[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4995 Reported in House (RH)]

<DOC>





                                                 Union Calendar No. 414
116th CONGRESS
  2d Session
                                H. R. 4995

                          [Report No. 116-514]

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 8, 2019

 Mr. Engel (for himself, Mr. Bucshon, Ms. Torres Small of New Mexico, 
 Mr. Latta, Ms. Adams, and Mr. Stivers) introduced the following bill; 
       which was referred to the Committee on Energy and Commerce

                           September 17, 2020

Additional sponsors: Mr. Carson of Indiana, Ms. Kelly of Illinois, Ms. 
Herrera Beutler, Mr. Marshall, Mr. Burgess, Mr. Walden, Mrs. Hayes, Mr. 
 O'Halleran, Ms. Kuster of New Hampshire, Mr. Guthrie, Mr. Trone, Ms. 
  Craig, Mr. Fitzpatrick, Ms. Schakowsky, Mr. Casten of Illinois, Mr. 
 Cunningham, Ms. Norton, Ms. Underwood, Mr. McGovern, Ms. Finkenauer, 
Mr. Morelle, Ms. Houlahan, Ms. Gabbard, Mr. Ruiz, Mrs. Napolitano, and 
                         Mr. Levin of Michigan

                           September 17, 2020

  Reported with an amendment; committed to the Committee of the Whole 
       House on the State of the Union and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
    [For text of introduced bill, see copy of bill as introduced on 
                           November 8, 2019]


_______________________________________________________________________

                                 A BILL


 
 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 2019''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

            TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS

Sec. 101. Improving rural maternal and obstetric care data.
Sec. 102. Rural obstetric network grants.
Sec. 103. Telehealth network and telehealth resource centers grant 
                            programs.
Sec. 104. Rural maternal and obstetric care training demonstration.
Sec. 105. GAO report.

             TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE

Sec. 201. Innovation for maternal health.
Sec. 202. Training for health care providers.
Sec. 203. Study on training to reduce and prevent discrimination.
Sec. 204. Perinatal quality collaboratives.
Sec. 205. Integrated services for pregnant and postpartum women.

            TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS

SEC. 101. 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, including among American Indians and Alaska Natives, 
as such terms are defined in section 4 of the Indian Health Care 
Improvement Act, geographic,'' after ``biological,''.
    (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 before the period 
        at the end the following: ``, including improving collection of 
        data on race, ethnicity, and other demographic information''; 
        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 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 pregnancy;''; and
            (2) in subsection (d)(4)(A)(iv), by inserting ``, including 
        maternal mortality and other maternal morbidity outcomes'' 
        before the semicolon.

SEC. 102. RURAL OBSTETRIC NETWORK GRANTS.

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

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

    ``(a) Program Established.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall award grants to eligible entities to establish collaborative 
improvement and innovation networks (referred to in this section as 
`rural obstetric networks') to improve birth outcomes and reduce 
maternal morbidity and mortality by improving maternity care and access 
to care in rural areas, frontier areas, maternity care health 
professional target areas, and Indian country and with Indian Tribes 
and tribal organizations.
    ``(b) Use of Funds.--Rural obstetric networks receiving funds 
pursuant to this section may use such funds to--
            ``(1) assist pregnant women and individuals in areas and 
        within populations referenced in subsection (a) with accessing 
        and utilizing maternal and obstetric care, including 
        preconception, pregnancy, labor and delivery, postpartum, and 
        interconception services to improve outcomes in birth and 
        maternal mortality and morbidity;
            ``(2) identify successful delivery models for maternal and 
        obstetric care (including preconception, pregnancy, labor and 
        delivery, postpartum, and interconception services) for 
        individuals in areas and within populations referenced by 
        subsection (a), 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 care unit and health 
        facilities that do not have an obstetric care unit to improve 
        access to and the delivery of obstetric services in communities 
        lacking these services;
            ``(4) provide training and guidance on obstetric care for 
        health facilities that do not have obstetric care units;
            ``(5) collaborate with academic institutions that can 
        provide regional expertise and research on access, outcomes, 
        needs assessments, and other identified data and measurement 
        activities needed to inform rural obstetric network efforts to 
        improve obstetric care; and
            ``(6) measure and address inequities in birth outcomes 
        among rural residents, with an emphasis on racial and ethnic 
        minorities and underserved populations.
    ``(c) Definitions.--In this section:
            ``(1) Eligible entities.--The term `eligible entities' 
        means entities providing obstetric, gynecologic, and other 
        maternal health care services in rural areas, frontier areas, 
        or medically underserved areas, or to medically underserved 
        populations or Native Americans, including 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 country.--The term `Indian country' has the 
        meaning given such term in section 1151 of title 18, United 
        States Code.
            ``(4) Maternity care health professional target area.--The 
        term `maternity care health professional target area' has the 
        meaning of such term as used in section 332(k)(2).
            ``(5) Rural area.--The term `rural area' has the meaning 
        given that term in section 1886(d)(2) of the Social Security 
        Act.
            ``(6) Indian tribes; tribal organization.--The terms 
        `Indian Tribe' and `tribal organization' have the meaning given 
        such terms in section 4 of the Indian Self-Determination and 
        Education Assistance Act.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $3,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 103. 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 operating obstetric care 
                                units.''; and
            (2) in subsection (i)(1)(B), by inserting ``labor and 
        birth, postpartum,'' before ``or prenatal''.

