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116th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 116-514
======================================================================
MATERNAL HEALTH QUALITY IMPROVEMENT ACT OF 2019
_______
September 17, 2020.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Pallone, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 4995]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 4995) to amend the Public Health Service Act to
improve obstetric care and maternal health outcomes, and for
other purposes, having considered the same, reports favorably
thereon with an amendment and recommends that the bill as
amended do pass.
CONTENTS
Page
I. Purpose and Summary.............................................8
II. Background and Need for the Legislation.........................9
III. Committee Hearings.............................................12
IV. Committee Consideration........................................12
V. Committee Votes................................................13
VI. Oversight Findings.............................................13
VII. New Budget Authority, Entitlement Authority, and Tax Expenditur13
VIII. Congressional Budget Office Estimate...........................13
IX. Federal Mandates Statement.....................................15
X. Statement of General Performance Goals and Objectives..........15
XI. Duplication of Federal Programs................................15
XII. Committee Cost Estimate........................................15
XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits....16
XIV. Advisory Committee Statement...................................16
XV. Applicability to Legislative Branch............................16
XVI. Section-by-Section Analysis of the Legislation.................16
XVII. Changes in Existing Law Made by the Bill, as Reported..........20
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Maternal Health Quality Improvement
Act of 2019''.
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--IMPROVING OBSTETRIC CARE IN RURAL AREAS
Sec. 101. Improving rural maternal and obstetric care data.
Sec. 102. Rural obstetric network grants.
Sec. 103. Telehealth network and telehealth resource centers grant
programs.
Sec. 104. Rural maternal and obstetric care training demonstration.
Sec. 105. GAO report.
TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE
Sec. 201. Innovation for maternal health.
Sec. 202. Training for health care providers.
Sec. 203. Study on training to reduce and prevent discrimination.
Sec. 204. Perinatal quality collaboratives.
Sec. 205. Integrated services for pregnant and postpartum women.
TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS
SEC. 101. 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, including among American Indians and Alaska Natives,
as such terms are defined in section 4 of the Indian Health Care
Improvement Act, geographic,'' after ``biological,''.
(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 before the period
at the end the following: ``, including improving collection of
data on race, ethnicity, and other demographic information'';
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 and obstetric 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), by amending paragraph (3) to read as
follows:
``(3) carry out paragraphs (1) and (2) with respect to--
``(A) the aging process in women, with priority given
to menopause; and
``(B) pregnancy, with priority given to deaths
related to pregnancy;''; and
(2) in subsection (d)(4)(A)(iv), by inserting ``, including
maternal mortality and other maternal morbidity outcomes''
before the semicolon.
SEC. 102. 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, acting through the
Administrator of the Health Resources and Services Administration,
shall award grants to eligible entities to establish collaborative
improvement and innovation networks (referred to in this section as
`rural obstetric networks') to improve birth outcomes and reduce
maternal morbidity and mortality by improving maternity care and access
to care in rural areas, frontier areas, maternity care health
professional target areas, and Indian country and with Indian Tribes
and tribal organizations.
``(b) Use of Funds.--Rural obstetric networks receiving funds
pursuant to this section may use such funds to--
``(1) assist pregnant women and individuals in areas and
within populations referenced in subsection (a) with accessing
and utilizing maternal and obstetric care, including
preconception, pregnancy, labor and delivery, postpartum, and
interconception services to improve outcomes in birth and
maternal mortality and morbidity;
``(2) identify successful delivery models for maternal and
obstetric care (including preconception, pregnancy, labor and
delivery, postpartum, and interconception services) for
individuals in areas and within populations referenced by
subsection (a), 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 care unit and health
facilities that do not have an obstetric care unit to improve
access to and the delivery of obstetric services in communities
lacking these services;
``(4) provide training and guidance on obstetric care for
health facilities that do not have obstetric care units;
``(5) collaborate with academic institutions that can provide
regional expertise and research on access, outcomes, needs
assessments, and other identified data and measurement
activities needed to inform rural obstetric network efforts to
improve obstetric care; and
``(6) measure and address inequities in birth outcomes among
rural residents, with an emphasis on racial and ethnic
minorities and underserved populations.
``(c) Definitions.--In this section:
``(1) Eligible entities.--The term `eligible entities' means
entities providing obstetric, gynecologic, and other maternal
health care services in rural areas, frontier areas, or
medically underserved areas, or to medically underserved
populations or Native Americans, including 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 country.--The term `Indian country' has the
meaning given such term in section 1151 of title 18, United
States Code.
``(4) Maternity care health professional target area.--The
term `maternity care health professional target area' has the
meaning of such term as used in section 332(k)(2).
``(5) Rural area.--The term `rural area' has the meaning
given that term in section 1886(d)(2) of the Social Security
Act.
``(6) Indian tribes; tribal organization.--The terms `Indian
Tribe' and `tribal organization' have the meaning given such
terms in section 4 of the Indian Self-Determination and
Education Assistance Act.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $3,000,000 for each of fiscal
years 2020 through 2024.''.
SEC. 103. 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 operating obstetric care
units.''; and
(2) in subsection (i)(1)(B), by inserting ``labor and birth,
postpartum,'' before ``or prenatal''.
SEC. 104. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.
Subpart 1 of part E of title VII of the Public Health Service Act is
amended by inserting after section 760 (42 U.S.C. 294n et seq.), as
amended by section 202, is amended by adding at the end the following:
``SEC. 764. 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 nurse practitioners, physician assistants,
nurses, certified nurse midwives, home visiting nurses and non-
clinical home visiting workforce professionals and
paraprofessionals, or non-clinical professionals, who meet
applicable State training and licensing requirements, 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) 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 are evidence-
based and include instruction on--
``(A) maternal mental health, including perinatal
depression and anxiety;
``(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); or
``(F) an Indian Health Program 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, respectively).
``(3) Academic units or programs.--To be eligible to receive
a grant under subsection (a)(3), an entity shall be a school of
medicine, a school of osteopathic medicine, a school of nursing
(as defined in section 801), a physician assistant education
program, an accredited public or nonprofit private hospital, an
accredited medical residency training program, a school
accredited by the Midwifery Education and Accreditation
Council, by the Accreditation Commission for Midwifery
Education, or by the American Midwifery Certification Board, or
a public or private nonprofit educational 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) 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 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
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.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $5,000,000 for each of fiscal
years 2020 through 2024.''.
SEC. 105. GAO REPORT.
Not later than 18 months after the date of enactment of this Act, the
Comptroller General of the United States shall 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 on maternal care in rural areas, including prenatal, labor and
birth, and postpartum care in rural areas. Such report shall include
the following:
(1) Trends in data that may identify potential gaps in
maternal and obstetric clinicians and health professionals,
including non-clinical professionals.
(2) Trends in the number of facilities able to provide
maternal care, 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 morbidity and
recommendations to standardize the format on collecting data
related to maternal mortality and morbidity.
(4) The gaps in maternal health outcomes by race and
ethnicity in rural communities, with a focus on racial
inequities for residents who are racial and ethnic minorities
or members of underserved populations.
(5) An examination of--
(A) activities which the Secretary of Health and
Human Services plans to conduct to improve maternal
care in rural areas, including prenatal, labor and
birth, and postpartum care; and
(B) the extent to which the Secretary has a plan for
completing these activities, has identified the lead
agency responsible for each activity, has identified
any needed coordination among agencies, and has
developed a budget for conducting such activities.
(6) Other information that the Comptroller General determines
appropriate.
TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE
SEC. 201. INNOVATION FOR MATERNAL HEALTH.
The Public Health Service Act is amended--
(1) in the section designation of section 330M (42 U.S.C.
254c-19) by inserting a period after ``330M''; and
(2) by inserting after such section 330M the following:
``SEC. 330N. 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,
eliminate preventable maternal mortality and severe maternal
morbidity, and improve infant health outcomes, 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, including 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;
``(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) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $10,000,000 for each of fiscal
years 2020 through 2024.''.
SEC. 202. 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 reduce and prevent
discrimination (including training related to implicit and explicit
biases) in the provision of health care services related to prenatal
care, labor care, birthing, and postpartum 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 Requirement.--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.
``(d) Best Practices.--The Secretary may identify and disseminate
best practices for the training of health care professionals to reduce
and prevent discrimination (including training related to implicit and
explicit biases) in the provision of health care services related to
prenatal care, labor care, birthing, and postpartum care.
``(e) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $5,000,000 for each of fiscal
years 2020 through 2024.''.
SEC. 203. STUDY ON TRAINING TO REDUCE AND PREVENT DISCRIMINATION.
Not later than 2 years after date of enactment of this Act, the
Secretary of Health and Human Services (referred to in this section as
the ``Secretary'') 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 reduce and prevent discrimination,
including training related to implicit and explicit biases, in the
provision of health care services related to prenatal care, labor care,
birthing, and postpartum care.
SEC. 204. PERINATAL QUALITY COLLABORATIVES.
(a) Grants.--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) Authorization of Appropriations.--Section 317K(f) of the Public
Health Service Act (42 U.S.C. 247b-12(f)) is amended by striking
``$58,000,000 for each of fiscal years 2019 through 2023'' and
inserting ``$65,000,000 for each of fiscal years 2020 through 2024''.
SEC. 205. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.
(a) Grants.--The Public Health Service Act is amended by inserting
after section 330N of such Act, as added by section 201, the following:
``SEC. 330O. 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--
``(1) to reduce adverse maternal health outcomes, pregnancy-
related deaths, and related health disparities (including such
disparities associated with racial and ethnic minority
populations); and
``(2) as appropriate, by addressing issues researched under
section 317K(b)(2).
``(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 (including
coordinating resources and referrals for health care and social
services) 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 ethnicity 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) Preference.--In awarding grants under
subsection (a), the Secretary shall--
``(i) give preference 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) Priority.--In awarding grants under subsection
(a), the Secretary shall give priority to applications
from up to 15 entities described in subparagraph
(B)(i).
``(D) Evaluation.--The Secretary shall require
grantees to evaluate the outcomes of the programs
supported under the grant.
``(c) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $15,000,000 for each of fiscal
years 2020 through 2024.''.
(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
Energy and Commerce of the House of Representatives and the
Committee on Health, Education, Labor, and Pensions of the
Senate 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 section 330O of the Public
Health Service Act (as added 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.
I. Purpose and Summary
H.R. 4995, the ``Maternal Health Quality Improvement Act of
2019'', was introduced on November 8, 2019, by Representatives
Eliot L. Engel (D-NY), Larry Bucshon (R-IN), Xochitl Torres
Small (D-NM), Robert E. Latta (R-OH), Alma S. Adams (D-NC), and
Steve Stivers (R-OH). H.R. 4995 authorizes public health
programs designed to improve maternal health outcomes,
including initiatives that: enhance data collection and
coordination of health services in rural areas; expand the use
of telehealth services for maternal health care; train health
providers in rural areas; provide innovation in maternal health
grants; train providers on how to reduce racial disparities in
maternal health outcomes; provide grants for perinatal quality
collaboratives; and integrate services for pregnant and
postpartum women to reduce adverse maternal health outcomes.
