Rural MOMS Act

I 116TH CONGRESS 1ST SESSION H. R. 4243 To amend the Public Health Service Act to improve obstetric care in rural areas. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 9, 2019 Ms. TORRES SMALL of New Mexico (for herself, Mr. NEWHOUSE, Ms. FINKENAUER, Mr. LATTA, Mr. LUJA´N, and Mr. COLE) introduced the following bill; which was referred to the Committee on Energy and Com- merce A BILL To amend the Public Health Service Act to improve obstetric care in rural areas. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Rural Maternal and 4 Obstetric Modernization of Services Act’’ or the ‘‘Rural 5 MOMS Act’’. 6 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 2 •HR 4243 IH SEC. 2. IMPROVING RURAL MATERNAL AND OBSTETRIC 1 CARE DATA. 2 (a) MATERNAL MORTALITY AND MORBIDITY ACTIVI- 3 TIES.—Section 301 of the Public Health Service Act (42 4 U.S.C. 241) is amended— 5 (1) by redesignating subsections (e) through (h) 6 as subsections (f) through (i), respectively; and 7 (2) by inserting after subsection (d), the fol- 8 lowing: 9 ‘‘(e) The Secretary, acting through the Director of 10 the Centers for Disease Control and Prevention, shall ex- 11 pand, intensify, and coordinate the activities of the Cen- 12 ters for Disease Control and Prevention with respect to 13 maternal mortality and morbidity.’’. 14 (b) OFFICE OF WOMEN’S HEALTH.—Section 15 310A(b)(1) of the Public Health Service Act (42 U.S.C. 16 242s(b)(1)) is amended by inserting ‘‘sociocultural (race, 17 ethnicity, language, class, income), including among 18 American Indians and Alaska Natives, as such terms are 19 defined in section 4 of the Indian Health Care Improve- 20 ment Act, and geographic contexts,’’ after ‘‘biological,’’. 21 (c) SAFE MOTHERHOOD.—Section 317K(b)(2) of the 22 Public Health Service Act (42 U.S.C. 247b–12(b)(2)) is 23 amended— 24 (1) in subparagraph (L), by striking ‘‘and’’ at 25 the end; 26 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 3 •HR 4243 IH (2) by redesignating subparagraph (M) as sub- 1 paragraph (N); and 2 (3) by inserting after subparagraph (L), the fol- 3 lowing: 4 ‘‘(M) an examination of the relationship 5 between maternal health services in rural areas 6 and outcomes in delivery and postpartum care; 7 and’’. 8 (d) OFFICE OF RESEARCH ON WOMEN’S HEALTH.— 9 Section 486 of the Public Health Service Act (42 U.S.C. 10 287d) is amended— 11 (1) in subsection (b)— 12 (A) by redesignating paragraphs (4) 13 through (9) as paragraphs (5) through (10), re- 14 spectively; 15 (B) by inserting after paragraph (3) the 16 following: 17 ‘‘(4) carry out paragraphs (1) and (2) with re- 18 spect to pregnancy, with priority given to deaths re- 19 lated to pregnancy;’’; and 20 (C) in paragraph (5) (as so redesignated), 21 by striking ‘‘through (3)’’ and inserting 22 ‘‘through (4)’’; and 23 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 4 •HR 4243 IH (2) in subsection (d)(4)(A)(iv), by inserting ‘‘, 1 including maternal mortality and other maternal 2 morbidity outcomes’’ before the semicolon. 3 SEC. 3. RURAL OBSTETRIC NETWORK GRANTS. 4 The Public Health Service Act is amended by insert- 5 ing after section 317L–1 (42 U.S.C. 247b–13a) the fol- 6 lowing: 7 ‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 8 ‘‘(a) IN GENERAL.—For the purpose of enabling the 9 Secretary (through grants, contracts, or otherwise), acting 10 through the Administrator of the Health Resources and 11 Services Administration, to establish collaborative im- 12 provement and innovation networks (referred to in this 13 section as ‘rural obstetric networks’) to improve outcomes 14 in birth and maternal morbidity and mortality, there is 15 appropriated to the Secretary, out of any money in the 16 Treasury not otherwise appropriated, $3,000,000 for each 17 of fiscal years 2020 through 2024. Such amounts shall 18 remain available until expended. 19 ‘‘(b) USE OF FUNDS.—Amount appropriated under 20 subsection (a) shall be used for the establishment of col- 21 laborative improvement and innovation networks to im- 22 prove maternal health in rural areas by improving out- 23 comes in birth and maternal morbidity and mortality. 