,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bcgc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #ca1 #bjai,ms4   
,smi? 7= h]self1 ,ms4 ,murk[ski1 ,mr4   
,jones1 & ,mrs4 ,capito7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to am5d 
! ,public ,heal? ,s]vice ,act to improve
 ob/etric c>e 9 rural areas4  #a4 ,%ort 
title ,?is ,act may be cit$ z ! ,rural  
,mat]nal & ,ob/etric ,mod]nization (    
,s]vices ,act or ! ,rural ,,moms ,act4  
#b4 ,improv+ rural mat]nal & ob/etric   
c>e data  7a7 ,mat]nal mortality &      
morbidity activities ,section #cja ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bda7 is am5d$-- 7#a7 by      
r$esignat+ subsections 7e7 ?r\gh 7h7 z  
subsections 7f7 ?r\gh 7i71 respectively2
 &  7#b7 by ins]t+ aft] subsection 7d71 
! foll[+3  7e7 ,! ,secret>y1 act+ ?r\gh 
! ,director ( ! ,c5t]s = ,disease       
,control & ,prev5tion1 %all exp&1       
int5sify1 & coord9ate ! activities ( !  

,c5t]s = ,disease ,control & ,prev5tion 
) respect to mat]nal mortality &        
morbidity4  4  7b7 ,(fice ( ,wom5's     
,heal? ,section #caj;,a7b77#a7 ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bdbs7b77#a77 is am5d$ by     
ins]t+ sociocultural 7race1 e?nicity1   
language1 class1 income71 includ+ among 
,am]ican ,indians & ,alaska ,natives1 z 
su* t]ms are def9$ 9 section #d ( !     
,indian ,heal? ,c>e ,improvem5t ,act1 & 
geographic contexts1 aft] biological14  
7c7 ,safe mo!rhood ,section             
#cag,k7b77#b7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;b77#b77
 is am5d$-- 7#a7 9 subp>agraph 7,l71 by 
/rik+ & at ! end2  7#b7 by r$esignat+   
subp>agraph 7,m7 z subp>agraph 7,n72 &  
7#c7 by ins]t+ aft] subp>agraph 7,l71 ! 
foll[+3  7,m7 an exam9ation ( !         
relation%ip betwe5 mat]nal heal? s]vices
 9 rural areas & outcomes 9 deliv]y &   
po/p>tum c>e2 &  4  7d7 ,(fice ( ,rese>*
 on ,wom5's ,heal? ,section #dhf ( !    
,public ,heal? ,s]vice ,act 7#db        

,u4,s4,c4 #bhg;d7 is am5d$-- 7#a7 9     
subsection 7b7--  7,a7 by r$esignat+    
p>agraphs 7#d7 ?r\gh 7#i7 z p>agraphs   
7#e7 ?r\gh 7#aj71 respectively2  7,b7 by
 ins]t+ aft] p>agraph 7#c7 ! foll[+3    
7#d7 c>ry out p>agraphs 7#a7 & 7#b7 )   
respect to pregnancy1 ) priority giv5 to
 dea?s relat$ to pregnancy2  2 &  7,c7 9
 p>agraph 7#e7 7z s r$esignat$71 by     
/rik+ ?r\gh 7#c7 & ins]t+ ?r\gh 7#d72 & 
7#b7 9 subsection 7d77#d77;,a77iv71 by  
ins]t+ 1 includ+ mat]nal mortality & o!r
 mat]nal morbidity outcomes be=e !      
semicolon4  #c4 ,rural ,ob/etric        
,network ,grants ,! ,public ,heal?      
,s]vice ,act is am5d$ by ins]t+ aft]    
section #cag,l-#a 7#db ,u4,s4,c4        
#bdg;b-#ac;a7 ! foll[+3  #cag,l-#b4     
,rural ,ob/etric ,network ,grants  7a7  
,9 g5]al ,= ! purpose ( enabl+ !        
,secret>y 7?r\gh grants1 contracts1 or  
o!rwise71 act+ ?r\gh ! ,adm9i/rator ( ! 
,heal? ,res\rces & ,s]vices             
,adm9i/ration1 to e/abli% collaborative 
improvem5t & innovation networks 7ref]r$

