I 

113TH CONGRESS 

1ST SESSION H. R. 2286 

To promote optimal maternity outcomes by making evidence-based maternity 

care a national priority, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 6, 2013 

Ms. ROYBAL-ALLARD (for herself, Mrs. CAPPS, Mrs. CHRISTENSEN, Ms. LEE

of California, Ms. MCCOLLUM, Ms. PINGREE of Maine, and Mr. RANGEL) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To promote optimal maternity outcomes by making evidencebased maternity care a national priority, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Maximizing Optimal Maternity Services for the 21st 

6 Century’’ or the ‘‘MOMS for the 21st Century Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—HHS FOCUS ON THE PROMOTION OF OPTIMAL 

MATERNITY CARE 

Sec. 101. Additional focus area for the Office on Women’s Health. 

Sec. 102. Interagency Coordinating Committee on the Promotion of Optimal 

Maternity Outcomes. 

Sec. 103. Consumer education campaign. 

Sec. 104. Bibliographic database of systematic reviews for care of childbearing 

women and newborns. 

TITLE II—RESEARCH AND DATA COLLECTION ON MATERNITY 

CARE 

Sec. 201. Maternity care health professional shortage areas. 

Sec. 202. Expansion of CDC Prevention Research Centers program to include 

Centers on Optimal Maternity Outcomes. 

Sec. 203. Expanding models to be tested by Center for Medicare and Medicaid 

Innovation to include maternity care models. 

TITLE III—ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, 

AND ETHNICALLY DIVERSE INTERPROFESSIONAL MATERNITY 

WORKFORCE 

Sec. 301. Development of interprofessional maternity care educational models 

and tools. 

Sec. 302. Interprofessional training of medical students, residents, and student 

midwives in academic health centers and freestanding birth 

centers. 

Sec. 303. Grants to professional organizations to increase diversity in maternity 

care professionals. 

3 SEC. 2. FINDINGS. 

4 Congress finds the following: 

5 (1) Maternity expenditures in the United States 

6 surpass all other developed countries, but childbirth 

7 continues to carry significant risks for mothers in 

8 the United States, as demonstrated by the following: 

9 (A) More than two women die every day in 

10 the United States from pregnancy-related 

11 causes and the maternal mortality rate in the 


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1 United States has roughly doubled in the past 

2 25 years. According to data released in 2010, 

3 the maternal mortality ratio was 12.7 percent 

4 as compared to 6.6 percent in 1987. 

5 (B) More than one-third of all women who 

6 give birth in the United States (1,700,000 

7 women each year) experience some type of com8 plication that has an adverse effect on their 

9 health. 

10 (C) Severe complications that result in 

11 women nearly dying, known as a ‘‘near miss’’ 

12 or severe morbidity, increased by 25 percent be13 tween 1998 and 2005, to approximately 34,000 

14 cases a year. 

15 (D) African-American women have nearly 

16 a four times greater risk of dying from preg17 nancy-related complications than White women, 

18 and these disparities have not improved in 50 

19 years. 

20 (2) In spite of the considerable investment of 

21 the United States in maternity care, the United 

22 States is failing to ensure that all infants have a 

23 healthy start in life, as demonstrated by the fol24 lowing: 


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1 (A) Despite five years of modest reduction 

2 in pre-term births between 2006 and 2011, the 

3 United States continues to lag behind most 

4 other countries in pre-term birth rates, ranking 

5 131 out of 184 countries, according to a 2011 

6 report by the March of Dimes and the World 

7 Health Organization. 

8 (B) The proportion of low birth weight ba9 bies increased by 21 percent between 1981 and 

10 2008. 

11 (C) Non-Hispanic Black infants continue 

12 to experience significantly higher rates of both 

13 pre-term birth and low birthweight, two of the 

14 leading causes of infant mortality in this coun15 try. 

16 (3) Despite shortcomings in the United States 

17 statewide data collections systems, which make 

18 international comparisons more challenging, inter19 national health organizations have ranked the 

20 United States far behind almost all developed coun21 tries in important perinatal and maternal outcomes, 

22 as demonstrated by the following: 

23 (A) The World Health Organization identi24 fied 49 nations with lower rates of maternal 

25 deaths than the United States in 2008. 


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1 (B) In the World Health Report 2005, the 

2 World Health Organization identified 35 na3 tions with lower early neonatal mortality rates 

4 (4/1,000 live births) and 33 with lower neonatal 

5 mortality rates (5/1,000 live births) than the 

6 United States. 

7 (C) According to data from the 

8 Organisation for Economic Co-operation and 

9 Development (OECD), 26 countries (out of 29 

10 reporting) had low birthweight rates lower than 

11 that of the United States. 

