Rural Maternal and Obstetric Modernization of Services Act or the Rural MOMS Act
This bill expands initiatives to address maternal health in rural areas.
The bill provides funding for the Health Resources and Services Administration (HRSA) to establish rural obstetric networks for improving outcomes in birth and maternal morbidity. Specifically, these networks must (1) connect individuals with care providers, (2) identify successful maternal-care models, (3) facilitate collaboration among rural providers, (4) provide training and guidance, and (5) collaborate with academic institutions that have regional expertise.
HRSA also must award five-year demonstration program grants to (1) train physicians, medical residents, and other practitioners to provide maternal and obstetric services in rural communities; and (2) support academic programs that develop or provide training to improve maternal care in rural areas.
Further, the bill adds maternal-health services as part of the telehealth network and telehealth resource-centers grant programs.
The bill also makes a series of changes to the research and reporting requirements of the Department of Health and Human Services and the Government Accountability Office with respect to data on maternal-health outcomes.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3568 Introduced in Senate (IS)]
<DOC>
115th CONGRESS
2d Session
S. 3568
To amend the Social Security Act and Public Health Service Act to
improve obstetric care in rural areas.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 10, 2018
Ms. Heitkamp introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Social Security Act and Public Health Service Act to
improve obstetric care in rural areas.
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 ``Rural Maternal and Obstetric
Modernization of Services Act'' or the ``Rural MOMS Act''.
SEC. 2. 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, and geographic contexts,'' after ``biological,''.
(c) Safe Motherhood.--Section 317K(b)(2) of the Public Health
Service Act (42 U.S.C. 247b-12(b)(2)) is amended--
(1) in subparagraph (K), by striking ``and'' at the end;
(2) by redesignating subparagraph (L) as subparagraph (M);
and
(3) by inserting after subparagraph (K), the following:
``(L) an examination of the relationship between
maternal and obstetric health 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)--
(A) by redesignating paragraphs (4) through (9) as
paragraphs (5) through (10), respectively;
(B) by inserting after paragraph (3) the following:
``(4) carry out paragraphs (1) and (2) with respect to
pregnancy, with priority given to deaths related to
pregnancy;''; and
(C) in paragraph (5) (as so redesignated), by
striking ``through (3)'' and inserting ``through (4)'';
and
(2) in subsection (d)(4)(A)(iv), by inserting ``, including
maternal mortality and other maternal morbidity outcomes''
before the semicolon.
SEC. 3. COLLABORATIVE IMPROVEMENT AND INNOVATION NETWORKS TO IMPROVE
OBSTETRIC HEALTH IN RURAL AREAS.
Section 501 of the Social Security Act (42 U.S.C. 701) is amended--
(1) in subsection (a)(2), by inserting ``and the
establishment of collaborative improvement and innovation
networks to improve obstetric health in rural areas by
improving outcomes in birth and maternal morbidity and
mortality'' after ``services development''; and
(2) by adding at the end the following:
``(d)(1)(A) For the purpose of enabling the Secretary (through
grants, contracts, or otherwise) to establish, as special projects of
regional and national significance, collaborative improvement and
innovation networks (referred to in this subsection as `rural obstetric
health CoIINs') to improve obstetric health in rural areas by improving
outcomes in birth and maternal morbidity and mortality, there is
appropriated to the Secretary, out of any money in the Treasury not
otherwise appropriated, $3,000,000 for each of fiscal years 2019
through 2023.
``(B) Funds appropriated under subparagraph (A) shall--
``(i) be in addition to amounts appropriated under
subsection (a) and retained under section 502(a)(1) for the
purpose of carrying out activities described in subsection
(a)(2); and
``(ii) remain available until expended.
``(2) Rural obstetric health CoIINs established in accordance with
this subsection shall--
``(A) assist pregnant women in rural areas connect with
maternal, prenatal and postnatal, and obstetric care to improve
outcomes in birth and maternal mortality and morbidity;
``(B) identify successful maternal, prenatal and postnatal,
and obstetric health delivery models for women in rural areas;
``(C) develop a model for collaboration between health
facilities that have an obstetric health unit and health
facilities that do not have an obstetric health unit;
``(D) provide training and guidance for health facilities
that do not have obstetric health units; and
``(E) collaborate with academic institutions that can
provide regional expertise and research on access, outcomes,
needs assessments, and other identified data.
