#aafth ,,congress #b;d ,session ,h4 ,r4 #diie ,,an ,,act ,to amend the ,public ,health ,service ,act to improve obstetric care and maternal health outcomes1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,maternal ,health ,quality ,improvement ,act of #bjbj4 #b4 ,innovation for maternal health ,part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b et seq47 is amended-- 7#a7 in the section designation of section #ccj,m of such ,act 7#db ,u4,s4,c4 #bed;c-#ai7 by inserting a period after #ccj,m2 and 7#b7 by inserting after section #ccj,m of such ,act 7#db ,u4,s4,c4 #bed;c-#ai7 the following3 #ccj,n4 ,innovation for maternal health 7a7 ,in general ,the ,secretary1 in consultation with experts representing a variety of clinical specialties1 ,state1 ,tribal1 or local public health officials1 researchers1 epidemiologists1 statisticians1 and community organizations1 shall establish or continue a program to award competitive grants to eligible entities for the purposes of-- 7#a7 identifying1 developing1 or disseminating best practices to improve maternal health care quality and outcomes1 eliminate preventable maternal mortality and severe maternal morbidity1 and improve infant health outcomes1 which may include-- 7,a7 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 system1 including by addressing topics commonly associated with health complications or risks related to prenatal care1 labor care1 birthing1 and postpartum care2 7,b7 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 care1 labor care1 birthing1 and postpartum care2 and 7,c7 information on addressing determinants of health that impact maternal health outcomes for women before1 during1 and after pregnancy2 7#b7 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 morbidity2 7#c7 providing technical assistance and supporting the implementation of best practices identified pursuant to paragraph 7#a7 to entities providing health care services to pregnant and postpartum women2 and 7#d7 identifying1 developing1 and evaluating new models of care that improve maternal and infant health outcomes1 which may include the integration of community-based services and clinical care4 7b7 ,eligible entities ,to be eligible for a grant under subsection 7a71 an entity shall-- 7#a7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7#b7 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 health4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #c4 ,training for health care providers ,title ,,vii of the ,public ,health ,service ,act is amended by striking section #gfc 7#db ,u4,s4,c4 #bidp7 and inserting the following3 #gfc4 ,training for health care providers 7a7 ,grant program ,the ,secretary shall establish a program to award grants to accredited schools of allopathic medicine1 osteopathic medicine1 and nursing1 and other health professional training programs for the training of health care professionals to reduce and prevent discrimination 7including training related to implicit and explicit biases7 in the provision of health care services related to prenatal care1 labor care1 birthing1 and postpartum care4 7b7 ,eligibility ,to be eligible for a grant under subsection 7a71 an entity described in such subsection shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,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 grant1 including a description of the impact of such training on patient outcomes1 as applicable4 7d7 ,best practices ,the ,secretary may identify and disseminate best practices for the training of health care professionals to reduce and prevent discrimination 7including training related to implicit and explicit biases7 in the provision of health care services related to prenatal care1 labor care1 birthing1 and postpartum care4 7e7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #d4 ,study on training to reduce and prevent discrimination ,not later than #b years after date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall1 through a contract with an independent research organization1 conduct a study and make recommendations for accredited schools of allopathic medicine1 osteopathic medicine1 and nursing1 and other health professional training programs1 on best practices related to training to reduce and prevent discrimination1 including training related to implicit and explicit biases1 in the provision of health care services related to prenatal care1 labor care1 birthing1 and postpartum care4 #e4 ,perinatal quality collaboratives ,section #cag,k7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77#b77 is amended by adding at the end the following3 7,e7 7i7 ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and in coordination with other offices and agencies1 as appropriate1 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 infants4 ,a ,state1 ,indian ,tribe1 or ,tribal organization may use funds received through such grant to-- 7,i7 support the use of evidence-based or evidence-informed practices to improve outcomes for maternal and infant health2 7,,ii7 work with clinical teams2 experts2 ,state1 local1 and1 as appropriate1 ,tribal public health officials2 and stakeholders1 including patients and families1 to identify1 develop1 or disseminate best practices to improve perinatal care and outcomes2 and 7,,iii7 employ strategies that provide opportunities for health care professionals and clinical teams to collaborate across health care settings and disciplines1 including primary care and mental health1 as appropriate1 to improve maternal and infant health outcomes1 which may include the use of data to provide timely feedback across hospital and clinical teams to inform responses1 and to provide support and training to hospital and clinical teams for quality improvement1 as appropriate4 7ii7 ,to be eligible for a grant under clause 7i71 an entity shall submit to the ,secretary an application in such form and manner and containing such information as the ,secretary may require4 4 #f4 ,integrated services for pregnant and postpartum women 7a7 ,grants ,title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #ccj,n