,,ib ,union ,calendar ,no4 #dad #aafth ,,congress #b;d ,session ,h4 ,r4 #diie ,report ,no4 #aaf-ead ,,in ,,the ,,house ,,of ,,representatives ,november #h1 #bjai,mr4 ,engel 7for himself1 ,mr4 ,bucshon1 ,ms4 ,torres ,small of ,new ,mexico1 ,mr4 ,latta1 ,ms4 ,adams1 and ,mr4 ,stivers7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,september #ag1 #bjbj;,additional sponsors3 ,mr4 ,carson of ,indiana1 ,ms4 ,kelly of ,illinois1 ,ms4 ,herrera ,beutler1 ,mr4 ,marshall1 ,mr4 ,burgess1 ,mr4 ,walden1 ,mrs4 ,hayes1 ,mr4 ,o',halleran1 ,ms4 ,kuster of ,new ,hampshire1 ,mr4 ,guthrie1 ,mr4 ,trone1 ,ms4 ,craig1 ,mr4 ,fitzpatrick1 ,ms4 ,schakowsky1 ,mr4 ,casten of ,illinois1 ,mr4 ,cunningham1 ,ms4 ,norton1 ,ms4 ,underwood1 ,mr4 ,mc,govern1 ,ms4 ,finkenauer1 ,mr4 ,morelle1 ,ms4 ,houlahan1 ,ms4 ,gabbard1 ,mr4 ,ruiz1 ,mrs4 ,napolitano1 and ,mr4 ,levin of ,michigan ,september #ag1 #bjbj,reported with an amendment2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed,strike out all after the enacting clause and insert the part printed in italic,for text of introduced bill1 see copy of bill as introduced on ,november #h1 #bjai ,a ,,bill ,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 #bjai4 #b4 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title4,sec4 #b4 ,table of contents4,title ,i--,improving ,obstetric ,care in ,rural ,areas,sec4 #aja4 ,improving rural maternal and obstetric care data4,sec4 #ajb4 ,rural obstetric network grants4,sec4 #ajc4 ,telehealth network and telehealth resource centers grant programs4,sec4 #ajd4 ,rural maternal and obstetric care training demonstration4,sec4 #aje4 ,,gao report4,title ,,ii--,other ,improvements to ,maternal ,care,sec4 #bja4 ,innovation for maternal health4,sec4 #bjb4 ,training for health care providers4,sec4 #bjc4 ,study on training to reduce and prevent discrimination4,sec4 #bjd4 ,perinatal quality collaboratives4,sec4 #bje4 ,integrated services for pregnant and postpartum women4 ,i ,improving ,obstetric ,care in ,rural ,areas #aja4 ,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 including among ,american ,indians and ,alaska ,natives1 as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act1 geographic1 after biological14 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 before the period at the end the following3 1 including improving collection of data on race1 ethnicity1 and other demographic information2 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,l71 the following3 7,m7 an examination of the relationship between maternal 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 pregnancy2 2 and 7#b7 in subsection 7d77#d77;,a77iv71 by inserting 1 including maternal mortality and other maternal morbidity outcomes before the semicolon4 #ajb4 ,rural obstetric network grants ,the ,public ,health ,service ,act is amended by inserting after section #ccj;,a-#a of such ,act 7#db ,u4,s4,c4 #bed;c-#a;a7 the following3 #ccj;,a-#b4 ,rural obstetric network grants 7a7 ,program established ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants to eligible entities to establish collaborative improvement and innovation networks 7referred to in this section as rural obstetric networks7 to improve birth outcomes and reduce maternal morbidity and mortality by improving maternity care and access to care in rural areas1 frontier areas1 maternity care health professional target areas1 and ,indian country and with ,indian ,tribes and tribal organizations4 7b7 ,use of funds ,rural obstetric networks receiving funds pursuant to this section may use such funds to-- 7#a7 assist pregnant women and individuals in areas and within populations referenced in subsection 7a7 with accessing and utilizing maternal and obstetric care1 including preconception1 pregnancy1 labor and delivery1 postpartum1 and interconception services to improve outcomes in birth and maternal mortality and morbidity2 7#b7 identify successful delivery models for maternal and obstetric care 7including preconception1 pregnancy1 labor and delivery1 postpartum1 and interconception services7 for individuals in areas and within populations referenced by subsection 7a71 including evidence-based home visiting programs and successful1 culturally competent models with positive maternal health outcomes that advance health equity2 7#c7 develop a model for collaboration between health facilities that have an obstetric care unit and health facilities that do not have an obstetric care unit to improve access to and the delivery of obstetric services in communities lacking these services2 7#d7 provide training and guidance on obstetric care for health facilities that do not have obstetric care units2 7#e7 collaborate with academic institutions that can provide regional expertise and research on access1 outcomes1 needs assessments1 and other identified data and measurement activities needed to inform rural obstetric network