IB 

Union Calendar No. 414 

116TH CONGRESS 

2D SESSION H. R. 4995 

[Report No. 116–514] 

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 

SEPTEMBER 17, 2020 

Additional sponsors: Mr. CARSON of Indiana, Ms. KELLY of Illinois, Ms. HERRERA BEUTLER, Mr. MARSHALL, Mr. BURGESS, Mr. WALDEN, Mrs. 

HAYES, Mr. O’HALLERAN, Ms. KUSTER of New Hampshire, Mr. GUTHRIE, Mr. TRONE, Ms. CRAIG, Mr. FITZPATRICK, Ms. SCHAKOWSKY, Mr. 

CASTEN of Illinois, Mr. CUNNINGHAM, Ms. NORTON, Ms. UNDERWOOD, 

Mr. MCGOVERN, Ms. FINKENAUER, Mr. MORELLE, Ms. HOULAHAN, Ms. 

GABBARD, Mr. RUIZ, Mrs. NAPOLITANO, and Mr. LEVIN of Michigan 

SEPTEMBER 17, 2020 

Reported with an amendment; committed to the Committee of the Whole 

House on the State of the Union and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on November 8, 2019] 


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A BILL 

To amend the Public Health Service Act to improve obstetric 

care and maternal health outcomes, and for other purposes. 


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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. 

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. 

8 TITLE I—IMPROVING OBSTETRIC 

9 CARE IN RURAL AREAS 

10 SEC. 101. IMPROVING RURAL MATERNAL AND OBSTETRIC 

11 CARE DATA. 

12 (a) MATERNAL MORTALITY AND MORBIDITY ACTIVI13 TIES.—Section 301 of the Public Health Service Act (42 

14 U.S.C. 241) is amended— 

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

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


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1 (2) by inserting after subsection (d), the fol2 lowing: 

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

4 Centers for Disease Control and Prevention, shall expand, 

5 intensify, and coordinate the activities of the Centers for 

6 Disease Control and Prevention with respect to maternal 

7 mortality and morbidity.’’. 

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

9 310A(b)(1) of the Public Health Service Act (42 U.S.C. 

10 242s(b)(1)) is amended by inserting ‘‘sociocultural, includ11 ing among American Indians and Alaska Natives, as such 

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

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

14 (c) SAFE MOTHERHOOD.—Section 317K of the Public 

15 Health Service Act (42 U.S.C. 247b–12) is amended— 

16 (1) in subsection (a)(2)(A), by inserting before 

17 the period at the end the following: ‘‘, including im18 proving collection of data on race, ethnicity, and 

19 other demographic information’’; and 

20 (2) in subsection (b)(2)— 

21 (A) in subparagraph (L), by striking ‘‘and’’ 

22 at the end; 

23 (B) by redesignating subparagraph (M) as 

24 subparagraph (N); and 


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1 (C) by inserting after subparagraph (L), the 

2 following: 

3 ‘‘(M) an examination of the relationship be4 tween maternal and obstetric services in rural 

5 areas and outcomes in delivery and postpartum 

6 care; and’’. 

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

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

9 287d) is amended— 

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

11 (3) to read as follows: 

12 ‘‘(3) carry out paragraphs (1) and (2) with re13 spect to— 

14 ‘‘(A) the aging process in women, with pri15 ority given to menopause; and 

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

17 deaths related to pregnancy;’’; and 

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

19 including maternal mortality and other maternal 

20 morbidity outcomes’’ before the semicolon. 

21 SEC. 102. RURAL OBSTETRIC NETWORK GRANTS. 

22 The Public Health Service Act is amended by inserting 

23 after section 330A–1 of such Act (42 U.S.C. 254c–1a) the 

24 following: 


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

2 ‘‘(a) PROGRAM ESTABLISHED.—The Secretary, acting 

3 through the Administrator of the Health Resources and 

4 Services Administration, shall award grants to eligible enti5 ties to establish collaborative improvement and innovation 

6 networks (referred to in this section as ‘rural obstetric net7 works’) to improve birth outcomes and reduce maternal 

8 morbidity and mortality by improving maternity care and 

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

10 health professional target areas, and Indian country and 

11 with Indian Tribes and tribal organizations. 

