[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2373 Introduced in Senate (IS)]
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116th CONGRESS
1st Session
S. 2373
To amend the Public Health Service Act to improve obstetric care in
rural areas.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 31, 2019
Ms. Smith (for herself, Ms. Murkowski, Mr. Jones, and Mrs. Capito)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
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,
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 of
the Public Health Service Act (42 U.S.C. 241) is amended--
(1) by redesignating subsections (e) through (h) as
subsections (f) through (i), respectively; and
(2) by inserting after subsection (d), the following:
``(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.''.
(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 inserting
``sociocultural (race, ethnicity, language, class, income), 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,'' after ``biological,''.
(c) Safe Motherhood.--Section 317K(b)(2) of the Public Health
Service Act (42 U.S.C. 247b-12(b)(2)) is amended--
(1) in subparagraph (L), by striking ``and'' at the end;
(2) by redesignating subparagraph (M) as subparagraph (N);
and
(3) by inserting after subparagraph (L), the following:
``(M) an examination of the relationship between
maternal health services in rural areas and outcomes in
delivery and postpartum care; and''.
(d) Office of Research on Women's Health.--Section 486 of the
Public Health Service Act (42 U.S.C. 287d) is amended--
(1) in subsection (b)--
(A) by redesignating paragraphs (4) through (9) as
paragraphs (5) through (10), respectively;
(B) by inserting after paragraph (3) the following:
``(4) carry out paragraphs (1) and (2) with respect to
pregnancy, with priority given to deaths related to
pregnancy;''; and
(C) in paragraph (5) (as so redesignated), by
striking ``through (3)'' and inserting ``through (4)'';
and
(2) in subsection (d)(4)(A)(iv), by inserting ``, including
maternal mortality and other maternal morbidity outcomes''
before the semicolon.
SEC. 3. RURAL OBSTETRIC NETWORK GRANTS.
The Public Health Service Act is amended by inserting after section
317L-1 (42 U.S.C. 247b-13a) the following:
``SEC. 317L-2. RURAL OBSTETRIC NETWORK GRANTS.
``(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 2020 through 2024.
Such amounts shall remain available until expended.
``(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--
``(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;
``(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;
``(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;
``(4) provide training and guidance for health facilities
that do not have obstetric health units;
``(5) collaborate with academic institutions that can
provide regional expertise and research on access, outcomes,
needs assessments, and other identified data; and
``(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.
``(c) Requirements.--
``(1) Establishment.--Not later than October 1, 2020, the
Secretary shall establish rural obstetric health networks in at
least 5 regions.
``(2) Definitions.--In this section:
``(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.
``(B) Indian tribe.--The term `Indian tribe' has
the meaning given such term in section 4 of the Indian
Health Care Improvement Act.
``(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.
``(D) Region.--The term `region' means a State,
Indian tribe, rural area, or frontier area.
``(E) Rural area.--The term `rural area' has the
meaning given that term in section 1886(d)(2)(D) of the
Social Security Act.
``(F) Tribal organization.--The term `tribal
organization' has the meaning given such term in the
Indian Self-Determination Act.
``(G) State.--The term `State' has the meaning
given that term for purposes of title V of the Social
Security Act.''.
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)(1)(B)(iii), by adding at the end the
following:
``(XIII) Providers of maternal,
including prenatal, labor and birth,
and postpartum care services and
entities operation obstetric care
units.'';
(2) in subsection (i)(1)(B), by inserting ``labor and
birth, postpartum,'' before ``or prenatal''; and
(3) in subsection (k)(1)(B), by inserting ``equipment
useful for caring for pregnant women and individuals, including
ultrasound machines and fetal monitoring equipment,'' before
``and other equipment''.
SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.
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:
``SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.
``(a) In General.--The Secretary shall establish a training
demonstration program to award grants to eligible entities to support--
``(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;
``(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
``(3) establishing, maintaining, or improving academic
units or programs that--
``(A) provide training for students or faculty,
including through clinical experiences and research, to
improve maternal care in rural areas; or
``(B) develop evidence-based practices or
recommendations for the design of the units or programs
described in subparagraph (A), including curriculum
content standards.
``(b) Activities.--
``(1) Training for medical residents and fellows.--A
recipient of a grant under subsection (a)(1)--
``(A) shall use the grant funds--
``(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
``(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
``(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 for other providers.--A recipient of a grant
under subsection (a)(2)--
``(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
``(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.
``(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).
``(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--
``(A) maternal mental health, including perinatal
depression and anxiety and postpartum depression;
``(B) maternal substance use disorder;
``(C) social determinants of health that impact
individuals living in rural communities, including
poverty, social isolation, access to nutrition,
education, transportation, and housing; and
``(D) implicit bias.
``(c) Eligible Entities.--
``(1) Training for medical residents and fellows.--To be
eligible to receive a grant under subsection (a)(1), an entity
shall--
``(A) be a consortium consisting of--
``(i) at least one teaching health center;
or
``(ii) the sponsoring institution (or
parent institution of the sponsoring
institution) of--
``(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
``(II) a fellowship in maternal or
obstetric medicine, as determined
appropriate by the Secretary; or
``(B) be an entity described in subparagraph
(A)(ii) that provides opportunities for medical
residents or fellows to train in rural community-based
settings.
``(2) Training for other providers.--To be eligible to
receive a grant under subsection (a)(2), an entity shall be--
``(A) a teaching health center (as defined in
section 749A(f));
``(B) a federally qualified health center (as
defined in section 1905(l)(2)(B) of the Social Security
Act);
``(C) a community mental health center (as defined
in section 1861(ff)(3)(B) of the Social Security Act);
``(D) a rural health clinic (as defined in section
1861(aa) of the Social Security Act);
``(E) a freestanding birth center (as defined in
section 1905(l)(3) of the Social Security Act);
``(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
``(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.
``(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.
``(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).
``(d) Duration.--Grants awarded under this section shall be for a
minimum of 5 years.
``(e) Study and Report.--
``(1) Study.--
``(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.
``(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).
``(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--
``(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;
``(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 expanded.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $5,000,000 for each of fiscal
years 2020 through 2024.''.
SEC. 6. GAO REPORT.
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:
(1) The location of gaps in maternal and obstetric
clinicians and health professionals, including non-clinical
professionals such as doulas and community health workers.
(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.
(3) The gaps in data on maternal mortality and
recommendations to standardize the format on collecting data
related to maternal mortality and morbidity.
(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/Alaska
Native rural residents (as such terms are defined in section 4
of the Indian Health Care Improvement Act).
(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.
(6) A plan for completing such activities.
(7) An explanation of Federal agency involvement and
coordination needed to conduct such activities.
(8) A budget for conducting such activities.
(9) Other information that the Comptroller General
determines appropriate.
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