of such ,act1 as added by section #b1 the following3 #ccj,o4 ,integrated services for pregnant and postpartum women 7a7 ,in general ,the ,secretary may award grants to ,states1 ,indian ,tribes1 and ,tribal organizations for the purpose of establishing or operating evidence-based or innovative1 evidence-informed programs to deliver integrated health care services to pregnant and postpartum women to optimize the health of women and their infants1 including to reduce adverse maternal health outcomes1 pregnancy-related deaths1 and related health disparities 7including such disparities associated with racial and ethnic minority populations71 and1 as appropriate1 by addressing issues researched under subsection 7b77#b7 of section #cag,k4 7b7 ,integrated services for pregnant and postpartum women 7#a7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 a ,state1 ,indian ,tribe1 or ,tribal organization shall work with relevant stakeholders that coordinate care 7including coordinating resources and referrals for health care and social services7 to develop and carry out the program1 including-- 7,a7 ,state1 ,tribal1 and local agencies responsible for ,medicaid1 public health1 social services1 mental health1 and substance use disorder treatment and services2 7,b7 health care providers who serve pregnant and postpartum women2 and 7,c7 community-based health organizations and health workers1 including providers of home visiting services and individuals representing communities with disproportionately high rates of maternal mortality and severe maternal morbidity1 and including individuals representing racial and ethnic minority populations4 7#b7 ,terms 7,a7 ,period ,a grant awarded under subsection 7a7 shall be made for a period of #e years4 ,any supplemental award made to a grantee under subsection 7a7 may be made for a period of less than #e years4 7,b7 ,preference ,in awarding grants under subsection 7a71 the ,secretary shall-- 7i7 give preference to ,states1 ,indian ,tribes1 and ,tribal organizations that have the highest rates of maternal mortality and severe maternal morbidity relative to other such ,states1 ,indian ,tribes1 or ,tribal organizations1 respectively2 and 7ii7 shall consider health disparities related to maternal mortality and severe maternal morbidity1 including such disparities associated with racial and ethnic minority populations4 7,c7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to applications from up to #ae entities described in subparagraph 7,b77i74 7,d7 ,evaluation ,the ,secretary shall require grantees to evaluate the outcomes of the programs supported under the grant4 7c7 ,definitions ,in this section1 the terms ,indian ,tribe and ,tribal organization have the meanings given the terms ,indian tribe and tribal organization1 respectively1 in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 7b7 ,report on grant outcomes and dissemination of best practices 7#a7 ,report ,not later than ,february #a1 #bjbf1 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report that describes-- 7,a7 the outcomes of the activities supported by the grants awarded under the amendment made by this section on maternal and child health2 7,b7 best practices and models of care used by recipients of grants under such amendment2 and 7,c7 obstacles identified by recipients of grants under such amendment1 and strategies used by such recipients to deliver care1 improve maternal and child health1 and reduce health disparities4 7#b7 ,dissemination of best practices ,not later than ,august #a1 #bjbf1 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 7including best practices and models of care relating to the reduction of health disparities1 including such disparities associated with racial and ethnic minority populations1 in rates of maternal mortality and severe maternal morbidity7 to relevant stakeholders1 which may include health providers1 medical schools1 nursing schools1 relevant ,state1 ,tribal1 and local agencies1 and the general public4 #g4 ,improving rural maternal and obstetric care data 7a7 ,maternal mortality and morbidity activities ,section #cja7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda7;e77 is amended by inserting 1 preventable maternal mortality and severe maternal morbidity1 after delivery4 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 striking and sociocultural contexts1 and inserting sociocultural 7including among ,american ,indians1 ,native ,hawaiians1 and ,alaska ,natives71 and geographical contexts4 7c7 ,safe motherhood ,section #cag,k of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7 is amended-- 7#a7 in subsection 7a77#b77;,a71 by inserting 1 including improving collection of data on race1 ethnicity1 and other demographic information before the period2 and 7#b7 in subsection 7b77#b7-- 7,a7 in subparagraph 7,l71 by striking and at the end2 7,b7 by redesignating subparagraph 7,m7 as subparagraph 7,n72 and 7,c7 by inserting after subparagraph 7,l7 the following3 7,m7 an examination of the relationship between maternal health and obstetric 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 7b71 by amending paragraph 7#c7 to read as follows3 7#c7 carry out paragraphs 7#a7 and 7#b7 with respect to-- 7,a7 the aging process in women1 with priority given to menopause2 and 7,b7 pregnancy1 with priority given to deaths related to preventable maternal mortality and severe maternal morbidity2 2 and 7#b7 in subsection 7d77#d77;,a77iv71 by inserting 1 including preventable maternal morbidity and severe maternal morbidity before the semicolon4 #h4 ,rural obstetric network grants ,the ,public ,health ,service ,act is amended by inserting after section #ccj;,a-#a 7#db ,u4,s4,c4 #bed;c-#a;a7 the following3 #ccj;,a-#b4 ,rural obstetric network grants 7a7 ,program established ,the ,secretary shall award grants or cooperative agreements to eligible entities to establish collaborative improvement and innovation networks 7referred to in this section as rural obstetric networks7 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 areas1 frontier areas1 