,,ii #aaeth ,,congress #b;d ,session ,s4 #cefh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #aj1 #bjah ,ms4 ,heitkamp introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,social ,security ,act and ,public ,health ,service ,act to improve obstetric care in rural areas4 #a4 ,short title ,this ,act may be cited as the ,rural ,maternal and ,obstetric ,modernization of ,services ,act or the ,rural ,,moms ,act4 #b4 ,improving rural maternal and obstetric care data 7a7 ,maternal mortality and morbidity activities ,section #cja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda7 is amended-- 7#a7 by redesignating subsections 7e7 through 7h7 as subsections 7f7 through 7i71 respectively2 and 7#b7 by inserting after subsection 7d71 the following3 7e7 ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall expand1 intensify1 and coordinate the activities of the ,centers for ,disease ,control and ,prevention with respect to maternal mortality and morbidity4 4 7b7 ,office of ,women's ,health ,section #caj;,a7b77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdbs7b77#a77 is amended by inserting sociocultural1 and geographic contexts1 after biological14 7c7 ,safe motherhood ,section #cag,k7b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;b77#b77 is amended-- 7#a7 in subparagraph 7,k71 by striking and at the end2 7#b7 by redesignating subparagraph 7,l7 as subparagraph 7,m72 and 7#c7 by inserting after subparagraph 7,k71 the following3 7,l7 an examination of the relationship between maternal and obstetric health services in rural areas and outcomes in delivery and postpartum care2 and 4 7d7 ,office of ,research on ,women's ,health ,section #dhf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhg;d7 is amended-- 7#a7 in subsection 7b7-- 7,a7 by redesignating paragraphs 7#d7 through 7#i7 as paragraphs 7#e7 through 7#aj71 respectively2 7,b7 by inserting after paragraph 7#c7 the following3 7#d7 carry out paragraphs 7#a7 and 7#b7 with respect to pregnancy1 with priority given to deaths related to pregnancy2 2 and 7,c7 in paragraph 7#e7 7as so redesignated71 by striking through 7#c7 and inserting through 7#d72 and 7#b7 in subsection 7d77#d77;,a77iv71 by inserting 1 including maternal mortality and other maternal morbidity outcomes before the semicolon4 #c4 ,collaborative improvement and innovation networks to improve obstetric health in rural areas ,section #eja of the ,social ,security ,act 7#db ,u4,s4,c4 #gja7 is amended-- 7#a7 in subsection 7a77#b71 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 development2 and 7#b7 by adding at the end the following3 7d7 7#a7 7,a7 ,for the purpose of enabling the ,secretary 7through grants1 contracts1 or otherwise7 to establish1 as special projects of regional and national significance1 collaborative improvement and innovation networks 7referred to in this subsection as rural obstetric health ,co,i,i,ns7 to improve obstetric health in rural areas by improving outcomes in birth and maternal morbidity and mortality1 there is appropriated to the ,secretary1 out of any money in the ,treasury not otherwise appropriated1 #c1jjj1jjj for each of fiscal years #bjai through #bjbc4 7,b7 ,funds appropriated under subparagraph 7,a7 shall-- 7i7 be in addition to amounts appropriated under subsection 7a7 and retained under section #ejb7;a77#a7 for the purpose of carrying out activities described in subsection 7a77#b72 and 7ii7 remain available until expended4 7#b7 ,rural obstetric health ,co,i,i,ns established in accordance with this subsection shall-- 7,a7 assist pregnant women in rural areas connect with maternal1 prenatal and postnatal1 and obstetric care to improve outcomes in birth and maternal mortality and morbidity2 7,b7 identify successful maternal1 prenatal and postnatal1 and obstetric health delivery models for women in rural areas2 7,c7 develop a model for collaboration between health facilities that have an obstetric health unit and health facilities that do not have an obstetric health unit2 7,d7 provide training and guidance for health facilities that do not have obstetric health units2 and 7,e7 collaborate with academic institutions that can provide regional expertise and research on access1 outcomes1 needs assessments1 and other identified data4 7#c7 7,a7 ,not later than ,october #a1 #bjai1 the ,secretary shall establish rural obstetric health ,co,i,i,ns in at least #e regions4 7,b7 ,in this subsection3 7i7 ,the term frontier area means a frontier county1 as defined in section #ahhf7;d77#c77;,e77iii77,,iii74 7ii7 ,the term ,indian tribe has the meaning given such term in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7iii7 ,the term region means a ,state1 ,indian tribe1 rural area1 or frontier area4 7iv7 ,the term rural area has the meaning given that term in section #ahhf7;d77#b77;,d74 7v7 ,the term ,state has the meaning given that term for purposes of this title in section #aaja4 7#d7 ,the provisions of this title that are applicable to the funds made available to the ,secretary under section #ejb7;a77#a7 apply in the same manner to funds made available to the ,secretary under paragraph 7#a77;,a74 4 #d4 ,telehealth network and telehealth resource centers grant programs ,section #ccj;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#ad7 is amended-- 7#a7 in subsection 7f77#a77;,b77iii71 by adding at the end the following3 7,,xiii7 ,providers of maternal1 including prenatal and postnatal1 and obstetric care services and entities operation obstetric care units4 2 7#b7 in subsection 7i77#a77;,b71 by inserting maternal1 including prenatal and postnatal care1 obstetric care1 before or prenatal2 and 7#c7 in subsection 7k77#a77;,b71 by inserting equipment useful for caring for pregnant women1 including ultrasound machines and fetal monitoring equipment1 before and other equipment4 #e4 ,rural maternal and obstetric care training demonstration ,part ,d of title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #gfj 7#db ,u4,s4,c4 #bidk7 the following3 #gfj;,a4 ,rural maternal and obstetric care training demonstration 7a7 ,in general ,the ,secretary shall establish a training demonstration program to award grants to eligible entities to support-- 7#a7 training for physicians1 medical residents1 including family practice residents1 and fellows to practice