[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1491 Reported in Senate (RS)]

<DOC>





                                                        Calendar No. 70
117th CONGRESS
  1st Session
                                S. 1491

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 29, 2021

   Ms. Smith (for herself, Ms. Murkowski, Mr. King, Ms. Ernst, Mrs. 
  Gillibrand, Ms. Stabenow, Mr. Lujan, Mrs. Capito, and Ms. Collins) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

                              June 8, 2021

               Reported by Mrs. Murray, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


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

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

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

<DELETED>SEC. 2. IMPROVING RURAL MATERNAL AND OBSTETRIC CARE 
              DATA.</DELETED>

<DELETED>    (a) Maternal Mortality and Morbidity Activities.--Section 
301 of the Public Health Service Act (42 U.S.C. 241) is amended--
</DELETED>
        <DELETED>    (1) by redesignating subsections (e) through (h) 
        as subsections (f) through (i), respectively; and</DELETED>
        <DELETED>    (2) by inserting after subsection (d), the 
        following:</DELETED>
<DELETED>    ``(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.''.</DELETED>
<DELETED>    (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 
``sociocultural contexts'' and inserting ``sociocultural (race, 
ethnicity, language, class, income) contexts (including among American 
Indians and Alaska Natives, as such terms are defined in section 4 of 
the Indian Health Care Improvement Act), and geographic 
contexts''.</DELETED>
<DELETED>    (c) Safe Motherhood.--Section 317K(b)(2) of the Public 
Health Service Act (42 U.S.C. 247b-12(b)(2)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (L), by striking ``and'' at 
        the end;</DELETED>
        <DELETED>    (2) by redesignating subparagraph (M) as 
        subparagraph (N); and</DELETED>
        <DELETED>    (3) by inserting after subparagraph (L), the 
        following:</DELETED>
                <DELETED>    ``(M) an examination of the relationship 
                between maternal health services in rural areas and 
                outcomes in delivery and postpartum care; 
                and''.</DELETED>
<DELETED>    (d) Office of Research on Women's Health.--Section 486 of 
the Public Health Service Act (42 U.S.C. 287d) is amended--</DELETED>
        <DELETED>    (1) in subsection (b)--</DELETED>
                <DELETED>    (A) by redesignating paragraphs (4) 
                through (9) as paragraphs (5) through (10), 
                respectively;</DELETED>
                <DELETED>    (B) by inserting after paragraph (3) the 
                following:</DELETED>
        <DELETED>    ``(4) carry out paragraphs (1) and (2) with 
        respect to pregnancy, with priority given to deaths related to 
        pregnancy;''; and</DELETED>
                <DELETED>    (C) in paragraph (5) (as so redesignated), 
                by striking ``through (3)'' and inserting ``through 
                (4)''; and</DELETED>
        <DELETED>    (2) in subsection (d)(4)(A)(iv), by inserting ``, 
        including maternal mortality and other maternal morbidity 
        outcomes'' before the semicolon.</DELETED>

