116TH CONGRESS 

2D SESSION H. R. 4995 

AN ACT 

To amend the Public Health Service Act to improve obstetric 

care and maternal health outcomes, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Maternal Health Qual3 ity Improvement Act of 2020’’. 

4 SEC. 2. INNOVATION FOR MATERNAL HEALTH. 

5 Part D of title III of the Public Health Service Act 

6 (42 U.S.C. 254b et seq.) is amended— 

7 (1) in the section designation of section 330M 

8 of such Act (42 U.S.C. 254c–19) by inserting a pe9 riod after ‘‘330M’’; and 

10 (2) by inserting after section 330M of such Act 

11 (42 U.S.C. 254c–19) the following: 

12 ‘‘SEC. 330N. INNOVATION FOR MATERNAL HEALTH. 

13 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

14 with experts representing a variety of clinical specialties, 

15 State, Tribal, or local public health officials, researchers, 

16 epidemiologists, statisticians, and community organiza17 tions, shall establish or continue a program to award com18 petitive grants to eligible entities for the purposes of— 

19 ‘‘(1) identifying, developing, or disseminating 

20 best practices to improve maternal health care qual21 ity and outcomes, eliminate preventable maternal 

22 mortality and severe maternal morbidity, and im23 prove infant health outcomes, which may include— 

24 ‘‘(A) information on evidence-based prac25 tices to improve the quality and safety of ma26 ternal health care in hospitals and other health 
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1 care settings of a State or health care system, 

2 including by addressing topics commonly associ3 ated with health complications or risks related 

4 to prenatal care, labor care, birthing, and 

5 postpartum care; 

6 ‘‘(B) best practices for improving maternal 

7 health care based on data findings and reviews 

8 conducted by a State maternal mortality review 

9 committee that address topics of relevance to 

10 common complications or health risks related to 

11 prenatal care, labor care, birthing, and 

12 postpartum care; and 

13 ‘‘(C) information on addressing deter14 minants of health that impact maternal health 

15 outcomes for women before, during, and after 

16 pregnancy; 

17 ‘‘(2) collaborating with State maternal mor18 tality review committees to identify issues for the de19 velopment and implementation of evidence-based 

20 practices to improve maternal health outcomes and 

21 reduce preventable maternal mortality and severe 

22 maternal morbidity; 

23 ‘‘(3) providing technical assistance and sup24 porting the implementation of best practices identi25 fied pursuant to paragraph (1) to entities providing 
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1 health care services to pregnant and postpartum 

2 women; and 

3 ‘‘(4) identifying, developing, and evaluating new 

4 models of care that improve maternal and infant 

5 health outcomes, which may include the integration 

6 of community-based services and clinical care. 

7 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible for a grant 

8 under subsection (a), an entity shall— 

9 ‘‘(1) submit to the Secretary an application at 

10 such time, in such manner, and containing such in11 formation as the Secretary may require; and 

12 ‘‘(2) demonstrate in such application that the 

13 entity is capable of carrying out data-driven mater14 nal safety and quality improvement initiatives in the 

15 areas of obstetrics and gynecology or maternal 

16 health. 

17 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 

18 carry out this section, there are authorized to be appro19 priated $5,000,000 for each of fiscal years 2021 through 

20 2025.’’. 

21 SEC. 3. TRAINING FOR HEALTH CARE PROVIDERS. 

22 Title VII of the Public Health Service Act is amended 

23 by striking section 763 (42 U.S.C. 294p) and inserting 

24 the following: 
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1 ‘‘SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS. 

2 ‘‘(a) GRANT PROGRAM.—The Secretary shall estab3 lish a program to award grants to accredited schools of 

4 allopathic medicine, osteopathic medicine, and nursing, 

5 and other health professional training programs for the 

6 training of health care professionals to reduce and prevent 

7 discrimination (including training related to implicit and 

8 explicit biases) in the provision of health care services re9 lated to prenatal care, labor care, birthing, and 

10 postpartum care. 

