may be 
                made for a period of less than 5 years.
                    ``(B) Preference.--In awarding grants under 
                subsection (a), the Secretary shall--
                            ``(i) give preference to States, Indian 
                        Tribes, and Tribal organizations that have the 
                        highest rates of maternal mortality and severe 
                        maternal morbidity relative to other such 
                        States, Indian Tribes, or Tribal organizations, 
                        respectively; and
                            ``(ii) shall consider health disparities 
                        related to maternal mortality and severe 
                        maternal morbidity, including such disparities 
                        associated with racial and ethnic minority 
                        populations.
                    ``(C) Priority.--In awarding grants under 
                subsection (a), the Secretary shall give priority to 
                applications from up to 15 entities described in 
                subparagraph (B)(i).
                    ``(D) Evaluation.--The Secretary shall require 
                grantees to evaluate the outcomes of the programs 
                supported under the grant.
    ``(c) Definitions.--In this section, the terms `Indian Tribe' and 
`Tribal organization' have the meanings given the terms `Indian tribe' 
and `tribal organization', respectively, in section 4 of the Indian 
Self-Determination and Education Assistance Act.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2021 through 2025.''.
    (b) Report on Grant Outcomes and Dissemination of Best Practices.--
            (1) Report.--Not later than February 1, 2026, the Secretary 
        of Health and Human Services shall submit to the Committee on 
        Health, Education, Labor, and Pensions of the Senate and the 
        Committee on Energy and Commerce of the House of 
        Representatives a report that describes--
                    (A) the outcomes of the activities supported by the 
                grants awarded under the amendment made by this section 
                on maternal and child health;
                    (B) best practices and models of care used by 
                recipients of grants under such amendment; and
                    (C) obstacles identified by recipients of grants 
                under such amendment, and strategies used by such 
                recipients to deliver care, improve maternal and child 
                health, and reduce health disparities.
            (2) Dissemination of best practices.--Not later than August 
        1, 2026, the Secretary of Health and Human Services shall 
        disseminate information on best practices and models of care 
        used by recipients of grants under the amendment made by this 
        section (including best practices and models of care relating 
        to the reduction of health disparities, including such 
        disparities associated with racial and ethnic minority 
        populations, in rates of maternal mortality and severe maternal 
        morbidity) to relevant stakeholders, which may include health 
        providers, medical schools, nursing schools, relevant State, 
        Tribal, and local agencies, and the general public.

SEC. 7. IMPROVING RURAL MATERNAL AND OBSTETRIC CARE DATA.

    (a) Maternal Mortality and Morbidity Activities.--Section 301(e) of 
the Public Health Service Act (42 U.S.C. 241(e)) is amended by 
inserting ``, preventable maternal mortality and severe maternal 
morbidity,'' after ``delivery''.
    (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 striking ``and 
sociocultural contexts,'' and inserting ``sociocultural (including 
among American Indians, Native Hawaiians, and Alaska Natives), and 
geographical contexts''.
    (c) Safe Motherhood.--Section 317K of the Public Health Service Act 
(42 U.S.C. 247b-12) is amended--
            (1) in subsection (a)(2)(A), by inserting ``, including 
        improving collection of data on race, ethnicity, and other 
        demographic information'' before the period; and
            (2) in subsection (b)(2)--
                    (A) in subparagraph (L), by striking ``and'' at the 
                end;
                    (B) by redesignating subparagraph (M) as 
                subparagraph (N); and
                    (C) by inserting after subparagraph (L) the 
                following:
                    ``(M) an examination of the relationship between 
                maternal health and obstetric 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), by amending paragraph (3) to read as 
        follows:
            ``(3) carry out paragraphs (1) and (2) with respect to--
                    ``(A) the aging process in women, with priority 
                given to menopause; and
                    ``(B) pregnancy, with priority given to deaths 
                related to preventable maternal mortality and severe 
                maternal morbidity;''; and
            (2) in subsection (d)(4)(A)(iv), by inserting ``, including 
        preventable maternal morbidity and severe maternal morbidity'' 
        before the semicolon.

SEC. 8. RURAL OBSTETRIC NETWORK GRANTS.

    The Public Health Service Act is amended by inserting after section 
330A-1 (42 U.S.C. 254c-1a) the following:

``SEC. 330A-2. RURAL OBSTETRIC NETWORK GRANTS.

