,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #bbhf  ,,in ,,the ,,house ,,of  
,,representatives  ,june #f1 #bjac ,ms4 
,roybal-,allard 7for herself1 ,mrs4     
,capps1 ,mrs4 ,christensen1 ,ms4 ,lee of
 ,california1 ,ms4 ,mc,collum1 ,ms4     
,pingree of ,maine1 and ,mr4 ,rangel7   
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce1 and in addition to the   
,committee on ,ways and ,means1 for a   
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
promote optimal maternity outcomes by   
making evidence-based maternity care a  
national priority1 and for other        
purposes4  #a4 ,short title2 table of   
contents  7a7 ,short title ,this ,act   
may be cited as the ,maximizing ,optimal
 ,maternity ,services for the #bast     
,century or the ,,moms for the #bast    
,century ,act4  7b7 ,table of contents  

,the table of contents for this ,act is 
as follows3  ,sec4 #a4 ,short title2    
table of contents4 ,sec4 #b4 ,findings4 
,title ,i--,,hhs ,focus on the          
,promotion of ,optimal ,maternity ,care 
,sec4 #aja4 ,additional focus area for  
the ,office on ,women's ,health4 ,sec4  
#ajb4 ,interagency ,coordinating        
,committee on the ,promotion of ,optimal
 ,maternity ,outcomes4 ,sec4 #ajc4      
,consumer education campaign4 ,sec4     
#ajd4 ,bibliographic database of        
systematic reviews for care of          
childbearing women and newborns4 ,title 
,,ii--,research and data collection on  
,maternity ,care ,sec4 #bja4 ,maternity 
care health professional shortage areas4
 ,sec4 #bjb4 ,expansion of ,,cdc        
,prevention ,research ,centers program  
to include ,centers on ,optimal         
,maternity ,outcomes4 ,sec4 #bjc4       
,expanding models to be tested by       
,center for ,medicare and ,medicaid     
,innovation to include maternity care   
models4 ,title ,,iii--,enhancement of a 

,geographically1 ,racially1 and         
,ethnically ,diverse ,interprofessional 
,maternity ,workforce ,sec4 #cja4       
,development of interprofessional       
maternity care educational models and   
tools4 ,sec4 #cjb4 ,interprofessional   
training of medical students1 residents1
 and student midwives in academic health
 centers and freestanding birth centers4
 ,sec4 #cjc4 ,grants to professional    
organizations to increase diversity in  
maternity care professionals4  #b4      
,findings ,congress finds the following3
  7#a7 ,maternity expenditures in the   
,united ,states surpass all other       
developed countries1 but childbirth     
continues to carry significant risks for
 mothers in the ,united ,states1 as     
demonstrated by the following3  7,a7    
,more than two women die every day in   
the ,united ,states from                
pregnancy-related causes and the        
maternal mortality rate in the ,united  
,states has roughly doubled in the past 
#be years4 ,according to data released  

in #bjaj1 the maternal mortality ratio  
was #ab4g percent as compared to #f4f   
percent in #aihg4  7,b7 ,more than      
one-third of all women who give birth in
 the ,united ,states 7#a1gjj1jjj women  
each year7 experience some type of      
complication that has an adverse effect 
on their health4  7,c7 ,severe          
complications that result in women      
nearly dying1 known as a near miss or   
severe morbidity1 increased by #be      
percent between #aiih and #bjje1 to     
approximately #cd1jjj cases a year4     
7,d7 ,african-,american women have      
nearly a four times greater risk of     
dying from pregnancy-related            
complications than ,white women1 and    
these disparities have not improved in  
#ej years4  7#b7 ,in spite of the       
considerable investment of the ,united  
,states in maternity care1 the ,united  
,states is failing to ensure that all   
infants have a healthy start in life1 as
 demonstrated by the following3  7,a7   
,despite five years of modest reduction 

in pre-term births between #bjjf and    
#bjaa1 the ,united ,states continues to 
lag behind most other countries in      
pre-term birth rates1 ranking #aca out  
of #ahd countries1 according to a #bjaa 
report by the ,march of ,dimes and the  
,world ,health ,organization4  7,b7 ,the
 proportion of low birth weight babies  
increased by #ba percent between #aiha  
and #bjjh4  7,c7 ,non-,hispanic ,black  
infants continue to experience          
significantly higher rates of both      
pre-term birth and low birthweight1 two 
of the leading causes of infant         
mortality in this country4  7#c7        
,despite shortcomings in the ,united    
,states statewide data collections      
systems1 which make international       
comparisons more challenging1           
international health organizations have 
ranked the ,united ,states far behind   
almost all developed countries in       
important perinatal and maternal        
outcomes1 as demonstrated by the        
following3  7,a7 ,the ,world ,health    