efforts to improve obstetric care2 and 7#f7 measure and address inequities in birth outcomes among rural residents1 with an emphasis on racial and ethnic minorities and underserved populations4 7c7 ,definitions ,in this section3 7#a7 ,eligible entities ,the term eligible entities means entities providing obstetric1 gynecologic1 and other maternal health care services in rural areas1 frontier areas1 or medically underserved areas1 or to medically underserved populations or ,native ,americans1 including ,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 country ,the term ,indian country has the meaning given such term in section #aaea of title #ah1 ,united ,states ,code4 7#d7 ,maternity care health professional target area ,the term maternity care health professional target area has the meaning of such term as used in section #ccb7k77#b74 7#e7 ,rural area ,the term rural area has the meaning given that term in section #ahhf7;d77#b7 of the ,social ,security ,act4 7#f7 ,indian tribes2 tribal organization ,the terms ,indian ,tribe and tribal organization have the meaning given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7d7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this section #c1jjj1jjj for each of fiscal years #bjbj through #bjbd4 4 #ajc4 ,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 prenatal1 labor and birth1 and postpartum care services and entities operating obstetric care units4 2 and 7#b7 in subsection 7i77#a77;,b71 by inserting labor and birth1 postpartum1 before or prenatal4 #ajd4 ,rural maternal and obstetric care training demonstration ,subpart #a of part ,e of title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #gfj 7#db ,u4,s4,c4 #bidn et seq471 as amended by section #bjb1 is amended by adding at the end the following3 #gfd4 ,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 medicine and obstetrics and gynecology residents1 and fellows to practice maternal and obstetric medicine in rural community-based settings2 7#b7 training for nurse practitioners1 physician assistants1 nurses1 certified nurse midwives1 home visiting nurses and non-clinical home visiting workforce professionals and paraprofessionals1 or non-clinical professionals1 who meet applicable ,state training and licensing requirements1 to provide maternal 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 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 medical 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 and gynecology residents and fellows2 or 7ii7 to train new family practice or obstetrics and gynecology 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 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 ,training program requirements ,the recipient of a grant under subsection 7a77#a7 or 7a77#b7 shall ensure that training programs carried out under the grant are evidence-based and include instruction on-- 7,a7 maternal mental health1 including perinatal depression and anxiety2 7,b7 maternal substance use disorder2 7,c7 social determinants of health that impact individuals living in rural communities1 including poverty1 social isolation1 access to nutrition1 education1 transportation1 and housing2 and 7,d7 implicit bias4 7c7 ,eligible entities 7#a7 ,training for medical 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 or 7ii7 the sponsoring institution 7or parent institution of the sponsoring institution7 of-- 7,i7 an obstetrics and gynecology or family medicine 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 medical 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 freestanding birth center 7as defined in section #aije7l77#c7 of the ,social ,security ,act72 or 7,f7 an ,indian ,health ,program or a ,native ,hawaiian health care system 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act and section #ab of the ,native ,hawaiian ,health ,care ,improvement ,act1 respectively74 7#c7 ,academic units or programs ,to be eligible to receive a grant under subsection 7a77#c71 an entity shall be a school of medicine1 a school of osteopathic medicine1 a school of nursing 7as defined in section #hja71 a physician assistant education program1 an accredited public or nonprofit private hospital1 an accredited medical residency training program1 a school accredited by the ,midwifery ,education and ,accreditation ,council1 by the ,accreditation ,commission for ,midwifery ,education1 or by the ,american ,midwifery ,certification ,board1 or a public or private nonprofit educational entity which the ,secretary has determined is capable of carrying out such grant4 7#d7 ,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 require1 including an estimate of the amount to be expended to conduct training activities under the grant 7including ancillary and administrative costs74 7d7 ,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 for the duration of the grant1 