``(3)(A) Not later than October 1, 2019, the Secretary shall
establish rural obstetric health CoIINs in at least 5 regions.
``(B) In this subsection:
``(i) The term `frontier area' means a frontier county, as
defined in section 1886(d)(3)(E)(iii)(III).
``(ii) The term `Indian tribe' has the meaning given such
term in section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603).
``(iii) The term `region' means a State, Indian tribe,
rural area, or frontier area.
``(iv) The term `rural area' has the meaning given that
term in section 1886(d)(2)(D).
``(v) The term `State' has the meaning given that term for
purposes of this title in section 1101.
``(4) The provisions of this title that are applicable to the funds
made available to the Secretary under section 502(a)(1) apply in the
same manner to funds made available to the Secretary under paragraph
(1)(A).''.
SEC. 4. 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 and postnatal, and
obstetric care services and entities
operation obstetric care units.'';
(2) in subsection (i)(1)(B), by inserting ``maternal,
including prenatal and postnatal care, obstetric care,'' before
``or prenatal''; and
(3) in subsection (k)(1)(B), by inserting ``equipment
useful for caring for pregnant women, including ultrasound
machines and fetal monitoring equipment,'' before ``and other
equipment''.
SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.
Part D of title VII of the Public Health Service Act is amended by
inserting after section 760 (42 U.S.C. 294k) the following:
SEC. 760A. 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 practice residents, and fellows to practice maternal and
obstetric medicine in rural, community-based settings;
(2) training for nurse practitioners, physician assistants,
nurse midwives, and doulas to provide maternal and obstetric
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 and obstetric 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 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
residents and fellows; or
(ii) to train new family practice or
obstetrics 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 and
obstetric 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) Academic units or programs.--A recipient of a grant
under subsection (a)(3) shall enter into a partnership with
organizations such as an education accrediting organization
(such as the Liaison Committee on Medical Education, the
Accreditation Council for Graduate Medical Education, the
Commission on Osteopathic College Accreditation, the
Accreditation Commission for Education in Nursing, the
Commission on Collegiate Nursing Education, or the
Accreditation Review Commission on Education for the Physician
Assistant) to carry out activities under subsection (a)(3).
(c) Eligible Entities.--
(1) Training for 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;
and
(ii) the sponsoring institution (or parent
institution of the sponsoring institution) of--
(I) an obstetric 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 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 health center operated by the Indian Health
Service, an Indian tribe, a tribal organization, or an
urban Indian organization (as defined in section 4 of
the Indian Health Care Improvement Act); or
(F) an entity with a demonstrated record of success
in providing training for nurse practitioners,
physician assistants, nurse midwives, or doulas.
(3) Academic units or programs.--To be eligible to receive
a grant under subsection (a)(3), an entity shall be a school of
medicine or osteopathic medicine, a nursing school, a physician
assistant training program, an accredited public or nonprofit
private hospital, an accredited medical residency program, or a
public or private nonprofit entity which the Secretary has
determined is capable of carrying out such grant.
(d) Duration.--Grants awarded under this section shall be for a
minimum of 5 years.
(e) 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 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 Congress 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 and
postnatal, and obstetric care services;
(B) an analysis of the effect of the demonstration
program on the prevalence of maternal mortality in the
surrounding communities of health centers participating
in the demonstration; and
(C) recommendations on whether the demonstration
program should be expanded.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $5,000,000 for each of fiscal
years 2019 through 2023.
SEC. 6. GAO REPORT.
Not later than 1 year after the date of enactment of this Act, the
Comptroller General of the United States shall submit to the
appropriate committees of Congress a report on the maternal, including
prenatal and postnatal, care and obstetric care in rural areas. Such
report shall include the following:
(1) The location of gaps in maternal and obstetric health
care workers, including non-physicians such as doulas and
community health workers.
(2) A list of specific activities that the Comptroller
General plans to conduct on maternal, including prenatal and
postnatal, and obstetric care.
(3) A plan for completing such activities.
(4) An explanation of Federal agency involvement and
coordination needed to conduct such activities.
(5) A budget for conducting such activities.
(6) Other information that the Comptroller General
determines appropriate.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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