,,ii ,cal5d> ,no4 #ebe #aai? ,,congress 
#b;d ,session  ,s4 #chj  ,,9 ,,! ,,s5ate
 ,,( ,,! ,,unit$ ,,/ates  ,febru>y #d1  
#bjbe,ms4 ,hassan 7= h]self1 ,ms4       
,coll9s1 ,mrs4 ,britt1 ,ms4 ,smi?1 ,mrs4
 ,capito1 ,ms4 ,cantwell1 ,mr4 ,coons1 &
 ,mr4 ,ju/ice7 introduc$ ! foll[+ bill2 
:i* 0 read twice & ref]r$ to !          
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions  ,july #bh1          
#bjbf,report$ by ,mr4 ,cassidy1 ) an    
amendment,strike out all aft] ! enact+  
clause & ins]t ! "p pr9t$ 9 italic  ,a  
,,bill  ,to improve ob/etric em]g5cy    
c>e4  #a4 ,%ort title ,?is ,act may be  
cit$ z ! ,rural ,ob/etrics ,read9ess    
,act4  #b4 ,ob/etric em]g5cy tra9+      
program ,section #ccj,o ( ! ,public     
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;c-#ba7 is am5d$-- 7#a7 9 subsection
 7a7-- 7,a7 9 p>agraph 7#c71 by /rik+ 2 
& & ins]t+ a semicolon2  7,b7 9 p>agraph
 7#d71 by /rik+ ! p]iod & ins]t+ 2 &2 & 
7,c7 by add+ at ! end ! foll[+3  7#e7   
develop+1 & facilitat+ access to1 an    

evid5ce-bas$ program to tra9            
practition]s 9 rural heal? c>e          
facilities )\t d$icat$ ob/etric units to
 provide em]g5cy ob/etric s]vices dur+  
pregnancy1 labor1 deliv]y1 or ! po/p>tum
 p]iod1 includ+ tra9+ on h[ to prep>e =1
 id5tify1 /abilize1 & safely transf]1 z 
appropriate & )9 ! scope ( practice ( an
 individual practition]1 a woman        
exp]i5c+ labor1 deliv]y1 ob/etric       
hemorrhage1 sev]e hyp]t5sion1 c>diac    
conditions1 p]9atal m5tal heal?         
conditions1 sub/ance use1 sepsis1 or o!r
 conditions1 z appropriate4  2  7#b7 by 
r$esignat+ subsections 7c7 & 7d7 z      
subsections 7d7 & 7e71 respectively2    
7#c7 by ins]t+ aft] subsection 7b7 !    
foll[+3  7c7 ,tra9+ program = eligible  
practition]s 9 rural heal? c>e          
facilities ,a tra9+ program describ$ 9  
subsection 7a77#e7 %all include an      
assessm5t ( ob/etric tra9+ ne$s = rural 
heal? c>e facilities )\t d$icat$        
ob/etric units4 ,9 develop+ ! tra9+     
program1 a recipi5t ( a grant "u su*    

subsection %all-- 7#a7 "w 9 consultation
 ) at lea/ "o repres5tative f a national
 m$ical society t has exp]i5ce or       
exp]tise 9 rural heal? c>e deliv]y 9 ea*
 ( ! fields ( gynecology & ob/etrics1   
em]g5cy m$ic9e1 family m$ic9e1 &        
ane/hesiology2 &  7#b7 facilitate access
 to ob/etric read9ess tra9+ via regional
 tra9+ p>tn]%ips & te*nical assi/ance to
 rural heal? c>e facilities4  2 &  7#d7 
9 subsection 7e71 z s r$esignat$1 by    
add+ at ! end ! foll[+3 ,9 addition to  
am\nts appropriat$ "u ! previ\s s5t5ce1 
= grants = ! purpose describ$ 9         
subsection 7a77#e71 !re are au?oriz$ to 
be appropriat$ #e1jjj1jjj = ! p]iod (   
fiscal ye>s #bjbf ?r\gh #bjbh4  #c4     
,grant fund+ = equipm5t & supplies ,"p  
,d ( title ,,iii ( ! ,public ,heal?     
,s]vice ,act 7#db ,u4,s4,c4 #bed;b et   
seq47 is am5d$ by ins]t+ aft] section   
#ccj;,a-#b ! foll[+3  #ccj;,a-#c4       
,program ( support = ob/etric s]vices   
7a7 ,9 g5]al ,! ,secret>y %all aw>d     
grants1 contracts1 or coop]ative        