12 (D) 21 OECD countries (out of 27 report13 ing) had lower cesarean section rates than the 

14 United States. 

15 (4) Maternity care is a major component of the 

16 escalating health care costs in the United States, as 

17 demonstrated by the following: 

18 (A) With 4,000,000 deliveries yearly, the 

19 vast majority of which occur in hospitals, ma20 ternity care for mothers and their newborns is 

21 the number one reason for hospitalization in the 

22 United States, exceeding such prevalent condi23 tions as pneumonia, cancer, fracture, and heart 

24 disease. Of those discharged from hospitals in 


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1 the United States in 2009, nearly one in four 

2 were childbearing women and newborns. 

3 (B) Combined mother and baby charges 

4 for hospitalization, which was $98,000,000,000 

5 in 2008, far exceeded charges for any other 

6 hospital condition in the United States. 

7 (5) Maternity care also accounts for a signifi8 cant proportion of expenditures under the Medicaid 

9 program, which covers 42 percent of births in this 

10 country, as demonstrated by the following: 

11 (A) In 2008, 26 percent of all hospital 

12 charges for which payment was made under the 

13 Medicaid program (totaling $41,000,000,000) 

14 was for birthing women and newborns. 

15 (B) The two most common conditions for 

16 which payments were made under the Medicaid 

17 program in 2007 were pregnancy and childbirth 

18 (constituting 28 percent of such payments) and 

19 newborns (constituting 26 percent of such pay20 ments), which together accounted for 53 per21 cent of hospital discharges billed to Medicaid. 

22 (C) The two most costly conditions for 

23 which payment was made under the Medicaid 

24 program in 2008 were ‘‘mother’s pregnancy and 

25 delivery’’ and care for ‘‘newborn infants’’, which 


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1 together accounted for 26 percent of all Med2 icaid expenditures. 

3 (6) Maternity care facility charges vary signifi4 cantly by setting and type of birth. Part of the 

5 charge differentials between facilities are attrib6 utable to high overhead of hospitals— 

7 (A) in 2008, the average charge for a hos8 pital cesarean birth with complications was 

9 $20,080, and without complications was 

10 $14,900; 

11 (B) in 2008, the average charge for a hos12 pital vaginal birth with complications was 

13 $11,410, and without complications was 

14 $8,920; and 

15 (C) in 2010, the average charge for a birth 

16 center vaginal birth was $2,277. 

17 (7) The procedure-intensity of birth-related hos18 pital stays also helps to explain the high costs of 

19 such hospital stays. In 2008, 6 of the 10 most com20 monly performed hospital procedures for all patients 

21 with all diagnoses involved childbirth and newborn 

22 care. Cesarean section was the most common oper23 ating room procedure. 

24 (8) Two non-invasive maternity practices, smok25 ing cessation programs during pregnancy and exterVerDate Mar 15 2010 04:37 Jun 09, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2286.IH H2286

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1 nal version to turn breech babies at term, have 

2 strong proven correlation with considerable improve3 ment in outcomes with no detrimental side effects, 

4 but are significantly underused in the United States. 

5 (9) There is a growing body of evidence that 

6 other non-invasive practices which are underused in 

7 current practice may also be associated with im8 proved outcomes. These non-invasive practices in9 clude group model prenatal care (such as the 

10 CenteringPregnancy model), continuous labor sup11 port, and non-supine positions for birth. 

12 (10) The growing shortage of maternity health 

13 care professionals and childbirth facilities is creating 

14 a serious obstacle to timely and adequate maternity 

15 health care for women, particularly in rural areas 

16 and the inner cities. 

17 (11) There are significant racial and ethnic dis18 parities across the maternity care workforce creating 

19 additional access barriers to culturally and linguis20 tically competent maternity services. 


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1 TITLE I—HHS FOCUS ON THE 

2 PROMOTION OF OPTIMAL MA3 TERNITY CARE 

4 SEC. 101. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 

5 WOMEN’S HEALTH. 

6 Section 229(b) of the Public Health Service Act (42 

7 U.S.C. 237a(b)) is amended— 

8 (1) in paragraph (6), at the end, by striking 

9 ‘‘and’’; 

10 (2) in paragraph (7), at the end, by striking the 

11 period and inserting ‘‘; and’’; and 

12 (3) by adding at the end the following new 

13 paragraph: 

14 ‘‘(8) facilitate policy makers, health system 

15 leaders and providers, consumers, and other stake16 holders in their understanding optimal maternity 

17 care and support for the provision of such care, in18 cluding the priorities of— 

19 ‘‘(A) protecting, promoting, and supporting 

20 the innate capacities of childbearing women and 

21 their newborns for childbirth, breast-feeding, 

22 and attachment; 