12 ‘‘(b) USE OF FUNDS.—Rural obstetric networks receiv13 ing funds pursuant to this section may use such funds to— 

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

15 areas and within populations referenced in subsection 

16 (a) with accessing and utilizing maternal and obstet17 ric care, including preconception, pregnancy, labor 

18 and delivery, postpartum, and interconception serv19 ices to improve outcomes in birth and maternal mor20 tality and morbidity; 

21 ‘‘(2) identify successful delivery models for ma22 ternal and obstetric care (including preconception, 

23 pregnancy, labor and delivery, postpartum, and 

24 interconception services) for individuals in areas and 

25 within populations referenced by subsection (a), in26 cluding evidence-based home visiting programs and 


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1 successful, culturally competent models with positive 

2 maternal health outcomes that advance health equity; 

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

4 health facilities that have an obstetric care unit and 

5 health facilities that do not have an obstetric care 

6 unit to improve access to and the delivery of obstetric 

7 services in communities lacking these services; 

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

9 care for health facilities that do not have obstetric 

10 care units; 

11 ‘‘(5) collaborate with academic institutions that 

12 can provide regional expertise and research on access, 

13 outcomes, needs assessments, and other identified data 

14 and measurement activities needed to inform rural 

15 obstetric network efforts to improve obstetric care; and 

16 ‘‘(6) measure and address inequities in birth out17 comes among rural residents, with an emphasis on 

18 racial and ethnic minorities and underserved popu19 lations. 

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

21 ‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible en22 tities’ means entities providing obstetric, gynecologic, 

23 and other maternal health care services in rural 

24 areas, frontier areas, or medically underserved areas, 

25 or to medically underserved populations or Native 


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1 Americans, including Indian tribes or tribal organi2 zations. 

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

4 means a frontier county, as defined in section 

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

6 ‘‘(3) INDIAN COUNTRY.—The term ‘Indian coun7 try’ has the meaning given such term in section 1151 

8 of title 18, United States Code. 

9 ‘‘(4) MATERNITY CARE HEALTH PROFESSIONAL

10 TARGET AREA.—The term ‘maternity care health pro11 fessional target area’ has the meaning of such term as 

12 used in section 332(k)(2). 

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

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

15 the Social Security Act. 

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

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

18 have the meaning given such terms in section 4 of the 

19 Indian Self-Determination and Education Assistance 

20 Act. 

21 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section 

23 $3,000,000 for each of fiscal years 2020 through 2024.’’. 


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1 SEC. 103. TELEHEALTH NETWORK AND TELEHEALTH RE2 SOURCE CENTERS GRANT PROGRAMS. 

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

4 U.S.C. 254c–14) is amended— 

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

6 end the following: 

7 ‘‘(XIII) Providers of maternal, in8 cluding prenatal, labor and birth, and 

9 postpartum care services and entities 

10 operating obstetric care units.’’; and 

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

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

13 SEC. 104. RURAL MATERNAL AND OBSTETRIC CARE TRAIN14 ING DEMONSTRATION. 

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

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

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

18 by adding at the end the following: 

19 ‘‘SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAIN20 ING DEMONSTRATION. 

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

22 training demonstration program to award grants to eligible 

23 entities to support— 

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

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1 cology residents, and fellows to practice maternal and 

2 obstetric medicine in rural community-based settings; 

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

4 assistants, nurses, certified nurse midwives, home vis5 iting nurses and non-clinical home visiting workforce 

6 professionals and paraprofessionals, or non-clinical 

7 professionals, who meet applicable State training and 

8 licensing requirements, to provide maternal care serv9 ices in rural community-based settings; and 

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

11 academic units or programs that— 

12 ‘‘(A) provide training for students or fac13 ulty, including through clinical experiences and 

14 research, to improve maternal care in rural 

15 areas; or 

16 ‘‘(B) develop evidence-based practices or rec17 ommendations for the design of the units or pro18 grams described in subparagraph (A), including 

19 curriculum content standards. 