II. Background and Need for Legislation
According to the Centers for Disease Control and Prevention
(CDC), women in the United States are more likely to die from
childbirth or pregnancy-related causes than other women in the
developed world, with about 700 women dying every year from
pregnancy-related complications.\1\\2\ More details are needed
to better understand the actual causes of death, but research
suggests that approximately three in every five pregnancy-
related deaths are preventable.\3\ The deaths are roughly
evenly split between those that occur during pregnancy (31
percent of deaths), during delivery or in the week after
delivery (36 percent of deaths), and between one week and one
year postpartum (33 percent of deaths).\4\
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\1\Centers for Disease Control and Prevention, Vital Signs:
Pregnancy-related Deaths: Saving Women's Lives, Before, During and
After Delivery (https://www.cdc.gov/vitalsigns/maternal-deaths/
index.html) (May 7, 2019).
\2\Centers for Disease Control and Prevention, Pregnancy Related
Deaths (https://www.cdc.gov/reproductivehealth/maternalinfanthealth/
pregnancy-relatedmortality.htm) (Feb. 26, 2019).
\3\Centers for Disease Control and Prevention, Vital Signs:
Pregnancy-related Deaths: Saving Women's Lives, Before, During and
After Delivery (https://www.cdc.gov/vitalsigns/maternal-deaths/
index.html) (May 7, 2019).
\4\Id.
---------------------------------------------------------------------------
Causes of pregnancy-related deaths differ throughout
pregnancy and after delivery. Heart disease and stroke cause
the most deaths overall, while obstetric emergencies, such as
severe bleeding and amniotic fluid embolism cause the most
deaths at delivery.\5\ Severe bleeding, high blood pressure,
and infection are the leading causes of death in the week after
delivery, and weakened heart muscle is the leading cause of
deaths one week to one year postpartum.\6\ Observers have also
noted postpartum depression as a common condition in postpartum
women, with suicide among the leading causes of death in
postpartum women.\7\
---------------------------------------------------------------------------
\5\Id.
\6\Id.
\7\Dorothy Sit et al., Suicidal Ideation in Depressed Postpartum
Women: Associations with Childhood Trauma, Sleep Disturbance and
Anxiety, 66 J. Psychiatric Research 95 (2015).
---------------------------------------------------------------------------
In addition to high rates of maternal mortality, rates of
severe maternal morbidity (SMM) are on the rise. SMM is defined
as a condition that includes unexpected outcomes of labor and
delivery that result in significant short- or long-term
consequences to a woman's health. As tracked by the CDC, the
rate of overall SMM rose nearly 200 percent between 1993 and
2014, with most women with a SMM requiring blood transfusion,
but others requiring hysterectomy and ventilation or a
temporary tracheostomy.\8\
---------------------------------------------------------------------------
\8\Id.
---------------------------------------------------------------------------
Across nearly all causes of maternal mortality and
morbidity, there are significant and pervasive racial
disparities. Though literature has not fully explained all of
the factors contributing to racial disparities in maternal
health outcomes, statistics show non-Hispanic black and
American Indian/Alaska Native women are about three times more
likely to die from pregnancy-related causes than White
women.\9\ For women over the age of 30, pregnancy-related
mortality for Black and American Indian/Alaska Native women is
four to five times higher than it is for White women.\10\ These
disparities persist despite education level and socioeconomic
status.\11\ For example, the data show that pregnancy-related
deaths for Black and American Indian/Alaska Native women with
some college education were higher than those for all other
racial/ethnic groups with less than a high school diploma.\12\
To address these disparities, CDC has recommended that
hospitals and health care systems implement standardized
protocols in quality improvement initiatives, especially among
facilities that serve disproportionately affected communities.
CDC has also encouraged hospitals and health systems to
identify and address implicit biases in health care in order to
improve patient-provider interactions, health communication,
and health outcomes.\13\
---------------------------------------------------------------------------
\9\Id.
\10\Centers for Disease Control and Prevention, Racial and Ethnic
Disparities Continue in Pregnancy-Related Deaths (https://www.cdc.gov/
media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-
deaths.html) (Sept. 5, 2019).
\11\Elizabeth A. Howell, Reducing Disparities in Severe Maternal
Morbidity and Mortality, 61 Clinical Obstetrics and Gynecology 387
(June 2018).
\12\Emely E. Petersen et al., Racial/Ethnic Disparities in
Pregnancy-Related Deaths--United States, 2007-2016, 68 Morbidity and
Mortality Weekly Report 762 (available at https://www.cdc.gov/mmwr/
volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_w) (Sept. 6, 2019).
\13\See note 9.
---------------------------------------------------------------------------
Pregnant women in rural areas also face higher negative
health outcomes. While the maternal mortality rate in urban
areas was 18.2 maternal deaths per 100,000 live births in 2015,
very rural areas had a maternal death rate of 29.4 per 100,000
live births.\14\ Almost half of rural counties in the United
States do not have a hospital with obstetric services, which
means that most rural women do not have access to perinatal
services within a 30-minute drive, and more than ten percent of
women must drive 100 miles or more for perinatal services.\15\
Providers of maternal health care are sparse throughout rural
areas; nearly half of all counties do not have a single OB-GYN
or certified nurse midwife.\16\ While telehealth and
telemedicine have been recognized as methods of providing
health care in rural areas, its adoption has been limited for
various reasons, such as limited access to broadband in rural
areas and cost of equipment or technologies.\17\ These barriers
to care have been shown to increase rates of maternal
mortality, SMM, and postpartum depression.\18\
---------------------------------------------------------------------------
\14\Dina Fine Maron, Maternal Health Care is Disappearing in Rural
America, Scientific American (https://www.scientificamerican.com/
article/maternal-health-care-is-disappearing-in-rural-america/) (Feb.
15, 2017).
\15\Centers for Medicare and Medicaid Services, Improving Access to
Maternal Health Care in Rural Communities (https://www.cms.gov/About-
CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-
Maternal-Health-Care-in-Rural-Communities.pdf) (June 2019).
\16\Id.
\17\Id.
\18\Id.
---------------------------------------------------------------------------
Legislation is necessary to authorize Federally-supported
initiatives that will further improve access to maternal health
services, develop the maternal health care workforce, continue
to develop and deploy best practices in maternal health care,
and establish innovative evidence-informed programs that
integrate services for pregnant and postpartum women.
Title I--Improving Obstetric Care in Rural Areas
Title I establishes Rural Obstetric Network Grants to
improve maternal health care in rural areas. Through these
grants, care providers in rural areas, frontier areas,
medically underserved areas, and others, will be able to
provide greater access to health services, improve training and
awareness on providing care in rural areas, and allow for
collaboration between health facilities that have obstetric
care units and those that do not. This collaboration will
foster better implementation of best practices to help women at
risk of maternal mortality and SMM in hospital settings,
including those facing severe hemorrhage and hypertension.
Title I also ensures telehealth grants will be available for
maternal health care and creates a new training demonstration
grant program to improve and expand training in maternal mental
health, substance use disorder, social determinants of health,
and implicit bias for new health care providers in rural areas.
This title also requires the Government Accountability Office
(GAO) to report on maternal care in rural areas, including an
examination of gaps in data on maternal mortality, morbidity
and maternal health outcomes by race and ethnicity in rural
communities, with a focus on inequities for residents who are
racial and ethnic minorities or members of underserved
populations.
Title II--Other Improvements to Maternal Health
Title II authorizes the Alliance for Innovation on Maternal
Health, or AIM Program at the Department of Health and Human
Services, which works to improve maternal health care standards
across all settings, through patient safety bundles, grants,
and other tools for the purposes of: identifying, developing,
or disseminating best practices to improve maternal health care
quality and outcomes and eliminate preventable maternal
mortality and SMM; providing technical assistance to implement
best practices; and implementing new models of care that
improve maternal and infant health outcomes. H.R. 4995
authorizes $10 million in annual appropriations to help expand
and improve on this program.
For the purposes of addressing the stark racial disparities
in maternal health outcomes, title II authorizes $5 million in
grants to medical and nursing schools, as well as other health
professional programs, to help reduce and prevent
discrimination, through training related to implicit and
explicit biases in providing prenatal care, labor care,
birthing, and postpartum care. Title II also requires the
Secretary to enter into a contract with an independent research
organization to study and make recommendations for medical
schools, nursing schools, and other health professional
training programs on best practices related to training to
reduce and prevent discrimination and implicit and explicit
biases.
Title II also supports States' work to improve maternal
health outcomes by authorizing and expanding grants for
perinatal quality collaboratives (PQCs) through CDC's National
Network of Perinatal Quality Collaboratives, which currently
helps States coordinate to share data and best practices. PQCs
are State or multi-State networks working to improve the
quality of care for women and newborns. PQCs may include health
care providers, hospitals, and public health officials, and may
focus exclusively on maternal health or neonatal health, or
both, depending on the needs of the States. State PQCs
generally develop relationships to improve the collection of
data and implementation of best practice in the State.
To further improve care delivery, title II authorizes $15
million for grants to establish or operate evidence-based or
innovative, evidence-informed programs to deliver integrated
health care services to pregnant and postpartum women to
optimize their health and the health of their infants. To
receive grants, States, Indian tribes, and tribal organizations
are required to work with relevant stakeholders to coordinate
care, including agencies responsible for Medicaid, public
health, social service, mental health, substance use disorder
treatment and services, providers of home visiting services,
and others. These grants may be used to support delivery of
care to improve health outcomes to States, Indian Tribes, and
tribal organizations that face the highest rates of maternal
mortality and SMM, as well as areas where there are health
disparities associated with racial and ethnic minority
populations.
Finally, title II requires the Secretary to produce a
report no later than February 2026 describing the outcomes of
activities supported by grants, best practices and models of
care used by recipients of grants, and any obstacles identified
by grant recipients. The Secretary will also be required to
disseminate information on best practices and models of care
used by recipients of grants to relevant stakeholders, which
may include health providers, medical schools, nursing schools,
relevant State, tribal, and local agencies, and the general
public.
