[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4387 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 4387

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 9, 2021

    Ms. Kelly of Illinois (for herself, Mr. Bucshon, Ms. Adams, Mr. 
  Burgess, Mrs. Hayes, and Mr. Latta) 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 maternal health, to 
     improve obstetric care in rural areas, 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 2021''.

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--IMPROVEMENTS TO MATERNAL HEALTH CARE

Sec. 101. Innovation for maternal health.
Sec. 102. Training for health care providers.
Sec. 103. Study on improving training for health care providers.
Sec. 104. Perinatal quality collaboratives.
Sec. 105. Integrated services for pregnant and postpartum women.
Sec. 106. Maternal vaccination awareness.
    TITLE II--RURAL MATERNAL AND OBSTETRIC MODERNIZATION OF SERVICES

Sec. 201. Improving rural maternal and obstetric care data.
Sec. 202. Rural obstetric network grants.
Sec. 203. Telehealth network and telehealth resource centers grant 
                            programs.
Sec. 204. Rural maternal and obstetric care training demonstration.

             TITLE I--IMPROVEMENTS TO MATERNAL HEALTH CARE

SEC. 101. INNOVATION FOR MATERNAL HEALTH.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by inserting after section 330N of such Act, the following:

``SEC. 330O. 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, 
        improve maternal and infant health, and eliminate preventable 
        maternal mortality and severe maternal morbidity, 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 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, consistent with section 317K;
            ``(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) Report.--Not later than September 30, 2024, and every 2 years 
thereafter, the Secretary shall submit a report to Congress on the 
practices described in paragraphs (1) and (2) of subsection (a). Such 
report shall include a description of the extent to which such 
practices reduced preventable maternal mortality and severe maternal 
morbidity, and whether such practices improved maternal and infant 
health. The Secretary shall disseminate information on such practices, 
as appropriate.
    ``(d) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $9,000,000 for each of fiscal 
years 2022 through 2026.''.

SEC. 102. 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 improve the provision 
of prenatal care, labor care, birthing, and postpartum care for racial 
and ethnic minority populations, including with respect to perceptions 
and biases that may affect the approach to, and provision of, 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 Requirements.--
            ``(1) Periodic grantee reports.--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.
            ``(2) Report to congress.--Not later than September 30, 
        2025, the Secretary shall submit a report to Congress on the 
        activities conducted using grants under subsection (a) and any 
        best practices identified and disseminated under subsection 
        (d).
    ``(d) Best Practices.--The Secretary may identify and disseminate 
best practices for the training described in subsection (a).
    ``(e) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $5,000,000 for each of fiscal 
years 2022 through 2026.''.

SEC. 103. STUDY ON IMPROVING TRAINING FOR HEALTH CARE PROVIDERS.

    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 improve the 
provision of prenatal care, labor care, birthing, and postpartum care 
for racial and ethnic minority populations, including with respect to 
perceptions and biases that may affect the approach to, and provision 
of, care.

SEC. 104. PERINATAL QUALITY COLLABORATIVES.

    (a) In General.--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) Report to Congress.--Not later than September 30, 2025, the 
Secretary of Health and Human Services shall submit to Congress a 
report regarding the activities conducted by recipients of grants under 
subsection (a)(2)(E) of section 317K of the Public Health Service Act 
(42 U.S.C. 247b-12).

SEC. 105. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

    (a) Grants.--Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by inserting after section 330O of such Act, as 
added by section 101, the following:

``SEC. 330P. 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 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 
        (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 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 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) Priorities.--In awarding grants under 
                subsection (a), the Secretary shall--
                            ``(i) give priority 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) Evaluation.--The Secretary shall require 
                grantees to evaluate the outcomes of the programs 
                supported under the grant.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2022 through 2026.''.
    (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 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 the amendments 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. 106. MATERNAL VACCINATION AWARENESS.

    In carrying out the public awareness initiative related to 
vaccinations pursuant to section 313 of the Public Health Service Act 
(42 U.S.C. 245), the Secretary of Health and Human Services shall take 
into consideration the importance of increasing awareness and knowledge 
of the safety and effectiveness of vaccines to prevent disease in 
pregnant and postpartum women and in infants and the need to improve 
vaccination rates in communities and populations with low rates of 
vaccination.

    TITLE II--RURAL MATERNAL AND OBSTETRIC MODERNIZATION OF SERVICES

SEC. 201. 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) 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 disaggregation of data (in a manner consistent with 
        applicable State and Federal privacy laws)'' 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(d)(4)(A)(iv) 
of the Public Health Service Act (42 U.S.C. 287d(d)(4)(A)(iv)) is 
amended by inserting ``, including preventable maternal mortality and 
severe maternal morbidity'' before the semicolon.

SEC. 202. 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 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 and infant health outcomes and reduce preventable 
maternal mortality and severe maternal morbidity by improving prenatal 
care, labor care, birthing, and postpartum care services in rural 
areas. 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 prenatal care, labor care, birthing, and 
        postpartum care services to improve outcomes in birth and 
        maternal mortality and morbidity;
            ``(2) identify and implement evidence-based and sustainable 
        delivery models for providing prenatal care, labor care, 
        birthing, and postpartum care services, 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 such areas described 
        in subsection (a).
    ``(c) Definitions.--In this section:
            ``(1) Eligible entities.--The term `eligible entities' 
        means entities providing prenatal care, labor care, birthing, 
        and postpartum 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' 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) Report to Congress.--Not later than September 30, 2025, the 
Secretary shall submit to Congress a report on activities supported by 
grants awarded under this section, including--
            ``(1) a description of activities conducted pursuant to 
        paragraphs (1) through (6) of subsection (b); and
            ``(2) an analysis of the effects of rural obstetric 
        networks on improving maternal and infant health outcomes.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $3,000,000 for each of fiscal 
years 2022 through 2026.''.

SEC. 203. 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 prenatal, labor care, birthing, 
                and postpartum care services, including hospitals that 
                operate obstetric care units.''; and
            (2) in subsection (h)(1)(B), by striking ``or prenatal care 
        for high-risk pregnancies'' and inserting ``prenatal care, 
        labor care, birthing care, or postpartum care''.

SEC. 204. 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 
        reduce preventable maternal mortality and severe maternal 
        morbidity by improving prenatal care, labor care, birthing, and 
        postpartum care 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 prenatal 
                care, labor care, birthing, and postpartum 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 prenatal care, labor care, birthing, and postpartum 
        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) improving the provision of prenatal care, 
                labor care, birthing, and postpartum care for racial 
                and ethnic minority populations, including with respect 
                to perceptions and biases that may affect the approach 
                to, and provision of, care.
    ``(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 Congress 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 prenatal care, labor care, 
                birthing, 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 continued.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2022 through 2026.''.
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