20 ‘‘(b) ACTIVITIES.— 

21 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND

22 FELLOWS.—A recipient of a grant under subsection 

23 (a)(1)— 

24 ‘‘(A) shall use the grant funds— 


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

2 training program to provide obstetric care 

3 in rural areas for family practice or obstet4 rics and gynecology residents and fellows; or 

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

6 obstetrics and gynecology residents and fel7 lows in maternal and obstetric health care 

8 to provide and expand access to maternal 

9 and obstetric health care in rural areas; 

10 and 

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

12 additional support for the administration of the 

13 program or to meet the costs of projects to estab14 lish, maintain, or improve faculty development, 

15 or departments, divisions, or other units nec16 essary to implement such training. 

17 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re18 cipient of a grant under subsection (a)(2)— 

19 ‘‘(A) shall use the grant funds to plan, de20 velop, or operate a training program to provide 

21 maternal health care services in rural, commu22 nity-based settings; and 

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

24 additional support for the administration of the 

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1 lish, maintain, or improve faculty development, 

2 or departments, divisions, or other units nec3 essary to implement such program. 

4 ‘‘(3) TRAINING PROGRAM REQUIREMENTS.—The 

5 recipient of a grant under subsection (a)(1) or (a)(2) 

6 shall ensure that training programs carried out under 

7 the grant are evidence-based and include instruction 

8 on— 

9 ‘‘(A) maternal mental health, including 

10 perinatal depression and anxiety; 

11 ‘‘(B) maternal substance use disorder; 

12 ‘‘(C) social determinants of health that im13 pact individuals living in rural communities, 

14 including poverty, social isolation, access to nu15 trition, education, transportation, and housing; 

16 and 

17 ‘‘(D) implicit bias. 

18 ‘‘(c) ELIGIBLE ENTITIES.— 

19 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND

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

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

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

23 ‘‘(i) at least one teaching health center; 

24 or 


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1 ‘‘(ii) the sponsoring institution (or 

2 parent institution of the sponsoring institu3 tion) of— 

4 ‘‘(I) an obstetrics and gynecology 

5 or family medicine residency program 

6 that is accredited by the Accreditation 

7 Council of Graduate Medical Edu8 cation (or the parent institution of 

9 such a program); or 

10 ‘‘(II) a fellowship in maternal or 

11 obstetric medicine, as determined ap12 propriate by the Secretary; or 

13 ‘‘(B) be an entity described in subpara14 graph (A)(ii) that provides opportunities for 

15 medical residents or fellows to train in rural 

16 community-based settings. 

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

18 eligible to receive a grant under subsection (a)(2), an 

19 entity shall be— 

20 ‘‘(A) a teaching health center (as defined in 

21 section 749A(f)); 

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

23 defined in section 1905(l)(2)(B) of the Social Se24 curity Act); 


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

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

3 Security Act); 

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

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

6 ‘‘(E) a freestanding birth center (as defined 

7 in section 1905(l)(3) of the Social Security Act); 

8 or 

9 ‘‘(F) an Indian Health Program or a Na10 tive Hawaiian health care system (as such terms 

11 are defined in section 4 of the Indian Health 

12 Care Improvement Act and section 12 of the Na13 tive Hawaiian Health Care Improvement Act, 

14 respectively). 

15 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be eli16 gible to receive a grant under subsection (a)(3), an 

17 entity shall be a school of medicine, a school of osteo18 pathic medicine, a school of nursing (as defined in 

19 section 801), a physician assistant education pro20 gram, an accredited public or nonprofit private hos21 pital, an accredited medical residency training pro22 gram, a school accredited by the Midwifery Education 

23 and Accreditation Council, by the Accreditation Com24 mission for Midwifery Education, or by the American 

25 Midwifery Certification Board, or a public or private 


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1 nonprofit educational entity which the Secretary has 

2 determined is capable of carrying out such grant. 

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

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

5 the Secretary an application at such time, in such 

6 manner, and containing such information as the Sec7 retary may require, including an estimate of the 

8 amount to be expended to conduct training activities 

9 under the grant (including ancillary and administra10 tive costs). 