III. Committee Hearings
For the purposes of section 103(i) of H. Res. 6 of the
116th Congress, the following hearing was used to develop or
consider H.R. 4995:
The Subcommittee on Health held a legislative hearing on
September 10, 2019, entitled ``Improving Maternal Health:
Legislation to Advance Prevention Efforts and Access to Care''
to review related legislation, including H.R. 1897, the
``Mothers and Offspring Mortality and Morbidity Awareness
Act''; H.R. 1551, the ``Quality Care for Moms and Babies Act'';
H.R. 2902, the ``Maternal Care Access and Reducing Emergencies
Act''; and H.R. 2602, the ``Healthy MOMMIES Act''. The
Subcommittee received testimony from the following witnesses:
Wanda Irving, Mother of Dr. Shalon Irving
Patrice Harris, M.D., President, Board of
Trustees, American Medical Association
Elizabeth Howell, M.D., M.P.P., Director,
Blavatnik Family Women's Health Research Institute, Icahn
School of Medicine at Mount Sinai
David Nelson, M.D., Chief of Obstetrics, Parkland
Health and Hospital System
Usha Ranji, Associate Director, Women's Health
Policy, Kaiser Family Foundation.
IV. Committee Consideration
Representatives Engel (D-NY), Bucshon (R-IN), Torres Small
(D-MN), Latta (R-OH), Adams (D-NC), and Stivers (R-OH)
introduced H.R. 4995, the ``Maternal Health Quality Improvement
Act of 2019'', on November 8, 2019, and the bill was referred
to the Committee on Energy and Commerce. Subsequently, the bill
was referred to the Subcommittee on Health on November 12,
2019.
On November 13, 2019, the Subcommittee on Health met in
open markup session, pursuant to notice, to consider H.R. 4995.
No amendments were offered during consideration of the bill.
The Subcommittee on Health then agreed to a motion by Ms.
Eshoo, Chairwoman of the subcommittee, to forward favorably
H.R. 4995, without amendment, to the full Committee on Energy
and Commerce by a voice vote.
On November 19, 2019, the full Committee met in open markup
session, pursuant to notice, to consider the bill H.R. 4995.
During consideration of the bill, an amendment offered by Mr.
Cardenas of California was agreed to by a voice vote. At the
conclusion of the markup of the bill, Mr. Pallone, Chairman of
the committee, moved that H.R. 4995 be ordered reported
favorably to the House, amended. The full Committee agreed to
the Pallone motion on final passage by a voice vote, a quorum
being present.
V. Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list each record vote
on the motion to report legislation and amendments thereto. The
Committee advises that there were no record votes taken on H.R.
4995, including the motion for final passage of the bill.
VI. Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1)
of rule X of the Rules of the House of Representatives, the
oversight findings and recommendations of the Committee are
reflected in the descriptive portion of the report.
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to 3(c)(2) of rule XIII of the Rules of the House
of Representatives, the Committee adopts as its own the
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues contained in the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
VIII. Congressional Budget Office Estimate
U.S. Congress,
Congressional Budget Office,
Washington, DC, February 12, 2020.
Hon. Frank Pallone, Jr.,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4995, the Maternal
Health Quality Improvement Act of 2019.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Philippa
Haven.
Sincerely,
Phillip L. Swagel,
Director.
Enclosure.
H.R. 4995 would require the Health Resources and Services
Administration or the Centers for Disease Control and
Prevention to establish five new grant programs and one new
demonstration program. Specifically:
Section 102 would establish a new grant program
for rural obstetric collaborative networks and would authorize
$3 million each year from 2020 through 2024 to support those
activities.
Section 104 would establish a demonstration
program to improve training for providers of maternal care in
rural areas and would authorize $5 million each year from 2020
through 2024 to support those activities.
Section 201 would establish a competitive grant
program to identify, develop, or disseminate for best practices
for improving maternal health care and infant health outcomes
and would authorize $10 million each year from 2020 through
2024 to support those activities.
Section 202 would establish a grant program for
the training of health professionals to reduce and prevent
discrimination in the provision of maternal care and would
authorize $5 million each year from 2020 through 2024 to
support those activities.
Section 204 would establish a grant program to
improve perinatal care and health outcomes and would authorize
$65 million each year from 2020 through 2024 to support those
activities. Under current law, $58 million is authorized for
those activities each year through 2023. As a result, the bill
would increase authorized amounts by $7 million annually for
the 2020-2023 period.
Section 205 would establish a grant program for
states, Indian tribes, or tribal organizations to establish or
operate programs that optimize the health of women and their
infants through integrated care and would authorize $15 million
each year from 2020 through 2024 to support those activities.
Based on historical spending for similar programs, CBO
estimates that, in total, the grant programs would cost $230
million over the 2020-2025 period.
In addition, the bill would require two reports. Section
105 would require the Government Accountability Office to
publish a report on maternal care in rural areas. Section 203
would require the Department of Health and Human Services to
contract with an independent research organization to study and
recommend best practices for training to reduce and prevent
discrimination in the provision of prenatal labor, birthing,
and postpartum care.
Based on historical spending for similar activates, CBO
estimates that preparing those two reports would cost about $3
million over the 2020-2025 period.
In total and assuming appropriation of the necessary
amounts, CBO estimates that implementing H.R. 4995 would cost
$233 million over the 2020-2025 period. The costs of the
legislation, detailed in Table I, fall within budget function
550 (health).
TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 4995
----------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
----------------------------------------------------------------
2020 2021 2022 2023 2024 2025 2020-2025
----------------------------------------------------------------------------------------------------------------
Estimated Authorization........................ 46 46 46 45 103 0 286
Estimated Outlays.............................. * 6 31 56 70 70 233
----------------------------------------------------------------------------------------------------------------
* = between zero and $500,000.
The CBO staff contacts for this estimate are Alice Burns
(Health Resources and Services Administration) and Philippa
Haven (Centers for Disease Control and Prevention, Health and
Human Services, and National Institutes of Health). The
estimate was reviewed by Leo Lex, Deputy Director of Budget
Analysis.
IX. 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.
X. Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to improve
obstetric care and maternal health outcomes across health care
settings by increasing resources, improving standards of care,
and addressing health inequities.
XI. Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 4995 is known to be duplicative of another Federal
program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the
most recent Catalog of Federal Domestic Assistance.
XII. Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, 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.
XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 4995 contains no earmarks, limited
tax benefits, or limited tariff benefits.
XIV. Advisory Committee Statement
No advisory committee within the meaning of section 5(b) of
the Federal Advisory Committee Act was created by this
legislation.
XV. 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.
XVI. Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 designates that the short title of this Act may
be cited as the ``Maternal Health Quality Improvement Act of
2019''.
Sec. 2. Table of Contents
Section 2 provides the Table of Contents for H.R. 4995,
including Title I--Improving Obstetric Care in Rural Areas and
Title II--Other Improvements to Maternal Care.
TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS
Sec. 101. Improving rural maternal and obstetric care data
Section 101, as reported, improves data collection on
maternal and obstetric care in rural areas across the
Department of Health and Human Services (HHS), by requiring CDC
to expand, intensify, and coordinate activities with respect to
maternal mortality and morbidity; requiring the CDC Office of
Women's Health to report on women's health across all
geographic areas and among American Indians and Alaska Natives;
expanding research activities to improve data collection on
race, ethnicity, and other demographic information; examining
the relationship between maternal and obstetric services in
rural areas and outcomes in delivery and postpartum care; and
expanding activities within the Office of Research on Women's
Health at the National Institutes of Health (NIH) to include
maternal mortality and other maternal morbidity outcomes.
Sec. 102. Rural Obstetric Network Grants
Section 102 creates Rural Obstetric Network Grants at the
Health Resources and Services Administration (HRSA) to improve
birth outcomes and reduce maternal morbidity and mortality by
improving maternity care and access to care in rural areas,
frontier areas, maternity care health professional target
areas, and Indian country, and with Indian Tribes and tribal
organizations. To do so, the Administrator is authorized to
award grants to eligible entities to establish collaborative
improvement and innovation networks. These grants can be used
to assist pregnant women with accessing and utilizing maternal
and obstetric care, including preconception, pregnancy, labor
and delivery, postpartum, and interconception services to
improve outcomes in birth and maternal mortality and morbidity.
Grant funds may also be used for the identification of
successful delivery models for maternal and obstetric care in
applicable areas, the development of collaborative models
between health facilities that have an obstetric care unit and
health facilities that do not have an obstetric care unit, as
well as for training and guidance on obstetric care for health
facilities that do not have obstetric care units. Grantees may
also collaborate with academic institutions for regional
expertise and research and dedicate funds to measuring and
addressing inequities in birth outcomes among rural residents,
with an emphasis on racial and ethnic minorities and
underserved populations. Section 102 authorizes $3 million
annually to carry out these activities.
Sec. 103. Telehealth network and telehealth resource centers grant
program
This section adds providers of maternal care to the list of
eligible entities who may receive telehealth network and
telehealth resource center grants and ensures applicants who
provide care for labor and birth and postpartum care are
prioritized for receiving such grants.
Sec. 104. Rural maternal and obstetric care training demonstration
Section 104 establishes a training demonstration program to
award grants to support training for physicians, medical
residents (including family medicine and obstetrics and
gynecology residents), fellows, nurse practitioners, physician
assistants, nurses, certified nurse midwives, home visiting
nurses, and non-clinical professionals to practice maternal and
obstetric medicine in rural community-based settings. Those
receiving grants for these purposes are required to include
instruction on maternal mental health and substance use
disorder, social determinants of health that affect individuals
living in rural communities, and on the reduction of implicit
bias.
Section 104 also authorizes grants for medical schools,
nursing schools, physician assistant education programs,
accredited public and private nonprofit hospitals, accredited
medical residency training programs, accredited midwifery
schools to support establishing, maintaining, or improving
academic units or programs that provide training for students
or faculty to improve maternal care in rural areas and develop
evidence-based practices or recommendations for the design of
such units or programs.
Section 104 requires HRSA to submit a report to the House
Committee on Energy and Commerce and the Senate Committee on
Health, Education, Labor, and Pensions on the outcomes of the
demonstration program, including an analysis of the effect of
the program on the quality, quantity, and distribution of
maternal health care services, an analysis of maternal and
infant health outcomes in communities served by entities
participating in the demonstration program, and recommendations
on whether the program should be expanded.
Section 104 authorizes $5 million annually to carry out
these activities.
Sec. 105. GAO Report
Section 105 requires the Comptroller General to issue a
report no later than 18 months after the date of enactment
identifying potential gaps in maternal and obstetric clinicians
and health professionals, trends in the number of facilities
able to provide maternal care, gaps in maternal mortality and
morbidity data along with recommendations to standardize the
data collection related to maternal mortality and morbidity,
gaps in maternal health outcomes by race and ethnicity in rural
communities, activities which HHS plans to conduct to improve
maternal care in rural areas, and the extent to which the
Secretary has a plan for completing these activities, in
addition to any other information that the Comptroller General
determines appropriate.
TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE
Sec. 201. Innovation for maternal health
Section 201 requires 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, to
establish or continue competitive grants for the purposes of
identifying, developing, or disseminating best practices to
improve maternal health care quality and outcomes, eliminating
preventable maternal mortality and SMM, and facilitating better
health outcomes. Such best practices may be on improving the
quality and safety of maternal health care in hospitals and
other care settings; 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 addressing
determinants of health that impact maternal health outcomes.
Additionally, the grantees may use grant funds to collaborate
with maternal mortality review committees to identify issues
that will inform the development and implementation of
evidence-based practices to improve maternal health outcomes;
provide technical assistance and support for the implementation
of evidence-based practices; and identify, develop, and
evaluate new models of care that improve maternal and infant
health outcomes, which may include the integration of
community-based services and clinical care. Section 201
authorizes $10 million annually to carry out this grant
program.
Sec. 202. Training for health care providers
Section 202 requires the Secretary to establish a program
to award grants to accredited schools of allopathic medicine,
osteopathic medicine, nursing, and other health professional
training programs for the purpose of reducing and preventing
discrimination (including training related to implicit and
explicit biases) in the provision of health care services
related to prenatal care, labor care, birthing, and postpartum
care. Each entity awarded a grant under this program will be
required to report on activities conducted under the grant,
including a description of patient outcomes. This section also
authorizes the Secretary to identify and disseminate best
practices for the training of health professionals to reduce
and prevent discrimination. Section 202 authorizes $5 million
annually to carry out these activities.
Sec. 203. Study on Training To Reduce and Prevent Discrimination
Section 203 requires the Secretary to contract with an
independent research organization to conduct a study and make
recommendations for schools of allopathic medicine, osteopathic
medicine, nursing, and other health professional training
programs on best practices for health practitioner training on
reducing and preventing discrimination, along with implicit and
explicit biases related to the provision of health services in
prenatal care, labor care, birthing, and postpartum care.
Sec. 204. Perinatal Quality Collaboratives
Section 204 amends the Public Health Service Act to require
the Secretary, acting through the CDC Director, to establish or
continue grants for PQCs, which are used to improve perinatal
care and perinatal health outcomes for pregnant or postpartum
women and their infants. These grants may be used to support
the identification, development, and dissemination of evidence-
based or evidence-informed best practices to improve outcomes
for maternal and infant health, and employ strategies or
provide opportunities for health care professionals and
clinical teams to collaborate across health care settings and
disciplines to improve care. Section 204 increases CDC's
authorization for safe motherhood programs by $7 million
annually, to $65 million, to fund this grant program.
Sec. 205. Integrated services for pregnant and postpartum women
Section 205 authorizes the Secretary to award grants to
establish or operate evidence-based or innovative evidence-
informed programs to deliver integrated health care services to
pregnant and postpartum women in order to optimize their health
and the health of their infants. Programs supported by the
grants would include initiatives that reduce adverse maternal
health outcomes, pregnancy-related deaths, and related
disparities, including disparities associated with racial and
ethnic minority populations. Grantees are required to work with
stakeholders, including health care providers, relevant
Medicaid, public health, social services, mental health, and
substance use disorder treatment and services agencies, and
community-based health organizations to develop and carry out
the program. Grants under the program would be awarded for
five-year periods, and supplemental grants could be made for
less than five years. In awarding grants, the Secretary is
required to give preference to states, Tribes, and tribal
organizations with the highest rates of maternal mortality and
SMM, giving priority to up to 15 of these applications. The
Secretary is also required to consider health disparities
related to maternal mortality and SMM in awarding grants,
including those disparities associated with racial and ethnic
minority populations. Section 205 authorizes $15 million
annually to carry out these activities.
In addition, Section 205 would require the Secretary to
submit a report to the House Committee on Energy and Commerce
and the Senate Committee on Health, Education, Labor, and
Pensions describing the outcomes of activities supported by the
grants in this section, along with best practices, models of
care, and strategies used by grantees to deliver care, improve
health, and reduce health disparities, and obstacles identified
by grantees in conducting those activities. Furthermore,
Section 205 would require the Secretary to disseminate
information on best practices and models of care to relevant
stakeholders not later than August 1, 2026.
XVII. 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 (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, 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 A--Research and Investigation
in general
Sec. 301. (a) The Secretary shall conduct in the Service, and
encourage, cooperate with, and render assistance to other
appropriate public authorities, scientific institutions, and
scientists in the conduct of, and promote the coordination of,
research, investigations, experiments, demonstrations, and
studies relating to the causes, diagnosis, treatment, control,
and prevention of physical and mental diseases and impairments
of man, including water purification, sewage treatment, and
pollution of lakes and streams. In carrying out the foregoing
the Secretary is authorized to--
(1) collect and make available through publications
and other appropriate means, information as to, and the
practical application of, such research and other
activities;
(2) make available research facilities of the Service
to appropriate public authorities, and to health
officials and scientists engaged in special study;
(3) make grants-in-aid to universities, hospitals,
laboratories, and other public or private institutions,
and to individuals for such research projects as are
recommended by the advisory council to the entity of
the Department supporting such projects and make, upon
recommendation of the advisory council to the
appropriate entity of the Department, grants-in-aid to
public or nonprofit universities, hospitals,
laboratories, and other institutions for the general
support of their research;
(4) secure from time to time and for such periods as
he deems advisable, the assistance and advice of
experts, scholars, and consultants from the United
States or abroad;
(5) for purposes of study, admit and treat at
institutions, hospitals, and stations of the Service,
persons not otherwise eligible for such treatment;
(6) make available, to health officials, scientists,
and appropriate public and other nonprofit institutions
and organizations, technical advice and assistance on
the application of statistical methods to experiments,
studies, and surveys in health and medical fields;
(7) enter into contracts, including contracts for
research in accordance with and subject to the
provisions of law applicable to contracts entered into
by the military departments under title 10, United
States Code, sections 2353 and 2354, except that
determination, approval, and certification required
thereby shall be by the Secretary of Health, Education,
and Welfare; and
(8) adopt, upon recommendations of the advisory
councils to the appropriate entities of the Department
or, with respect to mental health, the National
Advisory Mental Health Council, such additional means
as the Secretary considers necessary or appropriate to
carry out the purposes of this section.
(b)(1) The Secretary shall conduct and may support through
grants and contracts studies and testing of substances for
carcinogenicity, teratogenicity, mutagenicity, and other
harmful biological effects. In carrying out this paragraph, the
Secretary shall consult with entities of the Federal
Government, outside of the Department of Health, Education, and
Welfare, engaged in comparable activities. The Secretary, upon
request of such an entity and under appropriate arrangements
for the payment of expenses, may conduct for such entity
studies and testing of substances for carcinogenicity,
teratogenicity, mutagenicity, and other harmful biological
effects.
(2)(A) The Secretary shall establish a comprehensive program
of research into the biological effects of low-level ionizing
radiation under which program the Secretary shall conduct such
research and may support such research by others through grants
and contracts.
(B) The Secretary shall conduct a comprehensive review of
Federal programs of research on the biological effects of
ionizing radiation.
(3) The Secretary shall conduct and may support through
grants and contracts research and studies on human nutrition,
with particular emphasis on the role of nutrition in the
prevention and treatment of disease and on the maintenance and
promotion of health, and programs for the dissemination of
information respecting human nutrition to health professionals
and the public. In carrying out activities under this
paragraph, the Secretary shall provide for the coordination of
such of these activities as are performed by the different
divisions within the Department of Health, Education, and
Welfare and shall consult with entities of the Federal
Government, outside of the Department of Health, Education, and
Welfare, engaged in comparable activities. The Secretary, upon
request of such an entity and under appropriate arrangements
for the payment of expenses, may conduct and support such
activities for such entity.
(4) The Secretary shall publish a biennial report which
contains--
(A) a list of all substances (i) which either are
known to be carcinogens or may reasonably be
anticipated to be carcinogens and (ii) to which a
significant number of persons residing in the United
States are exposed;
(B) information concerning the nature of such
exposure and the estimated number of persons exposed to
such substances;
(C) a statement identifying (i) each substance
contained in the list under subparagraph (A) for which
no effluent, ambient, or exposure standard has been
established by a Federal agency, and (ii) for each
effluent, ambient, or exposure standard established by
a Federal agency with respect to a substance contained
in the list under subparagraph (A), the extent to
which, on the basis of available medical, scientific,
or other data, such standard, and the implementation of
such standard by the agency, decreases the risk to
public health from exposure to the substance; and
(D) a description of (i) each request received during
the year involved--
(I) from a Federal agency outside the
Department of Health, Education, and Welfare
for the Secretary, or
(II) from an entity within the Department of
Health, Education, and Welfare to any other
entity within the Department,
to conduct research into, or testing for, the
carcinogenicity of substances or to provide information
described in clause (ii) of subparagraph (C), and (ii)
how the Secretary and each such other entity,
respectively, have responded to each such request.
(5) The authority of the Secretary to enter into any contract
for the conduct of any study, testing, program, research, or
review, or assessment under this subsection shall be effective
for any fiscal year only to such extent or in such amounts as
are provided in advance in Appropriation Acts.
(c) The Secretary may conduct biomedical research, directly
or through grants or contracts, for the identification,
control, treatment, and prevention of diseases (including
tropical diseases) which do not occur to a significant extent
in the United States.
(d)(1)(A) If a person is engaged in biomedical, behavioral,
clinical, or other research, in which identifiable, sensitive
information is collected (including research on mental health
and research on the use and effect of alcohol and other
psychoactive drugs), the Secretary, in coordination with other
agencies, as applicable--
(i) shall issue to such person a certificate of
confidentiality to protect the privacy of individuals
who are the subjects of such research if the research
is funded wholly or in part by the Federal Government;
and
(ii) may, upon application by a person engaged in
research, issue to such person a certificate of
confidentiality to protect the privacy of such
individuals if the research is not so funded.
(B) Except as provided in subparagraph (C), any person to
whom a certificate is issued under subparagraph (A) to protect
the privacy of individuals described in such subparagraph shall
not disclose or provide to any other person not connected with
the research the name of such an individual or any information,
document, or biospecimen that contains identifiable, sensitive
information about such an individual and that was created or
compiled for purposes of the research.
(C) The disclosure prohibition in subparagraph (B) shall not
apply to disclosure or use that is--
(i) required by Federal, State, or local laws,
excluding instances described in subparagraph (D);
(ii) necessary for the medical treatment of the
individual to whom the information, document, or
biospecimen pertains and made with the consent of such
individual;
(iii) made with the consent of the individual to whom
the information, document, or biospecimen pertains; or
(iv) made for the purposes of other scientific
research that is in compliance with applicable Federal
regulations governing the protection of human subjects
in research.