23 ‘‘(B) using obstetric interventions only 

24 when such interventions are supported by 

25 strong, high-quality evidence, and minimizing 


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1 overuse of maternity practices that have been 

2 shown to have benefit in limited situations and 

3 that can expose women, infants, or both to risk 

4 of harm if used routinely and indiscriminately, 

5 including continuous electronic fetal monitoring, 

6 labor induction, epidural analgesia, primary ce7 sarean section, and routine repeat cesarean 

8 birth; 

9 ‘‘(C) reliably incorporating non-invasive, 

10 evidence-based practices that have documented 

11 correlation with considerable improvement in 

12 outcomes with no detrimental side effects, such 

13 as smoking cessation programs in pregnancy 

14 and proven models of group prenatal care that 

15 integrate health assessment, education, and 

16 support into a unified program; 

17 ‘‘(D) a shared understanding of the quali18 fications of licensed providers of maternity care 

19 and the best evidence about the safety, satisfac20 tion, outcomes, and costs of their care, and ap21 propriate deployment of such caregivers within 

22 the maternity care workforce to address the 

23 needs of childbearing women and newborns and 

24 the growing shortage of maternity caregivers; 


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1 ‘‘(E) a shared understanding of the results 

2 of the best available research comparing hos3 pital, birth center, and planned home births, in4 cluding information about each setting’s safety, 

5 satisfaction, outcomes, and costs; and 

6 ‘‘(F) high-quality, evidence-based child7 birth education that promotes a natural, 

8 healthy, and safe approach to pregnancy, child9 birth, and early parenting; is taught by certified 

10 educators, peer counselors, and health profes11 sionals; and promotes informed decisionmaking 

12 by childbearing women.’’. 

13 SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON 

14 THE PROMOTION OF OPTIMAL MATERNITY 

15 OUTCOMES. 

16 (a) IN GENERAL.—Part A of title II of the Public 

17 Health Service Act (42 U.S.C. 202 et seq.) is amended 

18 by adding at the end the following new section: 

19 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 

20 THE PROMOTION OF OPTIMAL MATERNITY 

21 OUTCOMES. 

22 ‘‘(a) IN GENERAL.—The Secretary of Health and 

23 Human Services, acting through the Deputy Assistant 

24 Secretary for Women’s Health under section 229 and in 

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1 section (b), shall establish the Interagency Coordinating 

2 Committee on the Promotion of Optimal Maternity Out3 comes (referred to in this subsection as the ‘ICCPOM’). 

4 ‘‘(b) OTHER AGENCIES.—The officials specified in 

5 this subsection are the Secretary of Labor, the Secretary 

6 of Defense, the Secretary of Veterans Affairs, the Surgeon 

7 General, the Director of the Centers for Disease Control 

8 and Prevention, the Administrator of the Health Re9 sources and Services Agency, the Administrator of the 

10 Centers for Medicare & Medicaid Services, the Director 

11 of the Indian Health Service, the Administrator of the 

12 Substance Abuse and Mental Health Services Administra13 tion, the Director of the National Institute on Child 

14 Health and Development, the Director of the Agency for 

15 Healthcare Research and Quality, the Assistant Secretary 

16 for Children and Families, the Deputy Assistant Secretary 

17 for Minority Health, the Director of the Office of Per18 sonnel Management, and such other Federal officials as 

19 the Secretary of Health and Human Services determines 

20 to be appropriate. 

21 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 

22 Women’s Health shall serve as the chair of the ICCPOM. 

23 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 

24 program development across the Federal Government with 

25 respect to promotion of optimal maternity care, provided, 


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1 however, that nothing in this section shall be construed 

2 as transferring regulatory or program authority from an 

3 Agency to the Coordinating Committee. 

4 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 

5 seek the input of, and shall consult with, all appropriate 

6 and interested stakeholders, including State Health De7 partments, public health research and interest groups, 

8 foundations, childbearing women and their advocates, and 

9 maternity care professional associations and organiza10 tions, reflecting racially, ethnically, demographically, and 

11 geographically diverse communities. 

12 ‘‘(f) ANNUAL REPORT.— 

13 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 

14 the ICCPOM, shall annually submit to Congress a 

15 report that summarizes— 

16 ‘‘(A) all programs and policies of Federal 

17 agencies (including the Medicare program 

18 under title XVIII of the Social Security Act and 

19 the Medicaid program under title XIX of such 

20 Act) designed to promote optimal maternity 

21 care, focusing particularly on programs and 

22 policies that support the adoption of evidence 

23 based maternity care, as defined by timely, sci24 entifically sound systematic reviews; 


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1 ‘‘(B) all programs and policies of Federal 

2 agencies (including the Medicare program 

3 under title XVIII of the Social Security Act and 

4 the Medicaid program under title XIX of such 

5 Act) designed to address the problems of mater6 nal mortality and morbidity, infant mortality, 

7 prematurity, and low birth weight, including 

8 such programs and policies designed to address 

9 racial and ethnic disparities with respect to 

10 each of such problems; 

11 ‘‘(C) the extent of progress in reducing 

12 maternal mortality and infant mortality, low 

13 birth weight, and prematurity at State and na14 tional levels; and 

15 ‘‘(D) such other information regarding op16 timal maternity care as the Secretary deter17 mines to be appropriate. 

