69–006 

114TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 114–802 

IMPROVING ACCESS TO MATERNITY CARE ACT 

NOVEMBER 14, 2016.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 1209] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 1209) to amend the Public Health Service Act to provide for the designation of maternity care health professional shortage areas, having considered the same, report favorably thereon 

with amendments and recommend that the bill as amended do 

pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 3 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 3 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 4 

Duplication of Federal Programs ............................................................................ 4 

Disclosure of Directed Rule Makings ..................................................................... 4 

Advisory Committee Statement .............................................................................. 4 

Applicability to Legislative Branch ........................................................................ 4 

Section-by-Section Analysis of the Legislation ...................................................... 4 

Changes in Existing Law Made by the Bill, as Reported ..................................... 5 

The amendments are as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Improving Access to Maternity Care Act’’. 


lotter on DSK3GDR082PROD with REPORTS
2 

SEC. 2. MATERNITY CARE HEALTH PROFESSIONAL TARGET AREAS. 

Section 332 of the Public Health Service Act (42 U.S.C. 254e) is amended by adding at the end the following new subsection: 

‘‘(k)(1) The Secretary, acting through the Administrator of the Health Resources 

and Services Administration, shall identify, based on the data collected under paragraph (3), maternity care health professional target areas that satisfy the criteria 

described in paragraph (2) for purposes of, in connection with receipt of assistance 

under this title, assigning to such identified areas maternity care health professionals who, without application of this subsection, would otherwise be eligible for 

such assistance. The Secretary shall distribute maternity care health professionals 

within health professional shortage areas using the maternity care health professional target areas so identified. 

‘‘(2) For purposes of paragraph (1), the Secretary shall establish criteria for maternity care health professional target areas that identify geographic areas within 

health professional shortage areas that have a shortage of maternity care health 

professionals. 

‘‘(3) For purposes of this subsection, the Secretary shall collect and publish in the 

Federal Register data comparing the availability and need of maternity care health 

services in health professional shortage areas and in areas within such health professional shortage areas. 

‘‘(4) In carrying out paragraph (1), the Secretary shall seek input from relevant 

provider organizations, including medical societies, organizations representing medical facilities, and other organizations with expertise in maternity care. 

‘‘(5) For purposes of this subsection, the term ‘full scope maternity care health 

services’ includes during labor care, birthing, prenatal care, and postpartum care. 

‘‘(6) Nothing in this subsection shall be construed as— 

‘‘(A) requiring the identification of a maternity care health professional target 

area in an area not otherwise already designated as a health professional shortage area; or 

‘‘(B) affecting the types of health professionals, without application of this 

subsection, otherwise eligible for assistance, including a loan repayment or 

scholarship, pursuant to the application of this section.’’. 

Amend the title so as to read: 

A bill to amend the Public Health Service Act to distribute maternity care health professionals to health professional shortage 

areas identified as in need of maternity care health services. 

PURPOSE AND SUMMARY

H.R. 1209 was introduced on March 3, 2015 by Rep. Michael 

Burgess (R–TX), Rep. Lois Capps (D–CA), and Rep. Tammy 

Duckworth (D–IL). H.R. 1209 improves data collection to better 

place maternity health care professionals in existing primary care 

health professional shortage areas (HPSAs). 

BACKGROUND AND NEED FOR LEGISLATION

Currently, maternity health care professionals may participate in 

the National Health Service Corps (NHSC) Loan Repayment Program in which eligible licensed health care providers may earn up 

to $50,000 toward student loans in exchange for a two-year commitment at a NHSC approved site in a HPSA. They also can participate in the NHSC Scholarship Program while in medical school. 