(D) Any person to whom a certificate is issued under
subparagraph (A) to protect the privacy of an individual
described in such subparagraph shall not, in any Federal,
State, or local civil, criminal, administrative, legislative,
or other proceeding, disclose or provide the name of such
individual or any such information, document, or biospecimen
that contains identifiable, sensitive information about the
individual and that was created or compiled for purposes of the
research, except in the circumstance described in subparagraph
(C)(iii).
(E) Identifiable, sensitive information protected under
subparagraph (A), and all copies thereof, shall be immune from
the legal process, and shall not, without the consent of the
individual to whom the information pertains, be admissible as
evidence or used for any purpose in any action, suit, or other
judicial, legislative, or administrative proceeding.
(F) Identifiable, sensitive information collected by a person
to whom a certificate has been issued under subparagraph (A),
and all copies thereof, shall be subject to the protections
afforded by this section for perpetuity.
(G) The Secretary shall take steps to minimize the burden to
researchers, streamline the process, and reduce the time it
takes to comply with the requirements of this subsection.
(2) The Secretary shall coordinate with the heads of other
applicable Federal agencies to ensure that such departments
have policies in place with respect to the issuance of a
certificate of confidentiality pursuant to paragraph (1) and
other requirements of this subsection.
(3) Nothing in this subsection shall be construed to limit
the access of an individual who is a subject of research to
information about himself or herself collected during such
individual's participation in the research.
(4) For purposes of this subsection, the term ``identifiable,
sensitive information'' means information that is about an
individual and that is gathered or used during the course of
research described in paragraph (1)(A) and--
(A) through which an individual is identified; or
(B) for which there is at least a very small risk, as
determined by current scientific practices or
statistical methods, that some combination of the
information, a request for the information, and other
available data sources could be used to deduce the
identity of an individual.
(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.
[(e)] (f) 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 preterm labor
and delivery and infant mortality.
[(f)] (g)(1) The Secretary may exempt from disclosure under
section 552(b)(3) of title 5, United States Code, biomedical
information that is about an individual and that is gathered or
used during the course of biomedical research if--
(A) an individual is identified; or
(B) there is at least a very small risk, as
determined by current scientific practices or
statistical methods, that some combination of the
information, the request, and other available data
sources could be used to deduce the identity of an
individual.
(2)(A) Each determination of the Secretary under paragraph
(1) to exempt information from disclosure shall be made in
writing and accompanied by a statement of the basis for the
determination.
(B) Each such determination and statement of basis shall be
available to the public, upon request, through the Office of
the Chief FOIA Officer of the Department of Health and Human
Services.
(3) Nothing in this subsection shall be construed to limit a
research participant's access to information about such
participant collected during the participant's participation in
the research.
[(g)] (h) Subchapter I of chapter 35 of title 44, United
States Code, shall not apply to the voluntary collection of
information during the conduct of research by the National
Institutes of Health.
[(h)] (i)(1) The Secretary may make available to individuals
and entities, for biomedical and behavioral research,
substances and living organisms. Such substances and organisms
shall be made available under such terms and conditions
(including payment for them) as the Secretary determines
appropriate.
(2) Where research substances and living organisms are made
available under paragraph (1) through contractors, the
Secretary may direct such contractors to collect payments on
behalf of the Secretary for the costs incurred to make
available such substances and organisms and to forward amounts
so collected to the Secretary, in the time and manner specified
by the Secretary.
(3) Amounts collected under paragraph (2) shall be credited
to the appropriations accounts that incurred the costs to make
available the research substances and living organisms
involved, and shall remain available until expended for
carrying out activities under such accounts.
* * * * * * *
SEC. 310A. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF WOMEN'S
HEALTH.
(a) Establishment.--There is established within the Office of
the Director of the Centers for Disease Control and Prevention,
an office to be known as the Office of Women's Health (referred
to in this section as the ``Office''). The Office shall be
headed by a director who shall be appointed by the Director of
such Centers.
(b) Purpose.--The Director of the Office shall--
(1) report to the Director of the Centers for Disease
Control and Prevention on the current level of the
Centers' activity regarding women's health conditions
across, where appropriate, age, biological,
sociocultural, including among American Indians and
Alaska Natives, as such terms are defined in section 4
of the Indian Health Care Improvement Act, geographic,
and sociocultural contexts, in all aspects of the
Centers' work, including prevention programs, public
and professional education, services, and treatment;
(2) establish short-range and long-range goals and
objectives within the Centers for women's health and,
as relevant and appropriate, coordinate with other
appropriate offices on activities within the Centers
that relate to prevention, research, education and
training, service delivery, and policy development, for
issues of particular concern to women;
(3) identify projects in women's health that should
be conducted or supported by the Centers;
(4) consult with health professionals,
nongovernmental organizations, consumer organizations,
women's health professionals, and other individuals and
groups, as appropriate, on the policy of the Centers
with regard to women; and
(5) serve as a member of the Department of Health and
Human Services Coordinating Committee on Women's Health
(established under section 229(b)(4)).
(c) Definition.--As used in this section, the term ``women's
health conditions'', with respect to women of all age, ethnic,
and racial groups, means diseases, disorders, and conditions--
(1) unique to, significantly more serious for, or
significantly more prevalent in women; and
(2) for which the factors of medical risk or type of
medical intervention are different for women, or for
which there is reasonable evidence that indicates that
such factors or types may be different for women.
(d) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2010 through 2014.
Part B--Federal-State Cooperation
* * * * * * *
safe motherhood
Sec. 317K. (a) Surveillance.--
(1) Purpose.--The purposes of this subsection are to
establish or continue a Federal initiative to support
State and tribal maternal mortality review committees,
to improve data collection and reporting around
maternal mortality, and to develop or support
surveillance systems at the local, State, and national
level to better understand the burden of maternal
complications and mortality and to decrease the
disparities among populations at risk of death and
severe complications from pregnancy.
(2) Activities.--For the purpose described in
paragraph (1), the Secretary, acting through the
Director of the Centers for Disease Control and
Prevention, may carry out the following activities:
(A) The Secretary may continue and improve
activities related to a national maternal
mortality data collection and surveillance
program to identify and support the review of
pregnancy-associated deaths and pregnancy-
related deaths that occur during, or within 1
year following, pregnancy.
(B) The Secretary may expand the Pregnancy
Risk Assessment Monitoring System to provide
surveillance and collect data in each State.
(C) The Secretary may expand the Maternal and
Child Health Epidemiology Program to provide
technical support, financial assistance, or the
time-limited assignment of senior
epidemiologists to maternal and child health
programs in each State.
(D) The Secretary may, in cooperation with
States, Indian tribes, and tribal
organizations, develop a program to support
States, Indian tribes, and tribal organizations
in establishing or operating maternal mortality
review committees, in accordance with
subsection (d).
(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) Prevention Research.--
(1) Purpose.--The purpose of this subsection is to
provide the Secretary with the authority to further
expand research concerning risk factors, prevention
strategies, and the roles of the family, health care
providers and the community in safe motherhood.
(2) Research.--The Secretary may carry out activities
to expand research relating to--
(A) prepregnancy counseling, especially for
at risk populations such as women with diabetes
and women with substance use disorder;
(B) the identification of critical components
of prenatal delivery and postpartum care;
(C) the identification of outreach and
support services, such as folic acid education,
that are available for pregnant women;
(D) the identification of women who are at
high risk for complications;
(E) preventing preterm delivery;
(F) preventing urinary tract infections;
(G) preventing unnecessary caesarean
sections;
(H) the identification of the determinants of
disparities in maternal care, health risks, and
health outcomes, including an examination of
the higher rates of maternal mortality among
African American women and other groups of
women with disproportionately high rates of
maternal mortality;
(I) activities to reduce disparities in
maternity services and outcomes;
(J) an examination of the relationship
between interpersonal violence and maternal
complications and mortality;
(K) preventing and reducing adverse health
consequences that may result from smokingand
substance abuse and misuse before, during and
after pregnancy;
(L) preventing infections that cause maternal
and infant complications; [and]
(M) an examination of the relationship
between maternal and obstetric services in
rural areas and outcomes in delivery and
postpartum care; and
[(M)] (N) other areas determined appropriate
by the Secretary.
(c) Prevention Programs.--The Secretary may carry out
activities to promote safe motherhood, including--
(1) public education campaigns on healthy
pregnancies;
(2) education programs for physicians, nurses and
other health care providers;
(3) activities to promote community support services
for pregnant women; and
(4) activities to promote physical, mental, and
behavioral health during, and up to 1 year following,
pregnancy, with an emphasis on prevention of, and
treatment for, mental health disorders and substance
use disorder.
(d) Maternal Mortality Review Committees.--
(1) In general.--In order to participate in the
program under subsection (a)(2)(D), the applicable
maternal mortality review committee of the State,
Indian tribe, or tribal organization shall--
(A) include multidisciplinary and diverse
membership that represents a variety of
clinical specialties, State, tribal, or local
public health officials, epidemiologists,
statisticians, community organizations,
geographic regions within the area covered by
such committee, and individuals or
organizations that represent the populations in
the area covered by such committee that are
most affected by pregnancy-related deaths or
pregnancy-associated deaths and lack of access
to maternal health care services; and
(B) demonstrate to the Centers for Disease
Control and Prevention that such maternal
mortality review committee's methods and
processes for data collection and review, as
required under paragraph (3), use best
practices to reliably determine and include all
pregnancy-associated deaths and pregnancy-
related deaths, regardless of the outcome of
the pregnancy.
(2) Process for confidential reporting.--States,
Indian tribes, and tribal organizations that
participate in the program described in this subsection
shall, through the State maternal mortality review
committee, develop a process that--
(A) provides for confidential case reporting
of pregnancy-associated and pregnancy-related
deaths to the appropriate State or tribal
health agency, including such reporting by--
(i) health care professionals;
(ii) health care facilities;
(iii) any individual responsible for
completing death records, including
medical examiners and medical coroners;
and
(iv) other appropriate individuals or
entities; and
(B) provides for voluntary and confidential
case reporting of pregnancy-associated deaths
and pregnancy-related deaths to the appropriate
State or tribal health agency by family members
of the deceased, and other appropriate
individuals, for purposes of review by the
applicable maternal mortality review committee;
and
(C) shall include--
(i) making publicly available contact
information of the committee for use in
such reporting; and
(ii) conducting outreach to local
professional organizations, community
organizations, and social services
agencies regarding the availability of
the review committee.