18 The information specified in subparagraph (C) shall 

19 be included in each such report in a manner that 

20 disaggregates such information by race, ethnicity, 

21 and indigenous status in order to determine the ex22 tent of progress in reducing racial and ethnic dis23 parities and disparities related to indigenous status. 

24 ‘‘(2) CERTAIN INFORMATION.—Each report 

25 under paragraph (1) shall include information 


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1 (disaggregated by race, ethnicity, and indigenous 

2 status, as applicable) on the following rates and 

3 costs by State: 

4 ‘‘(A) The rate of primary cesarean deliv5 eries and repeat cesarean deliveries. 

6 ‘‘(B) The rate of vaginal births after cesar7 ean. 

8 ‘‘(C) The rate of vaginal breech births. 

9 ‘‘(D) The rate of induction of labor. 

10 ‘‘(E) The rate of freestanding birth center 

11 births. 

12 ‘‘(F) The rate of planned and unplanned 

13 home birth. 

14 ‘‘(G) The rate of attended births by pro15 vider, including by an obstetrician-gynecologist, 

16 family practice physician, obstetrician-gyne17 cologist physician assistant, certified nurse-mid18 wife, certified midwife, and certified profes19 sional midwife. 

20 ‘‘(H) The cost of maternity care 

21 disaggregated by place of birth and provider of 

22 care, including— 

23 ‘‘(i) uncomplicated vaginal birth; 

24 ‘‘(ii) complicated vaginal birth; 


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1 ‘‘(iii) uncomplicated cesarean birth; 

2 and 

3 ‘‘(iv) complicated cesarean birth. 

4 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

5 is authorized to be appropriated, in addition to such 

6 amounts authorized to be appropriated under section 

7 229(e), to carry out this section $1,000,000 for each of 

8 the fiscal years 2014 through 2018.’’. 

9 (b) CONFORMING AMENDMENTS.— 

10 (1) INCLUSION AS DUTY OF HHS OFFICE ON

11 WOMEN’S HEALTH.—Section 229(b) of such Act (42 

12 U.S.C. 237a(b)), as amended by section 101, is 

13 amended— 

14 (A) in paragraph (7), at the end, by strik15 ing ‘‘and’’; 

16 (B) in paragraph (8), at the end, by strik17 ing the period and inserting ‘‘; and’’; and 

18 (C) by adding at the end the following new 

19 paragraph: 

20 ‘‘(9) establish the Interagency Coordinating 

21 Committee on the Promotion of Optimal Maternity 

22 Outcomes in accordance with section 229A.’’. 

23 (2) TREATMENT OF BIENNIAL REPORTS.—Sec24 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 


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1 amended by inserting ‘‘(other than under subsection 

2 (b)(9))’’ after ‘‘under this section’’. 

3 SEC. 103. CONSUMER EDUCATION CAMPAIGN. 

4 Section 229 of the Public Health Service Act (42 

5 U.S.C. 237a), as amended by sections 101 and 102, is 

6 further amended— 

7 (1) in subsection (b)— 

8 (A) in paragraph (8), at the end, by strik9 ing ‘‘and’’; 

10 (B) in paragraph (9), at the end, by strik11 ing the period and inserting ‘‘; and’’; and 

12 (C) by adding at the end the following new 

13 paragraph: 

14 ‘‘(10) not later than one year after the date of 

15 the enactment of the MOMS for the 21st Century 

16 Act, develop and implement a 4-year culturally and 

17 linguistically appropriate multi-media consumer edu18 cation campaign to promote understanding and ac19 ceptance of evidence based maternity practices and 

20 models of care for optimal maternity outcomes 

21 among women of childbearing ages and families of 

22 such women and that— 

23 ‘‘(A) highlights the importance of pro24 tecting, promoting, and supporting the innate 

25 capacities of childbearing women and their 


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1 newborns for childbirth, breast-feeding, and at2 tachment; 

3 ‘‘(B) promotes understanding of the impor4 tance of using obstetric interventions when 

5 medically necessary and when supported by 

6 strong, high-quality evidence; 

7 ‘‘(C) highlights the widespread overuse of 

8 maternity practices that have been shown to 

9 have benefit when used appropriately in situa10 tions of medical necessity, but which can expose 