The NHSC Scholarship Program pays tuition, fees, other educational costs, and provides a living stipend in return for at least 

a two-year commitment at NHSC approved site in a HPSA. Maternity health care professionals participate in the NHSC under the 

primary care designation. This legislation is needed to improve 

data collection under the existing HPSA to better place maternity 

health care professionals in areas with the greatest need for their 

services. 


lotter on DSK3GDR082PROD with REPORTS
3 

HEARINGS

The Subcommittee on Health held a hearing on H.R. 1209 on December 9, 2015. The hearing was entitled ‘‘Examining Legislation 

to Improve Health Care and Treatment’’ and witnesses included 

the following: 

• Chad Asplund, Director, Athletic Medicine and Head Team 

Physician, Georgia Southern University; 

• Ovidio Bermudez, Chief Clinical Officer and Medical Director of Child and Adolescent Services, Eating Recovery Center; 

• Ginger Breedlove, President, American College of Nurse 

Midwives; 

• Anthony Gregg, Professor and Chief, Division of MaternalFetal Medicine, University of Florida Department of Obstetrics 

and Gynecology; 

• Jonathan Reiner, Director, Cardiac Catheterization Laboratory, George Washington University Hospital; 

• Deborah Trautman, President and CEO, American Association of Colleges of Nursing. 

COMMITTEE CONSIDERATION

On December 9, 2015, the Subcommittee on Health met in open 

markup session and forwarded H.R. 1209 to the full Committee, 

without amendment, by a voice vote. 

On September 20 and 21, 2016, the full Committee on Energy 

and Commerce met in open markup session and ordered H.R. 1209 

reported to the House, as amended, by a voice vote. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no 

record votes taken in connection with ordering H.R. 1209 reported. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee held a hearing and made findings that are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

This legislation improves data collection for placing maternity 

care providers in HPSAs through the NHSC. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 1209 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the 

Rules of the House of Representatives, the Committee finds that 


lotter on DSK3GDR082PROD with REPORTS
4 

H.R. 1209 contains no earmarks, limited tax benefits, or limited 

tariff benefits. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. At the time this report was filed, the estimate was not available. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

At the time this report was filed, the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974 was not available. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 

DUPLICATION OF FEDERAL PROGRAMS

No provision of H.R. 1209 establishes or reauthorizes a program 

of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the 

Government Accountability Office to Congress pursuant to section 

21 of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULE MAKINGS

The Committee estimates that enacting H.R. 1209 specifically directs to be completed no rule making within the meaning of 5 

U.S.C. 551. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 provides that the Act may be cited as the ‘‘Improving 

Access to Maternity Care Act’’. 

Section 2. Maternity care health professional target areas 

Section 2 directs the Secretary of Health and Human Services, 

acting through the Administrator of the Health Resources and 

Services Administration, to identify maternity health professional 


lotter on DSK3GDR082PROD with REPORTS
5 

target areas. These are to be geographic areas within HPSAs that 

have a shortage of maternity health care professionals. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (new matter is printed in italic 

and existing law in which no change is proposed is shown in 

roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

* * * * * * * 

PART D—PRIMARY HEALTH CARE

* * * * * * * 

Subpart II—National Health Service Corps Program 

* * * * * * * 

DESIGNATION OF HEALTH PROFESSIONAL SHORTAGE AREAS

SEC. 332. (a)(1) For purposes of this subpart the term ‘‘health 

professional shortage area’’ means (A) an area in an urban or rural 

area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of 

health services) which the Secretary determines has a health manpower shortage, (B) a population group which the Secretary determines has such a shortage, or (C) a public or nonprofit private 

medical facility or other public facility which the Secretary determines has such a shortage. All Federally qualified health centers 

and rural health clinics, as defined in section 1861(aa) of the Social 

Security Act (42 U.S.C. 1395x(aa)), that meet the requirements of 

section 334 shall be automatically designated as having such a 

shortage. The Secretary shall not remove an area from the areas 

determined to be health professional shortage areas under subparagraph (A) of the preceding sentence until the Secretary has afforded interested persons and groups in such area an opportunity 

to provide data and information in support of the designation as a 

health professional shortage area or a population group described 

in subparagraph (B) of such sentence or a facility described in subparagraph (C) of such sentence, and has made a determination on 

the basis of the data and information submitted by such persons 

and groups and other data and information available to the Secretary. 

(2) For purposes of this subsection, the term ‘‘medical facility’’ 

means a facility for the delivery of health services and includes— 

(A) a hospital, State mental hospital, public health center, 

outpatient medical facility, rehabilitation facility, facility for 

long-term care, community mental health center, migrant 

health center, facility operated by a city or county health deVerDate Sep 11 2014 05:25 Nov 17, 2016 Jkt 069006 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\HR802.XXX HR802

lotter on DSK3GDR082PROD with REPORTS
6 

partment, and community health center and which is not reasonably accessible to an adequately served area; 

(B) such a facility of a State correctional institution or of the 

Indian Health Service, and a health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act; 

(C) such a facility used in connection with the delivery of 

health services under section 321 (relating to hospitals), 322 

(relating to care and treatment of persons under quarantine 

and others), 323 (relating to care and treatment of Federal 

prisoners), 324 (relating to examination and treatment of certain Federal employees), 325 (relating to examination of 

aliens), 326 (relating to services to certain Federal employees), 

320 (relating to services for persons with Hansen’s disease), or 

330(h) (relating to the provision of health services to homeless 

individuals); and 

(D) a Federal medical facility. 

(3) Homeless individuals (as defined in section 330(h)(5)), seasonal agricultural workers (as defined in section 330(g)(3)) and migratory agricultural workers (as so defined)), and residents of public housing (as defined in section 3(b)(1) of the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(1))) may be population groups 

under paragraph (1). 

(b) The Secretary shall establish by regulation criteria for the 

designation of areas, population groups, medical facilities, and 

other public facilities, in the States, as health professional shortage 

areas. In establishing such criteria, the Secretary shall take into 

consideration the following: 

(1) The ratio of available health manpower to the number of 

individuals in an area or population group, or served by a medical facility or other public facility under consideration for designation. 

(2) Indicators of a need, notwithstanding the supply of health 

manpower, for health services for the individuals in an area or 

population group or served by a medical facility or other public 

facility under consideration for designation. 

(3) The percentage of physicians serving an area, population 

group, medical facility, or other public facility under consideration for designation who are employed by hospitals and who 

are graduates of foreign medical schools. 

(c) In determining whether to make a designation, the Secretary 

shall take into consideration the following: 

(1) The recommendations of the Governor of each State in 

which the area, population group, medical facility, or other 

public facility under consideration for designation is in whole 

or part located. 

(2) The extent to which individuals who are (A) residents of 

the area, members of the population group, or patients in the 

medical facility or other public facility under consideration for 

designation, and (B) entitled to have payment made for medical services under title XVIII, XIX, or XXI of the Social Security Act, cannot obtain such services because of suspension of 

physicians from the programs under such titles. 

(d)(1) In accordance with the criteria established under subsection (b) and the considerations listed in subsection (c), the SecVerDate Sep 11 2014 05:25 Nov 17, 2016 Jkt 069006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR802.XXX HR802

lotter on DSK3GDR082PROD with REPORTS
7 

retary shall designate health professional shortage areas in the 

States, publish a descriptive list of the areas, population groups, 

medical facilities, and other public facilities so designated, and at 

least annually review and, as necessary, revise such designations. 

(2) For purposes of paragraph (1), a complete descriptive list 

shall be published in the Federal Register not later than July 1 of 

1991 and each subsequent year. 

(e)(1) Prior to the designation of a public facility, including a Federal medical facility, as a health professional shortage area, the 

Secretary shall give written notice of such proposed designation to 

the chief administrative officer of such facility and request comments within 30 days with respect to such designation. 

(2) Prior to the designation of a health professional shortage area 

under this section, the Secretary shall, to the extent practicable, 

give written notice of the proposed designation of such area to appropriate public or private nonprofit entities which are located or 

have a demonstrated interest in such area and request comments 

from such entities with respect to the proposed designation of such 

area. 

(f) The Secretary shall give written notice of the designation of 

a health professional shortage area, not later than 60 days from 

the date of such designation, to— 

(1) the Governor of each State in which the area, population 

group, medical facility, or other public facility so designated is 

in whole or part located; and 

(2) appropriate public or nonprofit private entities which are 

located or which have a demonstrated interest in the area so 

designated. 

(g) Any person may recommend to the Secretary the designation 

of an area, population group, medical facility, or other public facility as a health professional shortage area. 

(h) The Secretary may conduct such information programs in 

areas, among population groups, and in medical facilities and other 

public facilities designated under this section as health professional 

shortage areas as may be necessary to inform public and nonprofit 

private entities which are located or have a demonstrated interest 

in such areas of the assistance available under this title by virtue 

of the designation of such areas. 

(i) DISSEMINATION.—The Administrator of the Health Resources 

and Services Administration shall disseminate information concerning the designation criteria described in subsection (b) to— 

(1) the Governor of each State; 

(2) the representative of any area, population group, or facility selected by any such Governor to receive such information; 

(3) the representative of any area, population group, or facility that requests such information; and 

(4) the representative of any area, population group, or facility determined by the Administrator to be likely to meet the 

criteria described in subsection (b). 

(j)(1) The Secretary shall submit the report described in paragraph (2) if the Secretary, acting through the Administrator of the 

Health Resources and Services Administration, issues— 

(A) a regulation that revises the definition of a health professional shortage area for purposes of this section; or 


lotter on DSK3GDR082PROD with REPORTS
8 

(B) a regulation that revises the standards concerning priority of such an area under section 333A. 

(2) On issuing a regulation described in paragraph (1), the Secretary shall prepare and submit to the Committee on Energy and 

Commerce of the House of Representatives and the Committee on 

Health, Education, Labor, and Pensions of the Senate a report that 

describes the regulation. 

(3) Each regulation described in paragraph (1) shall take effect 

180 days after the committees described in paragraph (2) receive 

a report referred to in such paragraph describing the regulation. 

(k)(1) The Secretary, acting through the Administrator of the 

Health Resources and Services Administration, shall identify, based 

on the data collected under paragraph (3), maternity care health 

professional target areas that satisfy the criteria described in paragraph (2) for purposes of, in connection with receipt of assistance 

under this title, assigning to such identified areas maternity care 

health professionals who, without application of this subsection, 

would otherwise be eligible for such assistance. The Secretary shall 

distribute maternity care health professionals within health professional shortage areas using the maternity care health professional 

target areas so identified. 

(2) For purposes of paragraph (1), the Secretary shall establish 

criteria for maternity care health professional target areas that 

identify geographic areas within health professional shortage areas 

that have a shortage of maternity care health professionals. 

(3) For purposes of this subsection, the Secretary shall collect and 

publish in the Federal Register data comparing the availability and 

need of maternity care health services in health professional shortage areas and in areas within such health professional shortage 

areas. 

(4) In carrying out paragraph (1), the Secretary shall seek input 

from relevant provider organizations, including medical societies, 

organizations representing medical facilities, and other organizations with expertise in maternity care. 

(5) For purposes of this subsection, the term ‘‘full scope maternity 

care health services’’ includes during labor care, birthing, prenatal 

care, and postpartum care. 

(6) Nothing in this subsection shall be construed as— 

(A) requiring the identification of a maternity care health 

professional target area in an area not otherwise already designated as a health professional shortage area; or 

(B) affecting the types of health professionals, without application of this subsection, otherwise eligible for assistance, including a loan repayment or scholarship, pursuant to the application of this section. 

* * * * * * * 

Æ 


lotter on DSK3GDR082PROD with REPORTS