<DELETED>SEC. 3. RURAL OBSTETRIC NETWORK GRANTS.</DELETED>

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

<DELETED>``SEC. 317L-2. RURAL OBSTETRIC NETWORK GRANTS.</DELETED>

<DELETED>    ``(a) In General.--For the purpose of enabling the 
Secretary (through grants, contracts, or otherwise), acting through the 
Administrator of the Health Resources and Services Administration, to 
establish collaborative improvement and innovation networks (referred 
to in this section as `rural obstetric networks') to improve outcomes 
in birth and maternal morbidity and mortality, there is appropriated to 
the Secretary, out of any money in the Treasury not otherwise 
appropriated, $3,000,000 for each of fiscal years 2021 through 2025. 
Such amounts shall remain available until expended.</DELETED>
<DELETED>    ``(b) Use of Funds.--Amount appropriated under subsection 
(a) shall be used for the establishment of collaborative improvement 
and innovation networks to improve maternal health in rural areas by 
improving outcomes in birth and maternal morbidity and mortality. Rural 
obstetric networks established in accordance with this section shall--
</DELETED>
        <DELETED>    ``(1) assist pregnant women and individuals in 
        rural areas connect with prenatal, labor and birth, and 
        postpartum care to improve outcomes in birth and maternal 
        mortality and morbidity;</DELETED>
        <DELETED>    ``(2) identify successful prenatal, labor and 
        birth, and postpartum health delivery models for individuals in 
        rural areas, including evidence-based home visiting programs 
        and successful, culturally competent models with positive 
        maternal health outcomes that advance health equity;</DELETED>
        <DELETED>    ``(3) develop a model for collaboration between 
        health facilities that have an obstetric health unit and health 
        facilities that do not have an obstetric health unit;</DELETED>
        <DELETED>    ``(4) provide training and guidance for health 
        facilities that do not have obstetric health units;</DELETED>
        <DELETED>    ``(5) collaborate with academic institutions that 
        can provide regional expertise and research on access, 
        outcomes, needs assessments, and other identified data; 
        and</DELETED>
        <DELETED>    ``(6) measure and address inequities in birth 
        outcomes among rural residents, with an emphasis on Black and 
        American Indians and Alaska Native residents, as such terms are 
        defined in section 4 of the Indian Health Care Improvement 
        Act.</DELETED>
<DELETED>    ``(c) Requirements.--</DELETED>
        <DELETED>    ``(1) Establishment.--Not later than October 1, 
        2021, the Secretary shall establish rural obstetric health 
        networks in at least 5 regions.</DELETED>
        <DELETED>    ``(2) Definitions.--In this section:</DELETED>
                <DELETED>    ``(A) Frontier area.--The term `frontier 
                area' means a frontier county, as defined in section 
                1886(d)(3)(E)(iii)(III) of the Social Security 
                Act.</DELETED>
                <DELETED>    ``(B) Indian tribe.--The term `Indian 
                tribe' has the meaning given such term in section 4 of 
                the Indian Health Care Improvement Act.</DELETED>
                <DELETED>    ``(C) Native hawaiian health care 
                system.--The term `Native Hawaiian Health Care System' 
                has the meaning given such term in section 12 of the 
                Native Hawaiian Health Care Improvement Act.</DELETED>
                <DELETED>    ``(D) Region.--The term `region' means a 
                State, Indian tribe, rural area, or frontier 
                area.</DELETED>
                <DELETED>    ``(E) Rural area.--The term `rural area' 
                has the meaning given that term in section 
                1886(d)(2)(D) of the Social Security Act.</DELETED>
                <DELETED>    ``(F) Tribal organization.--The term 
                `tribal organization' has the meaning given such term 
                in the Indian Self-Determination Act.</DELETED>
                <DELETED>    ``(G) State.--The term `State' has the 
                meaning given that term for purposes of title V of the 
                Social Security Act.''.</DELETED>

<DELETED>SEC. 4. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS 
              GRANT PROGRAMS.</DELETED>

<DELETED>    Section 330I of the Public Health Service Act (42 U.S.C. 
254c-14) is amended--</DELETED>
        <DELETED>    (1) in subsection (f)(3), by adding at the end the 
        following:</DELETED>
                <DELETED>    ``(M) Providers of maternal, including 
                prenatal, labor and birth, and postpartum care services 
                and entities operation obstetric care 
                units.'';</DELETED>
        <DELETED>    (2) in subsection (h)(1)(B), by inserting ``labor 
        and birth, postpartum,'' before ``or prenatal''; and</DELETED>
        <DELETED>    (3) in subsection (j)(1)(B), by inserting ``, 
        including equipment useful for caring for pregnant women and 
        individuals, including ultrasound machines and fetal monitoring 
        equipment'' before the semicolon.</DELETED>

<DELETED>SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAINING 
              DEMONSTRATION.</DELETED>

