[Senate Report 116-304]
[From the U.S. Government Publishing Office]


                                                      Calendar No. 604
116th Congress     }                                     {      Report
                                 SENATE
 2d Session        }                                     {     116-304 
_______________________________________________________________________

                                     




                 DATA MAPPING TO SAVE MOMS' LIVES ACT

                               __________

                              R E P O R T

                                 of the

           COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION

                                   on

                                S. 3152









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                 December 8, 2020 Ordered to be printed 
                 
                 
                 
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                 U.S. GOVERNMENT PUBLISHING OFFICE
                 
19-010                   WASHINGTON : 2020
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
       SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION
                     one hundred sixteenth congress
                             second session

                 ROGER F. WICKER, Mississippi, Chairman
JOHN THUNE, South Dakota             MARIA CANTWELL, Washington
ROY BLUNT, Missouri                  AMY KLOBUCHAR, Minnesota
TED CRUZ, Texas                      RICHARD BLUMENTHAL, Connecticut
DEB FISCHER, Nebraska                BRIAN SCHATZ, Hawaii
JERRY MORAN, Kansas                  EDWARD J. MARKEY, Massachusetts
DAN SULLIVAN, Alaska                 TOM UDALL, New Mexico
CORY GARDNER, Colorado               GARY C. PETERS, Michigan
MARSHA BLACKBURN, Tennessee          TAMMY BALDWIN, Wisconsin
SHELLEY MOORE CAPITO, West Virginia  TAMMY DUCKWORTH, Illinois
MIKE LEE, Utah                       JON TESTER, Montana
RON JOHNSON, Wisconsin               KYRSTEN SINEMA, Arizona
TODD C. YOUNG, Indiana               JACKY ROSEN, Nevada
RICK SCOTT, Florida
                       John Keast, Staff Director
               David Strickland, Minority Staff Director

















                                                      Calendar No. 604
116th Congress     }                                     {      Report
                                 SENATE
 2d Session        }                                     {     116-304

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



 
                  DATA MAPPING TO SAVE MOMS' LIVES ACT

                                _______
                                

                December 8, 2020.--Ordered to be printed

                                _______
                                

       Mr. Wicker, from the Committee on Commerce, Science, and 
                Transportation, submitted the following

                              R E P O R T

                         [To accompany S. 3152]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Commerce, Science, and Transportation, to 
which was referred the bill (S. 3152) to require the Federal 
Communications Commission to incorporate data on maternal 
health outcomes into its broadband health maps, having 
considered the same, reports favorably thereon with an 
amendment (in the nature of a substitute) and recommends that 
the bill (as amended) do pass.

                          PURPOSE OF THE BILL

    S. 3152 would require the Federal Communications Commission 
(FCC or Commission) to incorporate data from the Centers for 
Disease Control and Prevention (CDC) on maternal health 
outcomes into its most recently available broadband health 
mapping tools.