11 ‘‘(b) ELIGIBILITY.—To be eligible for a grant under 

12 subsection (a), an entity described in such subsection shall 

13 submit to the Secretary an application at such time, in 

14 such manner, and containing such information as the Sec15 retary may require. 

16 ‘‘(c) REPORTING REQUIREMENT.—Each entity 

17 awarded a grant under this section shall periodically sub18 mit to the Secretary a report on the status of activities 

19 conducted using the grant, including a description of the 

20 impact of such training on patient outcomes, as applicable. 

21 ‘‘(d) BEST PRACTICES.—The Secretary may identify 

22 and disseminate best practices for the training of health 

23 care professionals to reduce and prevent discrimination 

24 (including training related to implicit and explicit biases) 

25 in the provision of health care services related to prenatal 

26 care, labor care, birthing, and postpartum care. 
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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there are authorized to be appro3 priated $5,000,000 for each of fiscal years 2021 through 

4 2025.’’. 

5 SEC. 4. STUDY ON TRAINING TO REDUCE AND PREVENT 

6 DISCRIMINATION. 

7 Not later than 2 years after date of enactment of this 

8 Act, the Secretary of Health and Human Services shall, 

9 through a contract with an independent research organiza10 tion, conduct a study and make recommendations for ac11 credited schools of allopathic medicine, osteopathic medi12 cine, and nursing, and other health professional training 

13 programs, on best practices related to training to reduce 

14 and prevent discrimination, including training related to 

15 implicit and explicit biases, in the provision of health care 

16 services related to prenatal care, labor care, birthing, and 

17 postpartum care. 

18 SEC. 5. PERINATAL QUALITY COLLABORATIVES. 

19 Section 317K(a)(2) of the Public Health Service Act 

20 (42 U.S.C. 247b–12(a)(2)) is amended by adding at the 

21 end the following: 

22 ‘‘(E)(i) The Secretary, acting through the 

23 Director of the Centers for Disease Control and 

24 Prevention and in coordination with other of25 fices and agencies, as appropriate, shall estab-
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1 lish or continue a competitive grant program 

2 for the establishment or support of perinatal 

3 quality collaboratives to improve perinatal care 

4 and perinatal health outcomes for pregnant and 

5 postpartum women and their infants. A State, 

6 Indian Tribe, or Tribal organization may use 

7 funds received through such grant to— 

8 ‘‘(I) support the use of evidence-based 

9 or evidence-informed practices to improve 

10 outcomes for maternal and infant health; 

11 ‘‘(II) work with clinical teams; ex12 perts; State, local, and, as appropriate, 

13 Tribal public health officials; and stake14 holders, including patients and families, to 

15 identify, develop, or disseminate best prac16 tices to improve perinatal care and out17 comes; and 

18 ‘‘(III) employ strategies that provide 

19 opportunities for health care professionals 

20 and clinical teams to collaborate across 

21 health care settings and disciplines, includ22 ing primary care and mental health, as ap23 propriate, to improve maternal and infant 

24 health outcomes, which may include the 

25 use of data to provide timely feedback 
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1 across hospital and clinical teams to in2 form responses, and to provide support 

3 and training to hospital and clinical teams 

4 for quality improvement, as appropriate. 

5 ‘‘(ii) To be eligible for a grant under 

6 clause (i), an entity shall submit to the Sec7 retary an application in such form and manner 

8 and containing such information as the Sec9 retary may require.’’. 