SEC. 104. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

    Subpart 1 of part E of title VII of the Public Health Service Act 
is amended by inserting after section 760 (42 U.S.C. 294n et seq.), as 
amended by section 202, is amended by adding at the end the following:

``SEC. 764. 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 nurse practitioners, physician 
        assistants, nurses, certified nurse midwives, home visiting 
        nurses and non-clinical home visiting workforce professionals 
        and paraprofessionals, or non-clinical professionals, who meet 
        applicable State training and licensing requirements, 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) 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 are evidence-
        based and include instruction on--
                    ``(A) maternal mental health, including perinatal 
                depression and anxiety;
                    ``(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); or
                    ``(F) an Indian Health Program 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, respectively).
            ``(3) Academic units or programs.--To be eligible to 
        receive a grant under subsection (a)(3), an entity shall be a 
        school of medicine, a school of osteopathic medicine, a school 
        of nursing (as defined in section 801), a physician assistant 
        education program, an accredited public or nonprofit private 
        hospital, an accredited medical residency training program, a 
        school accredited by the Midwifery Education and Accreditation 
        Council, by the Accreditation Commission for Midwifery 
        Education, or by the American Midwifery Certification Board, or 
        a public or private nonprofit educational 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) 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 the Committee on Energy and Commerce 
        of the House of Representatives and the Committee on Health, 
        Education, Labor, and Pensions of the Senate 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.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 105. GAO REPORT.

    Not later than 18 months after the date of enactment of this Act, 
the Comptroller General of the United States shall submit to the 
Committee on Energy and Commerce of the House of Representatives and 
the Committee on Health, Education, Labor, and Pensions of the Senate a 
report on maternal care in rural areas, including prenatal, labor and 
birth, and postpartum care in rural areas. Such report shall include 
the following:
            (1) Trends in data that may identify potential gaps in 
        maternal and obstetric clinicians and health professionals, 
        including non-clinical professionals.
            (2) Trends in the number of facilities able to provide 
        maternal care, 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 morbidity 
        and recommendations to standardize the format on collecting 
        data related to maternal mortality and morbidity.
            (4) The gaps in maternal health outcomes by race and 
        ethnicity in rural communities, with a focus on racial 
        inequities for residents who are racial and ethnic minorities 
        or members of underserved populations.
            (5) An examination of--
                    (A) activities which the Secretary of Health and 
                Human Services plans to conduct to improve maternal 
                care in rural areas, including prenatal, labor and 
                birth, and postpartum care; and
                    (B) the extent to which the Secretary has a plan 
                for completing these activities, has identified the 
                lead agency responsible for each activity, has 
                identified any needed coordination among agencies, and 
                has developed a budget for conducting such activities.
            (6) Other information that the Comptroller General 
        determines appropriate.

             TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE

SEC. 201. INNOVATION FOR MATERNAL HEALTH.

    The Public Health Service Act is amended--
            (1) in the section designation of section 330M (42 U.S.C. 
        254c-19) by inserting a period after ``330M''; and
            (2) by inserting after such section 330M 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 purpose 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 in 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 is authorized to be appropriated $10,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 202. 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 is authorized to be appropriated $5,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 203. 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 (referred to in this section as 
the ``Secretary'') 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. 204. PERINATAL QUALITY COLLABORATIVES.

    (a) Grants.--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.''.
    (b) Authorization of Appropriations.--Section 317K(f) of the Public 
Health Service Act (42 U.S.C. 247b-12(f)) is amended by striking 
``$58,000,000 for each of fiscal years 2019 through 2023'' and 
inserting ``$65,000,000 for each of fiscal years 2020 through 2024''.

SEC. 205. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

    (a) Grants.--The Public Health Service Act is amended by inserting 
after section 330N of such Act, as added by section 201, the following:

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

    ``(a) In General.--The Secretary may award grants 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--
            ``(1) to reduce adverse maternal health outcomes, 
        pregnancy-related deaths, and related health disparities 
        (including such disparities associated with racial and ethnic 
        minority populations); and
            ``(2) as appropriate, by addressing issues researched under 
        section 317K(b)(2).
    ``(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 
        (as such terms are defined in section 4 of the Indian Self-
        Determination and Education Assistance Act) 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 those 
                representing racial and ethnicity 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) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2020 through 2024.''.
    (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 
        Energy and Commerce of the House of Representatives and the 
        Committee on Health, Education, Labor, and Pensions of the 
        Senate a report that describes--
                    (A) the outcomes of the activities supported by the 
                grants awarded under the amendments made by this 
                section on maternal and child health;
                    (B) best practices and models of care used by 
                recipients of grants under such amendments; and
                    (C) obstacles identified by recipients of grants 
                under such amendments, 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 section 330O of the Public 
        Health Service Act (as added 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.
                                                 Union Calendar No. 414

116th CONGRESS

  2d Session

                               H. R. 4995

                          [Report No. 116-514]

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                           September 17, 2020

  Reported with an amendment; committed to the Committee of the Whole 
       House on the State of the Union and ordered to be printed