,organization identified #di nations    
with lower rates of maternal deaths than
 the ,united ,states in #bjjh4  7,b7 ,in
 the ,world ,health ,report #bjje1 the  
,world ,health ,organization identified 
#ce nations with lower early neonatal   
mortality rates 7#d_/a1jjj live births7 
and #cc with lower neonatal mortality   
rates 7#e_/a1jjj live births7 than the  
,united ,states4  7,c7 ,according to    
data from the ,organisation for         
,economic ,co-operation and ,development
 7,,oecd71 #bf countries 7out of #bi    
reporting7 had low birthweight rates    
lower than that of the ,united ,states4 
7,d7 #ba ,,oecd countries 7out of #bg   
reporting7 had lower cesarean section   
rates than the ,united ,states4  7#d7   
,maternity care is a major component of 
the escalating health care costs in the 
,united ,states1 as demonstrated by the 
following3  7,a7 ,with #d1jjj1jjj       
deliveries yearly1 the vast majority of 
which occur in hospitals1 maternity care
 for mothers and their newborns is the  

number one reason for hospitalization in
 the ,united ,states1 exceeding such    
prevalent conditions as pneumonia1      
cancer1 fracture1 and heart disease4 ,of
 those discharged from hospitals in the 
,united ,states in #bjji1 nearly one in 
four were childbearing women and        
newborns4  7,b7 ,combined mother and    
baby charges for hospitalization1 which 
was #ih1jjj1jjj1jjj in #bjjh1 far       
exceeded charges for any other hospital 
condition in the ,united ,states4  7#e7 
,maternity care also accounts for a     
significant proportion of expenditures  
under the ,medicaid program1 which      
covers #db percent of births in this    
country1 as demonstrated by the         
following3  7,a7 ,in #bjjh1 #bf percent 
of all hospital charges for which       
payment was made under the ,medicaid    
program 7totaling #da1jjj1jjj1jjj7 was  
for birthing women and newborns4  7,b7  
,the two most common conditions for     
which payments were made under the      
,medicaid program in #bjjg were         

pregnancy and childbirth 7constituting  
#bh percent of such payments7 and       
newborns 7constituting #bf percent of   
such payments71 which together accounted
 for #ec percent of hospital discharges 
billed to ,medicaid4  7,c7 ,the two most
 costly conditions for which payment was
 made under the ,medicaid program in    
#bjjh were mother's pregnancy and       
delivery and care for newborn infants1  
which together accounted for #bf percent
 of all ,medicaid expenditures4  7#f7   
,maternity care facility charges vary   
significantly by setting and type of    
birth4 ,part of the charge differentials
 between facilities are attributable to 
high overhead of hospitals--  7,a7 in   
#bjjh1 the average charge for a hospital
 cesarean birth with complications was  
#bj1jhj1 and without complications was  
#ad1ijj2  7,b7 in #bjjh1 the average    
charge for a hospital vaginal birth with
 complications was #aa1daj1 and without 
complications was #h1ibj2 and  7,c7 in  
#bjaj1 the average charge for a birth   

center vaginal birth was #b1bgg4  7#g7  
,the procedure-intensity of             
birth-related hospital stays also helps 
to explain the high costs of such       
hospital stays4 ,in #bjjh1 #f of the #aj
 most commonly performed hospital       
procedures for all patients with all    
diagnoses involved childbirth and       
newborn care4 ,cesarean section was the 
most common operating room procedure4   
7#h7 ,two non-invasive maternity        
practices1 smoking cessation programs   
during pregnancy and external version to
 turn breech babies at term1 have strong
 proven correlation with considerable   
improvement in outcomes with no         
detrimental side effects1 but are       
significantly underused in the ,united  
,states4  7#i7 ,there is a growing body 
of evidence that other non-invasive     
practices which are underused in current
 practice may also be associated with   
improved outcomes4 ,these non-invasive  
practices include group model prenatal  
care 7such as the ,centering,pregnancy  

model71 continuous labor support1 and   
non-supine positions for birth4  7#aj7  
,the growing shortage of maternity      
health care professionals and childbirth
 facilities is creating a serious       
obstacle to timely and adequate         
maternity health care for women1        
particularly in rural areas and the     
inner cities4  7#aa7 ,there are         
significant racial and ethnic           
disparities across the maternity care   
workforce creating additional access    
barriers to culturally and              
linguistically competent maternity      
services4  ,i ,,hhs ,focus on the       
,promotion of ,optimal ,maternity ,care 
#aja4 ,additional focus area for the    
,office on ,women's ,health ,section    
#bbi7;b7 of the ,public ,health ,service
 ,act 7#db ,u4,s4,c4 #bcg;a7b77 is      
amended--  7#a7 in paragraph 7#f71 at   
the end1 by striking and2  7#b7 in      
paragraph 7#g71 at the end1 by striking 
the period and inserting 2 and2 and     
7#c7 by adding at the end the following 