24 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 5 •HR 4243 IH Rural obstetric networks established in accordance with 1 this section shall— 2 ‘‘(1) assist pregnant women and individuals in 3 rural areas connect with prenatal, labor and birth, 4 and postpartum care to improve outcomes in birth 5 and maternal mortality and morbidity; 6 ‘‘(2) identify successful prenatal, labor and 7 birth, and postpartum health delivery models for in- 8 dividuals in rural areas, including evidence-based 9 home visiting programs and successful, culturally 10 competent models with positive maternal health out- 11 comes that advance health equity; 12 ‘‘(3) develop a model for collaboration between 13 health facilities that have an obstetric health unit 14 and health facilities that do not have an obstetric 15 health unit; 16 ‘‘(4) provide training and guidance for health 17 facilities that do not have obstetric health units; 18 ‘‘(5) collaborate with academic institutions that 19 can provide regional expertise and research on ac- 20 cess, outcomes, needs assessments, and other identi- 21 fied data; and 22 ‘‘(6) measure and address inequities in birth 23 outcomes among rural residents, with an emphasis 24 on Black and American Indians and Alaska Native 25 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 6 •HR 4243 IH residents, as such terms are defined in section 4 of 1 the Indian Health Care Improvement Act. 2 ‘‘(c) REQUIREMENTS.— 3 ‘‘(1) ESTABLISHMENT.—Not later than October 4 1, 2020, the Secretary shall establish rural obstetric 5 health networks in at least 5 regions. 6 ‘‘(2) DEFINITIONS.—In this section: 7 ‘‘(A) FRONTIER AREA.—The term ‘frontier 8 area’ means a frontier county, as defined in sec- 9 tion 1886(d)(3)(E)(iii)(III) of the Social Secu- 10 rity Act. 11 ‘‘(B) INDIAN TRIBE.—The term ‘Indian 12 tribe’ has the meaning given such term in sec- 13 tion 4 of the Indian Health Care Improvement 14 Act. 15 ‘‘(C) NATIVE HAWAIIAN HEALTH CARE 16 SYSTEM.—The term ‘Native Hawaiian Health 17 Care System’ has the meaning given such term 18 in section 12 of the Native Hawaiian Health 19 Care Improvement Act. 20 ‘‘(D) REGION.—The term ‘region’ means a 21 State, Indian tribe, rural area, or frontier area. 22 ‘‘(E) RURAL AREA.—The term ‘rural area’ 23 has the meaning given that term in section 24 1886(d)(2)(D) of the Social Security Act. 25 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 7 •HR 4243 IH ‘‘(F) TRIBAL ORGANIZATION.—The term 1 ‘tribal organization’ has the meaning given such 2 term in the Indian Self-Determination Act. 3 ‘‘(G) STATE.—The term ‘State’ has the 4 meaning given that term for purposes of title V 5 of the Social Security Act.’’. 6 SEC. 4. TELEHEALTH NETWORK AND TELEHEALTH RE- 7 SOURCE CENTERS GRANT PROGRAMS. 8 Section 330I of the Public Health Service Act (42 9 U.S.C. 254c–14) is amended— 10 (1) in subsection (f)(1)(B)(iii), by adding at the 11 end the following: 12 ‘‘(XIII) Providers of maternal, 13 including prenatal, labor and birth, 14 and postpartum care services and en- 15 tities operation obstetric care units.’’; 16 (2) in subsection (i)(1)(B), by inserting ‘‘labor 17 and birth, postpartum,’’ before ‘‘or prenatal’’; and 18 (3) in subsection (k)(1)(B), by inserting ‘‘equip- 19 ment useful for caring for pregnant women and indi- 20 viduals, including ultrasound machines and fetal 21 monitoring equipment,’’ before ‘‘and other equip- 22 ment’’. 23 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 8 •HR 4243 IH SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAIN- 1 ING DEMONSTRATION. 2 Part D of title VII of the Public Health Service Act 3 is amended by inserting after section 760 (42 U.S.C. 4 294k) the following: 5 ‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 6 TRAINING DEMONSTRATION. 7 ‘‘(a) IN GENERAL.—The Secretary shall establish a 8 training demonstration program to award grants to eligi- 9 ble entities to support— 10 ‘‘(1) training for physicians, medical residents, 11 including family medicine and obstetrics and gyne- 12 cology residents, and fellows to practice maternal 13 and obstetric medicine in rural community-based 14 settings; 15 ‘‘(2) training for licensed and accredited nurse 16 practitioners, physician assistants, certified nurse 17 midwives, certified midwives, certified professional 18 midwives, home visiting nurses, or non-clinical pro- 19 fessionals such as doulas and community health 20 workers, to provide maternal care services in rural 21 community-based settings; and 22 ‘‘(3) establishing, maintaining, or improving 23 academic units or programs that— 24 ‘‘(A) provide training for students or fac- 25 ulty, including through clinical experiences and 26 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 9 •HR 4243 IH research, to improve maternal care in rural 1 areas; or 2 ‘‘(B) develop evidence-based practices or 3 recommendations for the design of the units or 4 programs described in subparagraph (A), in- 5 cluding curriculum content standards. 