maternal and obstetric medicine in rural1 community-based settings2 7#b7 training for nurse practitioners1 physician assistants1 nurse midwives1 and doulas to provide maternal and obstetric care services in rural community-based settings2 and 7#c7 establishing1 maintaining1 or improving academic units or programs that-- 7,a7 provide training for students or faculty1 including through clinical experiences and research1 to improve maternal and obstetric care in rural areas2 or 7,b7 develop evidence-based practices or recommendations for the design of the units or programs described in subparagraph 7,a71 including curriculum content standards4 7b7 ,activities 7#a7 ,training for residents and fellows ,a recipient of a grant under subsection 7a77#a7-- 7,a7 shall use the grant funds-- 7i7 to plan1 develop1 and operate a training program to provide obstetric care in rural areas for family practice or obstetrics residents and fellows2 or 7ii7 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 areas2 and 7,b7 may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish1 maintain1 or improve faculty development1 or departments1 divisions1 or other units necessary to implement such training4 7#b7 ,training for other providers ,a recipient of a grant under subsection 7a77#b7-- 7,a7 shall use the grant funds to plan1 develop1 or operate a training program to provide maternal and obstetric health care services in rural1 community-based settings2 and 7,b7 may use the grant funds to provide additional support for the administration of the program or to meet the costs of projects to establish1 maintain1 or improve faculty development1 or departments1 divisions1 or other units necessary to implement such program4 7#c7 ,academic units or programs ,a recipient of a grant under subsection 7a77#c7 shall enter into a partnership with organizations such as an education accrediting organization 7such as the ,liaison ,committee on ,medical ,education1 the ,accreditation ,council for ,graduate ,medical ,education1 the ,commission on ,osteopathic ,college ,accreditation1 the ,accreditation ,commission for ,education in ,nursing1 the ,commission on ,collegiate ,nursing ,education1 or the ,accreditation ,review ,commission on ,education for the ,physician ,assistant7 to carry out activities under subsection 7a77#c74 7c7 ,eligible entities 7#a7 ,training for residents and fellows ,to be eligible to receive a grant under subsection 7a77#a71 an entity shall-- 7,a7 be a consortium consisting of-- 7i7 at least one teaching health center2 and 7ii7 the sponsoring institution 7or parent institution of the sponsoring institution7 of-- 7,i7 an obstetric residency program that is accredited by the ,accreditation ,council of ,graduate ,medical ,education 7or the parent institution of such a program72 or 7,,ii7 a fellowship in maternal or obstetric medicine1 as determined appropriate by the ,secretary2 or 7,b7 be an entity described in subparagraph 7,a77ii7 that provides opportunities for residents or fellows to train in rural community-based settings4 7#b7 ,training for other providers ,to be eligible to receive a grant under subsection 7a77#b71 an entity shall be-- 7,a7 a teaching health center 7as defined in section #gdi;,a7f772 7,b7 a ,federally qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act72 7,c7 a community mental health center 7as defined in section #ahfa7;ff77#c77;,b7 of the ,social ,security ,act72 7,d7 a rural health clinic 7as defined in section #ahfa7;aa7 of the ,social ,security ,act72 7,e7 a health center operated by the ,indian ,health ,service1 an ,indian tribe1 a tribal organization1 or an urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act72 or 7,f7 an entity with a demonstrated record of success in providing training for nurse practitioners1 physician assistants1 nurse midwives1 or doulas4 7#c7 ,academic units or programs ,to be eligible to receive a grant under subsection 7a77#c71 an entity shall be a school of medicine or osteopathic medicine1 a nursing school1 a physician assistant training program1 an accredited public or nonprofit private hospital1 an accredited medical residency program1 or a public or private nonprofit entity which the ,secretary has determined is capable of carrying out such grant4 7d7 ,duration ,grants awarded under this section shall be for a minimum of #e years4 7e7 ,study and report 7#a7 ,study 7,a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall conduct a study on the results of the demonstration program under this section4 7,b7 ,data submission ,not later than #ij days after the completion of the first year of the training program1 and each subsequent year that the program is in effect1 each recipient of a grant under subsection 7a7 shall submit to the ,secretary such data as the ,secretary may require for analysis for the report described in paragraph 7#b74 7#b7 ,report to ,congress ,not later than #a year after receipt of the data described in paragraph 7#a77;,b71 the ,secretary shall submit to ,congress a report that includes-- 7,a7 an analysis of the effect of the demonstration program under this section on the quality1 quantity1 and distribution of maternal1 including prenatal and postnatal1 and obstetric care services2 7,b7 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 demonstration2 and 7,c7 recommendations on whether the demonstration program should be expanded4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #e1jjj1jjj for each of fiscal years #bjai through #bjbc4 #f4 ,,gao report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate committees of ,congress a report on the maternal1 including prenatal and postnatal1 care and obstetric care in rural areas4 ,such report shall include the following3 7#a7 ,the location of gaps in maternal and obstetric health care workers1 including non-physicians such as doulas and community health workers4 7#b7 ,a list of specific activities that the ,comptroller ,general plans to conduct on maternal1 including prenatal and postnatal1 and obstetric care4 7#c7 ,a plan for completing such activities4 7#d7 ,an explanation of ,federal agency involvement and coordination needed to conduct such activities4 7#e7 ,a budget for conducting such activities4 7#f7 ,other information that the ,comptroller ,general determines appropriate4