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

<DELETED>``SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE TRAINING 
              DEMONSTRATION.</DELETED>

<DELETED>    ``(a) In General.--The Secretary shall establish a 
training demonstration program to award grants to eligible entities to 
support--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) training for licensed and accredited nurse 
        practitioners, physician assistants, certified nurse midwives, 
        certified midwives, certified professional midwives, home 
        visiting nurses, or non-clinical professionals such as doulas 
        and community health workers, to provide maternal care services 
        in rural community-based settings; and</DELETED>
        <DELETED>    ``(3) establishing, maintaining, or improving 
        academic units or programs that--</DELETED>
                <DELETED>    ``(A) provide training for students or 
                faculty, including through clinical experiences and 
                research, to improve maternal care in rural areas; 
                or</DELETED>
                <DELETED>    ``(B) develop evidence-based practices or 
                recommendations for the design of the units or programs 
                described in subparagraph (A), including curriculum 
                content standards.</DELETED>
<DELETED>    ``(b) Activities.--</DELETED>
        <DELETED>    ``(1) Training for medical residents and 
        fellows.--A recipient of a grant under subsection (a)(1)--
        </DELETED>
                <DELETED>    ``(A) shall use the grant funds--
                </DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Training for other providers.--A recipient 
        of a grant under subsection (a)(2)--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Academic units or programs.--A recipient of 
        a grant under subsection (a)(3) shall enter into a partnership 
        with organizations such as an education accrediting 
        organization (such as the Liaison Committee on Medical 
        Education, the Accreditation Council for Graduate Medical 
        Education, the Commission on Osteopathic College Accreditation, 
        the Accreditation Commission for Education in Nursing, the 
        Commission on Collegiate Nursing Education, the Accreditation 
        Commission for Midwifery Education, or the Accreditation Review 
        Commission on Education for the Physician Assistant) to carry 
        out activities under subsection (a)(3).</DELETED>
        <DELETED>    ``(4) Training program requirements.--The 
        recipient of a grant under subsection (a)(1) or (a)(2) shall 
        ensure that training programs carried out under the grant 
        include instruction on--</DELETED>
                <DELETED>    ``(A) maternal mental health, including 
                perinatal depression and anxiety and postpartum 
                depression;</DELETED>
                <DELETED>    ``(B) maternal substance use 
                disorder;</DELETED>
                <DELETED>    ``(C) social determinants of health that 
                impact individuals living in rural communities, 
                including poverty, social isolation, access to 
                nutrition, education, transportation, and housing; 
                and</DELETED>
                <DELETED>    ``(D) implicit bias.</DELETED>
<DELETED>    ``(c) Eligible Entities.--</DELETED>
        <DELETED>    ``(1) Training for medical residents and 
        fellows.--To be eligible to receive a grant under subsection 
        (a)(1), an entity shall--</DELETED>
                <DELETED>    ``(A) be a consortium consisting of--
                </DELETED>
                        <DELETED>    ``(i) at least one teaching health 
                        center; or</DELETED>
                        <DELETED>    ``(ii) the sponsoring institution 
                        (or parent institution of the sponsoring 
                        institution) of--</DELETED>
                                <DELETED>    ``(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</DELETED>
                                <DELETED>    ``(II) a fellowship in 
                                maternal or obstetric medicine, as 
                                determined appropriate by the 
                                Secretary; or</DELETED>
                <DELETED>    ``(B) be an entity described in 
                subparagraph (A)(ii) that provides opportunities for 
                medical residents or fellows to train in rural 
                community-based settings.</DELETED>
        <DELETED>    ``(2) Training for other providers.--To be 
        eligible to receive a grant under subsection (a)(2), an entity 
        shall be--</DELETED>
                <DELETED>    ``(A) a teaching health center (as defined 
                in section 749A(f));</DELETED>
                <DELETED>    ``(B) a Federally-qualified health center 
                (as defined in section 1905(l)(2)(B) of the Social 
                Security Act);</DELETED>
                <DELETED>    ``(C) a community mental health center (as 
                defined in section 1861(ff)(3)(B) of the Social 
                Security Act);</DELETED>
                <DELETED>    ``(D) a rural health clinic (as defined in 
                section 1861(aa) of the Social Security Act);</DELETED>
                <DELETED>    ``(E) a freestanding birth center (as 
                defined in section 1905(l)(3) of the Social Security 
                Act);</DELETED>
                <DELETED>    ``(F) a health center operated by the 
                Indian Health Service, an Indian tribe, a tribal 
                organization, or a Native Hawaiian Health Care System 
                (as such terms are defined in section 4 of the Indian 
                Health Care Improvement Act and section 12 of the 
                Native Hawaiian Health Care Improvement Act); 
                or</DELETED>
                <DELETED>    ``(G) an entity with a demonstrated record 
                of success in providing academic training for nurse 
                practitioners, physician assistants, certified nurse-
                midwives, certified midwives, certified professional 
                midwives, home visiting nurses, or non-clinical 
                professionals, such as doulas and community health 
                workers.</DELETED>
        <DELETED>    ``(3) Academic units or programs.--To be eligible 
        to receive a grant under subsection (a)(3), an entity shall be 
        a school of medicine or osteopathic medicine, a nursing school, 
        a physician assistant training program, an accredited public or 
        nonprofit private hospital, an accredited medical residency 
        program, a school accredited by the Midwifery Education and 
        Accreditation Council, or a public or private nonprofit entity 
        which the Secretary has determined is capable of carrying out 
        such grant.</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(d) Duration.--Grants awarded under this section shall 
be for a minimum of 5 years.</DELETED>
<DELETED>    ``(e) Study and Report.--</DELETED>
        <DELETED>    ``(1) Study.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Report to congress.--Not later than 1 year 
        after receipt of the data described in paragraph (1)(B), the 
        Secretary shall submit to Congress a report that includes--
        </DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(C) recommendations on whether the 
                demonstration program should be expanded.</DELETED>
<DELETED>    ``(f) 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.''.</DELETED>