                          BACKGROUND AND NEEDS

    According to the CDC, severe complications related to 
pregnancy, known as severe maternal morbidity (SMM), impacted 
over 50,000 women in the United States in 2014.\1\ The CDC 
recently published a study that found that SMM causes 
approximately 700 deaths in the United States each year.\2\ 
After evaluating 232 of these deaths, the CDC determined that 
139 were preventable (60 percent of the total).\3\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, ``Reproductive 
Health: Severe Maternal Morbidity in the United States,'' last reviewed 
Jan. 31, 2020 (https://www.cdc.gov/reproductivehealth/
maternalinfanthealth/severematernalmorbidity.html#::text=The%20
overall%20rate%20of%20SMM,1993%20to%20122.3%20in%202014) (accessed Oct. 
27, 2020).
    \2\Emily E. Petersen et al., Vital Signs: Pregnancy-Related Deaths, 
United States, 2011-2015, and Strategies for Prevention, 13 States, 
2013-2017, Centers for Disease Control and Prevention, Morbidity and 
Mortality Weekly Report, p. 425, May 7, 2019 (https://www.cdc.gov/mmwr/
volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w) (accessed Oct. 27, 2020).
    \3\Ibid.
---------------------------------------------------------------------------
    The CDC determined that there are a number of factors 
contributing to maternal deaths including: (1) limited access 
to transportation; (2) health facilities having limited 
experience with obstetric emergencies and a lack of appropriate 
personnel or services; (3) lack of patient knowledge of warning 
signs; (4) missed or delayed diagnoses; (5) a lack of 
continuity of care; and (6) inadequate access to care.\4\ 
Researchers believe that these factors are more prevalent in 
rural areas, in part due to rural hospitals closing their 
obstetric services or shutting down entirely, rural workforce 
shortages, and other systemic issues.\5\
---------------------------------------------------------------------------
    \4\Ibid. at 425.
    \5\Centers for Medicare and Medicaid Services, Improving Access to 
Maternal Health Care in Rural Communities, p. 1, Sep. 3, 2019 (https://
www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-
health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf) 
(accessed Oct. 27, 2020).
---------------------------------------------------------------------------
    In an effort to prevent maternal deaths, the CDC recommends 
providing telehealth technologies to health facilities lacking 
on-site obstetric services. Telehealth enables collaboration 
between health facilities with obstetric services and health 
facilities that lack on-site obstetric services.\6\ It can also 
help facilitate the transportation of patients to other 
hospitals, clinics, or health centers that offer obstetric 
services or make care as safe as possible locally when 
transport is not an option.\7\ There are real-world examples 
supporting the CDC's recommendations. For example, telehealth 
is being successfully utilized to treat SMM in rural areas of 
America, including in Minnesota and South Dakota.\8\
---------------------------------------------------------------------------
    \6\Ibid. at 20.
    \7\For a case study concerning the use of telehealth in addressing 
maternal health issues, see Susan Mann, M.D., Kimberly McKay, M.D., and 
Haywood Brown, M.D., ``NEJM: The Maternal Health Compact,'' New England 
Journal of Medicine, Apr. 5, 2017 (https://obgyn.duke.edu/news/nejm-
maternal-health-compact) (accessed Oct. 27, 2020).
    \8\Ibid.
---------------------------------------------------------------------------
    However, telehealth requires access to broadband. 
Unfortunately, many rural areas lack broadband,\9\ just as they 
lack on-site obstetric services, thus preventing the widespread 
use of telehealth by both patients and healthcare providers. 
The CDC also has documented various structural barriers to the 
adoption of telehealth to combat maternal health issues, 
pointing in particular both to broadband availability issues, 
as well as the cost of service and equipment.\10\
---------------------------------------------------------------------------
    \9\Federal Communications Commission, Inquiry Concerning Deployment 
of Advanced Telecommunications Capability to All Americans in a 
Reasonable and Timely Fashion, 2020 Broadband Deployment Report, GN 
Docket No. 19-285, Fig. 1, released Apr. 24, 2020 (https://
docs.fcc.gov/public/attachments/FCC-20-50A1.pdf) (accessed Oct. 27, 
2020).
    \10\Supra note 5 at 20.
---------------------------------------------------------------------------
    Broadband mapping could lead to better maternal health 
outcomes. The FCC, through its Connect2Health Task Force, 
already maps information related to broadband availability and 
diabetes, obesity, physician access, poor health, preventable 
hospitalization, and sick days.\11\ These maps help show the 
intersection between connectivity (or lack thereof) and health 
outcomes in these areas at granular levels,\12\ which helps 
policymakers, medical professionals, and State and local 
communities make more efficient, data-driven decisions.\13\
---------------------------------------------------------------------------
    \11\Federal Communications Commission, Connect2Health Task Force, 
``Mapping Broadband Health in America 2017'' (https://www.fcc.gov/
reports-research/maps/connect2health/#ll=18.562942,-
112.529295&z=3&t=health&hhm=hh_diabetes_rate&advbb=in_bb_access$60_
80&dmf=none) (accessed Oct. 27, 2020).
    \12\Federal Communications Commission, ``Mapping Broadband Health 
in America'' (https://www.fcc.gov/health/maps) (accessed Oct. 27, 
2020).
    \13\Federal Communications Commission, Office of Media Relations, 
``FCC's Connect2Health Task Force Announces Data Update for Broadband 
Health Mapping Platform,'' Jun. 8, 2017 (https://docs.fcc.gov/public/
attachments/DOC-344778A1.pdf) (accessed Oct. 27, 2020).
---------------------------------------------------------------------------
    The FCC, however, does not map the intersection of maternal 
health outcomes and broadband availability. S. 3152 would 
require the FCC to incorporate data on maternal health outcomes 
into its most recently available broadband health mapping tools 
for no less than 1 year postpartum. Such a map could help 
increase the quality of maternal care and reduce the prevalence 
of poor maternal health outcomes. For example, creating such a 
map could establish a picture of where maternal mortality rates 
are especially high and where critical telehealth resources 
need to be deployed by providers or the FCC. Indeed, the 
National Institutes of Health reports that telehealth resources 
have become crucial to obstetric care during the COVID-19 
pandemic.\14\
---------------------------------------------------------------------------
    \14\Kimberly Fryer et al., ``Implementation of Obstetric Telehealth 
During COVID-19 and Beyond,'' Maternal and Child Health Journal, Jun. 
20, 2020 (https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC7305486/) (accessed Oct. 27, 2020).
---------------------------------------------------------------------------

                          LEGISLATIVE HISTORY

    S. 3152 was introduced on January 7, 2020, by Senator Rosen 
(for herself and Senators Fischer, Young, and Schatz) and was 
referred to the Committee on Commerce, Science, and 
Transportation of the Senate. Senators Jones, Markey, Collins, 
Smith, King, Braun, Van Hollen, Blumenthal, Klobuchar, and 
Peters are additional cosponsors. On July 22, 2020, the 
Committee met in open Executive Session and, by voice vote, 
ordered S. 3152 reported favorably with an amendment (in the 
nature of a substitute). The Committee also approved, by voice 
vote, an amendment offered by Senator Rick Scott to direct the 
Government Accountability Office (GAO) to study the 
relationship between internet connectivity and maternal 
morbidity.
    S. 3152 is substantially similar to H.R. 5640, a bill 
introduced on January 16, 2020, by Representative G.K. 
Butterfield (for himself and Representatives Greg Gianforte, 
Susan W. Brooks, Robin L. Kelly, and Lisa Blunt Rochester) and 
referred to the Committee on Energy and Commerce in the House 
of Representatives.