 to 9 ?is section z rural ob/etric      
networks7 to improve outcomes 9 bir? &  
mat]nal morbidity & mortality1 !re is   
appropriat$ to ! ,secret>y1 out ( any   
money 9 ! ,treasury n o!rwise           
appropriat$1 #c1jjj1jjj = ea* ( fiscal  
ye>s #bjbj ?r\gh #bjbd4 ,su* am\nts %all
 rema9 available until exp5d$4  7b7 ,use
 ( funds ,am\nt appropriat$ "u          
subsection 7a7 %all be us$ = !          
e/abli%m5t ( collaborative improvem5t & 
innovation networks to improve mat]nal  
heal? 9 rural areas by improv+ outcomes 
9 bir? & mat]nal morbidity & mortality4 
,rural ob/etric networks e/abli%$ 9     
accordance ) ?is section %all--  7#a7   
assi/ pregnant wom5 & individuals 9     
rural areas connect ) pr5atal1 labor &  
bir?1 & po/p>tum c>e to improve outcomes
 9 bir? & mat]nal mortality & morbidity2
  7#b7 id5tify successful pr5atal1 labor
 & bir?1 & po/p>tum heal? deliv]y models
 = individuals 9 rural areas1 includ+   
evid5ce-bas$ home visit+ programs &     
successful1 culturally compet5t models )

 positive mat]nal heal? outcomes t      
advance heal? equity2  7#c7 develop a   
model = collaboration betwe5 heal?      
facilities t h an ob/etric heal? unit & 
heal? facilities t d n h an ob/etric    
heal? unit2  7#d7 provide tra9+ &       
guidance = heal? facilities t d n h     
ob/etric heal? units2  7#e7 collaborate 
) academic in/itutions t c provide      
regional exp]tise & rese>* on access1   
outcomes1 ne$s assessm5ts1 & o!r        
id5tifi$ data2 &  7#f7 measure & address
 inequities 9 bir? outcomes among rural 
resid5ts1 ) an emphasis on ,black &     
,am]ican ,indians & ,alaska ,native     
resid5ts1 z su* t]ms are def9$ 9 section
 #d ( ! ,indian ,heal? ,c>e ,improvem5t 
,act4  7c7 ,requirem5ts  7#a7           
,e/abli%m5t ,n lat] ?an ,octob] #a1     
#bjbj1 ! ,secret>y %all e/abli% rural   
ob/etric heal? networks 9 at lea/ #e    
regions4  7#b7 ,def9itions ,9 ?is       
section3 7,a7 ,fronti] area ,! t]m      
fronti] area means a fronti] c\nty1 z   
def9$ 9 section                         

#ahhf7;d77#c77;,e77iii77,,iii7 ( !      
,social ,security ,act4  7,b7 ,indian   
tribe ,! t]m ,indian tribe has ! mean+  
giv5 su* t]m 9 section #d ( ! ,indian   
,heal? ,c>e ,improvem5t ,act4  7,c7     
,native ,hawaiian heal? c>e sy/em ,! t]m
 ,native ,hawaiian ,heal? ,c>e ,sy/em   
has ! mean+ giv5 su* t]m 9 section #ab (
 ! ,native ,hawaiian ,heal? ,c>e        
,improvem5t ,act4  7,d7 ,region ,! t]m  
region means a ,/ate1 ,indian tribe1    
rural area1 or fronti] area4  7,e7      
,rural area ,! t]m rural area has !     
mean+ giv5 t t]m 9 section              
#ahhf7;d77#b77;,d7 ( ! ,social ,security
 ,act4  7,f7 ,tribal organization ,! t]m
 tribal organization has ! mean+ giv5   
su* t]m 9 ! ,indian ,self-,det]m9ation  
,act4  7,g7 ,/ate ,! t]m ,/ate has !    
mean+ giv5 t t]m = purposes ( title ,v (
 ! ,social ,security ,act4  4  #d4      
,teleheal? network & teleheal? res\rce  
c5t]s grant programs ,section #ccj;,i ( 
! ,public ,heal? ,s]vice ,act 7#db      
,u4,s4,c4 #bed;c-#ad7 is am5d$-- 7#a7 9 