(3) Data collection and review.--States, Indian
tribes, and tribal organizations that participate in
the program described in this subsection shall--
(A) annually identify pregnancy-associated
deaths and pregnancy-related deaths--
(i) through the appropriate vital
statistics unit by--
(I) matching each death
record related to a pregnancy-
associated death or pregnancy-
related death in the State or
tribal area in the applicable
year to a birth certificate of
an infant or fetal death
record, as applicable;
(II) to the extent
practicable, identifying an
underlying or contributing
cause of each pregnancy-
associated death and each
pregnancy-related death in the
State or tribal area in the
applicable year; and
(III) collecting data from
medical examiner and coroner
reports, as appropriate;
(ii) using other appropriate methods
or information to identify pregnancy-
associated deaths and pregnancy-related
deaths, including deaths from pregnancy
outcomes not identified through clause
(i)(I);
(B) through the maternal mortality review
committee, review data and information to
identify adverse outcomes that may contribute
to pregnancy-associated death and pregnancy-
related death, and to identify trends,
patterns, and disparities in such adverse
outcomes to allow the State, Indian tribe, or
tribal organization to make recommendations to
individuals and entities described in paragraph
(2)(A), as appropriate, to improve maternal
care and reduce pregnancy-associated death and
pregnancy-related death;
(C) identify training available to the
individuals and entities described in paragraph
(2)(A) for accurate identification and
reporting of pregnancy-associated and
pregnancy-related deaths;
(D) ensure that, to the extent practicable,
the data collected and reported under this
paragraph is in a format that allows for
analysis by the Centers for Disease Control and
Prevention; and
(E) publicly identify the methods used to
identify pregnancy-associated deaths and
pregnancy-related deaths in accordance with
this section.
(4) Confidentiality.--States, Indian tribes, and
tribal organizations participating in the program
described in this subsection shall establish
confidentiality protections to ensure, at a minimum,
that--
(A) there is no disclosure by the maternal
mortality review committee, including any
individual members of the committee, to any
person, including any government official, of
any identifying information about any specific
maternal mortality case; and
(B) no information from committee
proceedings, including deliberation or records,
is made public unless specifically authorized
under State and Federal law.
(5) Reports to cdc.--For fiscal year 2019, and each
subsequent fiscal year, each maternal mortality review
committee participating in the program described in
this subsection shall submit to the Director of the
Centers for Disease Control and Prevention a report
that includes--
(A) data, findings, and any recommendations
of such committee; and
(B) as applicable, information on the
implementation during such year of any
recommendations submitted by the committee in a
previous year.
(6) State partnerships.--States may partner with one
or more neighboring States to carry out the activities
under this subparagraph. With respect to the States in
such a partnership, any requirement under this
subparagraph relating to the reporting of information
related to such activities shall be deemed to be
fulfilled by each such State if a single such report is
submitted for the partnership.
(7) Appropriate mechanisms for indian tribes and
tribal organizations.--The Secretary, in consultation
with Indian tribes, shall identify and establish
appropriate mechanisms for Indian tribes and tribal
organizations to demonstrate, report data, and conduct
the activities as required for participation in the
program described in this subsection. Such mechanisms
may include technical assistance with respect to grant
application and submission procedures, and award
management activities.
(8) Research availability.--The Secretary shall
develop a process to ensure that data collected under
paragraph (5) is made available, as appropriate and
practicable, for research purposes, in a manner that
protects individually identifiable or potentially
identifiable information and that is consistent with
State and Federal privacy law.
(e) Definitions.--In this section--
(1) the terms ``Indian tribe'' and ``tribal
organization'' have the meanings given such terms in
section 4 of the Indian Self-Determination and
Education Assistance Act;
(2) the term ``pregnancy-associated death'' means a
death of a woman, by any cause, that occurs during, or
within 1 year following, her pregnancy, regardless of
the outcome, duration, or site of the pregnancy; and
(3) the term ``pregnancy-related death'' means a
death of a woman that occurs during, or within 1 year
following, her pregnancy, regardless of the outcome,
duration, or site of the pregnancy--
(A) from any cause related to, or aggravated
by, the pregnancy or its management; and
(B) not from accidental or incidental causes.
(f) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated [$58,000,000 for each of fiscal years 2019 through
2023] $65,000,000 for each of fiscal years 2020 through 2024.
* * * * * * *
Part D--Primary Health Care
Subpart I--Health Centers
* * * * * * *
SEC. 330A-2. RURAL OBSTETRIC NETWORK GRANTS.
(a) Program Established.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall award grants to eligible entities to
establish collaborative improvement and innovation networks
(referred to in this section as ``rural obstetric networks'')
to improve birth outcomes and reduce maternal morbidity and
mortality by improving maternity care and access to care in
rural areas, frontier areas, maternity care health professional
target areas, and Indian country and with Indian Tribes and
tribal organizations.
(b) Use of Funds.--Rural obstetric networks receiving funds
pursuant to this section may use such funds to--
(1) assist pregnant women and individuals in areas
and within populations referenced in subsection (a)
with accessing and utilizing maternal and obstetric
care, including preconception, pregnancy, labor and
delivery, postpartum, and interconception services to
improve outcomes in birth and maternal mortality and
morbidity;
(2) identify successful delivery models for maternal
and obstetric care (including preconception, pregnancy,
labor and delivery, postpartum, and interconception
services) for individuals in areas and within
populations referenced by subsection (a), 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 care unit and health
facilities that do not have an obstetric care unit to
improve access to and the delivery of obstetric
services in communities lacking these services;
(4) provide training and guidance on obstetric care
for health facilities that do not have obstetric care
units;
(5) collaborate with academic institutions that can
provide regional expertise and research on access,
outcomes, needs assessments, and other identified data
and measurement activities needed to inform rural
obstetric network efforts to improve obstetric care;
and
(6) measure and address inequities in birth outcomes
among rural residents, with an emphasis on racial and
ethnic minorities and underserved populations.
(c) Definitions.--In this section:
(1) Eligible entities.--The term ``eligible
entities'' means entities providing obstetric,
gynecologic, and other maternal health care services in
rural areas, frontier areas, or medically underserved
areas, or to medically underserved populations or
Native Americans, including 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 country.--The term ``Indian country'' has
the meaning given such term in section 1151 of title
18, United States Code.
(4) Maternity care health professional target area.--
The term ``maternity care health professional target
area'' has the meaning of such term as used in section
332(k)(2).
(5) Rural area.--The term ``rural area'' has the
meaning given that term in section 1886(d)(2) of the
Social Security Act.
(6) Indian tribes; tribal organization.--The terms
``Indian Tribe'' and ``tribal organization'' have the
meaning given such terms in section 4 of the Indian
Self-Determination and Education Assistance Act.
(d) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section $3,000,000 for each
of fiscal years 2020 through 2024.
* * * * * * *
SEC. 330I. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT
PROGRAMS.
(a) Definitions.--In this section:
(1) Director; office.--The terms ``Director'' and
``Office'' mean the Director and Office specified in
subsection (c).
(2) Federally qualified health center and rural
health clinic.--The term ``Federally qualified health
center'' and ``rural health clinic'' have the meanings
given the terms in section 1861(aa) of the Social
Security Act (42 U.S.C. 1395x(aa)).
(3) Frontier community.--The term ``frontier
community'' shall have the meaning given the term in
regulations issued under subsection (r).
(4) Medically underserved area.--The term ``medically
underserved area'' has the meaning given the term
``medically underserved community'' in section 799B(6).
(5) Medically underserved population.--The term
``medically underserved population'' has the meaning
given the term in section 330(b)(3).
(6) Telehealth services.--The term ``telehealth
services'' means services provided through telehealth
technologies.
(7) Telehealth technologies.--The term ``telehealth
technologies'' means technologies relating to the use
of electronic information, and telecommunications
technologies, to support and promote, at a distance,
health care, patient and professional health-related
education, health administration, and public health.
(b) Programs.--The Secretary shall establish, under section
301, telehealth network and telehealth resource centers grant
programs.
(c) Administration.--
(1) Establishment.--There is established in the
Health Resources and Services Administration an Office
for the Advancement of Telehealth. The Office shall be
headed by a Director.
(2) Duties.--The telehealth network and telehealth
resource centers grant programs established under
section 301 shall be administered by the Director, in
consultation with the State offices of rural health,
State offices concerning primary care, or other
appropriate State government entities.
(d) Grants.--
(1) Telehealth network grants.--The Director may, in
carrying out the telehealth network grant program
referred to in subsection (b), award grants to eligible
entities for projects to demonstrate how telehealth
technologies can be used through telehealth networks in
rural areas, frontier communities, and medically
underserved areas, and for medically underserved
populations, to--
(A) expand access to, coordinate, and improve
the quality of health care services;
(B) improve and expand the training of health
care providers; and
(C) expand and improve the quality of health
information available to health care providers,
and patients and their families, for
decisionmaking.
(2) Telehealth resource centers grants.--The Director
may, in carrying out the telehealth resource centers
grant program referred to in subsection (b), award
grants to eligible entities for projects to demonstrate
how telehealth technologies can be used in the areas
and communities, and for the populations, described in
paragraph (1), to establish telehealth resource
centers.
(e) Grant Periods.--The Director may award grants under this
section for periods of not more than 4 years.
(f) Eligible Entities.--
(1) Telehealth network grants.--
(A) Grant recipient.--To be eligible to
receive a grant under subsection (d)(1), an
entity shall be a nonprofit entity.
(B) Telehealth networks.--
(i) In general.--To be eligible to
receive a grant under subsection
(d)(1), an entity shall demonstrate
that the entity will provide services
through a telehealth network.
(ii) Nature of entities.--Each entity
participating in the telehealth network
may be a nonprofit or for-profit
entity.
(iii) Composition of network.--The
telehealth network shall include at
least 2 of the following entities (at
least 1 of which shall be a community-
based health care provider):
(I) Community or migrant
health centers or other
Federally qualified health
centers.
(II) Health care providers,
including pharmacists, in
private practice.
(III) Entities operating
clinics, including rural health
clinics.
(IV) Local health
departments.
(V) Nonprofit hospitals,
including community access
hospitals.
(VI) Other publicly funded
health or social service
agencies.
(VII) Long-term care
providers.
(VIII) Providers of health
care services in the home.
(IX) Providers of outpatient
mental health services and
entities operating outpatient
mental health facilities.
(X) Local or regional
emergency health care
providers.
(XI) Institutions of higher
education.
(XII) Entities operating
dental clinics.
(XIII) Providers of maternal,
including prenatal, labor and
birth, and postpartum care
services and entities operating
obstetric care units.
(2) Telehealth resource centers grants.--To be
eligible to receive a grant under subsection (d)(2), an
entity shall be a nonprofit entity.