11 ‘‘(d) STUDY AND REPORT.— 

12 ‘‘(1) STUDY.— 

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

14 through the Administrator of the Health Re15 sources and Services Administration, shall con16 duct a study on the results of the demonstration 

17 program under this section. 

18 ‘‘(B) DATA SUBMISSION.—Not later than 90 

19 days after the completion of the first year of the 

20 training program, and each subsequent year for 

21 the duration of the grant, that the program is in 

22 effect, each recipient of a grant under subsection 

23 (a) shall submit to the Secretary such data as 

24 the Secretary may require for analysis for the re25 port described in paragraph (2). 


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

2 year after receipt of the data described in paragraph 

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

4 on Energy and Commerce of the House of Representa5 tives and the Committee on Health, Education, 

6 Labor, and Pensions of the Senate a report that in7 cludes— 

8 ‘‘(A) an analysis of the effect of the dem9 onstration program under this section on the 

10 quality, quantity, and distribution of maternal 

11 (including prenatal, labor and birth, and 

12 postpartum) care services and the demographics 

13 of the recipients of those services; 

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

15 health outcomes (including quality of care, mor16 bidity, and mortality) before and after imple17 mentation of the program in the communities 

18 served by entities participating in the dem19 onstration; and 

20 ‘‘(C) recommendations on whether the dem21 onstration program should be expanded. 

22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There is 

23 authorized to be appropriated to carry out this section, 

24 $5,000,000 for each of fiscal years 2020 through 2024.’’. 


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1 SEC. 105. GAO REPORT. 

2 Not later than 18 months after the date of enactment 

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

4 shall submit to the Committee on Energy and Commerce 

5 of the House of Representatives and the Committee on 

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

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

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

9 report shall include the following: 

10 (1) Trends in data that may identify potential 

11 gaps in maternal and obstetric clinicians and health 

12 professionals, including non-clinical professionals. 

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

14 provide maternal care, including prenatal, labor and 

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

16 care for high-risk pregnancies. 

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

18 morbidity and recommendations to standardize the 

19 format on collecting data related to maternal mor20 tality and morbidity. 

21 (4) The gaps in maternal health outcomes by 

22 race and ethnicity in rural communities, with a focus 

23 on racial inequities for residents who are racial and 

24 ethnic minorities or members of underserved popu25 lations. 

26 (5) An examination of— 


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1 (A) activities which the Secretary of Health 

2 and Human Services plans to conduct to im3 prove maternal care in rural areas, including 

4 prenatal, labor and birth, and postpartum care; 

5 and 

6 (B) the extent to which the Secretary has a 

7 plan for completing these activities, has identi8 fied the lead agency responsible for each activity, 

9 has identified any needed coordination among 

10 agencies, and has developed a budget for con11 ducting such activities. 

12 (6) Other information that the Comptroller Gen13 eral determines appropriate. 

14 TITLE II—OTHER IMPROVE15 MENTS TO MATERNAL CARE 

16 SEC. 201. INNOVATION FOR MATERNAL HEALTH. 

17 The Public Health Service Act is amended— 

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

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

20 ‘‘330M’’; and 

21 (2) by inserting after such section 330M the fol22 lowing: 

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

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

25 with experts representing a variety of clinical specialties, 


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

2 epidemiologists, statisticians, and community organiza3 tions, shall establish or continue a program to award com4 petitive grants to eligible entities for the purpose of— 

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

6 best practices to improve maternal health care quality 

7 and outcomes, eliminate preventable maternal mor8 tality and severe maternal morbidity, and improve 

9 infant health outcomes, which may include— 

10 ‘‘(A) information on evidence-based prac11 tices to improve the quality and safety of mater12 nal health care in hospitals and other health care 

13 settings of a State or health care system, includ14 ing by addressing topics commonly associated 

15 with health complications or risks related to pre16 natal care, labor care, birthing, and postpartum 

17 care; 