new paragraph3  7#h7 facilitate policy  
makers1 health system leaders and       
providers1 consumers1 and other         
stakeholders in their understanding     
optimal maternity care and support for  
the provision of such care1 including   
the priorities of--  7,a7 protecting1   
promoting1 and supporting the innate    
capacities of childbearing women and    
their newborns for childbirth1          
breast-feeding1 and attachment2  7,b7   
using obstetric interventions only when 
such interventions are supported by     
strong1 high-quality evidence1 and      
minimizing overuse of maternity         
practices that have been shown to have  
benefit in limited situations and that  
can expose women1 infants1 or both to   
risk of harm if used routinely and      
indiscriminately1 including continuous  
electronic fetal monitoring1 labor      
induction1 epidural analgesia1 primary  
cesarean section1 and routine repeat    
cesarean birth2  7,c7 reliably          
incorporating non-invasive1             

evidence-based practices that have      
documented correlation with considerable
 improvement in outcomes with no        
detrimental side effects1 such as       
smoking cessation programs in pregnancy 
and proven models of group prenatal care
 that integrate health assessment1      
education1 and support into a unified   
program2  7,d7 a shared understanding of
 the qualifications of licensed         
providers of maternity care and the best
 evidence about the safety1             
satisfaction1 outcomes1 and costs of    
their care1 and appropriate deployment  
of such caregivers within the maternity 
care workforce to address the needs of  
childbearing women and newborns and the 
growing shortage of maternity           
caregivers2  7,e7 a shared understanding
 of the results of the best available   
research comparing hospital1 birth      
center1 and planned home births1        
including information about each        
setting's safety1 satisfaction1         
outcomes1 and costs2 and  7,f7          

high-quality1 evidence-based childbirth 
education that promotes a natural1      
healthy1 and safe approach to pregnancy1
 childbirth1 and early parenting2 is    
taught by certified educators1 peer     
counselors1 and health professionals2   
and promotes informed decisionmaking by 
childbearing women4  4  #ajb4           
,interagency ,coordinating ,committee on
 the ,promotion of ,optimal ,maternity  
,outcomes  7a7 ,in general ,part ,a of  
title ,,ii of the ,public ,health       
,service ,act 7#db ,u4,s4,c4 #bjb et    
seq47 is amended by adding at the end   
the following new section3  #bbi;,a4    
,interagency ,coordinating ,committee on
 the ,promotion of ,optimal ,maternity  
,outcomes  7a7 ,in general ,the         
,secretary of ,health and ,human        
,services1 acting through the ,deputy   
,assistant ,secretary for ,women's      
,health under section #bbi and in       
collaboration with the ,federal         
officials specified in subsection 7b71  
shall establish the ,interagency        

,coordinating ,committee on the         
,promotion of ,optimal ,maternity       
,outcomes 7referred to in this          
subsection as the ,,iccpom74  7b7 ,other
 agencies ,the officials specified in   
this subsection are the ,secretary of   
,labor1 the ,secretary of ,defense1 the 
,secretary of ,veterans ,affairs1 the   
,surgeon ,general1 the ,director of the 
,centers for ,disease ,control and      
,prevention1 the ,administrator of the  
,health ,resources and ,services        
,agency1 the ,administrator of the      
,centers for ,medicare  ,medicaid       
,services1 the ,director of the ,indian 
,health ,service1 the ,administrator of 
the ,substance ,abuse and ,mental       
,health ,services ,administration1 the  
,director of the ,national ,institute on
 ,child ,health and ,development1 the   
,director of the ,agency for ,healthcare
 ,research and ,quality1 the ,assistant 
,secretary for ,children and ,families1 
the ,deputy ,assistant ,secretary for   
,minority ,health1 the ,director of the 

,office of ,personnel ,management1 and  
such other ,federal officials as the    
,secretary of ,health and ,human        
,services determines to be appropriate4 
7c7 ,chair ,the ,deputy ,assistant      
,secretary for ,women's ,health shall   
serve as the chair of the ,,iccpom4  7d7
 ,duties ,the ,,iccpom shall guide      
policy and program development across   
the ,federal ,government with respect to
 promotion of optimal maternity care1   
provided1 however1 that nothing in this 
section shall be construed as           
transferring regulatory or program      
authority from an ,agency to the        
,coordinating ,committee4  7e7          
,consultations ,the ,,iccpom shall      
actively seek the input of1 and shall   
consult with1 all appropriate and       
interested stakeholders1 including      
,state ,health ,departments1 public     
health research and interest groups1    
foundations1 childbearing women and     
their advocates1 and maternity care     
professional associations and           

organizations1 reflecting racially1     
ethnically1 demographically1 and        
geographically diverse communities4  7f7
 ,annual report  7#a7 ,in general ,the  
,secretary1 on behalf of the ,,iccpom1  
shall annually submit to ,congress a    
report that summarizes--  7,a7 all      
programs and policies of ,federal       
agencies 7including the ,medicare       
program under title ,,xviii of the      
,social ,security ,act and the ,medicaid
 program under title ,,xix of such ,act7
 designed to promote optimal maternity  
care1 focusing particularly on programs 
and policies that support the adoption  
of evidence based maternity care1 as    
defined by timely1 scientifically sound 
systematic reviews2  7,b7 all programs  
and policies of ,federal agencies       
7including the ,medicare program under  
title ,,xviii of the ,social ,security  
,act and the ,medicaid program under    
title ,,xix of such ,act7 designed to   
address the problems of maternal        
mortality and morbidity1 infant         