    ``(a) Program Established.--The Secretary shall award grants or 
cooperative agreements to eligible entities to establish collaborative 
improvement and innovation networks (referred to in this section as 
`rural obstetric networks') to improve maternal and infant health 
outcomes and reduce preventable maternal mortality and severe maternal 
morbidity by improving maternity care and access to care in rural 
areas, frontier areas, maternity care health professional target areas, 
or jurisdictions of Indian Tribes and Tribal organizations.
    ``(b) Use of Funds.--Grants or cooperative agreements awarded 
pursuant to this section shall be used for the establishment or 
continuation of collaborative improvement and innovation networks to 
improve maternal health in rural areas by improving infant health and 
maternal outcomes and reducing preventable maternal mortality and 
severe maternal morbidity. Rural obstetric networks established in 
accordance with this section may--
            ``(1) develop a network to improve coordination and 
        increase access to maternal health care and assist pregnant 
        women in the areas described in subsection (a) with accessing 
        and utilizing maternal and obstetric care, including health 
        care services related to prenatal care, labor care, birthing, 
        and postpartum care to improve outcomes in birth and maternal 
        mortality and morbidity;
            ``(2) identify and implement evidence-based and sustainable 
        delivery models for maternal and obstetric care (including 
        health care services related to prenatal care, labor care, 
        birthing, and postpartum care for women in the areas described 
        in subsection (a), including home visiting programs and 
        culturally appropriate care models that reduce health 
        disparities;
            ``(3) develop a model for maternal health care 
        collaboration between health care settings to improve access to 
        care in areas described in subsection (a), which may include 
        the use of telehealth;
            ``(4) provide training for professionals in health care 
        settings that do not have specialty maternity care;
            ``(5) collaborate with academic institutions that can 
        provide regional expertise and help identify barriers to 
        providing maternal health care, including strategies for 
        addressing such barriers; and
            ``(6) assess and address disparities in infant and maternal 
        health outcomes, including among racial and ethnic minority 
        populations and underserved populations in areas described in 
        subsection (a).
    ``(c) Definitions.--In this section:
            ``(1) Eligible entities.--The term `eligible entities' 
        means entities providing maternal health care services in rural 
        areas, frontier areas, or medically underserved areas, or to 
        medically underserved populations or Indian Tribes or Tribal 
        organizations.
            ``(2) 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.
            ``(3) Indian tribes; tribal organization.--The terms 
        `Indian Tribe' and `Tribal organization' have the meanings 
        given the terms `Indian tribe' and `tribal organization', 
        respectively, in section 4 of the Indian Self-Determination and 
        Education Assistance Act.
            ``(4) Maternity care health professional target area.--The 
        term `maternity care health professional target area' has the 
        meaning described in section 332(k)(2).
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $3,000,000 for each of fiscal 
years 2021 through 2025.''.

SEC. 9. 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)(3), by adding at the end the 
        following:
                    ``(M) Providers of maternal care, including 
                prenatal, labor care, birthing, and postpartum care 
                services and entities operating obstetric care 
                units.''; and
            (2) in subsection (h)(1)(B), by inserting ``labor care, 
        birthing care, postpartum care,'' before ``or prenatal''.

SEC. 10. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

    Subpart 1 of part E of title VII of the Public Health Service Act 
(42 U.S.C. 294n et seq.) is amended by adding at the end the following:

``SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

    ``(a) In General.--The Secretary shall award grants to accredited 
schools of allopathic medicine, osteopathic medicine, and nursing, and 
other appropriate health professional training programs, to establish a 
training demonstration program to support--
            ``(1) training for physicians, medical residents, fellows, 
        nurse practitioners, physician assistants, nurses, certified 
        nurse midwives, relevant home visiting workforce professionals 
        and paraprofessionals, or other professionals who meet relevant 
        State training and licensing requirements, as applicable, to 
        provide maternal health care services in rural community-based 
        settings; and
            ``(2) developing recommendations for such training 
        programs.
    ``(b) 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.
    ``(c) Activities.--
            ``(1) Training for health care professionals.--A recipient 
        of a grant under subsection (a)--
                    ``(A) shall use the grant funds to plan, develop, 
                and operate a training program to provide maternal 
                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 program requirements.--The recipient of a 
        grant under subsection (a) shall ensure that training programs 
        carried out under the grant are evidence-based and address 
        improving maternal health care in rural areas, and such 
        programs may include training on topics such as--
                    ``(A) maternal mental health, including perinatal 
                depression and anxiety;
                    ``(B) substance use disorders;
                    ``(C) social determinants of health that affect 
                individuals living in rural areas; and
                    ``(D) implicit and explicit bias.
    ``(d) Evaluation and Report.--
            ``(1) Evaluation.--
                    ``(A) In general.--The Secretary shall evaluate the 
                outcomes of the demonstration program under this 
                section.
                    ``(B) Data submission.--Recipients of a grant under 
                subsection (a) shall submit to the Secretary 
                performance metrics and other related data in order to 
                evaluate the program for the report described in 
                paragraph (2).
            ``(2) Report to congress.--Not later than January 1, 2025, 
        the Secretary shall submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives a report 
        that includes--
                    ``(A) an analysis of the effects of the 
                demonstration program under this section on the 
                quality, quantity, and distribution of maternal health 
                care services, including health care services related 
                to prenatal care, labor care, birthing, and postpartum 
                care, 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 program; and
                    ``(C) recommendations on whether the demonstration 
                program should be continued.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2021 through 2025.''.

            Passed the House of Representatives September 21, 2020.

            Attest:

                                             CHERYL L. JOHNSON,

                                                                 Clerk.