,,ii #aafth ,,congress #ast ,session ,s4 #bcgc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ca1 #bjai,ms4 ,smith 7for herself1 ,ms4 ,murkowski1 ,mr4 ,jones1 and ,mrs4 ,capito7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,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 sociocultural 7race1 ethnicity1 language1 class1 income71 including among ,american ,indians and ,alaska ,natives1 as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act1 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,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 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 ,rural ,obstetric ,network ,grants ,the ,public ,health ,service ,act is amended by inserting after section #cag,l-#a 7#db ,u4,s4,c4 #bdg;b-#ac;a7 the following3 #cag,l-#b4 ,rural ,obstetric ,network ,grants 7a7 ,in general ,for the purpose of enabling the ,secretary 7through grants1 contracts1 or otherwise71 acting through the ,administrator of the ,health ,resources and ,services ,administration1 to establish collaborative improvement and innovation networks 7referred to in this section as rural obstetric networks7 to improve 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 #bjbj through #bjbd4 ,such amounts shall remain available until expended4 7b7 ,use of funds ,amount appropriated under subsection 7a7 shall be used for the establishment of collaborative improvement and innovation networks to improve maternal health in rural areas by improving outcomes in birth and maternal morbidity and mortality4 ,rural obstetric networks established in accordance with this section shall-- 7#a7 assist pregnant women and individuals in rural areas connect with prenatal1 labor and birth1 and postpartum care to improve outcomes in birth and maternal mortality and morbidity2 7#b7 identify successful prenatal1 labor and birth1 and postpartum health delivery models for individuals in rural areas1 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 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 7#e7 collaborate with academic institutions that can provide regional expertise and research on access1 outcomes1 needs assessments1 and other identified data2 and 7#f7 measure and address inequities in birth outcomes among rural residents1 with an emphasis on ,black and ,american ,indians and ,alaska ,native residents1 as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act4 7c7 ,requirements 7#a7 ,establishment ,not later than ,october #a1 #bjbj1 the ,secretary shall establish rural obstetric health networks in at least #e regions4 7#b7 ,definitions ,in this section3 7,a7 ,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,b7 ,indian tribe ,the term ,indian tribe has the meaning given such term in section #d of the ,indian ,health ,care ,improvement ,act4 7,c7 ,native ,hawaiian health care system ,the term ,native ,hawaiian ,health ,care ,system has the meaning given such term in section #ab of the ,native ,hawaiian ,health ,care ,improvement ,act4 7,d7 ,region ,the term region means a ,state1 ,indian tribe1 rural area1 or frontier area4 7,e7 ,rural area ,the term rural area has the meaning given that term in section #ahhf7;d77#b77;,d7 of the ,social ,security ,act4 7,f7 ,tribal organization ,the term tribal organization has the meaning given such term in the ,indian ,self-,determination ,act4 7,g7 ,state ,the term ,state has the meaning given that term for purposes of title ,v of the ,social ,security ,act4 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 prenatal1 labor and birth1 and postpartum care services and entities operation obstetric care units4 2 7#b7 in subsection 7i77#a77;,b71 by inserting labor and birth1 postpartum1 before or prenatal2 and 7#c7 in subsection 7k77#a77;,b71 by inserting equipment useful for caring for pregnant women and individuals1 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 medicine and obstetrics and gynecology residents1 and fellows to practice maternal and obstetric medicine in rural community-based settings2 7#b7 training for licensed and accredited nurse practitioners1 physician assistants1 certified nurse midwives1 certified midwives1 certified professional midwives1 home visiting nurses1 or non-clinical professionals such as doulas and community health workers1 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 ,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 the ,accreditation ,commission for ,midwifery ,education1 or the ,accreditation ,review ,commission on ,education for the ,physician ,assistant7 to carry out activities under subsection 7a77#c74 7#d7 ,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 include instruction on-- 7,a7 maternal mental health1 including perinatal depression and anxiety and postpartum depression2 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 7,f7 a health center operated by the ,indian ,health ,service1 an ,indian tribe1 a tribal organization1 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 ,act72 or 7,g7 an entity with a demonstrated record of success in providing academic training for nurse practitioners1 physician assistants1 certified nurse-midwives1 certified midwives1 certified professional midwives1 home visiting nurses1 or non-clinical professionals1 such as doulas and community health workers4 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 a school accredited by the ,midwifery ,education and ,accreditation ,council1 or a public or private nonprofit 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 ,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 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 ,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 prenatal1 labor and birth1 and postpartum 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 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #e1jjj1jjj for each of fiscal years #bjbj through #bjbd4 4 #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 prenatal1 labor and birth1 and postpartum care in rural areas4 ,such report shall include the following3 7#a7 ,the location of gaps in maternal and obstetric clinicians and health professionals1 including non-clinical professionals such as doulas and community health workers4 7#b7 ,the location of gaps in facilities able to provide maternal1 including prenatal1 labor and birth1 and postpartum care in rural areas1 including care for high-risk pregnancies4 7#c7 ,the gaps in data on maternal mortality and recommendations to standardize the format on collecting data related to maternal mortality and morbidity4 7#d7 ,the gaps in maternal health by race and ethnicity in rural communities1 with a focus on racial inequities for ,black residents and among ,indian ,tribes and ,american ,indian_/,alaska ,native rural residents 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act74 7#e7 ,a list of specific activities that the ,secretary of ,health and ,human ,services plans to conduct on maternal1 including prenatal1 labor and birth1 and postpartum care4 7#f7 ,a plan for completing such activities4 7#g7 ,an explanation of ,federal agency involvement and coordination needed to conduct such activities4 7#h7 ,a budget for conducting such activities4 7#i7 ,other information that the ,comptroller ,general determines appropriate4