agreem5ts to eligible entities to       
integrate ob/etric read9ess tra9+       
curriculum into rural heal? c>e sett+s1 
build work=ce capacity1 & pur*ase       
equipm5t necess>y to manage ob/etric    
em]g5cies4  7b7 ,use ( funds ,a recipi5t
 ( funds "u ?is section %all use su*    
funds = ! purpose describ$ 9 subsection 
7a71 :i* may include any ( ! foll[+3    
7#a7 ,pur*as+ or provid+ equipm5t &     
te*nical assi/ance to tra9 practition]s 
:o are n specializ$ 9 ob/etrics 9 prep>+
 =1 id5tify+1 /abiliz+1 & transf]r+1 z  
appropriate & )9 ! scope ( practice ( ! 
practition]1 individuals exp]i5c+       
ob/etric em]g5cies4  7#b7 ,pur*as+ or   
provid+ equipm5t necess>y to prep>e =1  
id5tify1 /abilize1 or transf]1 z        
appropriate1 individuals exp]i5c+       
ob/etric em]g5cies4  7#c7 ,develop+ &   
c>ry+ out protocols = transf] ( pati5ts 
to o!r facilities & network engagem5t ) 
o!r facilities4  7#d7 ,hir+ additional  
p]sonnel or pay+ ! sal>ies ( p]sonnel4  
7#e7 ,e/abli%+ tra9+ opportunities to   

enable non-ob/etric heal? pr(essionals  
to ga9 exposure to1 & exp]tise 91 !     
deliv]y ( ob/etric s]vices1 includ+     
?r\gh cl9ical rotations1 fell[%ips1 or  
cross-tra9+ cl9icians 9 o!r specialties4
  7#f7 ,enabl+ cl9ical educators to     
coord9ate1 develop1 & implem5t          
compreh5sive int]discipl9>y tra9+s1     
includ+ team-bas$ simulation tra9+ =    
provid]s :o may ne$ to respond to an    
ob/etric em]g5cy4  7c7 ,eligible        
entities ,to be eligible to receive a   
grant "u ?is section1 an entity %all--  
7#a7 be-- 7,a7 a rural hospital1        
critical access hospital 7z det]m9$ "u  
section #ahbj7;c77#b7 ( ! ,social       
,security ,act71 or a rural em]g5cy     
hospital 7z def9$ 9 section             
#ahfa7kkk77#b7 ( ! ,social ,security    
,act7 t is locat$ 9 a mat]nity c>e heal?
 pr(essional t>get area or a rural area 
7z def9$ by ! ,secret>y72 or  7,b7 a    
consortium ( #c entities t includes at  
lea/ #b entities describ$ 9 subp>agraph 
7,a72 &  7#b7 agree to c>ry out !       

program describ$ 9 subsection 7a71 9    
coord9ation ) o!r f$]ally fund$ mat]nal 
& *ild heal? programs1 to ! ext5t       
practicable1 & 9 consultation ) o!r     
mat]nal & *ild heal? programs 9 ! same  
geographic area4  7d7 ,def9itions ,9 ?is
 section-- 7#a7 ! t]m mat]nity c>e heal?
 pr(essional t>get area means a prim>y  
c>e heal? pr(essional %ortage area t is 
exp]i5c+ a %ortage ( mat]nity heal? c>e 
pr(essionals1 z id5tifi$ "u section     
#ccb7k72 &  7#b7 ! t]m rural area has ! 
mean+ giv5 su* t]m by ! ,f$]al ,(fice ( 
,rural ,heal? ,policy4  7e7             
,au?orization ( appropriations ,to c>ry 
out ?is section1 !re is au?oriz$ to be  
appropriat$ #ae1jjj1jjj = ! p]iod (     
fiscal ye>s #bjbf ?r\gh #bjbi4  4  #d4  
,pilot program = teleconsultation ,"p ,d
 ( title ,,iii ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #bed;b et   
seq471 is am5d$ by ins]t+ aft] section  
#ccj;,a-#c1 z add$ by section #c1 !     
foll[+3  #ccj;,a-#d4 ,pilot program =   
teleconsultation  7a7 ,9 g5]al ,!       