18 ‘‘(B) best practices for improving maternal 

19 health care based on data findings and reviews 

20 conducted by a State maternal mortality review 

21 committee that address topics of relevance to 

22 common complications or health risks related to 

23 prenatal care, labor care, birthing, and post24 partum care; and 


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1 ‘‘(C) information on addressing deter2 minants of health that impact maternal health 

3 outcomes for women before, during, and after 

4 pregnancy; 

5 ‘‘(2) collaborating with State maternal mortality 

6 review committees to identify issues for the develop7 ment and implementation of evidence-based practices 

8 to improve maternal health outcomes and reduce pre9 ventable maternal mortality and severe maternal 

10 morbidity; 

11 ‘‘(3) providing technical assistance and sup12 porting the implementation of best practices identi13 fied in paragraph (1) to entities providing health 

14 care services to pregnant and postpartum women; and 

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

16 models of care that improve maternal and infant 

17 health outcomes, which may include the integration of 

18 community-based services and clinical care. 

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

20 under subsection (a), an entity shall— 

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

22 such time, in such manner, and containing such in23 formation as the Secretary may require; and 

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

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1 nal safety and quality improvement initiatives in the 

2 areas of obstetrics and gynecology or maternal health. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there is authorized to be appropriated 

5 $10,000,000 for each of fiscal years 2020 through 2024.’’. 

6 SEC. 202. TRAINING FOR HEALTH CARE PROVIDERS. 

7 Title VII of the Public Health Service Act is amended 

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

9 following: 

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

11 ‘‘(a) GRANT PROGRAM.—The Secretary shall establish 

12 a program to award grants to accredited schools of 

13 allopathic medicine, osteopathic medicine, and nursing, 

14 and other health professional training programs for the 

15 training of health care professionals to reduce and prevent 

16 discrimination (including training related to implicit and 

17 explicit biases) in the provision of health care services re18 lated to prenatal care, labor care, birthing, and postpartum 

19 care. 

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

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

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

23 such manner, and containing such information as the Sec24 retary may require. 


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1 ‘‘(c) REPORTING REQUIREMENT.—Each entity award2 ed a grant under this section shall periodically submit to 

3 the Secretary a report on the status of activities conducted 

4 using the grant, including a description of the impact of 

5 such training on patient outcomes, as applicable. 

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

7 and disseminate best practices for the training of health 

8 care professionals to reduce and prevent discrimination (in9 cluding training related to implicit and explicit biases) in 

10 the provision of health care services related to prenatal care, 

11 labor care, birthing, and postpartum care. 

12 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To carry 

13 out this section, there is authorized to be appropriated 

14 $5,000,000 for each of fiscal years 2020 through 2024.’’. 

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

16 DISCRIMINATION. 

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

18 Act, the Secretary of Health and Human Services (referred 

19 to in this section as the ‘‘Secretary’’) shall, through a con20 tract with an independent research organization, conduct 

21 a study and make recommendations for accredited schools 

22 of allopathic medicine, osteopathic medicine, and nursing, 

23 and other health professional training programs, on best 

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1 plicit biases, in the provision of health care services related 

2 to prenatal care, labor care, birthing, and postpartum care. 

3 SEC. 204. PERINATAL QUALITY COLLABORATIVES. 

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

5 Service Act (42 U.S.C. 247b–12(a)(2)) is amended by add6 ing 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 offices 

10 and agencies, as appropriate, shall establish or 

11 continue a competitive grant program for the es12 tablishment or support of perinatal quality 

13 collaboratives to improve perinatal care and 

14 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; experts; 

22 State, local, and, as appropriate, tribal 

23 public health officials; and stakeholders, in24 cluding patients and families, to identify, 


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1 develop, or disseminate best practices to im2 prove perinatal care and outcomes; 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 use 

10 of data to provide timely feedback across 

11 hospital and clinical teams to inform re12 sponses, and to provide support and train13 ing to hospital and clinical teams for qual14 ity improvement, as appropriate. 