10 SEC. 6. INTEGRATED SERVICES FOR PREGNANT AND 

11 POSTPARTUM WOMEN. 

12 (a) GRANTS.—Title III of the Public Health Service 

13 Act is amended by inserting after section 330N of such 

14 Act, as added by section 2, the following: 

15 ‘‘SEC. 330O. INTEGRATED SERVICES FOR PREGNANT AND 

16 POSTPARTUM WOMEN. 

17 ‘‘(a) IN GENERAL.—The Secretary may award grants 

18 to States, Indian Tribes, and Tribal organizations for the 

19 purpose of establishing or operating evidence-based or in20 novative, evidence-informed programs to deliver integrated 

21 health care services to pregnant and postpartum women 

22 to optimize the health of women and their infants, includ23 ing to reduce adverse maternal health outcomes, preg24 nancy-related deaths, and related health disparities (in25 cluding such disparities associated with racial and ethnic 
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1 minority populations), and, as appropriate, by addressing 

2 issues researched under subsection (b)(2) of section 317K. 

3 ‘‘(b) INTEGRATED SERVICES FOR PREGNANT AND

4 POSTPARTUM WOMEN.— 

5 ‘‘(1) ELIGIBILITY.—To be eligible to receive a 

6 grant under subsection (a), a State, Indian Tribe, or 

7 Tribal organization shall work with relevant stake8 holders that coordinate care (including coordinating 

9 resources and referrals for health care and social 

10 services) to develop and carry out the program, in11 cluding— 

12 ‘‘(A) State, Tribal, and local agencies re13 sponsible for Medicaid, public health, social 

14 services, mental health, and substance use dis15 order treatment and services; 

16 ‘‘(B) health care providers who serve preg17 nant and postpartum women; and 

18 ‘‘(C) community-based health organiza19 tions and health workers, including providers of 

20 home visiting services and individuals rep21 resenting communities with disproportionately 

22 high rates of maternal mortality and severe ma23 ternal morbidity, and including individuals rep24 resenting racial and ethnic minority popu25 lations. 
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1 ‘‘(2) TERMS.— 

2 ‘‘(A) PERIOD.—A grant awarded under 

3 subsection (a) shall be made for a period of 5 

4 years. Any supplemental award made to a 

5 grantee under subsection (a) may be made for 

6 a period of less than 5 years. 

7 ‘‘(B) PREFERENCE.—In awarding grants 

8 under subsection (a), the Secretary shall— 

9 ‘‘(i) give preference to States, Indian 

10 Tribes, and Tribal organizations that have 

11 the highest rates of maternal mortality and 

12 severe maternal morbidity relative to other 

13 such States, Indian Tribes, or Tribal orga14 nizations, respectively; and 

15 ‘‘(ii) shall consider health disparities 

16 related to maternal mortality and severe 

17 maternal morbidity, including such dispari18 ties associated with racial and ethnic mi19 nority populations. 

20 ‘‘(C) PRIORITY.—In awarding grants 

21 under subsection (a), the Secretary shall give 

22 priority to applications from up to 15 entities 

23 described in subparagraph (B)(i). 
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1 ‘‘(D) EVALUATION.—The Secretary shall 

2 require grantees to evaluate the outcomes of the 

3 programs supported under the grant. 

4 ‘‘(c) DEFINITIONS.—In this section, the terms ‘In5 dian Tribe’ and ‘Tribal organization’ have the meanings 

6 given the terms ‘Indian tribe’ and ‘tribal organization’, re7 spectively, in section 4 of the Indian Self-Determination 

8 and Education Assistance Act. 

9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

11 $10,000,000 for each of fiscal years 2021 through 2025.’’. 

12 (b) REPORT ON GRANT OUTCOMES AND DISSEMINA13 TION OF BEST PRACTICES.— 

14 (1) REPORT.—Not later than February 1, 

15 2026, the Secretary of Health and Human Services 

16 shall submit to the Committee on Health, Edu17 cation, Labor, and Pensions of the Senate and the 

18 Committee on Energy and Commerce of the House 

19 of Representatives a report that describes— 

20 (A) the outcomes of the activities sup21 ported by the grants awarded under the amend22 ment made by this section on maternal and 

23 child health; 
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1 (B) best practices and models of care used 

2 by recipients of grants under such amendment; 

3 and 

4 (C) obstacles identified by recipients of 

5 grants under such amendment, and strategies 

6 used by such recipients to deliver care, improve 

7 maternal and child health, and reduce health 

8 disparities. 