mortality1 prematurity1 and low birth   
weight1 including such programs and     
policies designed to address racial and 
ethnic disparities with respect to each 
of such problems2  7,c7 the extent of   
progress in reducing maternal mortality 
and infant mortality1 low birth weight1 
and prematurity at ,state and national  
levels2 and  7,d7 such other information
 regarding optimal maternity care as the
 ,secretary determines to be            
appropriate4  ,the information specified
 in subparagraph 7,c7 shall be included 
in each such report in a manner that    
disaggregates such information by race1 
ethnicity1 and indigenous status in     
order to determine the extent of        
progress in reducing racial and ethnic  
disparities and disparities related to  
indigenous status4  7#b7 ,certain       
information ,each report under paragraph
 7#a7 shall include information         
7disaggregated by race1 ethnicity1 and  
indigenous status1 as applicable7 on the
 following rates and costs by ,state3   

7,a7 ,the rate of primary cesarean      
deliveries and repeat cesarean          
deliveries4  7,b7 ,the rate of vaginal  
births after cesarean4  7,c7 ,the rate  
of vaginal breech births4  7,d7 ,the    
rate of induction of labor4  7,e7 ,the  
rate of freestanding birth center       
births4  7,f7 ,the rate of planned and  
unplanned home birth4  7,g7 ,the rate of
 attended births by provider1 including 
by an obstetrician-gynecologist1 family 
practice physician1                     
obstetrician-gynecologist physician     
assistant1 certified nurse-midwife1     
certified midwife1 and certified        
professional midwife4  7,h7 ,the cost of
 maternity care disaggregated by place  
of birth and provider of care1          
including--  7i7 uncomplicated vaginal  
birth2  7ii7 complicated vaginal birth2 
7iii7 uncomplicated cesarean birth2 and 
7iv7 complicated cesarean birth4  7g7   
,authorization of appropriations ,there 
is authorized to be appropriated1 in    
addition to such amounts authorized to  

be appropriated under section #bbi7;e71 
to carry out this section #a1jjj1jjj for
 each of the fiscal years #bjad through 
#bjah4  4  7b7 ,conforming amendments   
7#a7 ,inclusion as duty of ,,hhs ,office
 on ,women's ,health ,section #bbi7;b7  
of such ,act 7#db ,u4,s4,c4 #bcg;a7b771 
as amended by section #aja1 is amended--
  7,a7 in paragraph 7#g71 at the end1 by
 striking and2  7,b7 in paragraph 7#h71 
at the end1 by striking the period and  
inserting 2 and2 and  7,c7 by adding at 
the end the following new paragraph3    
7#i7 establish the ,interagency         
,coordinating ,committee on the         
,promotion of ,optimal ,maternity       
,outcomes in accordance with section    
#bbi;,a4  4  7#b7 ,treatment of biennial
 reports ,section #bbi7;d7 of such ,act 
7#db ,u4,s4,c4 #bcg;a7d77 is amended by 
inserting 7other than under subsection  
7b77#i77 after under this section4      
#ajc4 ,consumer education campaign      
,section #bbi of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #bcg;a71 as

 amended by sections #aja and #ajb1 is  
further amended--  7#a7 in subsection   
7b7--  7,a7 in paragraph 7#h71 at the   
end1 by striking and2  7,b7 in paragraph
 7#i71 at the end1 by striking the      
period and inserting 2 and2 and  7,c7 by
 adding at the end the following new    
paragraph3  7#aj7 not later than one    
year after the date of the enactment of 
the ,,moms for the #bast ,century ,act1 
develop and implement a #d-year         
culturally and linguistically           
appropriate multi-media consumer        
education campaign to promote           
understanding and acceptance of evidence
 based maternity practices and models of
 care for optimal maternity outcomes    
among women of childbearing ages and    
families of such women and that--  7,a7 
highlights the importance of protecting1
 promoting1 and supporting the innate   
capacities of childbearing women and    
their newborns for childbirth1          
breast-feeding1 and attachment2  7,b7   
promotes understanding of the importance

 of using obstetric interventions when  
medically necessary and when supported  
by strong1 high-quality evidence2  7,c7 
highlights the widespread overuse of    
maternity practices that have been shown
 to have benefit when used appropriately
 in situations of medical necessity1 but
 which can expose women1 infants1 or    
both to risk of harm if used routinely  
and indiscriminately1 including         
continuous fetal monitoring1 labor      
induction1 epidural anesthesia1 elective
 primary cesarean section1 and repeat   
cesarean delivery2  7,d7 emphasizes the 
non-invasive maternity practices that   
have strong proven correlation or may be
 associated with considerable           
improvement in outcomes with no         
detrimental side effects1 and are       
significantly underused in the ,united  
,states1 including smoking cessation    
programs in pregnancy1 group model      
prenatal care1 continuous labor support1
 non-supine positions for birth1 and    
external version to turn breech babies  