<DELETED>SEC. 6. GAO REPORT.</DELETED>

<DELETED>    Not later than 1 year after the date of enactment of this 
Act, the Comptroller General of the United States shall submit to the 
appropriate committees of Congress a report on the maternal, including 
prenatal, labor and birth, and postpartum care in rural areas. Such 
report shall include the following:</DELETED>
        <DELETED>    (1) The location of gaps in maternal and obstetric 
        clinicians and health professionals, including non-clinical 
        professionals such as doulas and community health 
        workers.</DELETED>
        <DELETED>    (2) The location of gaps in facilities able to 
        provide maternal, including prenatal, labor and birth, and 
        postpartum care in rural areas, including care for high-risk 
        pregnancies.</DELETED>
        <DELETED>    (3) The gaps in data on maternal mortality and 
        recommendations to standardize the format on collecting data 
        related to maternal mortality and morbidity.</DELETED>
        <DELETED>    (4) The gaps in maternal health by race and 
        ethnicity in rural communities, with a focus on racial 
        inequities for Black residents and among Indian Tribes and 
        American Indian and Alaska Native rural residents (as such 
        terms are defined in section 4 of the Indian Health Care 
        Improvement Act).</DELETED>
        <DELETED>    (5) A list of specific activities that the 
        Secretary of Health and Human Services plans to conduct on 
        maternal, including prenatal, labor and birth, and postpartum 
        care.</DELETED>
        <DELETED>    (6) A plan for completing such 
        activities.</DELETED>
        <DELETED>    (7) An explanation of Federal agency involvement 
        and coordination needed to conduct such activities.</DELETED>
        <DELETED>    (8) A budget for conducting such 
        activities.</DELETED>
        <DELETED>    (9) Other information that the Comptroller General 
        determines appropriate.</DELETED>

SECTION 1. SHORT TITLE.

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

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

    (a) Maternal Mortality and Morbidity Activities.--Section 301(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. 3. 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. 4. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT 
              PROGRAMS.

    Section 330I of the Public Health Service Act (42 U.S.C. 254c-14) 
is amended--
            (1) in subsection (f)(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. 5. 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.''.
                                                        Calendar No. 70

117th CONGRESS

  1st Session

                                S. 1491

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                              June 8, 2021

                       Reported with an amendment