maternity care health professional target areas1 or jurisdictions of ,indian ,tribes and ,tribal organizations4 7b7 ,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 morbidity4 ,rural obstetric networks established in accordance with this section may-- 7#a7 develop a network to improve coordination and increase access to maternal health care and assist pregnant women in the areas described in subsection 7a7 with accessing and utilizing maternal and obstetric care1 including health care services related to prenatal care1 labor care1 birthing1 and postpartum care to improve outcomes in birth and maternal mortality and morbidity2 7#b7 identify and implement evidence-based and sustainable delivery models for maternal and obstetric care 7including health care services related to prenatal care1 labor care1 birthing1 and postpartum care for women in the areas described in subsection 7a71 including home visiting programs and culturally appropriate care models that reduce health disparities2 7#c7 develop a model for maternal health care collaboration between health care settings to improve access to care in areas described in subsection 7a71 which may include the use of telehealth2 7#d7 provide training for professionals in health care settings that do not have specialty maternity care2 7#e7 collaborate with academic institutions that can provide regional expertise and help identify barriers to providing maternal health care1 including strategies for addressing such barriers2 and 7#f7 assess and address disparities in infant and maternal health outcomes1 including among racial and ethnic minority populations and underserved populations in areas described in subsection 7a74 7c7 ,definitions ,in this section3 7#a7 ,eligible entities ,the term eligible entities means entities providing maternal health care services in rural areas1 frontier areas1 or medically underserved areas1 or to medically underserved populations or ,indian ,tribes or ,tribal organizations4 7#b7 ,frontier area ,the term frontier area means a frontier county1 as defined in section #ahhf7;d77#c77;,e77iii77,,iii7 of the ,social ,security ,act4 7#c7 ,indian ,tribes2 ,tribal organization ,the terms ,indian ,tribe and ,tribal organization have the meanings given the terms ,indian tribe and tribal organization1 respectively1 in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#d7 ,maternity care health professional target area ,the term maternity care health professional target area has the meaning described in section #ccb7k77#b74 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #c1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #i4 ,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#c71 by adding at the end the following3 7,m7 ,providers of maternal care1 including prenatal1 labor care1 birthing1 and postpartum care services and entities operating obstetric care units4 2 and 7#b7 in subsection 7h77#a77;,b71 by inserting labor care1 birthing care1 postpartum care1 before or prenatal4 #aj4 ,rural maternal and obstetric care training demonstration ,subpart #a of part ,e of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bidn et seq47 is amended by adding at the end the following3 #gfd4 ,rural maternal and obstetric care training demonstration 7a7 ,in general ,the ,secretary shall award grants to accredited schools of allopathic medicine1 osteopathic medicine1 and nursing1 and other appropriate health professional training programs1 to establish a training demonstration program to support-- 7#a7 training for physicians1 medical residents1 fellows1 nurse practitioners1 physician assistants1 nurses1 certified nurse midwives1 relevant home visiting workforce professionals and paraprofessionals1 or other professionals who meet relevant ,state training and licensing requirements1 as applicable1 to provide maternal health care services in rural community-based settings2 and 7#b7 developing recommendations for such training programs4 7b7 ,application ,to be eligible to receive a grant under subsection 7a71 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,activities 7#a7 ,training for health care professionals ,a recipient of a grant under subsection 7a7-- 7,a7 shall use the grant funds to plan1 develop1 and operate a training program to provide maternal 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 program requirements ,the recipient of a grant under subsection 7a7 shall ensure that training programs carried out under the grant are evidence-based and address improving maternal health care in rural areas1 and such programs may include training on topics such as-- 7,a7 maternal mental health1 including perinatal depression and anxiety2 7,b7 substance use disorders2 7,c7 social determinants of health that affect individuals living in rural areas2 and 7,d7 implicit and explicit bias4 7d7 ,evaluation and report 7#a7 ,evaluation 7,a7 ,in general ,the ,secretary shall evaluate the outcomes of the demonstration program under this section4 7,b7 ,data submission ,recipients of a grant under subsection 7a7 shall submit to the ,secretary performance metrics and other related data in order to evaluate the program for the report described in paragraph 7#b74 7#b7 ,report to ,congress ,not later than ,january #a1 #bjbe1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report that includes-- 7,a7 an analysis of the effects of the demonstration program under this section on the quality1 quantity1 and distribution of maternal health care services1 including health care services related to prenatal care1 labor care1 birthing1 and postpartum care1 and the demographics of the recipients of those services2 7,b7 an analysis of maternal and infant health outcomes 7including quality of care1 morbidity1 and mortality7 before and after implementation of the program in the communities served by entities participating in the demonstration program2 and 7,c7 recommendations on whether the demonstration program should be continued4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 ,passed the ,house of ,representatives ,september #ba1 #bjbj4;,clerk4