subsection 7f77#a77;,b77iii71 by add+ at
 ! end ! foll[+3  7,,xiii7 ,provid]s (  
mat]nal1 includ+ pr5atal1 labor & bir?1 
& po/p>tum c>e s]vices & entities       
op]ation ob/etric c>e units4  2  7#b7 9 
subsection 7i77#a77;,b71 by ins]t+ labor
 & bir?1 po/p>tum1 be=e or pr5atal2 &   
7#c7 9 subsection 7k77#a77;,b71 by      
ins]t+ equipm5t useful = c>+ = pregnant 
wom5 & individuals1 includ+ ultras\nd   
ma*9es & fetal monitor+ equipm5t1 be=e &
 o!r equipm5t4  #e4 ,rural mat]nal &    
ob/etric c>e tra9+ demon/ration ,"p ,d (
 title ,,vii ( ! ,public ,heal? ,s]vice 
,act is am5d$ by ins]t+ aft] section    
#gfj 7#db ,u4,s4,c4 #bidk7 ! foll[+3    
#gfj;,a4 ,rural mat]nal & ob/etric c>e  
tra9+ demon/ration  7a7 ,9 g5]al ,!     
,secret>y %all e/abli% a tra9+          
demon/ration program to aw>d grants to  
eligible entities to support--  7#a7    
tra9+ = physicians1 m$ical resid5ts1    
includ+ family m$ic9e & ob/etrics &     
gynecology resid5ts1 & fell[s to        
practice mat]nal & ob/etric m$ic9e 9    

rural community-bas$ sett+s2  7#b7 tra9+
 = lic5s$ & accr$it$ nurse practition]s1
 physician assi/ants1 c]tifi$ nurse     
midwives1 c]tifi$ midwives1 c]tifi$     
pr(essional midwives1 home visit+       
nurses1 or non-cl9ical pr(essionals su* 
z d\las & community heal? work]s1 to    
provide mat]nal c>e s]vices 9 rural     
community-bas$ sett+s2 &  7#c7 e/abli%+1
 ma9ta9+1 or improv+ academic units or  
programs t-- 7,a7 provide tra9+ = /ud5ts
 or faculty1 includ+ ?r\gh cl9ical      
exp]i5ces & rese>*1 to improve mat]nal  
c>e 9 rural areas2 or  7,b7 develop     
evid5ce-bas$ practices or recomm5dations
 = ! design ( ! units or programs       
describ$ 9 subp>agraph 7,a71 includ+    
curriculum cont5t /&>ds4  7b7           
,activities  7#a7 ,tra9+ = m$ical       
resid5ts & fell[s ,a recipi5t ( a grant 
"u subsection 7a77#a7-- 7,a7 %all use ! 
grant funds--  7i7 to plan1 develop1 &  
op]ate a tra9+ program to provide       
ob/etric c>e 9 rural areas = family     
practice or ob/etrics & gynecology      

resid5ts & fell[s2 or  7ii7 to tra9 new 
family practice or ob/etrics &          
gynecology resid5ts & fell[s 9 mat]nal &
 ob/etric heal? c>e to provide & exp&   
access to mat]nal & ob/etric heal? c>e 9
 rural areas2 &  7,b7 may use ! grant   
funds to provide additional support = ! 
adm9i/ration ( ! program or to meet !   
co/s ( projects to e/abli%1 ma9ta91 or  
improve faculty developm5t1 or          
dep>tm5ts1 divisions1 or o!r units      
necess>y to implem5t su* tra9+4  7#b7   
,tra9+ = o!r provid]s ,a recipi5t ( a   
grant "u subsection 7a77#b7-- 7,a7 %all 
use ! grant funds to plan1 develop1 or  
op]ate a tra9+ program to provide       
mat]nal heal? c>e s]vices 9 rural1      
community-bas$ sett+s2 &  7,b7 may use !
 grant funds to provide additional      
support = ! adm9i/ration ( ! program or 
to meet ! co/s ( projects to e/abli%1   
ma9ta91 or improve faculty developm5t1  
or dep>tm5ts1 divisions1 or o!r units   
necess>y to implem5t su* program4  7#c7 
,academic units or programs ,a recipi5t 