11 women, infants, or both to risk of harm if used 

12 routinely and indiscriminately, including contin13 uous fetal monitoring, labor induction, epidural 

14 anesthesia, elective primary cesarean section, 

15 and repeat cesarean delivery; 

16 ‘‘(D) emphasizes the non-invasive mater17 nity practices that have strong proven correla18 tion or may be associated with considerable im19 provement in outcomes with no detrimental side 

20 effects, and are significantly underused in the 

21 United States, including smoking cessation pro22 grams in pregnancy, group model prenatal care, 

23 continuous labor support, non-supine positions 

24 for birth, and external version to turn breech 

25 babies at term; 


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1 ‘‘(E) educates consumers about the quali2 fications of licensed providers of maternity care 

3 and the best evidence about their safety, satis4 faction, outcomes, and costs; 

5 ‘‘(F) informs consumers about the best 

6 available research comparing birth center 

7 births, planned home births, and hospital 

8 births, including information about each set9 ting’s safety, satisfaction, outcomes, and costs; 

10 ‘‘(G) fosters participation in high-quality, 

11 evidence-based childbirth education that pro12 motes a natural, healthy, and safe approach to 

13 pregnancy, childbirth, and early parenting; is 

14 taught by certified educators, peer counselors, 

15 and health professionals; and promotes in16 formed decisionmaking by childbearing women; 

17 and 

18 ‘‘(H) is pilot tested for consumer com19 prehension, cultural sensitivity, and acceptance 

20 of the messages across geographically, racially, 

21 ethnically, and linguistically diverse popu22 lations.’’. 


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1 SEC. 104. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE2 VIEWS FOR CARE OF CHILDBEARING WOMEN 

3 AND NEWBORNS. 

4 (a) IN GENERAL.—Not later than one year after the 

5 date of the enactment of this Act, the Secretary of Health 

6 and Human Services, through the Agency for Healthcare 

7 Research and Quality, shall— 

8 (1) make publicly available an online biblio9 graphic database identifying systematic reviews, in10 cluding an explanation of the level and quality of 

11 evidence, for care of childbearing women and 

12 newborns; and 

13 (2) initiate regular updates that incorporate 

14 newly issued and updated systematic reviews. 

15 (b) SOURCES.—To aim for a comprehensive inventory 

16 of systematic reviews relevant to maternal and newborn 

17 care, the database shall identify reviews from diverse 

18 sources, including— 

19 (1) scientific peer-reviewed journals; 

20 (2) databases, including Cochrane Database of 

21 Systematic Reviews, Clinical Evidence, and Data22 base of Abstracts of Reviews of Effects; and 

23 (3) Internet Web sites of agencies and organi24 zations throughout the world that produce such sys25 tematic reviews. 

26 (c) FEATURES.—The database shall— 


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1 (1) provide bibliographic citations for each 

2 record within the database, and for each such cita3 tion include an explanation of the level and quality 

4 of evidence; 

5 (2) include abstracts, as available; 

6 (3) provide reference to companion documents 

7 as may exist for each review, such as evidence tables 

8 and guidelines or consumer educational materials de9 veloped from the review; 

10 (4) provide links to the source of the full review 

11 and to any companion documents; 

12 (5) provide links to the source of a previous 

13 version or update of the review; 

14 (6) be searchable by intervention or other topic 

15 of the review, reported outcomes, author, title, and 

16 source; and 

17 (7) offer to users periodic electronic notification 

18 of database updates relating to users’ topics of inter19 est. 

20 (d) OUTREACH.—Not later than the first date the 

21 database is made publicly available and periodically there22 after, the Secretary of Health and Human Services shall 

23 publicize the availability, features, and uses of the data24 base under this section to the stakeholders described in 

25 subsection (e). 


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1 (e) CONSULTATION.—For purposes of developing the 

2 database under this section and maintaining and updating 

3 such database, the Secretary of Health and Human Serv4 ices shall convene and consult with an advisory committee 

5 composed of relevant stakeholders, including— 

6 (1) Federal Medicaid administrators and State 

7 agencies administrating State plans under title XIX 

8 of the Social Security Act pursuant to section 

9 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

10 (2) providers of maternity and newborn care 

11 from both academic and community-based settings, 

12 including obstetrician-gynecologists, family physi13 cians, certified nurse midwives, certified midwives, 

14 certified professional midwives, physician assistants, 

15 perinatal nurses, pediatricians, and nurse practi16 tioners; 

17 (3) maternal-fetal medicine specialists; 

18 (4) neonatologists; 

19 (5) childbearing women and advocates for such 

20 women, including childbirth educators certified by a 

21 nationally accredited program, representing commu22 nities that are diverse in terms of race, ethnicity, in23 digenous status, and geographic area; 

24 (6) employers and purchasers; 


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1 (7) health facility and system leaders, including 

2 both hospital and birth center facilities; 

3 (8) journalists; and 

4 (9) bibliographic informatics specialists. 