,secret>y1 act+ ?r\gh ! ,adm9i/rator ( !
 ,heal? ,res\rces & ,s]vices            
,adm9i/ration & 9 consultation ) !      
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 %all aw>d grants or  
coop]ative agreem5ts to ,/ates1         
political subdivisions ( ,/ates1 &      
,indian ,tribes & ,tribal organizations 
7z su* t]ms are def9$ 9 section #d ( !  
,indian ,self-,det]m9ation & ,education 
,assi/ance ,act7 to support ! provision 
( urg5t mat]nal heal? c>e 9 rural       
facilities )\t a d$icat$ ob/etric unit1 
includ+ by-- 7#a7 support+ ! developm5t 
( /atewide or regional mat]nal heal? c>e
 teleheal? access programs2 &  7#b7     
support+ ! improvem5t ( exi/+ /atewide  
or regional mat]nal heal? c>e teleheal? 
access programs describ$ 9 subsection   
7b74  7b7 ,/atewide or regional mat]nal 
heal? c>e teleheal? access programs ,a  
mat]nal heal? c>e teleheal? access      
program describ$ 9 ?is section1 )       
respect to :i* an aw>d "u subsection 7a7
 may be us$1 %all-- 7#a7 be a /atewide  

or regional network ( mat]nal heal? c>e 
teams t provide urg5t support to rural  
non-ob/etric sett+s ( c>e2  7#b7 support
 & fur!r develop organiz$ ,/ate or      
regional networks ( mat]nal heal? c>e   
teams to provide urg5t consultative     
support to rural non-ob/etric sett+s (  
c>e2  7#c7 conduct an assessm5t ( urg5t 
mat]nal heal? consultation ne$s among   
provid]s 9 rural non-ob/etric sett+s (  
c>e2  7#d7 provide assurances t !       
physicians responsive to !              
tele-consultation l9e are cr$5tial$ )9  
_! employ+ facility & c provide         
consultation :]e ! pati5t is receiv+ c>e
 consi/5t ) ,/ate requirem5ts to provide
 c>e to individuals exp]i5c+ labor1     
deliv]y1 ob/etric hemorrhage1 sev]e     
hyp]t5sion 9 pregnancy & po/p>tum1      
c>diac conditions relat$ to or exac]bat$
 by pregnancy1 p]9atal m5tal heal?      
conditions1 sub/ance use dur+ pregnancy 
or ! po/p>tum p]iod1 sepsis dur+        
pregnancy or aft] pregnancy end1 or o!r 
conditions1 z appropriate2  7#e7 provide

 rapid /atewide or regional cl9ical     
telephone or teleheal? consultations :5 
reque/$ betwe5 ! mat]nal c>e teams &    
provid]s 9 rural em]g5cy non-ob/etric   
sett+s2 &  7#f7 provide in=mation to    
heal? c>e provid]s ab\t available       
mat]nal heal? s]vices = p 9 ! community 
& assi/ ) ref]rals to specialty c>e &   
community or behavioral heal? res\rces4 
7c7 ,report+ ,an entity receiv+ an aw>d 
"u ?is section %all submit a report to !
 ,secret>y1 9 su* mann] & conta9+ su*   
in=mation z ! ,secret>y may require1 n  
lat] ?an #ah mon?s aft] initial receipt 
( ! grant4  7d7 ,au?orization (         
appropriations ,to c>ry out ?is section1
 !re is au?oriz$ to be appropriat$      
#e1jjj1jjj = ! p]iod ( fiscal ye>s #bjbf
 ?r\gh #bjbi4  4  #e4 ,/udy on ob/etric 
units 9 rural areas ,! ,secret>y (      
,heal? & ,human ,s]vices %all-- 7#a7    
conduct a /udy t maps mat]nity w>d      
closures & regional patt]ns ( pati5t    
transport & exam9es models = regional   
p>tn]%ips = rural ob/etric c>e2 &  7#b7 

