[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4995 Referred in Senate (RFS)]
<DOC>
116th CONGRESS
2d Session
H. R. 4995
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 22, 2020
Received; read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
AN ACT
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,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Maternal Health Quality Improvement
Act of 2020''.
SEC. 2. INNOVATION FOR MATERNAL HEALTH.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended--
(1) in the section designation of section 330M of such Act
(42 U.S.C. 254c-19) by inserting a period after ``330M''; and
(2) by inserting after section 330M of such Act (42 U.S.C.
254c-19) 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 purposes 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 pursuant to
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 are authorized to be appropriated $5,000,000 for each of fiscal
years 2021 through 2025.''.
SEC. 3. 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 are authorized to be appropriated $5,000,000 for each of fiscal
years 2021 through 2025.''.
SEC. 4. 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 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. 5. PERINATAL QUALITY COLLABORATIVES.
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.''.
SEC. 6. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.
(a) Grants.--Title III of the Public Health Service Act is amended
by inserting after section 330N of such Act, as added by section 2, the
following:
``SEC. 330O. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.
``(a) In General.--The Secretary may award grants to States, Indian
Tribes, and Tribal organizations for the purpose of establishing or
operating evidence-based or innovative, evidence-informed programs to
deliver integrated health care services to pregnant and postpartum
women to optimize the health of women and their infants, including to
reduce adverse maternal health outcomes, pregnancy-related deaths, and
related health disparities (including such disparities associated with
racial and ethnic minority populations), and, as appropriate, by
addressing issues researched under subsection (b)(2) of section 317K.
``(b) Integrated Services for Pregnant and Postpartum Women.--
``(1) Eligibility.--To be eligible to receive a grant under
subsection (a), a State, Indian Tribe, or Tribal organization
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 individuals
representing racial and ethnic minority populations.
``(2) Terms.--
``(A) Period.--A grant awarded under subsection (a)
shall be made for a period of 5 years. Any supplemental
award made to a grantee under subsection (a) may be
made for a period of less than 5 years.
``(B) 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) Definitions.--In this section, the terms `Indian Tribe' and
`Tribal organization' have the meanings given the terms `Indian tribe'
and `tribal organization', respectively, in section 4 of the Indian
Self-Determination and Education Assistance Act.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2021 through 2025.''.
(b) Report on Grant Outcomes and Dissemination of Best Practices.--
(1) Report.--Not later than February 1, 2026, the Secretary
of Health and Human Services shall submit to the Committee on
Health, Education, Labor, and Pensions of the Senate and the
Committee on Energy and Commerce of the House of
Representatives a report that describes--
(A) the outcomes of the activities supported by the
grants awarded under the amendment made by this section
on maternal and child health;
(B) best practices and models of care used by
recipients of grants under such amendment; and
(C) obstacles identified by recipients of grants
under such amendment, and strategies used by such
recipients to deliver care, improve maternal and child
health, and reduce health disparities.
(2) Dissemination of best practices.--Not later than August
1, 2026, the Secretary of Health and Human Services shall
disseminate information on best practices and models of care
used by recipients of grants under the amendment made by this
section (including best practices and models of care relating
to the reduction of health disparities, including such
disparities associated with racial and ethnic minority
populations, in rates of maternal mortality and severe maternal
morbidity) to relevant stakeholders, which may include health
providers, medical schools, nursing schools, relevant State,
Tribal, and local agencies, and the general public.
SEC. 7. IMPROVING RURAL MATERNAL AND OBSTETRIC CARE DATA.
(a) Maternal Mortality and Morbidity Activities.--Section 301(e) of
the Public Health Service Act (42 U.S.C. 241(e)) is amended by
inserting ``, preventable maternal mortality and severe maternal
morbidity,'' after ``delivery''.
(b) Office of Women's Health.--Section 310A(b)(1) of the Public
Health Service Act (42 U.S.C. 242s(b)(1)) is amended by striking ``and
sociocultural contexts,'' and inserting ``sociocultural (including
among American Indians, Native Hawaiians, and Alaska Natives), and
geographical contexts''.
(c) Safe Motherhood.--Section 317K of the Public Health Service Act
(42 U.S.C. 247b-12) is amended--
(1) in subsection (a)(2)(A), by inserting ``, including
improving collection of data on race, ethnicity, and other
demographic information'' before the period; and
(2) in subsection (b)(2)--
(A) in subparagraph (L), by striking ``and'' at the
end;
(B) by redesignating subparagraph (M) as
subparagraph (N); and
(C) by inserting after subparagraph (L) the
following:
``(M) an examination of the relationship between
maternal health and obstetric services in rural areas
and outcomes in delivery and postpartum care; and''.
(d) Office of Research on Women's Health.--Section 486 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 preventable maternal mortality and severe
maternal morbidity;''; and
(2) in subsection (d)(4)(A)(iv), by inserting ``, including
preventable maternal morbidity and severe maternal morbidity''
before the semicolon.
SEC. 8. RURAL OBSTETRIC NETWORK GRANTS.
The Public Health Service Act is amended by inserting after section
330A-1 (42 U.S.C. 254c-1a) the following:
``SEC. 330A-2. RURAL OBSTETRIC NETWORK GRANTS.
``(a) Program Established.--The Secretary shall award grants or
cooperative agreements to eligible entities to establish collaborative
improvement and innovation networks (referred to in this section as
`rural obstetric networks') to improve maternal and infant health
outcomes and reduce preventable maternal mortality and severe maternal
morbidity by improving maternity care and access to care in rural
areas, frontier areas, maternity care health professional target areas,
or jurisdictions of Indian Tribes and Tribal organizations.