6 ‘‘(b) ACTIVITIES.— 7 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 8 FELLOWS.—A recipient of a grant under subsection 9 (a)(1)— 10 ‘‘(A) shall use the grant funds— 11 ‘‘(i) to plan, develop, and operate a 12 training program to provide obstetric care 13 in rural areas for family practice or obstet- 14 rics and gynecology residents and fellows; 15 or 16 ‘‘(ii) to train new family practice or 17 obstetrics and gynecology residents and fel- 18 lows in maternal and obstetric health care 19 to provide and expand access to maternal 20 and obstetric health care in rural areas; 21 and 22 ‘‘(B) may use the grant funds to provide 23 additional support for the administration of the 24 program or to meet the costs of projects to es- 25 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 10 •HR 4243 IH tablish, maintain, or improve faculty develop- 1 ment, or departments, divisions, or other units 2 necessary to implement such training. 3 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re- 4 cipient of a grant under subsection (a)(2)— 5 ‘‘(A) shall use the grant funds to plan, de- 6 velop, or operate a training program to provide 7 maternal health care services in rural, commu- 8 nity-based settings; and 9 ‘‘(B) may use the grant funds to provide 10 additional support for the administration of the 11 program or to meet the costs of projects to es- 12 tablish, maintain, or improve faculty develop- 13 ment, or departments, divisions, or other units 14 necessary to implement such program. 15 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—A re- 16 cipient of a grant under subsection (a)(3) shall enter 17 into a partnership with organizations such as an 18 education accrediting organization (such as the Liai- 19 son Committee on Medical Education, the Accredita- 20 tion Council for Graduate Medical Education, the 21 Commission on Osteopathic College Accreditation, 22 the Accreditation Commission for Education in 23 Nursing, the Commission on Collegiate Nursing 24 Education, the Accreditation Commission for Mid- 25 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 11 •HR 4243 IH wifery Education, or the Accreditation Review Com- 1 mission on Education for the Physician Assistant) to 2 carry out activities under subsection (a)(3). 3 ‘‘(4) TRAINING PROGRAM REQUIREMENTS.— 4 The recipient of a grant under subsection (a)(1) or 5 (a)(2) shall ensure that training programs carried 6 out under the grant include instruction on— 7 ‘‘(A) maternal mental health, including 8 perinatal depression and anxiety and 9 postpartum depression; 10 ‘‘(B) maternal substance use disorder; 11 ‘‘(C) social determinants of health that im- 12 pact individuals living in rural communities, in- 13 cluding poverty, social isolation, access to nutri- 14 tion, education, transportation, and housing; 15 and 16 ‘‘(D) implicit bias. 17 ‘‘(c) ELIGIBLE ENTITIES.— 18 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 19 FELLOWS.—To be eligible to receive a grant under 20 subsection (a)(1), an entity shall— 21 ‘‘(A) be a consortium consisting of— 22 ‘‘(i) at least one teaching health cen- 23 ter; or 24 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 12 •HR 4243 IH ‘‘(ii) the sponsoring institution (or 1 parent institution of the sponsoring insti- 2 tution) of— 3 ‘‘(I) an obstetrics and gynecology 4 or family medicine residency program 5 that is accredited by the Accreditation 6 Council of Graduate Medical Edu- 7 cation (or the parent institution of 8 such a program); or 9 ‘‘(II) a fellowship in maternal or 10 obstetric medicine, as determined ap- 11 propriate by the Secretary; or 12 ‘‘(B) be an entity described in subpara- 13 graph (A)(ii) that provides opportunities for 14 medical residents or fellows to train in rural 15 community-based settings. 16 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 17 eligible to receive a grant under subsection (a)(2), 18 an entity shall be— 19 ‘‘(A) a teaching health center (as defined 20 in section 749A(f)); 21 ‘‘(B) a federally qualified health center (as 22 defined in section 1905(l)(2)(B) of the Social 23 Security Act); 24 VerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243 kjohnson on DSK79L0C42 with BILLS 13 •HR 4243 IH ‘‘(C) a community mental health center (as 1 defined in section 1861(ff)(3)(B) of the Social 2 Security Act); 3 ‘‘(D) a rural health clinic (as defined in 4 section 1861(aa) of the Social Security Act); 5 ‘‘(E) a freestanding birth center (as de- 6 fined in section 190 [Text truncated for display. 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