at term2  7,e7 educates consumers about 
the qualifications of licensed providers
 of maternity care and the best evidence
 about their safety1 satisfaction1      
outcomes1 and costs2  7,f7 informs      
consumers about the best available      
research comparing birth center births1 
planned home births1 and hospital       
births1 including information about each
 setting's safety1 satisfaction1        
outcomes1 and costs2  7,g7 fosters      
participation in high-quality1          
evidence-based childbirth education that
 promotes a natural1 healthy1 and safe  
approach to pregnancy1 childbirth1 and  
early parenting2 is taught by certified 
educators1 peer counselors1 and health  
professionals2 and promotes informed    
decisionmaking by childbearing women2   
and  7,h7 is pilot tested for consumer  
comprehension1 cultural sensitivity1 and
 acceptance of the messages across      
geographically1 racially1 ethnically1   
and linguistically diverse populations4 
4  #ajd4 ,bibliographic database of     

systematic reviews for care of          
childbearing women and newborns  7a7 ,in
 general ,not later than one year after 
the date of the enactment of this ,act1 
the ,secretary of ,health and ,human    
,services1 through the ,agency for      
,healthcare ,research and ,quality1     
shall--  7#a7 make publicly available an
 online bibliographic database          
identifying systematic reviews1         
including an explanation of the level   
and quality of evidence1 for care of    
childbearing women and newborns2 and    
7#b7 initiate regular updates that      
incorporate newly issued and updated    
systematic reviews4  7b7 ,sources ,to   
aim for a comprehensive inventory of    
systematic reviews relevant to maternal 
and newborn care1 the database shall    
identify reviews from diverse sources1  
including--  7#a7 scientific            
peer-reviewed journals2  7#b7 databases1
 including ,cochrane ,database of       
,systematic ,reviews1 ,clinical         
,evidence1 and ,database of ,abstracts  

of ,reviews of ,effects2 and  7#c7      
,internet ,web sites of agencies and    
organizations throughout the world that 
produce such systematic reviews4  7c7   
,features ,the database shall--  7#a7   
provide bibliographic citations for each
 record within the database1 and for    
each such citation include an           
explanation of the level and quality of 
evidence2  7#b7 include abstracts1 as   
available2  7#c7 provide reference to   
companion documents as may exist for    
each review1 such as evidence tables and
 guidelines or consumer educational     
materials developed from the review2    
7#d7 provide links to the source of the 
full review and to any companion        
documents2  7#e7 provide links to the   
source of a previous version or update  
of the review2  7#f7 be searchable by   
intervention or other topic of the      
review1 reported outcomes1 author1      
title1 and source2 and  7#g7 offer to   
users periodic electronic notification  
of database updates relating to users'  

topics of interest4  7d7 ,outreach ,not 
later than the first date the database  
is made publicly available and          
periodically thereafter1 the ,secretary 
of ,health and ,human ,services shall   
publicize the availability1 features1   
and uses of the database under this     
section to the stakeholders described in
 subsection 7e74  7e7 ,consultation ,for
 purposes of developing the database    
under this section and maintaining and  
updating such database1 the ,secretary  
of ,health and ,human ,services shall   
convene and consult with an advisory    
committee composed of relevant          
stakeholders1 including--  7#a7 ,federal
 ,medicaid administrators and ,state    
agencies administrating ,state plans    
under title ,,xix of the ,social        
,security ,act pursuant to section      
#aijb7;a77#e7 of such ,act 7#db         
,u4,s4,c4 #acif;a7a77#e772  7#b7        
providers of maternity and newborn care 
from both academic and community-based  
settings1 including                     

obstetrician-gynecologists1 family      
physicians1 certified nurse midwives1   
certified midwives1 certified           
professional midwives1 physician        
assistants1 perinatal nurses1           
pediatricians1 and nurse practitioners2 
7#c7 maternal-fetal medicine            
specialists2  7#d7 neonatologists2  7#e7
 childbearing women and advocates for   
such women1 including childbirth        
educators certified by a nationally     
accredited program1 representing        
communities that are diverse in terms of
 race1 ethnicity1 indigenous status1 and
 geographic area2  7#f7 employers and   
purchasers2  7#g7 health facility and   
system leaders1 including both hospital 
and birth center facilities2  7#h7      
journalists2 and  7#i7 bibliographic    
informatics specialists4  7f7           
,authorization of appropriations ,there 
is authorized to be appropriated        
#b1ejj1jjj for each of the fiscal years 
#bjad through #bjaf for the purpose of  
developing the database and such sums as