``(b) Use of Funds.--Grants or cooperative agreements awarded
pursuant to this section shall be used for the establishment or
continuation of collaborative improvement and innovation networks to
improve maternal health in rural areas by improving infant health and
maternal outcomes and reducing preventable maternal mortality and
severe maternal morbidity. Rural obstetric networks established in
accordance with this section may--
``(1) develop a network to improve coordination and
increase access to maternal health care and assist pregnant
women in the areas described in subsection (a) with accessing
and utilizing maternal and obstetric care, including health
care services related to prenatal care, labor care, birthing,
and postpartum care to improve outcomes in birth and maternal
mortality and morbidity;
``(2) identify and implement evidence-based and sustainable
delivery models for maternal and obstetric care (including
health care services related to prenatal care, labor care,
birthing, and postpartum care for women in the areas described
in subsection (a), including home visiting programs and
culturally appropriate care models that reduce health
disparities;
``(3) develop a model for maternal health care
collaboration between health care settings to improve access to
care in areas described in subsection (a), which may include
the use of telehealth;
``(4) provide training for professionals in health care
settings that do not have specialty maternity care;
``(5) collaborate with academic institutions that can
provide regional expertise and help identify barriers to
providing maternal health care, including strategies for
addressing such barriers; and
``(6) assess and address disparities in infant and maternal
health outcomes, including among racial and ethnic minority
populations and underserved populations in areas described in
subsection (a).
``(c) Definitions.--In this section:
``(1) Eligible entities.--The term `eligible entities'
means entities providing maternal health care services in rural
areas, frontier areas, or medically underserved areas, or to
medically underserved populations or Indian Tribes or Tribal
organizations.
``(2) Frontier area.--The term `frontier area' means a
frontier county, as defined in section 1886(d)(3)(E)(iii)(III)
of the Social Security Act.
``(3) Indian tribes; tribal organization.--The terms
`Indian Tribe' and `Tribal organization' have the meanings
given the terms `Indian tribe' and `tribal organization',
respectively, in section 4 of the Indian Self-Determination and
Education Assistance Act.
``(4) Maternity care health professional target area.--The
term `maternity care health professional target area' has the
meaning described in section 332(k)(2).
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $3,000,000 for each of fiscal
years 2021 through 2025.''.
SEC. 9. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT
PROGRAMS.
Section 330I of the Public Health Service Act (42 U.S.C. 254c-14)
is amended--
(1) in subsection (f)(3), by adding at the end the
following:
``(M) Providers of maternal care, including
prenatal, labor care, birthing, and postpartum care
services and entities operating obstetric care
units.''; and
(2) in subsection (h)(1)(B), by inserting ``labor care,
birthing care, postpartum care,'' before ``or prenatal''.
SEC. 10. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.
Subpart 1 of part E of title VII of the Public Health Service Act
(42 U.S.C. 294n et seq.) is amended by adding at the end the following:
``SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.
``(a) In General.--The Secretary shall award grants to accredited
schools of allopathic medicine, osteopathic medicine, and nursing, and
other appropriate health professional training programs, to establish a
training demonstration program to support--
``(1) training for physicians, medical residents, fellows,
nurse practitioners, physician assistants, nurses, certified
nurse midwives, relevant home visiting workforce professionals
and paraprofessionals, or other professionals who meet relevant
State training and licensing requirements, as applicable, to
provide maternal health care services in rural community-based
settings; and
``(2) developing recommendations for such training
programs.
``(b) Application.--To be eligible to receive a grant under
subsection (a), an entity shall submit to the Secretary an application
at such time, in such manner, and containing such information as the
Secretary may require.
``(c) Activities.--
``(1) Training for health care professionals.--A recipient
of a grant under subsection (a)--
``(A) shall use the grant funds to plan, develop,
and operate a training program to provide maternal
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 program requirements.--The recipient of a
grant under subsection (a) shall ensure that training programs
carried out under the grant are evidence-based and address
improving maternal health care in rural areas, and such
programs may include training on topics such as--
``(A) maternal mental health, including perinatal
depression and anxiety;
``(B) substance use disorders;
``(C) social determinants of health that affect
individuals living in rural areas; and
``(D) implicit and explicit bias.
``(d) Evaluation and Report.--
``(1) Evaluation.--
``(A) In general.--The Secretary shall evaluate the
outcomes of the demonstration program under this
section.
``(B) Data submission.--Recipients of a grant under
subsection (a) shall submit to the Secretary
performance metrics and other related data in order to
evaluate the program for the report described in
paragraph (2).
``(2) Report to congress.--Not later than January 1, 2025,
the Secretary shall submit to the Committee on Health,
Education, Labor, and Pensions of the Senate and the Committee
on Energy and Commerce of the House of Representatives a report
that includes--
``(A) an analysis of the effects of the
demonstration program under this section on the
quality, quantity, and distribution of maternal health
care services, including health care services related
to prenatal care, labor care, birthing, and postpartum
care, 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 program; and
``(C) recommendations on whether the demonstration
program should be continued.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $5,000,000 for each of fiscal
years 2021 through 2025.''.
Passed the House of Representatives September 21, 2020.
Attest:
CHERYL L. JOHNSON,
Clerk.
Maternal Health Quality Improvement Act of 2020
#4995 | HR Congress #116
Policy Area: Health
Subjects: Child healthCongressional oversightEmployment and training programsGovernment information and archivesGovernment studies and investigationsHealth care qualityHealth personnelHealth programs administration and fundingHealth technology, devices, suppliesIndian social and development programsMedical educationMedical researchMinority healthRural conditions and developmentWomen's health
Last Action: Received in the Senate and Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (9/22/2020)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text