[House Report 114-802]
[From the U.S. Government Publishing Office]


114th Congress    }                                      {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                      {     114-802

======================================================================



 
                 IMPROVING ACCESS TO MATERNITY CARE ACT

                                _______
                                

 November 14, 2016.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1209]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1209) to amend the Public Health Service Act to 
provide for the designation of maternity care health 
professional shortage areas, having considered the same, report 
favorably thereon with amendments and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     3
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     4
Duplication of Federal Programs..................................     4
Disclosure of Directed Rule Makings..............................     4
Advisory Committee Statement.....................................     4
Applicability to Legislative Branch..............................     4
Section-by-Section Analysis of the Legislation...................     4
Changes in Existing Law Made by the Bill, as Reported............     5

    The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Improving Access to Maternity Care 
Act''.

SEC. 2. MATERNITY CARE HEALTH PROFESSIONAL TARGET AREAS.

  Section 332 of the Public Health Service Act (42 U.S.C. 254e) is 
amended by adding at the end the following new subsection:
  ``(k)(1) The Secretary, acting through the Administrator of the 
Health Resources and Services Administration, shall identify, based on 
the data collected under paragraph (3), maternity care health 
professional target areas that satisfy the criteria described in 
paragraph (2) for purposes of, in connection with receipt of assistance 
under this title, assigning to such identified areas maternity care 
health professionals who, without application of this subsection, would 
otherwise be eligible for such assistance. The Secretary shall 
distribute maternity care health professionals within health 
professional shortage areas using the maternity care health 
professional target areas so identified.
  ``(2) For purposes of paragraph (1), the Secretary shall establish 
criteria for maternity care health professional target areas that 
identify geographic areas within health professional shortage areas 
that have a shortage of maternity care health professionals.
  ``(3) For purposes of this subsection, the Secretary shall collect 
and publish in the Federal Register data comparing the availability and 
need of maternity care health services in health professional shortage 
areas and in areas within such health professional shortage areas.
  ``(4) In carrying out paragraph (1), the Secretary shall seek input 
from relevant provider organizations, including medical societies, 
organizations representing medical facilities, and other organizations 
with expertise in maternity care.
  ``(5) For purposes of this subsection, the term `full scope maternity 
care health services' includes during labor care, birthing, prenatal 
care, and postpartum care.
  ``(6) Nothing in this subsection shall be construed as--
          ``(A) requiring the identification of a maternity care health 
        professional target area in an area not otherwise already 
        designated as a health professional shortage area; or
          ``(B) affecting the types of health professionals, without 
        application of this subsection, otherwise eligible for 
        assistance, including a loan repayment or scholarship, pursuant 
        to the application of this section.''.

    Amend the title so as to read:
    A bill to amend the Public Health Service Act to distribute 
maternity care health professionals to health professional 
shortage areas identified as in need of maternity care health 
services.

                          Purpose and Summary

    H.R. 1209 was introduced on March 3, 2015 by Rep. Michael 
Burgess (R-TX), Rep. Lois Capps (D-CA), and Rep. Tammy 
Duckworth (D-IL). H.R. 1209 improves data collection to better 
place maternity health care professionals in existing primary 
care health professional shortage areas (HPSAs).

                  Background and Need for Legislation

    Currently, maternity health care professionals may 
participate in the National Health Service Corps (NHSC) Loan 
Repayment Program in which eligible licensed health care 
providers may earn up to $50,000 toward student loans in 
exchange for a two-year commitment at a NHSC approved site in a 
HPSA. They also can participate in the NHSC Scholarship Program 
while in medical school. The NHSC Scholarship Program pays 
tuition, fees, other educational costs, and provides a living 
stipend in return for at least a two-year commitment at NHSC 
approved site in a HPSA. Maternity health care professionals 
participate in the NHSC under the primary care designation. 
This legislation is needed to improve data collection under the 
existing HPSA to better place maternity health care 
professionals in areas with the greatest need for their 
services.

                                Hearings

    The Subcommittee on Health held a hearing on H.R. 1209 on 
December 9, 2015. The hearing was entitled ``Examining 
Legislation to Improve Health Care and Treatment'' and 
witnesses included the following:
           Chad Asplund, Director, Athletic Medicine 
        and Head Team Physician, Georgia Southern University;
           Ovidio Bermudez, Chief Clinical Officer and 
        Medical Director of Child and Adolescent Services, 
        Eating Recovery Center;
           Ginger Breedlove, President, American 
        College of Nurse Midwives;
           Anthony Gregg, Professor and Chief, Division 
        of Maternal-Fetal Medicine, University of Florida 
        Department of Obstetrics and Gynecology;
           Jonathan Reiner, Director, Cardiac 
        Catheterization Laboratory, George Washington 
        University Hospital;
           Deborah Trautman, President and CEO, 
        American Association of Colleges of Nursing.