 may be necessary for each subsequent   
fiscal year for updating the database   
and providing outreach and notification 
to users1 as described in this section4 
,,ii ,research and data collection on   
,maternity ,care  #bja4 ,maternity care 
health professional shortage areas      
,section #ccb of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #bed;e7 is 
amended by adding at the end the        
following new subsection3  7k7 7#a7 ,the
 ,secretary1 acting through the         
,administrator of the ,health ,resources
 and ,services ,administration1 shall   
designate maternity care health         
professional shortage areas in the      
,states1 publish a descriptive list of  
the area's population groups1 medical   
facilities1 and other public facilities 
so designated1 and at least annually    
review and1 as necessary1 revise such   
designations4  7#b7 ,for purposes of    
paragraph 7#a71 a complete descriptive  
list shall be published in the ,federal 
,register not later than one year after 

the date of the enactment of the ,,moms 
for the #bast ,century ,act and annually
 thereafter4  7#c7 ,the provisions of   
subsections 7b71 7c71 7e71 7f71 7g71    
7h71 7i71 and 7j7 7other than           
7j77#a77;,b77 of this section shall     
apply to the designation of a maternity 
care health professional shortage area  
in a similar manner and extent as such  
provisions apply to the designation of  
health professional shortage areas1     
except in applying subsection 7b77#c71  
the reference in such subsection to     
physicians shall be deemed to be a      
reference to nationally certified and   
,state licensed obstetricians1 family   
practice physicians who practice        
full-scope maternity care1 certified    
nurse-midwives1 certified midwives1     
certified professional midwives1 and    
physician's assistants who practice full
 scope maternity care4  7#d7 ,for       
purposes of this subsection1 the term   
maternity care health professional      
shortage area means--  7,a7 an area in  

an urban or rural area 7which need not  
conform to the geographic boundaries of 
a political subdivision and which is a  
rational area for the delivery of health
 services7 which the ,secretary         
determines has a shortage of providers  
of maternity care health services       
including those referenced in paragraph 
7#c7 or an urban or rural area that the 
,secretary determines has lost a        
significant number of such providers    
during the #aj-year period beginning    
with #bjjd or has no obstetrical        
providers licensed to provide operative 
obstetrical services2  7,b7 an area in  
an urban or rural area 7which need not  
conform to the geographic boundaries of 
a political subdivision and which is a  
rational area for the delivery of health
 services7 which the ,secretary         
determines has a shortage of hospital or
 labor and delivery units1 hospital     
birth center units1 or freestanding     
birth centers or an area that lost a    
significant number of these units during

 the #aj-year period beginning with     
#bjjc2 or  7,c7 a population group which
 the ,secretary determines has such a   
shortage of providers or facilities4  4 
#bjb4 ,expansion of ,,cdc ,prevention   
,research ,centers program to include   
,centers on ,optimal ,maternity         
,outcomes  7a7 ,in general ,not later   
than one year after the date of the     
enactment of this ,act1 the ,secretary  
of ,health and ,human ,services1 shall  
support the establishment of #b         
additional ,prevention ,research        
,centers under the ,prevention ,research
 ,center ,program administered by the   
,centers for ,disease ,control and      
,prevention4 ,such additional centers   
shall each be known as a ,center for    
,excellence on ,optimal ,maternity      
,outcomes4  7b7 ,research ,each ,center 
for ,excellence on ,optimal ,maternity  
,outcomes shall--  7#a7 conduct at least
 one focused program of research to     
improve maternity outcomes1 including   
the reduction of cesarean birth rates1  

elective inductions1 prematurity rates1 
and low birth weight rates within an    
underserved population that has a       
disproportionately large burden of      
suboptimal maternity outcomes1 including
 maternal mortality and morbidity1      
infant mortality1 prematurity1 or low   
birth weight2  7#b7 work with partners  
on special interest projects1 as        
specified by the ,centers for ,disease  
,control and ,prevention and other      
relevant agencies within the ,department
 of ,health and ,human ,services1 and on
 projects funded by other sources2 and  
7#c7 involve a minimum of two distinct  
birth setting models1 such as a hospital
 labor and delivery model and           
freestanding birth center model2 or a   
hospital labor and delivery model and   
planned home birth model4  7c7          
,interdisciplinary providers ,each      
,center for ,excellence on ,optimal     
,maternity ,outcomes shall include the  
following interdisciplinary providers of
 maternity care3  7#a7                  