5 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated $2,500,000 for each of the 

7 fiscal years 2014 through 2016 for the purpose of devel8 oping the database and such sums as may be necessary 

9 for each subsequent fiscal year for updating the database 

10 and providing outreach and notification to users, as de11 scribed in this section. 

12 TITLE II—RESEARCH AND DATA 

13 COLLECTION ON MATERNITY 

14 CARE 

15 SEC. 201. MATERNITY CARE HEALTH PROFESSIONAL 

16 SHORTAGE AREAS. 

17 Section 332 of the Public Health Service Act (42 

18 U.S.C. 254e) is amended by adding at the end the fol19 lowing new subsection: 

20 ‘‘(k)(1) The Secretary, acting through the Adminis21 trator of the Health Resources and Services Administra22 tion, shall designate maternity care health professional 

23 shortage areas in the States, publish a descriptive list of 

24 the area’s population groups, medical facilities, and other 


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1 public facilities so designated, and at least annually review 

2 and, as necessary, revise such designations. 

3 ‘‘(2) For purposes of paragraph (1), a complete de4 scriptive list shall be published in the Federal Register not 

5 later than one year after the date of the enactment of the 

6 MOMS for the 21st Century Act and annually thereafter. 

7 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 

8 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 

9 shall apply to the designation of a maternity care health 

10 professional shortage area in a similar manner and extent 

11 as such provisions apply to the designation of health pro12 fessional shortage areas, except in applying subsection 

13 (b)(3), the reference in such subsection to ‘physicians’ 

14 shall be deemed to be a reference to nationally certified 

15 and State licensed obstetricians, family practice physicians 

16 who practice full-scope maternity care, certified nurse17 midwives, certified midwives, certified professional mid18 wives, and physician’s assistants who practice full scope 

19 maternity care. 

20 ‘‘(4) For purposes of this subsection, the term ‘ma21 ternity care health professional shortage area’ means— 

22 ‘‘(A) an area in an urban or rural area (which 

23 need not conform to the geographic boundaries of a 

24 political subdivision and which is a rational area for 

25 the delivery of health services) which the Secretary 


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1 determines has a shortage of providers of maternity 

2 care health services including those referenced in 

3 paragraph (3) or an urban or rural area that the 

4 Secretary determines has lost a significant number 

5 of such providers during the 10-year period begin6 ning with 2004 or has no obstetrical providers li7 censed to provide operative obstetrical services; 

8 ‘‘(B) an area in an urban or rural area (which 

9 need not conform to the geographic boundaries of a 

10 political subdivision and which is a rational area for 

11 the delivery of health services) which the Secretary 

12 determines has a shortage of hospital or labor and 

13 delivery units, hospital birth center units, or free14 standing birth centers or an area that lost a signifi15 cant number of these units during the 10-year pe16 riod beginning with 2003; or 

17 ‘‘(C) a population group which the Secretary 

18 determines has such a shortage of providers or fa19 cilities.’’. 

20 SEC. 202. EXPANSION OF CDC PREVENTION RESEARCH 

21 CENTERS PROGRAM TO INCLUDE CENTERS 

22 ON OPTIMAL MATERNITY OUTCOMES. 

23 (a) IN GENERAL.—Not later than one year after the 

24 date of the enactment of this Act, the Secretary of Health 

25 and Human Services, shall support the establishment of 


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1 2 additional Prevention Research Centers under the Pre2 vention Research Center Program administered by the 

3 Centers for Disease Control and Prevention. Such addi4 tional centers shall each be known as a Center for Excel5 lence on Optimal Maternity Outcomes. 

6 (b) RESEARCH.—Each Center for Excellence on Opti7 mal Maternity Outcomes shall— 

8 (1) conduct at least one focused program of re9 search to improve maternity outcomes, including the 

10 reduction of cesarean birth rates, elective inductions, 

11 prematurity rates, and low birth weight rates within 

12 an underserved population that has a disproportion13 ately large burden of suboptimal maternity out14 comes, including maternal mortality and morbidity, 

15 infant mortality, prematurity, or low birth weight; 

16 (2) work with partners on special interest 

17 projects, as specified by the Centers for Disease 

18 Control and Prevention and other relevant agencies 

19 within the Department of Health and Human Serv20 ices, and on projects funded by other sources; and 

21 (3) involve a minimum of two distinct birth set22 ting models, such as a hospital labor and delivery 

23 model and freestanding birth center model; or a hos24 pital labor and delivery model and planned home 

25 birth model. 