                            ESTIMATED COSTS

    In accordance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate and section 403 of the 
Congressional Budget Act of 1974, the Committee provides the 
following cost estimate, prepared by the Congressional Budget 
Office:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]


    S. 3152 would require the Federal Communications Commission 
(FCC) to incorporate data on maternal health outcomes into its 
most recently available broadband health mapping tools. In 
addition, the bill would require the Government Accountability 
Office (GAO) to report to the Congress on the effectiveness of 
Internet connectivity in reducing maternal morbidity rates.
    Using information about the cost of broadband mapping, CBO 
estimates that it would cost the FCC less than $500,000 to 
update its broadband health maps to incorporate maternal health 
outcomes. However, because the FCC is authorized to collect 
fees each year sufficient to offset the appropriated costs of 
its regulatory activities, CBO estimates that the net cost to 
the FCC would be negligible, assuming appropriation actions 
consistent with that authority. CBO estimates that it would 
cost the GAO less than $500,000 to complete the required 
report.
    If the FCC increases annual fee collections to offset the 
costs of implementing provisions in the bill, S. 3152 would 
increase the cost of an existing private-sector mandate on 
entities required to pay those fees. CBO estimates that the 
incremental cost of the mandate would be small and would fall 
well below the annual threshold established in the Unfunded 
Mandates Reform Act for private-sector mandates ($168 million 
in 2020, adjusted annually for inflation).
    The bill contains no intergovernmental mandates.
    The CBO staff contacts for this estimate are David Hughes 
(for federal costs) and Rachel Austin (for mandates). The 
estimate was reviewed by H. Samuel Papenfuss, Deputy Director 
of Budget Analysis.

                      REGULATORY IMPACT STATEMENT

    In accordance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee provides the 
following evaluation of the regulatory impact of the 
legislation, as reported:

Number of Persons Covered

    S. 3152 would have no further effect on the number or types 
of individuals and businesses regulated.

Economic Impact

    S. 3152 would not have a negative impact on the Nation's 
economy.

Privacy

    S. 3152 would not impact the personal privacy of affected 
individuals.

Paperwork

    S. 3152 would direct GAO to submit a report to Congress on 
the relationship between internet connectivity and maternal 
morbidity.

                   CONGRESSIONALLY DIRECTED SPENDING

    In compliance with paragraph 4(b) of rule XLIV of the 
Standing Rules of the Senate, the Committee provides that no 
provisions contained in the bill, as reported, meet the 
definition of congressionally directed spending items under the 
rule.

                      SECTION-BY-SECTION ANALYSIS

Section 1. Short title.

    This section would provide that the bill may be cited as 
the ``Data Mapping to Save Moms' Lives Act''.

Section 2. Mapping broadband connectivity and maternal health outcomes.

    Subsection (a) of this section would require the FCC to 
incorporate data on maternal health outcomes, for no less than 
1 year postpartum, into its most recently available broadband 
health mapping tools. Subsection (b) of this section would 
direct the Commission to consult with the CDC regarding the 
maternal health outcomes it should incorporate into its most 
recently available broadband health mapping tools.
    The Committee is aware that the FCC's Connect2Health Task 
Force has developed other maps displaying certain health 
outcomes overlaid against data on the availability of 
broadband. In some cases, those maps have been developed in 
coordination with the CDC and use CDC data. The Committee 
intends for the map required by this section to be developed 
using the same coordination processes. It also intends that the 
directive to the FCC to coordinate its actions be interpreted 
to direct the FCC to use the CDC-developed categories and data 
related to maternal health outcomes and not to develop its own 
categories or data. Additionally, the Committee intends that 
the FCC utilize its Connect2Health Task Force to the greatest 
extent possible in its execution of its responsibilities under 
this section. Finally, the Committee intends for the FCC to 
maintain the map required by this section (and any other maps 
it has developed relating broadband availability and health 
outcomes) as a publicly available map posted to the FCC website 
and for those maps to be updated and upgraded as data on 
broadband or health outcomes warrant.

Section 3. GAO study.

    Section 3 would require the GAO to study and submit a 
report to Congress not later than 1 year after enactment of 
this bill on the following two issues: (1) the effectiveness of 
internet connectivity in reducing maternal morbidity rates; and 
(2) who is best suited to take responsibility for ensuring 
better internet connectivity to reduce maternal morbidity 
rates.

                        CHANGES IN EXISTING LAW

    In compliance with paragraph 12 of rule XXVI of the 
Standing Rules of the Senate, the Committee states that the 
bill as reported would make no change to existing law.

                                  [all]