Union Calendar No. 414
116th CONGRESS 2d Session |
[Report No. 116–514]
To amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes.
November 8, 2019
Mr. Engel (for himself, Mr. Bucshon, Ms. Torres Small of New Mexico, Mr. Latta, Ms. Adams, and Mr. Stivers) introduced the following bill; which was referred to the Committee on Energy and Commerce
September 17, 2020
Additional sponsors: Mr. Carson of Indiana, Ms. Kelly of Illinois, Ms. Herrera Beutler, Mr. Marshall, Mr. Burgess, Mr. Walden, Mrs. Hayes, Mr. O'Halleran, Ms. Kuster of New Hampshire, Mr. Guthrie, Mr. Trone, Ms. Craig, Mr. Fitzpatrick, Ms. Schakowsky, Mr. Casten of Illinois, Mr. Cunningham, Ms. Norton, Ms. Underwood, Mr. McGovern, Ms. Finkenauer, Mr. Morelle, Ms. Houlahan, Ms. Gabbard, Mr. Ruiz, Mrs. Napolitano, and Mr. Levin of Michigan
September 17, 2020
Reported with an amendment; committed to the Committee of the Whole House on the State of the Union and ordered to be printed
[Strike out all after the enacting clause and insert the part printed in italic]
[For text of introduced bill, see copy of bill as introduced on November 8, 2019]
To amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
This Act may be cited as the “Maternal Health Quality Improvement Act of 2019”.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
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.
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.
(a) Maternal mortality and morbidity activities.—Section 301 of the Public Health Service Act (42 U.S.C. 241) is amended—
(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
(d) Office of research on women’s health.—Section 486 of the Public Health Service Act (42 U.S.C. 287d) is amended—
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;
“(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).
Section 330I of the Public Health Service Act (42 U.S.C. 254c–14) is amended—
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
“(b) Activities.—
“(1) TRAINING FOR MEDICAL RESIDENTS AND FELLOWS.—A recipient of a grant under subsection (a)(1)—
“(2) TRAINING FOR OTHER PROVIDERS.—A recipient of a grant under subsection (a)(2)—
“(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—
“(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—
“(2) TRAINING FOR OTHER PROVIDERS.—To be eligible to receive a grant under subsection (a)(2), an entity shall be—
“(B) a federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act);
“(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;
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.
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;
“(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;
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.
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.
(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.
(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”.
(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—
“(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;
“(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—
(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—
(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.
Union Calendar No. 414 | |||||
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[Report No. 116–514] | |||||
A BILL | |||||
To amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes. | |||||
September 17, 2020 | |||||
Reported with an amendment; committed to the Committee of the Whole House on the State of the Union and ordered to be printed |