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1 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

2 for Excellence on Optimal Maternity Outcomes shall in3 clude the following interdisciplinary providers of maternity 

4 care: 

5 (1) Obstetrician-gynecologists. 

6 (2) Certified nurse midwives or certified mid7 wives. 

8 (3) At least two of the following providers: 

9 (A) Family practice physicians. 

10 (B) Nurse practitioners. 

11 (C) Physician assistants. 

12 (D) Certified professional midwives. 

13 (d) SERVICES.—Research conducted by each Center 

14 for Excellence on Optimal Maternity Outcomes shall in15 clude at least 2 (and preferably more) of the following sup16 portive provider services: 

17 (1) Mental health. 

18 (2) Doula labor support. 

19 (3) Nutrition education. 

20 (4) Childbirth education. 

21 (5) Social work. 

22 (6) Physical therapy or occupation therapy. 

23 (7) Substance abuse services. 

24 (8) Home visiting. 


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1 (e) COORDINATION.—The programs of research at 

2 each of the two Centers of Excellence on Optimal Mater3 nity Outcomes shall compliment and not replicate the 

4 work of the other. 

5 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated to carry out this section 

7 $2,000,000 for each of the fiscal years 2014 through 

8 2018. 

9 SEC. 203. EXPANDING MODELS TO BE TESTED BY CENTER 

10 FOR MEDICARE AND MEDICAID INNOVATION 

11 TO INCLUDE MATERNITY CARE MODELS. 

12 Section 1115A(b)(2)(B) of the Social Security Act 

13 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

14 end the following new clause: 

15 ‘‘(xxi) Promoting evidence-based mod16 els of prenatal care that have been associ17 ated with reductions in maternal and in18 fant health disparities; incorporating the 

19 use of doula and promotoras support; and 

20 advancing out-of-hospital births, including 

21 births at home and in freestanding birth 

22 centers.’’. 


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1 TITLE III—ENHANCEMENT OF A 

2 GEOGRAPHICALLY, RA3 CIALLY, AND ETHNICALLY DI4 VERSE INTERPROFESSIONAL 

5 MATERNITY WORKFORCE 

6 SEC. 301. DEVELOPMENT OF INTERPROFESSIONAL MATER7 NITY CARE EDUCATIONAL MODELS AND 

8 TOOLS. 

9 (a) IN GENERAL.—Not later than 6 months after the 

10 date of the enactment of this Act, the Secretary of Health 

11 and Human Services, acting in conjunction with the Ad12 ministrator of Health Resources and Services Administra13 tion, shall convene, for a 1-year period, an Interprofes14 sional Maternity Provider Education Commission to dis15 cuss and make recommendations for— 

16 (1) a consensus standard physiologic maternity 

17 care curriculum that takes into account the core 

18 competencies for basic midwifery practice such as 

19 those developed by the American College of Nurse 

20 Midwives and the North American Registry of Mid21 wives, and the educational objectives for physicians 

22 practicing in obstetrics and gynecology as deter23 mined by the Council on Resident Education in Ob24 stetrics and Gynecology; 


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1 (2) suggestions for multi-disciplinary use of the 

2 consensus physiologic curriculum; 

3 (3) strategies to integrate and coordinate edu4 cation across maternity care disciplines, including 

5 recommendations to increase medical and midwifery 

6 student exposure to out-of-hospital birth; and 

7 (4) pilot demonstrations of interprofessional 

8 educational models. 

9 (b) PARTICIPANTS.—The Commission shall include 

10 maternity care educators, curriculum developers, service 

11 leaders, certification leaders, and accreditation leaders 

12 from the various professions that provide maternity care 

13 in this country. Such professions shall include obstetri14 cian-gynecologists, certified nurse midwives or certified 

15 midwives, family practice physicians, nurse practitioners, 

16 physician assistants, certified professional midwives, and 

17 perinatal nurses. Additionally, the Commission shall in18 clude representation from maternity care consumer advo19 cates. 

20 (c) CURRICULUM.—The consensus standard physio21 logic maternity care curriculum described in subsection 

22 (a)(1) shall— 

23 (1) have a public health focus with a foundation 

24 in health promotion and disease prevention; 


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1 (2) foster physiologic childbearing and woman 

2 and family centered care; 

3 (3) integrate strategies to reduce maternal and 

4 infant morbidity and mortality; 

5 (4) incorporate recommendations to ensure re6 spectful, safe, and seamless consultation, referral, 

7 transport, and transfer of care when necessary; and 

8 (5) include cultural sensitivity and strategies to 

9 decrease disparities in maternity outcomes. 

10 (d) REPORT.—Not later than 6 months after the final 

11 day of the summit, the Secretary of Health and Human 

12 Services shall— 

13 (1) submit to Congress a report containing the 

14 recommendations made by the summit under this 

15 section; and 

16 (2) make such report publicly available. 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $1,000,000 for each of the fiscal years 2014 and 2015, 

20 and such sums as are necessary for each of the fiscal years 

21 2016 through 2018. 


