[Congressional Record Volume 167, Number 200 (Wednesday, November 17, 2021)]
[Senate]
[Pages S8357-S8358]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 4740. Ms. SMITH (for herself and Ms. Murkowski) submitted an 
amendment intended to be proposed to amendment SA 3867 submitted by Mr. 
Reed and intended to be proposed to the bill H.R. 4350, to authorize 
appropriations for fiscal year 2022 for military activities of the 
Department of Defense, for military construction, and for defense 
activities of the Department of Energy, to prescribe military personnel 
strengths for such fiscal year, and for other purposes; which was 
ordered to lie on the table; as follows:

        At the end of title X, add the following:

   Subtitle H--Rural Maternal and Obstetric Modernization of Services

     SEC. 1071. 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. 1072. 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;

[[Page S8358]]

       ``(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. 1073. 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. 1074. 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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