                        Committee Consideration

    On December 9, 2015, the Subcommittee on Health met in open 
markup session and forwarded H.R. 1209 to the full Committee, 
without amendment, by a voice vote.
    On September 20 and 21, 2016, the full Committee on Energy 
and Commerce met in open markup session and ordered H.R. 1209 
reported to the House, as amended, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 1209 reported.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing and made 
findings that are reflected in this report.

         Statement of General Performance Goals and Objectives

    This legislation improves data collection for placing 
maternity care providers in HPSAs through the NHSC.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
1209 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the Rules of the House of Representatives, the Committee 
finds that H.R. 1209 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974. At the 
time this report was filed, the estimate was not available.

                  Congressional Budget Office Estimate

    At the time this report was filed, the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 1974 
was not available.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                    Duplication of Federal Programs

    No provision of H.R. 1209 establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                  Disclosure of Directed Rule Makings

    The Committee estimates that enacting H.R. 1209 
specifically directs to be completed no rule making within the 
meaning of 5 U.S.C. 551.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 provides that the Act may be cited as the 
``Improving Access to Maternity Care Act''.

Section 2. Maternity care health professional target areas

    Section 2 directs the Secretary of Health and Human 
Services, acting through the Administrator of the Health 
Resources and Services Administration, to identify maternity 
health professional target areas. These are to be geographic 
areas within HPSAs that have a shortage of maternity health 
care professionals.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *



Part D--Primary Health Care

           *       *       *       *       *       *       *



Subpart II--National Health Service Corps Program

           *       *       *       *       *       *       *



           designation of health professional shortage areas

  Sec. 332. (a)(1) For purposes of this subpart the term 
``health professional shortage area'' means (A) an area in an 
urban or rural area (which need not conform to the geographic 
boundaries of a political subdivision and which is a rational 
area for the delivery of health services) which the Secretary 
determines has a health manpower shortage, (B) a population 
group which the Secretary determines has such a shortage, or 
(C) a public or nonprofit private medical facility or other 
public facility which the Secretary determines has such a 
shortage. All Federally qualified health centers and rural 
health clinics, as defined in section 1861(aa) of the Social 
Security Act (42 U.S.C. 1395x(aa)), that meet the requirements 
of section 334 shall be automatically designated as having such 
a shortage. The Secretary shall not remove an area from the 
areas determined to be health professional shortage areas under 
subparagraph (A) of the preceding sentence until the Secretary 
has afforded interested persons and groups in such area an 
opportunity to provide data and information in support of the 
designation as a health professional shortage area or a 
population group described in subparagraph (B) of such sentence 
or a facility described in subparagraph (C) of such sentence, 
and has made a determination on the basis of the data and 
information submitted by such persons and groups and other data 
and information available to the Secretary.
  (2) For purposes of this subsection, the term ``medical 
facility'' means a facility for the delivery of health services 
and includes--
          (A) a hospital, State mental hospital, public health 
        center, outpatient medical facility, rehabilitation 
        facility, facility for long-term care, community mental 
        health center, migrant health center, facility operated 
        by a city or county health department, and community 
        health center and which is not reasonably accessible to 
        an adequately served area;
          (B) such a facility of a State correctional 
        institution or of the Indian Health Service, and a 
        health program or facility operated by a tribe or 
        tribal organization under the Indian Self-Determination 
        Act;
          (C) such a facility used in connection with the 
        delivery of health services under section 321 (relating 
        to hospitals), 322 (relating to care and treatment of 
        persons under quarantine and others), 323 (relating to 
        care and treatment of Federal prisoners), 324 (relating 
        to examination and treatment of certain Federal 
        employees), 325 (relating to examination of aliens), 
        326 (relating to services to certain Federal 
        employees), 320 (relating to services for persons with 
        Hansen's disease), or 330(h) (relating to the provision 
        of health services to homeless individuals); and
          (D) a Federal medical facility.
  (3) Homeless individuals (as defined in section 330(h)(5)), 
seasonal agricultural workers (as defined in section 330(g)(3)) 
and migratory agricultural workers (as so defined)), and 
residents of public housing (as defined in section 3(b)(1) of 
the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(1))) 
may be population groups under paragraph (1).
  (b) The Secretary shall establish by regulation criteria for 
the designation of areas, population groups, medical 
facilities, and other public facilities, in the States, as 
health professional shortage areas. In establishing such 
criteria, the Secretary shall take into consideration the 
following:
          (1) The ratio of available health manpower to the 
        number of individuals in an area or population group, 
        or served by a medical facility or other public 
        facility under consideration for designation.
          (2) Indicators of a need, notwithstanding the supply 
        of health manpower, for health services for the 
        individuals in an area or population group or served by 
        a medical facility or other public facility under 
        consideration for designation.
          (3) The percentage of physicians serving an area, 
        population group, medical facility, or other public 
        facility under consideration for designation who are 
        employed by hospitals and who are graduates of foreign 
        medical schools.
  (c) In determining whether to make a designation, the 
Secretary shall take into consideration the following:
          (1) The recommendations of the Governor of each State 
        in which the area, population group, medical facility, 
        or other public facility under consideration for 
        designation is in whole or part located.
          (2) The extent to which individuals who are (A) 
        residents of the area, members of the population group, 
        or patients in the medical facility or other public 
        facility under consideration for designation, and (B) 
        entitled to have payment made for medical services 
        under title XVIII, XIX, or XXI of the Social Security 
        Act, cannot obtain such services because of suspension 
        of physicians from the programs under such titles.
  (d)(1) In accordance with the criteria established under 
subsection (b) and the considerations listed in subsection (c), 
the Secretary shall designate health professional shortage 
areas in the States, publish a descriptive list of the areas, 
population groups, medical facilities, and other public 
facilities so designated, and at least annually review and, as 
necessary, revise such designations.
  (2) For purposes of paragraph (1), a complete descriptive 
list shall be published in the Federal Register not later than 
July 1 of 1991 and each subsequent year.
  (e)(1) Prior to the designation of a public facility, 
including a Federal medical facility, as a health professional 
shortage area, the Secretary shall give written notice of such 
proposed designation to the chief administrative officer of 
such facility and request comments within 30 days with respect 
to such designation.
  (2) Prior to the designation of a health professional 
shortage area under this section, the Secretary shall, to the 
extent practicable, give written notice of the proposed 
designation of such area to appropriate public or private 
nonprofit entities which are located or have a demonstrated 
interest in such area and request comments from such entities 
with respect to the proposed designation of such area.
  (f) The Secretary shall give written notice of the 
designation of a health professional shortage area, not later 
than 60 days from the date of such designation, to--
          (1) the Governor of each State in which the area, 
        population group, medical facility, or other public 
        facility so designated is in whole or part located; and
          (2) appropriate public or nonprofit private entities 
        which are located or which have a demonstrated interest 
        in the area so designated.
  (g) Any person may recommend to the Secretary the designation 
of an area, population group, medical facility, or other public 
facility as a health professional shortage area.
  (h) The Secretary may conduct such information programs in 
areas, among population groups, and in medical facilities and 
other public facilities designated under this section as health 
professional shortage areas as may be necessary to inform 
public and nonprofit private entities which are located or have 
a demonstrated interest in such areas of the assistance 
available under this title by virtue of the designation of such 
areas.
  (i) Dissemination.--The Administrator of the Health Resources 
and Services Administration shall disseminate information 
concerning the designation criteria described in subsection (b) 
to--
          (1) the Governor of each State;
          (2) the representative of any area, population group, 
        or facility selected by any such Governor to receive 
        such information;
          (3) the representative of any area, population group, 
        or facility that requests such information; and
          (4) the representative of any area, population group, 
        or facility determined by the Administrator to be 
        likely to meet the criteria described in subsection 
        (b).
  (j)(1) The Secretary shall submit the report described in 
paragraph (2) if the Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, issues--
          (A) a regulation that revises the definition of a 
        health professional shortage area for purposes of this 
        section; or
          (B) a regulation that revises the standards 
        concerning priority of such an area under section 333A.
  (2) On issuing a regulation described in paragraph (1), the 
Secretary shall prepare and 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 the regulation.
  (3) Each regulation described in paragraph (1) shall take 
effect 180 days after the committees described in paragraph (2) 
receive a report referred to in such paragraph describing the 
regulation.
  (k)(1) The Secretary, acting through the Administrator of the 
Health Resources and Services Administration, shall identify, 
based on the data collected under paragraph (3), maternity care 
health professional target areas that satisfy the criteria 
described in paragraph (2) for purposes of, in connection with 
receipt of assistance under this title, assigning to such 
identified areas maternity care health professionals who, 
without application of this subsection, would otherwise be 
eligible for such assistance. The Secretary shall distribute 
maternity care health professionals within health professional 
shortage areas using the maternity care health professional 
target areas so identified.
  (2) For purposes of paragraph (1), the Secretary shall 
establish criteria for maternity care health professional 
target areas that identify geographic areas within health 
professional shortage areas that have a shortage of maternity 
care health professionals.
  (3) For purposes of this subsection, the Secretary shall 
collect and publish in the Federal Register data comparing the 
availability and need of maternity care health services in 
health professional shortage areas and in areas within such 
health professional shortage areas.
  (4) In carrying out paragraph (1), the Secretary shall seek 
input from relevant provider organizations, including medical 
societies, organizations representing medical facilities, and 
other organizations with expertise in maternity care.
  (5) For purposes of this subsection, the term ``full scope 
maternity care health services'' includes during labor care, 
birthing, prenatal care, and postpartum care.
  (6) Nothing in this subsection shall be construed as--
          (A) requiring the identification of a maternity care 
        health professional target area in an area not 
        otherwise already designated as a health professional 
        shortage area; or
          (B) affecting the types of health professionals, 
        without application of this subsection, otherwise 
        eligible for assistance, including a loan repayment or 
        scholarship, pursuant to the application of this 
        section.

           *       *       *       *       *       *       *


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