9 (2) DISSEMINATION OF BEST PRACTICES.—Not 

10 later than August 1, 2026, the Secretary of Health 

11 and Human Services shall disseminate information 

12 on best practices and models of care used by recipi13 ents of grants under the amendment made by this 

14 section (including best practices and models of care 

15 relating to the reduction of health disparities, includ16 ing such disparities associated with racial and ethnic 

17 minority populations, in rates of maternal mortality 

18 and severe maternal morbidity) to relevant stake19 holders, which may include health providers, medical 

20 schools, nursing schools, relevant State, Tribal, and 

21 local agencies, and the general public. 

22 SEC. 7. IMPROVING RURAL MATERNAL AND OBSTETRIC 

23 CARE DATA. 

24 (a) MATERNAL MORTALITY AND MORBIDITY ACTIVI25 TIES.—Section 301(e) of the Public Health Service Act 
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1 (42 U.S.C. 241(e)) is amended by inserting ‘‘, preventable 

2 maternal mortality and severe maternal morbidity,’’ after 

3 ‘‘delivery’’. 

4 (b) OFFICE OF WOMEN’S HEALTH.—Section 

5 310A(b)(1) of the Public Health Service Act (42 U.S.C. 

6 242s(b)(1)) is amended by striking ‘‘and sociocultural con7 texts,’’ and inserting ‘‘sociocultural (including among 

8 American Indians, Native Hawaiians, and Alaska Na9 tives), and geographical contexts’’. 

10 (c) SAFE MOTHERHOOD.—Section 317K of the Pub11 lic Health Service Act (42 U.S.C. 247b–12) is amended— 

12 (1) in subsection (a)(2)(A), by inserting ‘‘, in13 cluding improving collection of data on race, eth14 nicity, and other demographic information’’ before 

15 the period; and 

16 (2) in subsection (b)(2)— 

17 (A) in subparagraph (L), by striking 

18 ‘‘and’’ at the end; 

19 (B) by redesignating subparagraph (M) as 

20 subparagraph (N); and 

21 (C) by inserting after subparagraph (L) 

22 the following: 

23 ‘‘(M) an examination of the relationship 

24 between maternal health and obstetric services 
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1 in rural areas and outcomes in delivery and 

2 postpartum care; and’’. 

3 (d) OFFICE OF RESEARCH ON WOMEN’S HEALTH.— 

4 Section 486 of the Public Health Service Act (42 U.S.C. 

5 287d) is amended— 

6 (1) in subsection (b), by amending paragraph 

7 (3) to read as follows: 

8 ‘‘(3) carry out paragraphs (1) and (2) with re9 spect to— 

10 ‘‘(A) the aging process in women, with pri11 ority given to menopause; and 

12 ‘‘(B) pregnancy, with priority given to 

13 deaths related to preventable maternal mor14 tality and severe maternal morbidity;’’; and 

15 (2) in subsection (d)(4)(A)(iv), by inserting ‘‘, 

16 including preventable maternal morbidity and severe 

17 maternal morbidity’’ before the semicolon. 

18 SEC. 8. RURAL OBSTETRIC NETWORK GRANTS. 

19 The Public Health Service Act is amended by insert20 ing after section 330A–1 (42 U.S.C. 254c–1a) the fol21 lowing: 

22 ‘‘SEC. 330A–2. RURAL OBSTETRIC NETWORK GRANTS. 

23 ‘‘(a) PROGRAM ESTABLISHED.—The Secretary shall 

24 award grants or cooperative agreements to eligible entities 

25 to establish collaborative improvement and innovation net-
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1 works (referred to in this section as ‘rural obstetric net2 works’) to improve maternal and infant health outcomes 

3 and reduce preventable maternal mortality and severe ma4 ternal morbidity by improving maternity care and access 

5 to care in rural areas, frontier areas, maternity care health 

6 professional target areas, or jurisdictions of Indian Tribes 

7 and Tribal organizations. 