( a grant "u subsection 7a77#c7 %all    
ent] into a p>tn]%ip ) organizations su*
 z an education accr$it+ organization   
7su* z ! ,liaison ,committee on ,m$ical 
,education1 ! ,accr$itation ,c\ncil =   
,graduate ,m$ical ,education1 !         
,commission on ,o/eopa?ic ,college      
,accr$itation1 ! ,accr$itation          
,commission = ,education 9 ,nurs+1 !    
,commission on ,collegiate ,nurs+       
,education1 ! ,accr$itation ,commission 
= ,midwif]y ,education1 or !            
,accr$itation ,review ,commission on    
,education = ! ,physician ,assi/ant7 to 
c>ry out activities "u subsection       
7a77#c74  7#d7 ,tra9+ program           
requirem5ts ,! recipi5t ( a grant "u    
subsection 7a77#a7 or 7a77#b7 %all      
ensure t tra9+ programs c>ri$ out "u !  
grant include in/ruction on--  7,a7     
mat]nal m5tal heal?1 includ+ p]9atal    
depression & anxiety & po/p>tum         
depression2  7,b7 mat]nal sub/ance use  
disord]2  7,c7 social det]m9ants ( heal?
 t impact individuals liv+ 9 rural      

communities1 includ+ pov]ty1 social     
isolation1 access to nutrition1         
education1 transportation1 & h\s+2 &    
7,d7 implicit bias4  7c7 ,eligible      
entities  7#a7 ,tra9+ = m$ical resid5ts 
& fell[s ,to be eligible to receive a   
grant "u subsection 7a77#a71 an entity  
%all--  7,a7 be a consortium consi/+ (--
 7i7 at lea/ "o tea*+ heal? c5t]2 or    
7ii7 ! sponsor+ in/itution 7or p>5t     
in/itution ( ! sponsor+ in/itution7 (-- 
7,i7 an ob/etrics & gynecology or family
 m$ic9e resid5cy program t is accr$it$  
by ! ,accr$itation ,c\ncil ( ,graduate  
,m$ical ,education 7or ! p>5t in/itution
 ( su* a program72 or  7,,ii7 a fell[%ip
 9 mat]nal or ob/etric m$ic9e1 z det]m9$
 appropriate by ! ,secret>y2 or  7,b7 be
 an entity describ$ 9 subp>agraph       
7,a77ii7 t provides opportunities =     
m$ical resid5ts or fell[s to tra9 9     
rural community-bas$ sett+s4  7#b7      
,tra9+ = o!r provid]s ,to be eligible to
 receive a grant "u subsection 7a77#b71 
an entity %all be-- 7,a7 a tea*+ heal?  

c5t] 7z def9$ 9 section #gdi;,a7f772    
7,b7 a f$]ally qualifi$ heal? c5t] 7z   
def9$ 9 section #aije7l77#b77;,b7 ( !   
,social ,security ,act72  7,c7 a        
community m5tal heal? c5t] 7z def9$ 9   
section #ahfa7;ff77#c77;,b7 ( ! ,social 
,security ,act72  7,d7 a rural heal?    
cl9ic 7z def9$ 9 section #ahfa7;aa7 ( ! 
,social ,security ,act72  7,e7 a free/&+
 bir? c5t] 7z def9$ 9 section           
#aije7l77#c7 ( ! ,social ,security      
,act72  7,f7 a heal? c5t] op]at$ by !   
,indian ,heal? ,s]vice1 an ,indian      
tribe1 a tribal organization1 or a      
,native ,hawaiian ,heal? ,c>e ,sy/em 7z 
su* t]ms are def9$ 9 section #d ( !     
,indian ,heal? ,c>e ,improvem5t ,act &  
section #ab ( ! ,native ,hawaiian ,heal?
 ,c>e ,improvem5t ,act72 or  7,g7 an    
entity ) a demon/rat$ record ( success 9
 provid+ academic tra9+ = nurse         
practition]s1 physician assi/ants1      
c]tifi$ nurse-midwives1 c]tifi$         
midwives1 c]tifi$ pr(essional midwives1 
home visit+ nurses1 or non-cl9ical      

pr(essionals1 su* z d\las & community   
heal? work]s4  7#c7 ,academic units or  
programs ,to be eligible to receive a   
grant "u subsection 7a77#c71 an entity  
%all be a s*ool ( m$ic9e or o/eopa?ic   
m$ic9e1 a nurs+ s*ool1 a physician      
assi/ant tra9+ program1 an accr$it$     
public or nonpr(it private hospital1 an 
accr$it$ m$ical resid5cy program1 a     
s*ool accr$it$ by ! ,midwif]y ,education
 & ,accr$itation ,c\ncil1 or a public or
 private nonpr(it entity :i* ! ,secret>y
 has det]m9$ is capable ( c>ry+ out su* 
grant4  7#d7 ,application ,to be        
eligible to receive a grant "u          
subsection 7a71 an entity %all submit to
 ! ,secret>y an application at su* "t1 9
 su* mann]1 & conta9+ su* in=mation z ! 
,secret>y may require1 includ+ an       
e/imate ( ! am\nt to be exp5d$ to       
conduct tra9+ activities "u ! grant     
7includ+ ancill>y & adm9i/rative co/s74 
7d7 ,duration ,grants aw>d$ "u ?is      
section %all be = a m9imum ( #e ye>s4   
7e7 ,/udy & report  7#a7 ,/udy  7,a7 ,9 

