[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4387 Introduced in House (IH)]
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117th CONGRESS
1st Session
H. R. 4387
To amend the Public Health Service Act to improve maternal health, to
improve obstetric care in rural areas, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 9, 2021
Ms. Kelly of Illinois (for herself, Mr. Bucshon, Ms. Adams, Mr.
Burgess, Mrs. Hayes, and Mr. Latta) introduced the following bill;
which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to improve maternal health, to
improve obstetric care in rural areas, and for other purposes.
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 ``Maternal Health Quality Improvement
Act of 2021''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title .
Sec. 2. Table of Contents.
TITLE I--IMPROVEMENTS TO MATERNAL HEALTH CARE
Sec. 101. Innovation for maternal health.
Sec. 102. Training for health care providers.
Sec. 103. Study on improving training for health care providers.
Sec. 104. Perinatal quality collaboratives.
Sec. 105. Integrated services for pregnant and postpartum women.
Sec. 106. Maternal vaccination awareness.
TITLE II--RURAL MATERNAL AND OBSTETRIC MODERNIZATION OF SERVICES
Sec. 201. Improving rural maternal and obstetric care data.
Sec. 202. Rural obstetric network grants.
Sec. 203. Telehealth network and telehealth resource centers grant
programs.
Sec. 204. Rural maternal and obstetric care training demonstration.
TITLE I--IMPROVEMENTS TO MATERNAL HEALTH CARE
SEC. 101. INNOVATION FOR MATERNAL HEALTH.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by inserting after section 330N of such Act, the following:
``SEC. 330O. INNOVATION FOR MATERNAL HEALTH.
``(a) In General.--The Secretary, in consultation with experts
representing a variety of clinical specialties, State, Tribal, or local
public health officials, researchers, epidemiologists, statisticians,
and community organizations, shall establish or continue a program to
award competitive grants to eligible entities for the purpose of--
``(1) identifying, developing, or disseminating best
practices to improve maternal health care quality and outcomes,
improve maternal and infant health, and eliminate preventable
maternal mortality and severe maternal morbidity, which may
include--
``(A) information on evidence-based practices to
improve the quality and safety of maternal health care
in hospitals and other health care settings of a State
or health care system by addressing topics commonly
associated with health complications or risks related
to prenatal care, labor care, birthing, and postpartum
care;
``(B) best practices for improving maternal health
care based on data findings and reviews conducted by a
State maternal mortality review committee that address
topics of relevance to common complications or health
risks related to prenatal care, labor care, birthing,
and postpartum care; and
``(C) information on addressing determinants of
health that impact maternal health outcomes for women
before, during, and after pregnancy;
``(2) collaborating with State maternal mortality review
committees to identify issues for the development and
implementation of evidence-based practices to improve maternal
health outcomes and reduce preventable maternal mortality and
severe maternal morbidity, consistent with section 317K;
``(3) providing technical assistance and supporting the
implementation of best practices identified in paragraph (1) to
entities providing health care services to pregnant and
postpartum women; and
``(4) identifying, developing, and evaluating new models of
care that improve maternal and infant health outcomes, which
may include the integration of community-based services and
clinical care.
``(b) Eligible Entities.--To be eligible for a grant under
subsection (a), an entity shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require; and
``(2) demonstrate in such application that the entity is
capable of carrying out data-driven maternal safety and quality
improvement initiatives in the areas of obstetrics and
gynecology or maternal health.
``(c) Report.--Not later than September 30, 2024, and every 2 years
thereafter, the Secretary shall submit a report to Congress on the
practices described in paragraphs (1) and (2) of subsection (a). Such
report shall include a description of the extent to which such
practices reduced preventable maternal mortality and severe maternal
morbidity, and whether such practices improved maternal and infant
health. The Secretary shall disseminate information on such practices,
as appropriate.
``(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $9,000,000 for each of fiscal
years 2022 through 2026.''.
SEC. 102. TRAINING FOR HEALTH CARE PROVIDERS.
Title VII of the Public Health Service Act is amended by striking
section 763 (42 U.S.C. 294p) and inserting the following:
``SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS.
``(a) Grant Program.--The Secretary shall establish a program to
award grants to accredited schools of allopathic medicine, osteopathic
medicine, and nursing, and other health professional training programs
for the training of health care professionals to improve 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.
``(b) Eligibility.--To be eligible for a grant under subsection
(a), an entity described in such subsection shall submit to the
Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.
``(c) Reporting Requirements.--
``(1) Periodic grantee reports.--Each entity awarded a
grant under this section shall periodically submit to the
Secretary a report on the status of activities conducted using
the grant, including a description of the impact of such
training on patient outcomes, as applicable.
``(2) Report to congress.--Not later than September 30,
2025, the Secretary shall submit a report to Congress on the
activities conducted using grants under subsection (a) and any
best practices identified and disseminated under subsection
(d).
``(d) Best Practices.--The Secretary may identify and disseminate
best practices for the training described in subsection (a).
``(e) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $5,000,000 for each of fiscal
years 2022 through 2026.''.
SEC. 103. STUDY ON IMPROVING TRAINING FOR HEALTH CARE PROVIDERS.
Not later than 2 years after date of enactment of this Act, the
Secretary of Health and Human Services shall, through a contract with
an independent research organization, conduct a study and make
recommendations for accredited schools of allopathic medicine,
osteopathic medicine, and nursing, and other health professional
training programs on best practices related to training to improve 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.
SEC. 104. PERINATAL QUALITY COLLABORATIVES.