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

16 (i), an entity shall submit to the Secretary an 

17 application in such form and manner and con18 taining such information as the Secretary may 

19 require.’’. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

21 317K(f) of the Public Health Service Act (42 U.S.C. 247b– 

22 12(f)) is amended by striking ‘‘$58,000,000 for each of fiscal 

23 years 2019 through 2023’’ and inserting ‘‘$65,000,000 for 

24 each of fiscal years 2020 through 2024’’. 


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25 

•HR 4995 RH

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 outcomes, 

15 pregnancy-related deaths, and related health dispari16 ties (including such disparities associated with racial 

17 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 stakeVerDate Sep 11 2014 00:32 Sep 18, 2020 Jkt 099200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6203 E:\BILLS\H4995.RH H4995

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•HR 4995 RH

1 holders that coordinate care (including coordinating 

2 resources and referrals for health care and social serv3 ices) to develop and carry out the program, includ4 ing— 

5 ‘‘(A) State, Tribal, and local agencies re6 sponsible for Medicaid, public health, social serv7 ices, mental health, and substance use disorder 

8 treatment and services; 

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

11 ‘‘(C) community-based health organizations 

12 and health workers, including providers of home 

13 visiting services and individuals representing 

14 communities with disproportionately high rates 

15 of maternal mortality and severe maternal mor16 bidity, and including those representing racial 

17 and ethnicity minority populations. 

18 ‘‘(2) TERMS.— 

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

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

21 years. Any supplemental award made to a 

22 grantee under subsection (a) may be made for a 

23 period of less than 5 years. 

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

25 under subsection (a), the Secretary shall— 


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•HR 4995 RH

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

2 Tribes, and tribal organizations that have 

3 the highest rates of maternal mortality and 

4 severe maternal morbidity relative to other 

5 such States, Indian Tribes, or tribal organi6 zations, respectively; and 

7 ‘‘(ii) shall consider health disparities 

8 related to maternal mortality and severe 

9 maternal morbidity, including such dispari10 ties associated with racial and ethnic mi11 nority populations. 

12 ‘‘(C) PRIORITY.—In awarding grants under 

13 subsection (a), the Secretary shall give priority 

14 to applications from up to 15 entities described 

15 in subparagraph (B)(i). 

16 ‘‘(D) EVALUATION.—The Secretary shall re17 quire grantees to evaluate the outcomes of the 

18 programs supported under the grant. 

19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

20 out this section, there is authorized to be appropriated 

21 $15,000,000 for each of fiscal years 2020 through 2024.’’. 

22 (b) REPORT ON GRANT OUTCOMES AND DISSEMINA23 TION OF BEST PRACTICES.— 

24 (1) REPORT.—Not later than February 1, 2026, 

25 the Secretary of Health and Human Services shall 


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•HR 4995 RH

1 submit to the Committee on Energy and Commerce of 

2 the House of Representatives and the Committee on 

3 Health, Education, Labor, and Pensions of the Senate 

4 a report that describes— 

5 (A) the outcomes of the activities supported 

6 by the grants awarded under the amendments 

7 made by this section on maternal and child 

8 health; 

9 (B) best practices and models of care used 

10 by recipients of grants under such amendments; 

11 and 

12 (C) obstacles identified by recipients of 

13 grants under such amendments, and strategies 

14 used by such recipients to deliver care, improve 

15 maternal and child health, and reduce health 

16 disparities. 

17 (2) DISSEMINATION OF BEST PRACTICES.—Not 

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

19 and Human Services shall disseminate information 

20 on best practices and models of care used by recipi21 ents of grants under section 330O of the Public 

22 Health Service Act (as added by this section) (includ23 ing best practices and models of care relating to the 

24 reduction of health disparities, including such dis25 parities associated with racial and ethnic minority 


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•HR 4995 RH

1 populations, in rates of maternal mortality and se2 vere maternal morbidity) to relevant stakeholders, 

3 which may include health providers, medical schools, 

4 nursing schools, relevant State, tribal, and local agen5 cies, and the general public. 


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Union Calendar No. 414 

116TH CONGRESS 

2D SESSION H. R. 4995 

[Report No. 116–514] 

A BILL 

To amend the Public Health Service Act to improve 

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

SEPTEMBER 17, 2020 

Reported with an amendment; committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union 


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