(g) Applications.--To be eligible to receive a grant under
subsection (d), an eligible entity, in consultation with the
appropriate State office of rural health or another appropriate
State entity, shall prepare and submit to the Secretary an
application, at such time, in such manner, and containing such
information as the Secretary may require, including--
(1) a description of the project that the eligible
entity will carry out using the funds provided under
the grant;
(2) a description of the manner in which the project
funded under the grant will meet the health care needs
of rural or other populations to be served through the
project, or improve the access to services of, and the
quality of the services received by, those populations;
(3) evidence of local support for the project, and a
description of how the areas, communities, or
populations to be served will be involved in the
development and ongoing operations of the project;
(4) a plan for sustaining the project after Federal
support for the project has ended;
(5) information on the source and amount of non-
Federal funds that the entity will provide for the
project;
(6) information demonstrating the long-term viability
of the project, and other evidence of institutional
commitment of the entity to the project;
(7) in the case of an application for a project
involving a telehealth network, information
demonstrating how the project will promote the
integration of telehealth technologies into the
operations of health care providers, to avoid
redundancy, and improve access to and the quality of
care; and
(8) other such information as the Secretary
determines to be appropriate.
(h) Terms; Conditions; Maximum Amount of Assistance.--The
Secretary shall establish the terms and conditions of each
grant program described in subsection (b) and the maximum
amount of a grant to be awarded to an individual recipient for
each fiscal year under this section. The Secretary shall
publish, in a publication of the Health Resources and Services
Administration, notice of the application requirements for each
grant program described in subsection (b) for each fiscal year.
(i) Preferences.--
(1) Telehealth networks.--In awarding grants under
subsection (d)(1) for projects involving telehealth
networks, the Secretary shall give preference to an
eligible entity that meets at least 1 of the following
requirements:
(A) Organization.--The eligible entity is a
rural community-based organization or another
community-based organization.
(B) Services.--The eligible entity proposes
to use Federal funds made available through
such a grant to develop plans for, or to
establish, telehealth networks that provide
mental health, public health, long-term care,
home care, preventive, case management
services, labor and birth, postpartum, or
prenatal care for high-risk pregnancies.
(C) Coordination.--The eligible entity
demonstrates how the project to be carried out
under the grant will be coordinated with other
relevant federally funded projects in the
areas, communities, and populations to be
served through the grant.
(D) Network.--The eligible entity
demonstrates that the project involves a
telehealth network that includes an entity
that--
(i) provides clinical health care
services, or educational services for
health care providers and for patients
or their families; and
(ii) is--
(I) a public library;
(II) an institution of higher
education; or
(III) a local government
entity.
(E) Connectivity.--The eligible entity
proposes a project that promotes local
connectivity within areas, communities, or
populations to be served through the project.
(F) Integration.--The eligible entity
demonstrates that health care information has
been integrated into the project.
(2) Telehealth resource centers.--In awarding grants
under subsection (d)(2) for projects involving
telehealth resource centers, the Secretary shall give
preference to an eligible entity that meets at least 1
of the following requirements:
(A) Provision of services.--The eligible
entity has a record of success in the provision
of telehealth services to medically underserved
areas or medically underserved populations.
(B) Collaboration and sharing of expertise.--
The eligible entity has a demonstrated record
of collaborating and sharing expertise with
providers of telehealth services at the
national, regional, State, and local levels.
(C) Broad range of telehealth services.--The
eligible entity has a record of providing a
broad range of telehealth services, which may
include--
(i) a variety of clinical specialty
services;
(ii) patient or family education;
(iii) health care professional
education; and
(iv) rural residency support
programs.
(j) Distribution of Funds.--
(1) In general.--In awarding grants under this
section, the Director shall ensure, to the greatest
extent possible, that such grants are equitably
distributed among the geographical regions of the
United States.
(2) Telehealth networks.--In awarding grants under
subsection (d)(1) for a fiscal year, the Director shall
ensure that--
(A) not less than 50 percent of the funds
awarded shall be awarded for projects in rural
areas; and
(B) the total amount of funds awarded for
such projects for that fiscal year shall be not
less than the total amount of funds awarded for
such projects for fiscal year 2001 under
section 330A (as in effect on the day before
the date of enactment of the Health Care Safety
Net Amendments of 2002).
(k) Use of Funds.--
(1) Telehealth network program.--The recipient of a
grant under subsection (d)(1) may use funds received
through such grant for salaries, equipment, and
operating or other costs, including the cost of--
(A) developing and delivering clinical
telehealth services that enhance access to
community-based health care services in rural
areas, frontier communities, or medically
underserved areas, or for medically underserved
populations;
(B) developing and acquiring, through lease
or purchase, computer hardware and software,
audio and video equipment, computer network
equipment, interactive equipment, data terminal
equipment, and other equipment that furthers
the objectives of the telehealth network grant
program;
(C)(i) developing and providing distance
education, in a manner that enhances access to
care in rural areas, frontier communities, or
medically underserved areas, or for medically
underserved populations; or
(ii) mentoring, precepting, or supervising
health care providers and students seeking to
become health care providers, in a manner that
enhances access to care in the areas and
communities, or for the populations, described
in clause (i);
(D) developing and acquiring instructional
programming;
(E)(i) providing for transmission of medical
data, and maintenance of equipment; and
(ii) providing for compensation (including
travel expenses) of specialists, and referring
health care providers, who are providing
telehealth services through the telehealth
network, if no third party payment is available
for the telehealth services delivered through
the telehealth network;
(F) developing projects to use telehealth
technology to facilitate collaboration between
health care providers;
(G) collecting and analyzing usage statistics
and data to document the cost-effectiveness of
the telehealth services; and
(H) carrying out such other activities as are
consistent with achieving the objectives of
this section, as determined by the Secretary.
(2) Telehealth resource centers.--The recipient of a
grant under subsection (d)(2) may use funds received
through such grant for salaries, equipment, and
operating or other costs for--
(A) providing technical assistance, training,
and support, and providing for travel expenses,
for health care providers and a range of health
care entities that provide or will provide
telehealth services;
(B) disseminating information and research
findings related to telehealth services;
(C) promoting effective collaboration among
telehealth resource centers and the Office;
(D) conducting evaluations to determine the
best utilization of telehealth technologies to
meet health care needs;
(E) promoting the integration of the
technologies used in clinical information
systems with other telehealth technologies;
(F) fostering the use of telehealth
technologies to provide health care information
and education for health care providers and
consumers in a more effective manner; and
(G) implementing special projects or studies
under the direction of the Office.
(l) Prohibited Uses of Funds.--An entity that receives a
grant under this section may not use funds made available
through the grant--
(1) to acquire real property;
(2) for expenditures to purchase or lease equipment,
to the extent that the expenditures would exceed 40
percent of the total grant funds;
(3) in the case of a project involving a telehealth
network, to purchase or install transmission equipment
(such as laying cable or telephone lines, or purchasing
or installing microwave towers, satellite dishes,
amplifiers, or digital switching equipment);
(4) to pay for any equipment or transmission costs
not directly related to the purposes for which the
grant is awarded;
(5) to purchase or install general purpose voice
telephone systems;
(6) for construction; or
(7) for expenditures for indirect costs (as
determined by the Secretary), to the extent that the
expenditures would exceed 15 percent of the total grant
funds.
(m) Collaboration.--In providing services under this section,
an eligible entity shall collaborate, if feasible, with
entities that--
(1)(A) are private or public organizations, that
receive Federal or State assistance; or
(B) are public or private entities that operate
centers, or carry out programs, that receive Federal or
State assistance; and
(2) provide telehealth services or related
activities.
(n) Coordination With Other Agencies.--The Secretary shall
coordinate activities carried out under grant programs
described in subsection (b), to the extent practicable, with
Federal and State agencies and nonprofit organizations that are
operating similar programs, to maximize the effect of public
dollars in funding meritorious proposals.
(o) Outreach Activities.--The Secretary shall establish and
implement procedures to carry out outreach activities to advise
potential end users of telehealth services in rural areas,
frontier communities, medically underserved areas, and
medically underserved populations in each State about the grant
programs described in subsection (b).
(p) Telehealth.--It is the sense of Congress that, for
purposes of this section, States should develop reciprocity
agreements so that a provider of services under this section
who is a licensed or otherwise authorized health care provider
under the law of 1 or more States, and who, through telehealth
technology, consults with a licensed or otherwise authorized
health care provider in another State, is exempt, with respect
to such consultation, from any State law of the other State
that prohibits such consultation on the basis that the first
health care provider is not a licensed or authorized health
care provider under the law of that State.
(q) Report.--Not later than September 30, 2005, the Secretary
shall prepare and submit to the appropriate committees of
Congress a report on the progress and accomplishments of the
grant programs described in subsection (b).
(r) Regulations.--The Secretary shall issue regulations
specifying, for purposes of this section, a definition of the
term ``frontier area''. The definition shall be based on
factors that include population density, travel distance in
miles to the nearest medical facility, travel time in minutes
to the nearest medical facility, and such other factors as the
Secretary determines to be appropriate. The Secretary shall
develop the definition in consultation with the Director of the
Bureau of the Census and the Administrator of the Economic
Research Service of the Department of Agriculture.
(s) Authorization of Appropriations.--There are authorized to
be appropriated to carry out this section--
(1) for grants under subsection (d)(1), $40,000,000
for fiscal year 2002, and such sums as may be necessary
for each of fiscal years 2003 through 2006; and
(2) for grants under subsection (d)(2), $20,000,000
for fiscal year 2002, and such sums as may be necessary
for each of fiscal years 2003 through 2006.
* * * * * * *
SEC. 330M. PEDIATRIC MENTAL HEALTH CARE ACCESS GRANTS.
(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in coordination with other relevant Federal
agencies, shall award grants to States, political subdivisions
of States, and Indian tribes and tribal organizations (for
purposes of this section, as such terms are defined in section
4 of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b)) to promote behavioral health integration in
pediatric primary care by--
(1) supporting the development of statewide or
regional pediatric mental health care telehealth access
programs; and
(2) supporting the improvement of existing statewide
or regional pediatric mental health care telehealth
access programs.
(b) Program Requirements.--
(1) In general.--A pediatric mental health care
telehealth access program referred to in subsection
(a), with respect to which a grant under such
subsection may be used, shall--
(A) be a statewide or regional network of
pediatric mental health teams that provide
support to pediatric primary care sites as an
integrated team;
(B) support and further develop organized
State or regional networks of pediatric mental
health teams to provide consultative support to
pediatric primary care sites;
(C) conduct an assessment of critical
behavioral consultation needs among pediatric
providers and such providers' preferred
mechanisms for receiving consultation,
training, and technical assistance;
(D) develop an online database and
communication mechanisms, including telehealth,
to facilitate consultation support to pediatric
practices;
(E) provide rapid statewide or regional
clinical telephone or telehealth consultations
when requested between the pediatric mental
health teams and pediatric primary care
providers;
(F) conduct training and provide technical
assistance to pediatric primary care providers
to support the early identification, diagnosis,
treatment, and referral of children with
behavioral health conditions;
(G) provide information to pediatric
providers about, and assist pediatric providers
in accessing, pediatric mental health care
providers, including child and adolescent
psychiatrists, and licensed mental health
professionals, such as psychologists, social
workers, or mental health counselors and in
scheduling and conducting technical assistance;
(H) assist with referrals to specialty care
and community or behavioral health resources;
and
(I) establish mechanisms for measuring and
monitoring increased access to pediatric mental
health care services by pediatric primary care
providers and expanded capacity of pediatric
primary care providers to identify, treat, and
refer children with mental health problems.