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 the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate 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 maternal 7including prenatal1 labor and birth1 and postpartum7 care services 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 demonstration2 and 7,c7 recommendations on whether the demonstration program should be expanded4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #e1jjj1jjj for each of fiscal years #bjbj through #bjbd4 4 #aje4 ,,gao report ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on maternal care in rural areas1 including prenatal1 labor and birth1 and postpartum care in rural areas4 ,such report shall include the following3 7#a7 ,trends in data that may identify potential gaps in maternal and obstetric clinicians and health professionals1 including non-clinical professionals4 7#b7 ,trends in the number of facilities able to provide maternal care1 including prenatal1 labor and birth1 and postpartum care1 in rural areas1 including care for high-risk pregnancies4 7#c7 ,the gaps in data on maternal mortality and morbidity and recommendations to standardize the format on collecting data related to maternal mortality and morbidity4 7#d7 ,the gaps in maternal health outcomes by race and ethnicity in rural communities1 with a focus on racial inequities for residents who are racial and ethnic minorities or members of underserved populations4 7#e7 ,an examination of-- 7,a7 activities which the ,secretary of ,health and ,human ,services plans to conduct to improve maternal care in rural areas1 including prenatal1 labor and birth1 and postpartum care2 and 7,b7 the extent to which the ,secretary has a plan for completing these activities1 has identified the lead agency responsible for each activity1 has identified any needed coordination among agencies1 and has developed a budget for conducting such activities4 7#f7 ,other information that the ,comptroller ,general determines appropriate4 ,,ii ,other ,improvements to ,maternal ,care #bja4 ,innovation for maternal health ,the ,public ,health ,service ,act is amended-- 7#a7 in the section designation of section #ccj,m 7#db ,u4,s4,c4 #bed;c-#ai7 by inserting a period after #ccj,m2 and 7#b7 by inserting after such section #ccj,m 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 purpose 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 in 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 is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjbj through #bjbd4 4 #bjb4 ,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 is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjbj through #bjbd4 4 #bjc4 ,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 7referred to in this section as the ,secretary7 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 #bjd4 ,perinatal quality collaboratives 7a7 ,grants ,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 7b7 ,authorization of appropriations ,section #cag,k7f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;f77 is amended by striking #eh1jjj1jjj for each of fiscal years #bjai through #bjbc and inserting #fe1jjj1jjj for each of fiscal years #bjbj through #bjbd4 #bje4 ,integrated services for pregnant and postpartum women 7a7 ,grants ,the ,public ,health ,service ,act is amended by inserting after section #ccj,n of such ,act1 as added by section #bja1 the following3 #ccj,o4 ,integrated services for pregnant and postpartum women 7a7 ,in general ,the ,secretary may award grants 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-- 7#a7 to reduce adverse maternal health outcomes1 pregnancy-related deaths1 and related health disparities 7including such disparities associated with racial and ethnic minority populations72 and 7#b7 as appropriate1 by addressing issues researched under section #cag,k7b77#b74 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 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act7 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 those representing racial and ethnicity 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 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjbj through #bjbd4 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 ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report that describes-- 7,a7 the outcomes of the activities supported by the grants awarded under the amendments made by this section on maternal and child health2 7,b7 best practices and models of care used by recipients of grants under such amendments2 and 7,c7 obstacles identified by recipients of grants under such amendments1 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 section #ccj,o of the ,public ,health ,service ,act 7as added by this section7 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 ,september #ag1 #bjbj,reported with an amendment2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed