I 

116TH CONGRESS 

1ST SESSION H. R. 4995 

To amend the Public Health Service Act to improve obstetric care and 

maternal health outcomes, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 8, 2019 

Mr. ENGEL (for himself, Mr. BUCSHON, Ms. TORRES SMALL of New Mexico, 

Mr. LATTA, Ms. ADAMS, and Mr. STIVERS) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Maternal Health Qual5 ity Improvement Act of 2019’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—IMPROVING OBSTETRIC CARE IN RURAL AREAS 

Sec. 101. Improving rural maternal and obstetric care data. 


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Sec. 102. Rural obstetric network grants. 

Sec. 103. Telehealth network and telehealth resource centers grant programs. 

Sec. 104. Rural maternal and obstetric care training demonstration. 

Sec. 105. GAO report. 

TITLE II—OTHER IMPROVEMENTS TO MATERNAL CARE 

Sec. 201. Innovation for maternal health. 

Sec. 202. Training for health care providers. 

Sec. 203. Study on training to reduce and prevent discrimination. 

Sec. 204. Perinatal quality collaboratives. 

Sec. 205. Integrated services for pregnant and postpartum women. 

1 TITLE I—IMPROVING OBSTET2 RIC CARE IN RURAL AREAS 

3 SEC. 101. IMPROVING RURAL MATERNAL AND OBSTETRIC 

4 CARE DATA. 

5 (a) MATERNAL MORTALITY AND MORBIDITY ACTIVI6 TIES.—Section 301 of the Public Health Service Act (42 

7 U.S.C. 241) is amended— 

8 (1) by redesignating subsections (e) through (h) 

9 as subsections (f) through (i), respectively; and 

10 (2) by inserting after subsection (d), the fol11 lowing: 

12 ‘‘(e) The Secretary, acting through the Director of 

13 the Centers for Disease Control and Prevention, shall ex14 pand, intensify, and coordinate the activities of the Cen15 ters for Disease Control and Prevention with respect to 

16 maternal mortality and morbidity.’’. 

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

18 310A(b)(1) of the Public Health Service Act (42 U.S.C. 

19 242s(b)(1)) is amended by inserting ‘‘sociocultural, includ20 ing among American Indians and Alaska Natives, as such 


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1 terms are defined in section 4 of the Indian Health Care 

2 Improvement Act, geographic,’’ after ‘‘biological,’’. 

3 (c) SAFE MOTHERHOOD.—Section 317K(b)(2) of the 

4 Public Health Service Act (42 U.S.C. 247b–12(b)(2)) is 

5 amended— 

6 (1) in subparagraph (L), by striking ‘‘and’’ at 

7 the end; 

8 (2) by redesignating subparagraph (M) as sub9 paragraph (N); and 

10 (3) by inserting after subparagraph (L), the fol11 lowing: 

12 ‘‘(M) an examination of the relationship 

13 between maternal and obstetric services in rural 

14 areas and outcomes in delivery and postpartum 

15 care; and’’. 

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

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

18 287d) is amended— 

19 (1) in subsection (b)— 

20 (A) by amending paragraph (3) to read as 

21 follows: 

22 ‘‘(3) carry out paragraphs (1) and (2) with re23 spect to— 

24 ‘‘(A) the aging process in women, with pri25 ority given to menopause; and 


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

2 deaths related to pregnancy;’’; and 

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

4 including maternal mortality and other maternal 

5 morbidity outcomes’’ before the semicolon. 

6 SEC. 102. RURAL OBSTETRIC NETWORK GRANTS. 

7 The Public Health Service Act is amended by insert8 ing after section 330A–1 of such Act (42 U.S.C. 254c– 

9 1a) the following: 

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

11 ‘‘(a) PROGRAM ESTABLISHED.—The Secretary, act12 ing through the Administrator of the Health Resources 

13 and Services Administration, shall award grants to eligible 

14 entities to establish collaborative improvement and innova15 tion networks (referred to in this section as ‘rural obstetric 

16 networks’) to improve birth outcomes and reduce maternal 

17 morbidity and mortality by improving maternity care and 

18 access to care in rural areas, frontier areas, maternity care 

19 health professional target areas, and Indian country and 

20 with Indian Tribes and tribal organizations. 

21 ‘‘(b) USE OF FUNDS.—Rural obstetric networks re22 ceiving funds pursuant to this section may use such funds 

23 to— 

24 ‘‘(1) assist pregnant women and individuals in 

25 areas and within populations referenced in subVerDate Sep 11 2014 22:49 Nov 15, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4995.IH H4995

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1 section (a) with accessing and utilizing maternal and 

2 obstetric care, including preconception, pregnancy, 

3 labor and delivery, postpartum, and interconception 

4 services to improve outcomes in birth and maternal 

5 mortality and morbidity; 

6 ‘‘(2) identify successful delivery models for ma7 ternal and obstetric care (including preconception, 

8 pregnancy, labor and delivery, postpartum, and 

9 interconception services) for individuals in areas and 

10 within populations referenced by subsection (a), in11 cluding evidence-based home visiting programs and 

12 successful, culturally competent models with positive 

13 maternal health outcomes that advance health eq14 uity; 

15 ‘‘(3) develop a model for collaboration between 

16 health facilities that have an obstetric care unit and 

17 health facilities that do not have an obstetric care 

18 unit to improve access to and the delivery of obstet19 ric services in communities lacking these services; 

20 ‘‘(4) provide training and guidance on obstetric 

21 care for health facilities that do not have obstetric 

22 care units; 

23 ‘‘(5) collaborate with academic institutions that 

24 can provide regional expertise and research on ac25 cess, outcomes, needs assessments, and other identiVerDate Sep 11 2014 22:49 Nov 15, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4995.IH H4995

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1 fied data and measurement activities needed to in2 form rural obstetric network efforts to improve ob3 stetric care; and 

4 ‘‘(6) measure and address inequities in birth 

5 outcomes among rural residents, with an emphasis 

6 on racial and ethnic minorities and underserved pop7 ulations. 

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

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

10 entities’ means entities providing obstetric, 

11 gynecologic, and other maternal health care services 

12 in rural areas, frontier areas, or medically under13 served areas, or to medically underserved popu14 lations or Native Americans, including Indian tribes 

15 or tribal organizations. 

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

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

18 1886(d)(3)(E)(iii)(III) of the Social Security Act. 

19 ‘‘(3) INDIAN COUNTRY.—The term ‘Indian 

20 country’ has the meaning given such term in section 

21 1151 of title 18, United States Code. 

22 ‘‘(4) MATERNITY CARE HEALTH PROFESSIONAL

23 TARGET AREA.—The term ‘maternity care health 

24 professional target area’ has the meaning of such 

25 term as used in section 332(k)(2). 


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1 ‘‘(5) RURAL AREA.—The term ‘rural area’ has 

2 the meaning given that term in section 1886(d)(2) 

3 of the Social Security Act. 

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

5 The terms ‘Indian Tribe’ and ‘tribal organization’ 

6 have the meaning given such terms in section 4 of 

7 the Indian Self-Determination and Education Assist8 ance Act. 

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

10 is authorized to be appropriated to carry out this section 

11 $3,000,000 for each of fiscal years 2020 through 2024.’’. 

12 SEC. 103. TELEHEALTH NETWORK AND TELEHEALTH RE13 SOURCE CENTERS GRANT PROGRAMS. 

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

15 U.S.C. 254c–14) is amended— 

16 (1) in subsection (f)(1)(B)(iii), by adding at the 

17 end the following: 

18 ‘‘(XIII) Providers of maternal, 

19 including prenatal, labor and birth, 

20 and postpartum care services and en21 tities operating obstetric care units.’’; 

22 and 

23 (2) in subsection (i)(1)(B), by inserting ‘‘labor 

24 and birth, postpartum,’’ before ‘‘or prenatal’’. 


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1 SEC. 104. RURAL MATERNAL AND OBSTETRIC CARE TRAIN2 ING DEMONSTRATION. 

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

4 Service Act is amended by inserting after section 760 (42 

5 U.S.C. 294n et seq.), as amended by section 202, is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAIN8 ING DEMONSTRATION. 

9 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

10 training demonstration program to award grants to eligi11 ble entities to support— 

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

13 including family medicine and obstetrics and gyne14 cology residents, and fellows to practice maternal 

15 and obstetric medicine in rural community-based 

16 settings; 

17 ‘‘(2) training for nurse practitioners, physician 

18 assistants, nurses, certified nurse midwives, home 

19 visiting nurses and non-clinical home visiting work20 force professionals and paraprofessionals, or non21 clinical professionals, who meet applicable State 

22 training and licensing requirements, to provide ma23 ternal care services in rural community-based set24 tings; and 

25 ‘‘(3) establishing, maintaining, or improving 

26 academic units or programs that— 


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1 ‘‘(A) provide training for students or fac2 ulty, including through clinical experiences and 

3 research, to improve maternal care in rural 

4 areas; or 

5 ‘‘(B) develop evidence-based practices or 

6 recommendations for the design of the units or 

7 programs described in subparagraph (A), in8 cluding curriculum content standards. 

9 ‘‘(b) ACTIVITIES.— 

10 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND

11 FELLOWS.—A recipient of a grant under subsection 

12 (a)(1)— 

13 ‘‘(A) shall use the grant funds— 

14 ‘‘(i) to plan, develop, and operate a 

15 training program to provide obstetric care 

16 in rural areas for family practice or obstet17 rics and gynecology residents and fellows; 

18 or 

19 ‘‘(ii) to train new family practice or 

20 obstetrics and gynecology residents and fel21 lows in maternal and obstetric health care 

22 to provide and expand access to maternal 

23 and obstetric health care in rural areas; 

24 and 


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

2 additional support for the administration of the 

3 program or to meet the costs of projects to es4 tablish, maintain, or improve faculty develop5 ment, or departments, divisions, or other units 

6 necessary to implement such training. 

7 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re8 cipient of a grant under subsection (a)(2)— 

9 ‘‘(A) shall use the grant funds to plan, de10 velop, or operate a training program to provide 

11 maternal health care services in rural, commu12 nity-based settings; and 

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

14 additional support for the administration of the 

15 program or to meet the costs of projects to es16 tablish, maintain, or improve faculty develop17 ment, or departments, divisions, or other units 

18 necessary to implement such program. 

19 ‘‘(3) TRAINING PROGRAM REQUIREMENTS.— 

20 The recipient of a grant under subsection (a)(1) or 

21 (a)(2) shall ensure that training programs carried 

22 out under the grant are evidence-based and include 

23 instruction on— 

24 ‘‘(A) maternal mental health, including 

25 perinatal depression and anxiety; 


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1 ‘‘(B) maternal substance use disorder; 

2 ‘‘(C) social determinants of health that im3 pact individuals living in rural communities, in4 cluding poverty, social isolation, access to nutri5 tion, education, transportation, and housing; 

6 and 

7 ‘‘(D) implicit bias. 

8 ‘‘(c) ELIGIBLE ENTITIES.— 

9 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND

10 FELLOWS.—To be eligible to receive a grant under 

11 subsection (a)(1), an entity shall— 

12 ‘‘(A) be a consortium consisting of— 

13 ‘‘(i) at least one teaching health cen14 ter; or 

15 ‘‘(ii) the sponsoring institution (or 

16 parent institution of the sponsoring insti17 tution) of— 

18 ‘‘(I) an obstetrics and gynecology 

19 or family medicine residency program 

20 that is accredited by the Accreditation 

21 Council of Graduate Medical Edu22 cation (or the parent institution of 

23 such a program); or 


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1 ‘‘(II) a fellowship in maternal or 

2 obstetric medicine, as determined ap3 propriate by the Secretary; or 

4 ‘‘(B) be an entity described in subpara5 graph (A)(ii) that provides opportunities for 

6 medical residents or fellows to train in rural 

7 community-based settings. 

8 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 

9 eligible to receive a grant under subsection (a)(2), 

10 an entity shall be— 

11 ‘‘(A) a teaching health center (as defined 

12 in section 749A(f)); 

13 ‘‘(B) a federally qualified health center (as 

14 defined in section 1905(l)(2)(B) of the Social 

15 Security Act); 

16 ‘‘(C) a community mental health center (as 

17 defined in section 1861(ff)(3)(B) of the Social 

18 Security Act); 

19 ‘‘(D) a rural health clinic (as defined in 

20 section 1861(aa) of the Social Security Act); 

21 ‘‘(E) a freestanding birth center (as de22 fined in section 1905(l)(3) of the Social Secu23 rity Act); or 

24 ‘‘(F) an Indian Health Program or a Na25 tive Hawaiian health care system (as such 


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1 terms are defined in section 4 of the Indian 

2 Health Care Improvement Act and section 12 

3 of the Native Hawaiian Health Care Improve4 ment Act, respectively). 

5 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 

6 eligible to receive a grant under subsection (a)(3), 

7 an entity shall be a school of medicine, a school of 

8 osteopathic medicine, a school of nursing (as defined 

9 in section 801), a physician assistant education pro10 gram, an accredited public or nonprofit private hos11 pital, an accredited medical residency training pro12 gram, a school accredited by the Midwifery Edu13 cation and Accreditation Council, by the Accredita14 tion Commission for Midwifery Education, or by the 

15 American Midwifery Certification Board, or a public 

16 or private nonprofit educational entity which the 

17 Secretary has determined is capable of carrying out 

18 such grant. 

19 ‘‘(4) APPLICATION.—To be eligible to receive a 

20 grant under subsection (a), an entity shall submit to 

21 the Secretary an application at such time, in such 

22 manner, and containing such information as the Sec23 retary may require, including an estimate of the 

24 amount to be expended to conduct training activities 


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1 under the grant (including ancillary and administra2 tive costs). 

3 ‘‘(d) STUDY AND REPORT.— 

4 ‘‘(1) STUDY.— 

5 ‘‘(A) IN GENERAL.—The Secretary, acting 

6 through the Administrator of the Health Re7 sources and Services Administration, shall con8 duct a study on the results of the demonstra9 tion program under this section. 

10 ‘‘(B) DATA SUBMISSION.—Not later than 

11 90 days after the completion of the first year 

12 of the training program, and each subsequent 

13 year for the duration of the grant, that the pro14 gram is in effect, each recipient of a grant 

15 under subsection (a) shall submit to the Sec16 retary such data as the Secretary may require 

17 for analysis for the report described in para18 graph (2). 

19 ‘‘(2) REPORT TO CONGRESS.—Not later than 1 

20 year after receipt of the data described in paragraph 

21 (1)(B), the Secretary shall submit to the Committee 

22 on Energy and Commerce of the House of Rep23 resentatives and the Committee on Health, Edu24 cation, Labor, and Pensions of the Senate a report 

25 that includes— 


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1 ‘‘(A) an analysis of the effect of the dem2 onstration program under this section on the 

3 quality, quantity, and distribution of maternal 

4 (including prenatal, labor and birth, and 

5 postpartum) care services and the demographics 

6 of the recipients of those services; 

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

8 health outcomes (including quality of care, mor9 bidity, and mortality) before and after imple10 mentation of the program in the communities 

11 served by entities participating in the dem12 onstration; and 

13 ‘‘(C) recommendations on whether the 

14 demonstration program should be expanded. 

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

16 is authorized to be appropriated to carry out this section, 

17 $5,000,000 for each of fiscal years 2020 through 2024.’’. 

18 SEC. 105. GAO REPORT. 

19 Not later than 18 months after the date of enactment 

20 of this Act, the Comptroller General of the United States 

21 shall submit to the Committee on Energy and Commerce 

22 of the House of Representatives and the Committee on 

23 Health, Education, Labor, and Pensions of the Senate a 

24 report on maternal care in rural areas, including prenatal, 


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1 labor and birth, and postpartum care in rural areas. Such 

2 report shall include the following: 

3 (1) Trends in data that may identify potential 

4 gaps in maternal and obstetric clinicians and health 

5 professionals, including non-clinical professionals. 

6 (2) Trends in the number of facilities able to 

7 provide maternal care, including prenatal, labor and 

8 birth, and postpartum care, in rural areas, including 

9 care for high-risk pregnancies. 

10 (3) The gaps in data on maternal mortality and 

11 morbidity and recommendations to standardize the 

12 format on collecting data related to maternal mor13 tality and morbidity. 

14 (4) The gaps in maternal health outcomes by 

15 race and ethnicity in rural communities, with a focus 

16 on racial inequities for residents who are racial and 

17 ethnic minorities or members of underserved popu18 lations. 

19 (5) An examination of— 

20 (A) activities which the Secretary of 

21 Health and Human Services plans to conduct to 

22 improve maternal care in rural areas, including 

23 prenatal, labor and birth, and postpartum care; 

24 and 


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1 (B) the extent to which the Secretary has 

2 a plan for completing these activities, has iden3 tified the lead agency responsible for each activ4 ity, has identified any needed coordination 

5 among agencies, and has developed a budget for 

6 conducting such activities. 

7 (6) Other information that the Comptroller 

8 General determines appropriate. 

9 TITLE II—OTHER IMPROVE10 MENTS TO MATERNAL CARE 

11 SEC. 201. INNOVATION FOR MATERNAL HEALTH. 

12 The Public Health Service Act is amended— 

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

14 (42 U.S.C. 254c–19) by inserting a period after 

15 ‘‘330M’’; and 

16 (2) by inserting after such section 330M the 

17 following: 

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

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

20 with experts representing a variety of clinical specialties, 

21 State, tribal, or local public health officials, researchers, 

22 epidemiologists, statisticians, and community organiza23 tions, shall establish or continue a program to award com24 petitive grants to eligible entities for the purpose of— 


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

2 best practices to improve maternal health care qual3 ity and outcomes, eliminate preventable maternal 

4 mortality and severe maternal morbidity, and im5 prove infant health outcomes, which may include— 

6 ‘‘(A) information on evidence-based prac7 tices to improve the quality and safety of ma8 ternal health care in hospitals and other health 

9 care settings of a State or health care system, 

10 including by addressing topics commonly associ11 ated with health complications or risks related 

12 to prenatal care, labor care, birthing, and 

13 postpartum care; 

14 ‘‘(B) best practices for improving maternal 

15 health care based on data findings and reviews 

16 conducted by a State maternal mortality review 

17 committee that address topics of relevance to 

18 common complications or health risks related to 

19 prenatal care, labor care, birthing, and post20 partum care; and 

21 ‘‘(C) information on addressing deter22 minants of health that impact maternal health 

23 outcomes for women before, during, and after 

24 pregnancy; 


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1 ‘‘(2) collaborating with State maternal mor2 tality review committees to identify issues for the de3 velopment and implementation of evidence-based 

4 practices to improve maternal health outcomes and 

5 reduce preventable maternal mortality and severe 

6 maternal morbidity; 

7 ‘‘(3) providing technical assistance and sup8 porting the implementation of best practices identi9 fied in paragraph (1) to entities providing health 

10 care services to pregnant and postpartum women; 

11 and 

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

13 models of care that improve maternal and infant 

14 health outcomes, which may include the integration 

15 of community-based services and clinical care. 

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

17 under subsection (a), an entity shall— 

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

19 such time, in such manner, and containing such in20 formation as the Secretary may require; and 

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

22 entity is capable of carrying out data-driven mater23 nal safety and quality improvement initiatives in the 

24 areas of obstetrics and gynecology or maternal 

25 health. 


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

2 carry out this section, there is authorized to be appro3 priated $10,000,000 for each of fiscal years 2020 through 

4 2024.’’. 

5 SEC. 202. TRAINING FOR HEALTH CARE PROVIDERS. 

6 Title VII of the Public Health Service Act is amended 

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

8 the following: 

9 ‘‘SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS. 

10 ‘‘(a) GRANT PROGRAM.—The Secretary shall estab11 lish a program to award grants to accredited schools of 

12 allopathic medicine, osteopathic medicine, and nursing, 

13 and other health professional training programs for the 

14 training of health care professionals to reduce and prevent 

15 discrimination (including training related to implicit and 

16 explicit biases) in the provision of health care services re17 lated to prenatal care, labor care, birthing, and 

18 postpartum care. 

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

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

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

22 such manner, and containing such information as the Sec23 retary may require. 

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

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1 mit to the Secretary a report on the status of activities 

2 conducted using the grant, including a description of the 

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

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

5 and disseminate best practices for the training of health 

6 care professionals to reduce and prevent discrimination 

7 (including training related to implicit and explicit biases) 

8 in the provision of health care services related to prenatal 

9 care, labor care, birthing, and postpartum care. 

10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

11 carry out this section, there is authorized to be appro12 priated $5,000,000 for each of fiscal years 2020 through 

13 2024.’’. 

14 SEC. 203. STUDY ON TRAINING TO REDUCE AND PREVENT 

15 DISCRIMINATION. 

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

17 Act, the Secretary of Health and Human Services (re18 ferred to in this section as the ‘‘Secretary’’) shall, through 

19 a contract with an independent research organization, con20 duct a study and make recommendations for accredited 

21 schools of allopathic medicine, osteopathic medicine, and 

22 nursing, and other health professional training programs, 

23 on best practices related to training to reduce and prevent 

24 discrimination, including training related to implicit and 

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1 lated to prenatal care, labor care, birthing, and 

2 postpartum care. 

3 SEC. 204. PERINATAL QUALITY COLLABORATIVES. 

4 (a) GRANTS.—Section 317K(a)(2) of the Public 

5 Health Service Act (42 U.S.C. 247b–12(a)(2)) is amended 

6 by adding at the end the following: 

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

8 Director of the Centers for Disease Control and 

9 Prevention and in coordination with other of10 fices and agencies, as appropriate, shall estab11 lish or continue a competitive grant program 

12 for the establishment or support of perinatal 

13 quality collaboratives to improve perinatal care 

14 and perinatal health outcomes for pregnant and 

15 postpartum women and their infants. A State, 

16 Indian Tribe, or tribal organization may use 

17 funds received through such grant to— 

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

19 or evidence-informed practices to improve 

20 outcomes for maternal and infant health; 

21 ‘‘(II) work with clinical teams; ex22 perts; State, local, and, as appropriate, 

23 tribal public health officials; and stake24 holders, including patients and families, to 

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1 tices to improve perinatal care and out2 comes; and 

3 ‘‘(III) employ strategies that provide 

4 opportunities for health care professionals 

5 and clinical teams to collaborate across 

6 health care settings and disciplines, includ7 ing primary care and mental health, as ap8 propriate, to improve maternal and infant 

9 health outcomes, which may include the 

10 use of data to provide timely feedback 

11 across hospital and clinical teams to in12 form responses, and to provide support 

13 and training to hospital and clinical teams 

14 for quality improvement, as appropriate. 

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

16 clause (i), an entity shall submit to the Sec17 retary an application in such form and manner 

18 and containing such information as the Sec19 retary may require.’’. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

21 317K(f) of the Public Health Service Act (42 U.S.C. 

22 247b–12(f)) is amended by striking ‘‘$58,000,000 for 

23 each of fiscal years 2019 through 2023’’ and inserting 

24 ‘‘$65,000,000 for each of fiscal years 2020 through 

25 2024’’. 