n lat] ?an #c ye>s aft] ! date (        
enactm5t ( ?is ,act1 submit to !        
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions ( ! ,s5ate & !       
,committee on ,en]gy & ,comm]ce & !     
,committee on ,education & ,work=ce ( ! 
,h\se ( ,repres5tatives1 a report on !  
results ( ! /udy conduct$ "u p>agraph   
7#a74  #a4 ,%ort title ,?is ,act may be 
cit$ z ! ,rural ,ob/etrics ,read9ess    
,act4  #b4 ,rural ob/etric m$ical       
em]g5cy tra9+ ,section #ccj;,a-#b ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bed;c-#a;b7 is am5d$-- 7#a7 9
 subsection 7b7-- 7,a7 by am5d+ p>agraph
 7#c7 to read z foll[s3  7#c7 develop a 
model = mat]nal heal? c>e collaboration 
betwe5 heal? c>e sett+s to improve      
access to c>e1 includ+ /abiliz+ pr5atal 
c>e1 labor c>e1 bir?+1 & po/p>tum c>e   
s]vices dur+ ob/etric em]g5cies1 9 areas
 describ$ 9 subsection 7a7 t d n h      
specialty mat]nity c>e or d$icat$       
ob/etric units1 :i* may include ! use ( 
teleheal?2  2 &  7,b7 by am5d+ p>agraph 

7#d7 to read z foll[s3  7#d7 provide    
tra9+ = pr(essionals 9 areas describ$ 9 
subsection 7a7 t d n h specialty        
mat]nity c>e or d$icat$ ob/etric units1 
includ+ provid+ tra9+ 9 /abiliz+ pr5atal
 c>e1 labor c>e1 bir?+1 & po/p>tum c>e  
dur+ ob/etric em]g5cies2  2  7,c7 9     
p>agraph 7#e71 by /rik+ 2 & & ins]t+ a  
semicolon2  7,d7 9 p>agraph 7#f71 by    
/rik+ ! p]iod & ins]t+ 2 &2 &  7,e7 by  
add+ at ! end ! foll[+3  7#g7 develop   
ob/etric read9ess programs1 9 areas     
describ$ 9 subsection 7a7 t d n h       
specialty mat]nity c>e or d$icat$       
ob/etric units1 t provide te*nical      
assi/ance necess>y to provide /abiliz+  
pr5atal c>e1 labor c>e1 bir?+1 &        
po/p>tum c>e s]vices dur+ ob/etric      
em]g5cies4  2  7#b7 9 subsection 7d7--  
7,a7 9 ! subsection head+1 by /rik+     
,report & ins]t+ ,reports2  7,b7 9 !    
matt] prec$+ p>agraph 7#a71 by /rik+    
#bjbf1 & ins]t+ #bjbh1 & e #b ye>s      
!reaft]12  7,c7 9 p>agraph 7#a7-- 7i7 by
 /rik+ 7#f7 & ins]t+ 7#g72 &  7ii7 by   