8 ‘‘(b) USE OF FUNDS.—Grants or cooperative agree9 ments awarded pursuant to this section shall be used for 

10 the establishment or continuation of collaborative improve11 ment and innovation networks to improve maternal health 

12 in rural areas by improving infant health and maternal 

13 outcomes and reducing preventable maternal mortality 

14 and severe maternal morbidity. Rural obstetric networks 

15 established in accordance with this section may— 

16 ‘‘(1) develop a network to improve coordination 

17 and increase access to maternal health care and as18 sist pregnant women in the areas described in sub19 section (a) with accessing and utilizing maternal and 

20 obstetric care, including health care services related 

21 to prenatal care, labor care, birthing, and 

22 postpartum care to improve outcomes in birth and 

23 maternal mortality and morbidity; 

24 ‘‘(2) identify and implement evidence-based and 

25 sustainable delivery models for maternal and obstet-
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1 ric care (including health care services related to 

2 prenatal care, labor care, birthing, and postpartum 

3 care for women in the areas described in subsection 

4 (a), including home visiting programs and culturally 

5 appropriate care models that reduce health dispari6 ties; 

7 ‘‘(3) develop a model for maternal health care 

8 collaboration between health care settings to improve 

9 access to care in areas described in subsection (a), 

10 which may include the use of telehealth; 

11 ‘‘(4) provide training for professionals in health 

12 care settings that do not have specialty maternity 

13 care; 

14 ‘‘(5) collaborate with academic institutions that 

15 can provide regional expertise and help identify bar16 riers to providing maternal health care, including 

17 strategies for addressing such barriers; and 

18 ‘‘(6) assess and address disparities in infant 

19 and maternal health outcomes, including among ra20 cial and ethnic minority populations and underserved 

21 populations in areas described in subsection (a). 

22 ‘‘(c) DEFINITIONS.—In this section: 

23 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible 

24 entities’ means entities providing maternal health 

25 care services in rural areas, frontier areas, or medi-
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1 cally underserved areas, or to medically underserved 

2 populations or Indian Tribes or Tribal organizations. 

3 ‘‘(2) FRONTIER AREA.—The term ‘frontier 

4 area’ means a frontier county, as defined in section 

5 1886(d)(3)(E)(iii)(III) of the Social Security Act. 

6 ‘‘(3) INDIAN TRIBES; TRIBAL ORGANIZATION.— 

7 The terms ‘Indian Tribe’ and ‘Tribal organization’ 

8 have the meanings given the terms ‘Indian tribe’ and 

9 ‘tribal organization’, respectively, in section 4 of the 

10 Indian Self-Determination and Education Assistance 

11 Act. 

12 ‘‘(4) MATERNITY CARE HEALTH PROFESSIONAL

13 TARGET AREA.—The term ‘maternity care health 

14 professional target area’ has the meaning described 

15 in section 332(k)(2). 

16 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 $3,000,000 for each of fiscal years 2021 through 2025.’’. 

19 SEC. 9. TELEHEALTH NETWORK AND TELEHEALTH RE20 SOURCE CENTERS GRANT PROGRAMS. 

21 Section 330I of the Public Health Service Act (42 

22 U.S.C. 254c–14) is amended— 

23 (1) in subsection (f)(3), by adding at the end 

24 the following: 
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1 ‘‘(M) Providers of maternal care, including 

2 prenatal, labor care, birthing, and postpartum 

3 care services and entities operating obstetric 

4 care units.’’; and 

5 (2) in subsection (h)(1)(B), by inserting ‘‘labor 

6 care, birthing care, postpartum care,’’ before ‘‘or 

7 prenatal’’. 

8 SEC. 10. RURAL MATERNAL AND OBSTETRIC CARE TRAIN9 ING DEMONSTRATION. 

10 Subpart 1 of part E of title VII of the Public Health 

11 Service Act (42 U.S.C. 294n et seq.) is amended by adding 

12 at the end the following: 

13 ‘‘SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAIN14 ING DEMONSTRATION. 

15 ‘‘(a) IN GENERAL.—The Secretary shall award 

16 grants to accredited schools of allopathic medicine, osteo17 pathic medicine, and nursing, and other appropriate 

18 health professional training programs, to establish a train19 ing demonstration program to support— 

20 ‘‘(1) training for physicians, medical residents, 

21 fellows, nurse practitioners, physician assistants, 

22 nurses, certified nurse midwives, relevant home vis23 iting workforce professionals and paraprofessionals, 

24 or other professionals who meet relevant State train25 ing and licensing requirements, as applicable, to pro-
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1 vide maternal health care services in rural commu2 nity-based settings; and 

3 ‘‘(2) developing recommendations for such 

4 training programs. 

5 ‘‘(b) APPLICATION.—To be eligible to receive a grant 

6 under subsection (a), an entity shall submit to the Sec7 retary an application at such time, in such manner, and 

8 containing such information as the Secretary may require. 

9 ‘‘(c) ACTIVITIES.— 

10 ‘‘(1) TRAINING FOR HEALTH CARE PROFES11 SIONALS.—A recipient of a grant under subsection 

12 (a)— 

13 ‘‘(A) shall use the grant funds to plan, de14 velop, and operate a training program to pro15 vide maternal health care in rural areas; and 

16 ‘‘(B) may use the grant funds to provide 

17 additional support for the administration of the 

18 program or to meet the costs of projects to es19 tablish, maintain, or improve faculty develop20 ment, or departments, divisions, or other units 

21 necessary to implement such training. 

22 ‘‘(2) TRAINING PROGRAM REQUIREMENTS.— 

23 The recipient of a grant under subsection (a) shall 

24 ensure that training programs carried out under the 

25 grant are evidence-based and address improving ma-
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1 ternal health care in rural areas, and such programs 

2 may include training on topics such as— 

3 ‘‘(A) maternal mental health, including 

4 perinatal depression and anxiety; 

5 ‘‘(B) substance use disorders; 

6 ‘‘(C) social determinants of health that af7 fect individuals living in rural areas; and 

8 ‘‘(D) implicit and explicit bias. 

9 ‘‘(d) EVALUATION AND REPORT.— 

10 ‘‘(1) EVALUATION.— 

11 ‘‘(A) IN GENERAL.—The Secretary shall 

12 evaluate the outcomes of the demonstration 

13 program under this section. 

14 ‘‘(B) DATA SUBMISSION.—Recipients of a 

15 grant under subsection (a) shall submit to the 

16 Secretary performance metrics and other re17 lated data in order to evaluate the program for 

18 the report described in paragraph (2). 

19 ‘‘(2) REPORT TO CONGRESS.—Not later than 

20 January 1, 2025, the Secretary shall submit to the 

21 Committee on Health, Education, Labor, and Pen22 sions of the Senate and the Committee on Energy 

23 and Commerce of the House of Representatives a re24 port that includes— 
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1 ‘‘(A) an analysis of the effects of the dem2 onstration program under this section on the 

3 quality, quantity, and distribution of maternal 

4 health care services, including health care serv5 ices related to prenatal care, labor care, birth6 ing, and postpartum care, and the demo7 graphics of the recipients of those services; 

8 ‘‘(B) an analysis of maternal and infant 

9 health outcomes (including quality of care, mor10 bidity, and mortality) before and after imple11 mentation of the program in the communities 

12 served by entities participating in the dem13 onstration program; and 

14 ‘‘(C) recommendations on whether the 

15 demonstration program should be continued. 

16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 $5,000,000 for each of fiscal years 2021 through 2025.’’. 

Passed the House of Representatives September 21, 

2020. 

Attest: 

Clerk. 
116TH CONGRESS 

2D SESSION H. R. 4995 

AN ACT 

To amend the Public Health Service Act to improve 

for other purposes. obstetric care and maternal health outcomes, and