,obstetrician-gynecologists4  7#b7      
,certified nurse midwives or certified  
midwives4  7#c7 ,at least two of the    
following providers3  7,a7 ,family      
practice physicians4  7,b7 ,nurse       
practitioners4  7,c7 ,physician         
assistants4  7,d7 ,certified            
professional midwives4  7d7 ,services   
,research conducted by each ,center for 
,excellence on ,optimal ,maternity      
,outcomes shall include at least #b 7and
 preferably more7 of the following      
supportive provider services3  7#a7     
,mental health4  7#b7 ,doula labor      
support4  7#c7 ,nutrition education4    
7#d7 ,childbirth education4  7#e7       
,social work4  7#f7 ,physical therapy or
 occupation therapy4  7#g7 ,substance   
abuse services4  7#h7 ,home visiting4   
7e7 ,coordination ,the programs of      
research at each of the two ,centers of 
,excellence on ,optimal ,maternity      
,outcomes shall compliment and not      
replicate the work of the other4  7f7   
,authorization of appropriations ,there 

is authorized to be appropriated to     
carry out this section #b1jjj1jjj for   
each of the fiscal years #bjad through  
#bjah4  #bjc4 ,expanding models to be   
tested by ,center for ,medicare and     
,medicaid ,innovation to include        
maternity care models ,section          
#aaae;,a7b77#b77;,b7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#b77;,b77 is amended by      
adding at the end the following new     
clause3  7xxi7 ,promoting evidence-based
 models of prenatal care that have been 
associated with reductions in maternal  
and infant health disparities2          
incorporating the use of doula and      
promotoras support2 and advancing       
out-of-hospital births1 including births
 at home and in freestanding birth      
centers4  4  ,,iii ,enhancement of a    
,geographically1 ,racially1 and         
,ethnically ,diverse ,interprofessional 
,maternity ,workforce  #cja4            
,development of interprofessional       
maternity care educational models and   

tools  7a7 ,in general ,not later than  
#f months after the date of the         
enactment of this ,act1 the ,secretary  
of ,health and ,human ,services1 acting 
in conjunction with the ,administrator  
of ,health ,resources and ,services     
,administration1 shall convene1 for a   
#a-year period1 an ,interprofessional   
,maternity ,provider ,education         
,commission to discuss and make         
recommendations for--  7#a7 a consensus 
standard physiologic maternity care     
curriculum that takes into account the  
core competencies for basic midwifery   
practice such as those developed by the 
,american ,college of ,nurse ,midwives  
and the ,north ,american ,registry of   
,midwives1 and the educational          
objectives for physicians practicing in 
obstetrics and gynecology as determined 
by the ,council on ,resident ,education 
in ,obstetrics and ,gynecology2  7#b7   
suggestions for multi-disciplinary use  
of the consensus physiologic curriculum2
  7#c7 strategies to integrate and      

coordinate education across maternity   
care disciplines1 including             
recommendations to increase medical and 
midwifery student exposure to           
out-of-hospital birth2 and  7#d7 pilot  
demonstrations of interprofessional     
educational models4  7b7 ,participants  
,the ,commission shall include maternity
 care educators1 curriculum developers1 
service leaders1 certification leaders1 
and accreditation leaders from the      
various professions that provide        
maternity care in this country4 ,such   
professions shall include               
obstetrician-gynecologists1 certified   
nurse midwives or certified midwives1   
family practice physicians1 nurse       
practitioners1 physician assistants1    
certified professional midwives1 and    
perinatal nurses4 ,additionally1 the    
,commission shall include representation
 from maternity care consumer advocates4
  7c7 ,curriculum ,the consensus        
standard physiologic maternity care     
curriculum described in subsection      

7a77#a7 shall--  7#a7 have a public     
health focus with a foundation in health
 promotion and disease prevention2  7#b7
 foster physiologic childbearing and    
woman and family centered care2  7#c7   
integrate strategies to reduce maternal 
and infant morbidity and mortality2     
7#d7 incorporate recommendations to     
ensure respectful1 safe1 and seamless   
consultation1 referral1 transport1 and  
transfer of care when necessary2 and    
7#e7 include cultural sensitivity and   
strategies to decrease disparities in   
maternity outcomes4  7d7 ,report ,not   
later than #f months after the final day
 of the summit1 the ,secretary of       
,health and ,human ,services shall--    
7#a7 submit to ,congress a report       
containing the recommendations made by  
the summit under this section2 and  7#b7
 make such report publicly available4   
7e7 ,authorization of appropriations    
,there is authorized to be appropriated 
to carry out this section #a1jjj1jjj for
 each of the fiscal years #bjad and     

#bjae1 and such sums as are necessary   
for each of the fiscal years #bjaf      
through #bjah4  #cjb4 ,interprofessional
 training of medical students1          
residents1 and student midwives in      
academic health centers and freestanding
 birth centers  7a7 ,including within   
inpatient hospital services under       
,medicare services furnished by certain 
students1 interns1 and residents        
supervised by certified nurse midwives  
,section #ahfa7;b7 of the ,social       
,security ,act 7#db ,u4,s4,c4 #aciex7b77
 is amended--  7#a7 in paragraph 7#f71  
by striking 2 or and inserting 1 or in  
the case of services in a hospital or   
osteopathic hospital by a student       
midwife or an intern or                 
resident-in-training under a teaching   
program previously described in this    
paragraph who is in the field of        
obstetrics and gynecology1 if such      
student midwife1 intern1 or             
resident-in-training is supervised by a 
certified nurse-midwife to the extent   