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1 SEC. 205. INTEGRATED SERVICES FOR PREGNANT AND 

2 POSTPARTUM WOMEN. 

3 (a) GRANTS.—The Public Health Service Act is 

4 amended by inserting after section 330N of such Act, as 

5 added by section 201, the following: 

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

7 POSTPARTUM WOMEN. 

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

9 for the purpose of establishing or operating evidence-based 

10 or innovative, evidence-informed programs to deliver inte11 grated health care services to pregnant and postpartum 

12 women to optimize the health of women and their infants, 

13 including— 

14 ‘‘(1) to reduce adverse maternal health out15 comes, pregnancy-related deaths, and related health 

16 disparities (including such disparities associated with 

17 racial and ethnic minority populations); and 

18 ‘‘(2) as appropriate, by addressing issues re19 searched under section 317K(b)(2). 

20 ‘‘(b) INTEGRATED SERVICES FOR PREGNANT AND

21 POSTPARTUM WOMEN.— 

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

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

24 tribal organization (as such terms are defined in sec25 tion 4 of the Indian Self-Determination and Edu26 cation Assistance Act) shall work with relevant 


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1 stakeholders that coordinate care (including coordi2 nating resources and referrals for health care and 

3 social services) to develop and carry out the pro4 gram, including— 

5 ‘‘(A) State, Tribal, and local agencies re6 sponsible for Medicaid, public health, social 

7 services, mental health, and substance use dis8 order treatment and services; 

9 ‘‘(B) health care providers who serve preg10 nant and postpartum women; and 

11 ‘‘(C) community-based health organiza12 tions and health workers, including providers of 

13 home visiting services and individuals rep14 resenting communities with disproportionately 

15 high rates of maternal mortality and severe ma16 ternal morbidity, and including those rep17 resenting racial and ethnicity minority popu18 lations. 

19 ‘‘(2) TERMS.— 

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

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

22 years. Any supplemental award made to a 

23 grantee under subsection (a) may be made for 

24 a period of less than 5 years. 


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•HR 4995 IH

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

2 under subsection (a), the Secretary shall— 

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

4 Tribes, and tribal organizations that have 

5 the highest rates of maternal mortality and 

6 severe maternal morbidity relative to other 

7 such States, Indian Tribes, or tribal orga8 nizations, respectively; and 

9 ‘‘(ii) shall consider health disparities 

10 related to maternal mortality and severe 

11 maternal morbidity, including such dispari12 ties associated with racial and ethnic mi13 nority populations. 

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

15 under subsection (a), the Secretary shall give 

16 priority to applications from up to 15 entities 

17 described in subparagraph (B)(i). 

18 ‘‘(D) EVALUATION.—The Secretary shall 

19 require grantees to evaluate the outcomes of the 

20 programs supported under the grant. 

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

22 carry out this section, there is authorized to be appro23 priated $15,000,000 for each of fiscal years 2020 through 

24 2024.’’. 


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1 (b) REPORT ON GRANT OUTCOMES AND DISSEMINA2 TION OF BEST PRACTICES.— 

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

4 2026, the Secretary of Health and Human Services 

5 shall submit to the Committee on Energy and Com6 merce of the House of Representatives and the Com7 mittee on Health, Education, Labor, and Pensions 

8 of the Senate a report that describes— 

9 (A) the outcomes of the activities sup10 ported by the grants awarded under the amend11 ments made by this section on maternal and 

12 child health; 

13 (B) best practices and models of care used 

14 by recipients of grants under such amendments; 

15 and 

16 (C) obstacles identified by recipients of 

17 grants under such amendments, and strategies 

18 used by such recipients to deliver care, improve 

19 maternal and child health, and reduce health 

20 disparities. 

21 (2) DISSEMINATION OF BEST PRACTICES.—Not 

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

23 and Human Services shall disseminate information 

24 on best practices and models of care used by recipi25 ents of grants under section 330O of the Public 


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1 Health Service Act (as added by this section) (in2 cluding best practices and models of care relating to 

3 the reduction of health disparities, including such 

4 disparities associated with racial and ethnic minority 

5 populations, in rates of maternal mortality and se6 vere maternal morbidity) to relevant stakeholders, 

7 which may include health providers, medical schools, 

8 nursing schools, relevant State, tribal, and local 

9 agencies, and the general public. 

Æ 


kjohnson on DSK79L0C42 with BILLS