(2) Pediatric mental health teams.--In this
subsection, the term ``pediatric mental health team''
means a team consisting of at least one case
coordinator, at least one child and adolescent
psychiatrist, and at least one licensed clinical mental
health professional, such as a psychologist, social
worker, or mental health counselor. Such a team may be
regionally based.
(c) Application.--A State, political subdivision of a State,
Indian tribe, or tribal organization seeking a grant under this
section shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may require, including a plan for the comprehensive
evaluation of activities that are carried out with funds
received under such grant.
(d) Evaluation.--A State, political subdivision of a State,
Indian tribe, or tribal organization that receives a grant
under this section shall prepare and submit an evaluation of
activities that are carried out with funds received under such
grant to the Secretary at such time, in such manner, and
containing such information as the Secretary may reasonably
require, including a process and outcome evaluation.
(e) Access to Broadband.--In administering grants under this
section, the Secretary may coordinate with other agencies to
ensure that funding opportunities are available to support
access to reliable, high-speed Internet for providers.
(f) Matching Requirement.--The Secretary may not award a
grant under this section unless the State, political
subdivision of a State, Indian tribe, or tribal organization
involved agrees, with respect to the costs to be incurred by
the State, political subdivision of a State, Indian tribe, or
tribal organization in carrying out the purpose described in
this section, to make available non-Federal contributions (in
cash or in kind) toward such costs in an amount that is not
less than 20 percent of Federal funds provided in the grant.
(g) Authorization of Appropriations.--To carry out this
section, there are authorized to be appropriated, $9,000,000
for the period of fiscal years 2018 through 2022.
SEC. 330N. 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, eliminate preventable maternal mortality and
severe maternal morbidity, and improve infant health
outcomes, 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,
including 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 post-
partum 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;
(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) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $10,000,000 for
each of fiscal years 2020 through 2024.
SEC. 330O. 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--
(1) to reduce adverse maternal health outcomes,
pregnancy-related deaths, and related health
disparities (including such disparities associated with
racial and ethnic minority populations); and
(2) as appropriate, by addressing issues researched
under section 317K(b)(2).
(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 (including coordinating resources and
referrals for health care and social services) 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 ethnicity 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) Preference In awarding grants under
subsection (a), the Secretary shall--
(i) give preference 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) Priority In awarding grants under
subsection (a), the Secretary shall give
priority to applications from up to 15 entities
described in subparagraph (B)(i).
(D) Evaluation The Secretary shall require
grantees to evaluate the outcomes of the
programs supported under the grant.
(c) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $15,000,000 for
each of fiscal years 2020 through 2024.
* * * * * * *
TITLE IV--NATIONAL RESEARCH INSTITUTES
* * * * * * *
Part F--Research on Women's Health
SEC. 486. OFFICE OF RESEARCH ON WOMEN'S HEALTH.
(a) Establishment.--There is established within the Office of
the Director of NIH an office to be known as the Office of
Research on Women's Health (in this part referred to as the
``Office''). The Office shall be headed by a director, who
shall be appointed by the Director of NIH and who shall report
directly to the Director.
(b) Purpose.--The Director of the Office shall--
(1) identify projects of research on women's health
that should be conducted or supported by the national
research institutes;
(2) identify multidisciplinary research relating to
research on women's health that should be so conducted
or supported;
[(3) carry out paragraphs (1) and (2) with respect to
the aging process in women, with priority given to
menopause;]
(3) carry out paragraphs (1) and (2) with respect
to--
(A) the aging process in women, with priority
given to menopause; and
(B) pregnancy, with priority given to deaths
related to pregnancy;
(4) promote coordination and collaboration among
entities conducting research identified under any of
paragraphs (1) through (3);
(5) encourage the conduct of such research by
entities receiving funds from the national research
institutes;
(6) recommend an agenda for conducting and supporting
such research;
(7) promote the sufficient allocation of the
resources of the national research institutes for
conducting and supporting such research;
(8) assist in the administration of section 492B with
respect to the inclusion of women as subjects in
clinical research; and
(9) prepare the report required in section 486B.
(c) Coordinating Committee.--
(1) In carrying out subsection (b), the Director of
the Office shall establish a committee to be known as
the Coordinating Committee on Research on Women's
Health (in this subsection referred to as the
``Coordinating Committee'').
(2) The Coordinating Committee shall be composed of
the Directors of the national research institutes (or
the senior-level staff designees of the Directors).
(3) The Director of the Office shall serve as the
chair of the Coordinating Committee.
(4) With respect to research on women's health, the
Coordinating Committee shall assist the Director of the
Office in--
(A) identifying the need for such research,
and making an estimate each fiscal year of the
funds needed to adequately support the
research;
(B) identifying needs regarding the
coordination of research activities, including
intramural and extramural multidisciplinary
activities;
(C) supporting the development of
methodologies to determine the circumstances in
which obtaining data specific to women
(including data relating to the age of women
and the membership of women in ethnic or racial
groups) is an appropriate function of clinical
trials of treatments and therapies;
(D) supporting the development and expansion
of clinical trials of treatments and therapies
for which obtaining such data has been
determined to be an appropriate function; and
(E) encouraging the national research
institutes to conduct and support such
research, including such clinical trials.
(d) Advisory Committee.--
(1) In carrying out subsection (b), the Director of
the Office shall establish an advisory committee to be
known as the Advisory Committee on Research on Women's
Health (in this subsection referred to as the
``Advisory Committee'').
(2) The Advisory Committee shall be composed of no
fewer than 12, and not more than 18 individuals, who
are not officers or employees of the Federal
Government. The Director of NIH shall make appointments
to the Advisory Committee from among physicians,
practitioners, scientists, and other health
professionals, whose clinical practice, research
specialization, or professional expertise includes a
significant focus on research on women's health. A
majority of the members of the Advisory Committee shall
be women.
(3) The Director of the Office shall serve as the
chair of the Advisory Committee.
(4) The Advisory Committee shall--
(A) advise the Director of the Office on
appropriate research activities to be
undertaken by the national research institutes
with respect to--
(i) research on women's health;
(ii) research on gender differences
in clinical drug trials, including
responses to pharmacological drugs;
(iii) research on gender differences
in disease etiology, course, and
treatment;
(iv) research on obstetrical and
gynecological health conditions,
diseases, and treatments, including
maternal mortality and other maternal
morbidity outcomes; and
(v) research on women's health
conditions which require a
multidisciplinary approach;
(B) report to the Director of the Office on
such research;
(C) provide recommendations to such Director
regarding activities of the Office (including
recommendations on the development of the
methodologies described in subsection (c)(4)(C)
and recommendations on priorities in carrying
out research described in subparagraph (A));
and
(D) assist in monitoring compliance with
section 492B regarding the inclusion of women
in clinical research.
(5)(A) The Advisory Committee shall prepare a
biennial report describing the activities of the
Committee, including findings made by the Committee
regarding--
(i) compliance with section 492B;
(ii) the extent of expenditures made for
research on women's health by the agencies of
the National Institutes of Health; and
(iii) the level of funding needed for such
research.
(B) The report required in subparagraph (A) shall be
submitted to the Director of NIH for inclusion in the
report required in section 403.
(e) Representation of Women Among Researchers.--The
Secretary, acting through the Assistant Secretary for Personnel
and in collaboration with the Director of the Office, shall
determine the extent to which women are represented among
senior physicians and scientists of the national research
institutes and among physicians and scientists conducting
research with funds provided by such institutes, and as
appropriate, carry out activities to increase the extent of
such representation.
(f) Definitions.--For purposes of this part:
(1) The term ``women's health conditions'', with
respect to women of all age, ethnic, and racial groups,
means all diseases, disorders, and conditions
(including with respect to mental health)--
(A) unique to, more serious, or more
prevalent in women;
(B) for which the factors of medical risk or
types of medical intervention are different for
women, or for which it is unknown whether such
factors or types are different for women; or
(C) with respect to which there has been
insufficient clinical research involving women
as subjects or insufficient clinical data on
women.
(2) The term ``research on women's health'' means
research on women's health conditions, including
research on preventing such conditions.
* * * * * * *
TITLE VII--HEALTH PROFESSIONS EDUCATION
* * * * * * *
PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE
Subpart 1--Health Professions Workforce Information and Analysis
* * * * * * *
[SEC. 763. PEDIATRIC RHEUMATOLOGY.
[(a) In General.--The Secretary, acting through the
appropriate agencies, shall evaluate whether the number of
pediatric rheumatologists is sufficient to address the health
care needs of children with arthritis and related conditions,
and if the Secretary determines that the number is not
sufficient, shall develop strategies to help address the
shortfall.
[(b) Report to Congress.--Not later than October 1, 2001, the
Secretary shall submit to the Congress a report describing the
results of the evaluation under subsection (a), and as
applicable, the strategies developed under such subsection.
[(c) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2001 through 2005.]
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 reduce and prevent discrimination (including
training related to implicit and explicit biases) in the
provision of health care services related to prenatal care,
labor care, birthing, and postpartum 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 Requirement.--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.
(d) Best Practices.--The Secretary may identify and
disseminate best practices for the training of health care
professionals to reduce and prevent discrimination (including
training related to implicit and explicit biases) in the
provision of health care services related to prenatal care,
labor care, birthing, and postpartum care.
(e) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $5,000,000 for
each of fiscal years 2020 through 2024.
SEC. 764. 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 nurse practitioners, physician
assistants, nurses, certified nurse midwives, home
visiting nurses and non-clinical home visiting
workforce professionals and paraprofessionals, or non-
clinical professionals, who meet applicable State
training and licensing requirements, 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) 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 are
evidence-based and include instruction on--
(A) maternal mental health, including
perinatal depression and anxiety;
(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); or
(F) an Indian Health Program 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,
respectively).
(3) Academic units or programs.--To be eligible to
receive a grant under subsection (a)(3), an entity
shall be a school of medicine, a school of osteopathic
medicine, a school of nursing (as defined in section
801), a physician assistant education program, an
accredited public or nonprofit private hospital, an
accredited medical residency training program, a school
accredited by the Midwifery Education and Accreditation
Council, by the Accreditation Commission for Midwifery
Education, or by the American Midwifery Certification
Board, or a public or private nonprofit educational
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) 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 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 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.
(e) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section, $5,000,000 for each
of fiscal years 2020 through 2024.
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