permitted under applicable ,state law   
and as may be authorized by the         
hospital22  7#b7 in paragraph 7#g71 by  
striking the period at the end and      
inserting 2 or2 and  7#c7 by adding at  
the end the following new paragraph3    
7#h7 a certified nurse-midwife where the
 hospital has a teaching program        
approved as specified in paragraph 7#f71
 if 7,a7 the hospital elects to receive 
any payment due under this title for    
reasonable costs of such services1 and  
7,b7 all certified nurse-midwives in    
such hospital agree not to bill charges 
for professional services rendered in   
such hospital to individuals covered    
under the insurance program established 
by this title4  4  7b7 ,effective date  
,the amendments made by subsection 7a7  
shall apply to services furnished on or 
after the date of the enactment of this 
,act4  #cjc4 ,grants to professional    
organizations to increase diversity in  
maternity care professionals  7a7 ,in   
general ,the ,secretary of ,health and  

,human ,services1 through the           
,administrator of the ,health ,resources
 and ,services ,administration1 shall   
carry out a grant program under which   
the ,secretary may make to eligible     
health professional organizations--     
7#a7 for fiscal year #bjad1 planning    
grants described in subsection 7b72 and 
7#b7 for the subsequent #d-year period1 
implementation grants described in      
subsection 7c74  7b7 ,planning grants   
7#a7 ,in general ,planning grants       
described in this subsection are grants 
for the following purposes3  7,a7 ,to   
collect data and identify any workforce 
disparities1 with respect to a health   
profession1 at each of the following    
areas along the health professional     
continuum3  7i7 ,pipeline availability  
with respect to students at the high    
school and college or university levels 
considering and working toward entrance 
in the profession4  7ii7 ,entrance into 
the training program for the profession4
  7iii7 ,graduation from such training  

program4  7iv7 ,entrance into practice4 
7v7 ,retention in practice for more than
 a #e-year period4  7,b7 ,to develop one
 or more strategies to address the      
workforce disparities within the health 
profession1 as identified under 7and in 
response to the findings pursuant to7   
subparagraph 7,a74  7#b7 ,application   
,to be eligible to receive a grant under
 this subsection1 an eligible health    
professional organization shall submit  
to the ,secretary of ,health and ,human 
,services an application in such form   
and manner and containing such          
information as specified by the         
,secretary4  7#c7 ,amount ,each grant   
awarded under this subsection shall be  
for an amount not to exceed #cjj1jjj4   
7#d7 ,report ,each recipient of a grant 
under this subsection shall submit to   
the ,secretary of ,health and ,human    
,services a report containing--  7,a7   
information on the extent and           
distribution of workforce disparities   
identified through the grant2 and  7,b7 

reasonable objectives and strategies    
developed to address such disparities   
within a #e-1 #aj-1 and #be-year period4
  7c7 ,implementation grants  7#a7 ,in  
general ,implementation grants described
 in this subsection are grants to       
implement one or more of the strategies 
developed pursuant to a planning grant  
awarded under subsection 7b74  7#b7     
,application ,to be eligible to receive 
a grant under this subsection1 an       
eligible health professional            
organization shall submit to the        
,secretary of ,health and ,human        
,services an application in such form   
and manner as specified by the          
,secretary4 ,each such application shall
 contain information on the capability  
of the organization to carry out a      
strategy described in paragraph 7#a71   
involvement of partners or coalitions1  
plans for developing sustainability of  
the efforts after the culmination of the
 grant cycle1 and any other information 
specified by the ,secretary4  7#c7      

,amount ,each grant awarded under this  
subsection shall be for an amount not to
 exceed #ejj1jjj each year during the   
#d-year period of the grant4  7#d7      
,reports ,for each of the first #c years
 for which an eligible health           
professional organization is awarded a  
grant under this subsection1 the        
organization shall submit to the        
,secretary of ,health and ,human        
,services a report on the activities    
carried out by such organization through
 the grant during such year and         
objectives for the subsequent year4 ,for
 the fourth year for which an eligible  
health professional organization is     
awarded a grant under this subsection1  
the organization shall submit to the    
,secretary a report that includes an    
analysis of all the activities carried  
out by the organization through the     
grant and a detailed plan for           
continuation of outreach efforts4  7d7  
,eligible health professional           
organization defined ,for purposes of   

this section1 the term eligible health  
professional organization means a       
professional organization representing  
obstetrician-gynecologists1 certified   
nurse midwives1 certified midwives1     
family practice physicians1 nurse       
practitioners whose scope of practice   
includes maternity care1 physician      
assistants whose scope of practice      
includes obstetrical care1 or certified 
professional midwives4  7e7             
,authorization of appropriations ,there 
is authorized to be appropriated to     
carry out this section #b1jjj1jjj for   
fiscal year #bjad and #c1jjj1jjj for    
each of the fiscal years #bjae through  
#bjah4