g5]al ,! ,secret>y1 act+ ?r\gh !        
,adm9i/rator ( ! ,heal? ,res\rces &     
,s]vices ,adm9i/ration1 %all conduct a  
/udy on ! results ( ! demon/ration      
program "u ?is section4  7,b7 ,data     
submission ,n lat] ?an #ij days aft] !  
completion ( ! fir/ ye> ( ! tra9+       
program1 & ea* subsequ5t ye> = !        
duration ( ! grant1 t ! program is 9    
effect1 ea* recipi5t ( a grant "u       
subsection 7a7 %all submit to !         
,secret>y su* data z ! ,secret>y may    
require = analysis = ! report describ$ 9
 p>agraph 7#b74  7#b7 ,report to        
,congress ,n lat] ?an #a ye> aft]       
receipt ( ! data describ$ 9 p>agraph    
7#a77;,b71 ! ,secret>y %all submit to   
,congress a report t includes--  7,a7 an
 analysis ( ! effect ( ! demon/ration   
program "u ?is section on ! quality1    
quantity1 & di/ribution ( mat]nal1      
includ+ pr5atal1 labor & bir?1 &        
po/p>tum c>e s]vices & ! demographics ( 
! recipi5ts ( ^? s]vices2  7,b7 an      
analysis ( mat]nal & infant heal?       

outcomes 7includ+ quality ( c>e1        
morbidity1 & mortality7 be=e & aft]     
implem5tation ( ! program 9 !           
communities s]v$ by entities p>ticipat+ 
9 ! demon/ration2 &  7,c7 recomm5dations
 on :e!r ! demon/ration program %\ld be 
exp&$4  7f7 ,au?orization (             
appropriations ,!re are au?oriz$ to be  
appropriat$ to c>ry out ?is section1    
#e1jjj1jjj = ea* ( fiscal ye>s #bjbj    
?r\gh #bjbd4  4  #f4 ,,gao report ,n    
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is ,act1 ! ,comptroll] ,g5]al ( !     
,unit$ ,/ates %all submit to !          
appropriate committees ( ,congress a    
report on ! mat]nal1 includ+ pr5atal1   
labor & bir?1 & po/p>tum c>e 9 rural    
areas4 ,su* report %all include !       
foll[+3  7#a7 ,! location ( gaps 9      
mat]nal & ob/etric cl9icians & heal?    
pr(essionals1 includ+ non-cl9ical       
pr(essionals su* z d\las & community    
heal? work]s4  7#b7 ,! location ( gaps 9
 facilities able to provide mat]nal1    
includ+ pr5atal1 labor & bir?1 &        

po/p>tum c>e 9 rural areas1 includ+ c>e 
= high-risk pregnancies4  7#c7 ,! gaps 9
 data on mat]nal mortality &            
recomm5dations to /&>dize ! =mat on     
collect+ data relat$ to mat]nal         
mortality & morbidity4  7#d7 ,! gaps 9  
mat]nal heal? by race & e?nicity 9 rural
 communities1 ) a focus on racial       
inequities = ,black resid5ts & among    
,indian ,tribes & ,am]ican              
,indian_/,alaska ,native rural resid5ts 
7z su* t]ms are def9$ 9 section #d ( !  
,indian ,heal? ,c>e ,improvem5t ,act74  
7#e7 ,a li/ ( specific activities t !   
,secret>y ( ,heal? & ,human ,s]vices    
plans to conduct on mat]nal1 includ+    
pr5atal1 labor & bir?1 & po/p>tum c>e4  
7#f7 ,a plan = complet+ su* activities4 
7#g7 ,an explanation ( ,f$]al ag5cy     
involvem5t & coord9ation ne$$ to conduct
 su* activities4  7#h7 ,a budget =      
conduct+ su* activities4  7#i7 ,o!r     
in=mation t ! ,comptroll] ,g5]al        
det]m9es appropriate4