/rik+ 2 & & ins]t+ a semicolon2  7,d7 9 
p>agraph 7#b71 by /rik+ ! p]iod at ! end
 & ins]t+ 2 &2 &  7,e7 by add+ at ! end 
! foll[+3  7#c7 a /udy t maps mat]nity  
w>d closures & regional patt]ns ( pati5t
 transport & exam9es models = regional  
p>tn]%ips = rural ob/etric c>e4  2  7#c7
 by r$esignat+ subsection 7e7 z         
subsection 7f72  7#d7 by ins]t+ aft]    
subsection 7d7 ! foll[+3  7e7           
,allocation  7#a7 ,9 g5]al ,subject to !
 availability ( appropriations1 !       
,secret>y %all aw>d a total ( n less ?an
 #b1jjj1jjj p] fiscal ye> 9 grants or   
coop]ative agreem5ts "u ?is section to  
eligible entities = purposes ( c>ry+ out
 activities describ$ 9 p>agraph 7#c71   
7#d71 or 7#g7 ( subsection 7b74  7#b7   
,limitation ,p>agraph 7#a7 %all n apply 
to a fiscal ye> unless ! am\nt made     
available to c>ry out ?is section = su* 
fiscal ye> exce$s ! am\nt appropriat$ to
 c>ry out ?is section = fiscal ye>      
#bjbf4  2 &  7#e7 9 subsection 7f71 z s 
r$esignat$1 by ins]t+ 1 & #ae1jjj1jjj = 

ea* ( fiscal ye>s #bjbh ?r\gh #bjcb be=e
 ! p]iod at ! end4  #c4 ,support (      
em]g5cy ob/etric m$ical s]vices ,section
 #ccj,o ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bed;c-#ba7 is am5d$--   
7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 
7#a7-- 7i7 9 ! matt] prec$+ subp>agraph 
7,a7 by ins]t+ & tra9+ aft] be/         
practices2  7ii7 9 subp>agraph 7,b7--   
7,i7 by ins]t+ evid5ce-bas$ be=e be/    
practices2 &  7,,ii7 by /rik+ 2 & &     
ins]t+ a semicolon2  7iii7 9 subp>agraph
 7,c71 by add+ & aft] ! semicolon at !  
end2 &  7iv7 by add+ at ! end ! foll[+3 
7,d7 evid5ce-bas$ be/ practices = heal? 
c>e pr(essionals 9 rural heal? c>e      
sett+s t d n h specialty mat]nity c>e or
 d$icat$ ob/etric units to provide      
/abiliz+ pr5atal c>e1 labor c>e1 bir?+1 
& po/p>tum c>e s]vices dur+ ob/etric    
em]g5cies2  2 &  7,b7 9 p>agraph 7#c71  
by ins]t+ 1 includ+ 9 rural heal? c>e   
sett+s t d n h specialty mat]nity c>e or
 d$icat$ ob/etric units be=e !          
semicolon2 &  7#b7 9 subsection 7d71 by 

ins]t+ 1 & #ag1cjj1jjj = ea* ( fiscal   
ye>s #bjbh ?r\gh #bjcb be=e ! p]iod at !
 end4  #d4 ,teleheal? network2 teleheal?
 res\rce c5t]s grant program2 exp&+     
capacity = heal? outcomes  7a7          
,teleheal? network2 teleheal? res\rce   
c5t]s grant program ,section #ccj;,i ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bed;c-#ad7 is am5d$-- 7#a7 9 
subsection 7h77#a71 by am5d+ subp>agraph
 7,b7 to read z foll[s3  7,b7 ,s]vices  
,! eligible entity proposes to use      
,f$]al funds made available ?r\gh su* a 
grant to develop plans =1 or to e/abli%1
 teleheal? networks t provide m5tal     
heal? c>e1 public heal? s]vices1        
long-t]m c>e1 home c>e1 prev5tive c>e1  
case managem5t s]vices1 urg5t c>e1      
pr5atal c>e1 labor c>e1 bir?+ c>e1 or   
po/p>tum c>e4  2 &  7#b7 9 subsection   
7q71 by /rik+ #bjba ?r\gh #bjbe & ins]t+
 #bjbg ?r\gh #bjca4  7b7 ,exp&+ capacity
 = heal? outcomes ,section #ccj,n7k7 ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bed;c-#bj7k77 is am5d$ by    

/rik+ #bjbb ?r\gh #bjbf & ins]t+ #bjbg  
?r\gh #bjca4  ,july #bh1 #bjbf,report$ )
 an am5dm5t