(a) In General.--Section 317K(a)(2) of the Public Health Service
Act (42 U.S.C. 247b-12(a)(2)) is amended by adding at the end the
following:
``(E)(i) The Secretary, acting through the Director of the
Centers for Disease Control and Prevention and in coordination
with other offices and agencies, as appropriate, shall
establish or continue a competitive grant program for the
establishment or support of perinatal quality collaboratives to
improve perinatal care and perinatal health outcomes for
pregnant and postpartum women and their infants. A State,
Indian Tribe, or Tribal organization may use funds received
through such grant to--
``(I) support the use of evidence-based or
evidence-informed practices to improve outcomes for
maternal and infant health;
``(II) work with clinical teams; experts; State,
local, and, as appropriate, Tribal public health
officials; and stakeholders, including patients and
families, to identify, develop, or disseminate best
practices to improve perinatal care and outcomes; and
``(III) employ strategies that provide
opportunities for health care professionals and
clinical teams to collaborate across health care
settings and disciplines, including primary care and
mental health, as appropriate, to improve maternal and
infant health outcomes, which may include the use of
data to provide timely feedback across hospital and
clinical teams to inform responses, and to provide
support and training to hospital and clinical teams for
quality improvement, as appropriate.
``(ii) To be eligible for a grant under clause (i), an
entity shall submit to the Secretary an application in such
form and manner and containing such information as the
Secretary may require.''.
(b) Report to Congress.--Not later than September 30, 2025, the
Secretary of Health and Human Services shall submit to Congress a
report regarding the activities conducted by recipients of grants under
subsection (a)(2)(E) of section 317K of the Public Health Service Act
(42 U.S.C. 247b-12).
SEC. 105. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.
(a) Grants.--Title III of the Public Health Service Act (42 U.S.C.
241 et seq.) is amended by inserting after section 330O of such Act, as
added by section 101, the following:
``SEC. 330P. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.
``(a) In General.--The Secretary may award grants for the purpose
of establishing or operating evidence-based or innovative, evidence-
informed programs to deliver integrated health care services to
pregnant and postpartum women to optimize the health of women and their
infants, including to reduce adverse maternal health outcomes,
pregnancy-related deaths, and related health disparities (including
such disparities associated with racial and ethnic minority
populations), and, as appropriate, by addressing issues researched
under subsection (b)(2) of section 317K.
``(b) Integrated Services for Pregnant and Postpartum Women.--
``(1) Eligibility.--To be eligible to receive a grant under
subsection (a), a State, Indian Tribe, or Tribal organization
(as such terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act) shall work with
relevant stakeholders that coordinate care to develop and carry
out the program, including--
``(A) State, Tribal, and local agencies responsible
for Medicaid, public health, social services, mental
health, and substance use disorder treatment and
services;
``(B) health care providers who serve pregnant and
postpartum women; and
``(C) community-based health organizations and
health workers, including providers of home visiting
services and individuals representing communities with
disproportionately high rates of maternal mortality and
severe maternal morbidity, and including those
representing racial and ethnic minority populations.
``(2) Terms.--
``(A) Period.--A grant awarded under subsection (a)
shall be made for a period of 5 years. Any supplemental
award made to a grantee under subsection (a) may be
made for a period of less than 5 years.
``(B) Priorities.--In awarding grants under
subsection (a), the Secretary shall--
``(i) give priority to States, Indian
Tribes, and Tribal organizations that have the
highest rates of maternal mortality and severe
maternal morbidity relative to other such
States, Indian Tribes, or Tribal organizations,
respectively; and
``(ii) shall consider health disparities
related to maternal mortality and severe
maternal morbidity, including such disparities
associated with racial and ethnic minority
populations.
``(C) Evaluation.--The Secretary shall require
grantees to evaluate the outcomes of the programs
supported under the grant.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2022 through 2026.''.
(b) Report on Grant Outcomes and Dissemination of Best Practices.--
(1) Report.--Not later than February 1, 2026, the Secretary
of Health and Human Services shall submit to the Committee on
Health, Education, Labor, and Pensions of the Senate and the
Committee on Energy and Commerce of the House of
Representatives a report that describes--
(A) the outcomes of the activities supported by the
grants awarded under the amendments made by this
section on maternal and child health;
(B) best practices and models of care used by
recipients of grants under such amendments; and
(C) obstacles identified by recipients of grants
under such amendments, and strategies used by such
recipients to deliver care, improve maternal and child
health, and reduce health disparities.
(2) Dissemination of best practices.--Not later than August
1, 2026, the Secretary of Health and Human Services shall
disseminate information on best practices and models of care
used by recipients of grants under the amendments made by this
section (including best practices and models of care relating
to the reduction of health disparities, including such
disparities associated with racial and ethnic minority
populations, in rates of maternal mortality and severe maternal
morbidity) to relevant stakeholders, which may include health
providers, medical schools, nursing schools, relevant State,
Tribal, and local agencies, and the general public.
SEC. 106. MATERNAL VACCINATION AWARENESS.
In carrying out the public awareness initiative related to
vaccinations pursuant to section 313 of the Public Health Service Act
(42 U.S.C. 245), the Secretary of Health and Human Services shall take
into consideration the importance of increasing awareness and knowledge
of the safety and effectiveness of vaccines to prevent disease in
pregnant and postpartum women and in infants and the need to improve
vaccination rates in communities and populations with low rates of
vaccination.
TITLE II--RURAL MATERNAL AND OBSTETRIC MODERNIZATION OF SERVICES
SEC. 201. 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. 202. 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. 203. 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. 204. 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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