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1 SEC. 302. INTERPROFESSIONAL TRAINING OF MEDICAL 

2 STUDENTS, RESIDENTS, AND STUDENT MID3 WIVES IN ACADEMIC HEALTH CENTERS AND 

4 FREESTANDING BIRTH CENTERS. 

5 (a) INCLUDING WITHIN INPATIENT HOSPITAL SERV6 ICES UNDER MEDICARE SERVICES FURNISHED BY CER7 TAIN STUDENTS, INTERNS, AND RESIDENTS SUPERVISED

8 BY CERTIFIED NURSE MIDWIVES.—Section 1861(b) of 

9 the Social Security Act (42 U.S.C. 1395x(b)) is amend10 ed— 

11 (1) in paragraph (6), by striking ‘‘; or’’ and in12 serting ‘‘, or in the case of services in a hospital or 

13 osteopathic hospital by a student midwife or an in14 tern or resident-in-training under a teaching pro15 gram previously described in this paragraph who is 

16 in the field of obstetrics and gynecology, if such stu17 dent midwife, intern, or resident-in-training is super18 vised by a certified nurse-midwife to the extent per19 mitted under applicable State law and as may be au20 thorized by the hospital;’’; 

21 (2) in paragraph (7), by striking the period at 

22 the end and inserting ‘‘; or’’; and 

23 (3) by adding at the end the following new 

24 paragraph: 

25 ‘‘(8) a certified nurse-midwife where the hos26 pital has a teaching program approved as specified 


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1 in paragraph (6), if (A) the hospital elects to receive 

2 any payment due under this title for reasonable 

3 costs of such services, and (B) all certified nurse4 midwives in such hospital agree not to bill charges 

5 for professional services rendered in such hospital to 

6 individuals covered under the insurance program es7 tablished by this title.’’. 

8 (b) EFFECTIVE DATE.—The amendments made by 

9 subsection (a) shall apply to services furnished on or after 

10 the date of the enactment of this Act. 

11 SEC. 303. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 

12 INCREASE DIVERSITY IN MATERNITY CARE 

13 PROFESSIONALS. 

14 (a) IN GENERAL.—The Secretary of Health and 

15 Human Services, through the Administrator of the Health 

16 Resources and Services Administration, shall carry out a 

17 grant program under which the Secretary may make to 

18 eligible health professional organizations— 

19 (1) for fiscal year 2014, planning grants de20 scribed in subsection (b); and 

21 (2) for the subsequent 4-year period, implemen22 tation grants described in subsection (c). 

23 (b) PLANNING GRANTS.— 

24 (1) IN GENERAL.—Planning grants described in 

25 this subsection are grants for the following purposes: 


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1 (A) To collect data and identify any work2 force disparities, with respect to a health pro3 fession, at each of the following areas along the 

4 health professional continuum: 

5 (i) Pipeline availability with respect to 

6 students at the high school and college or 

7 university levels considering and working 

8 toward entrance in the profession. 

9 (ii) Entrance into the training pro10 gram for the profession. 

11 (iii) Graduation from such training 

12 program. 

13 (iv) Entrance into practice. 

14 (v) Retention in practice for more 

15 than a 5-year period. 

16 (B) To develop one or more strategies to 

17 address the workforce disparities within the 

18 health profession, as identified under (and in 

19 response to the findings pursuant to) subpara20 graph (A). 

21 (2) APPLICATION.—To be eligible to receive a 

22 grant under this subsection, an eligible health pro23 fessional organization shall submit to the Secretary 

24 of Health and Human Services an application in 


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1 such form and manner and containing such informa2 tion as specified by the Secretary. 

3 (3) AMOUNT.—Each grant awarded under this 

4 subsection shall be for an amount not to exceed 

5 $300,000. 

6 (4) REPORT.—Each recipient of a grant under 

7 this subsection shall submit to the Secretary of 

8 Health and Human Services a report containing— 

9 (A) information on the extent and distribu10 tion of workforce disparities identified through 

11 the grant; and 

12 (B) reasonable objectives and strategies 

13 developed to address such disparities within a 

14 5-, 10-, and 25-year period. 

15 (c) IMPLEMENTATION GRANTS.— 

16 (1) IN GENERAL.—Implementation grants de17 scribed in this subsection are grants to implement 

18 one or more of the strategies developed pursuant to 

19 a planning grant awarded under subsection (b). 

20 (2) APPLICATION.—To be eligible to receive a 

21 grant under this subsection, an eligible health pro22 fessional organization shall submit to the Secretary 

23 of Health and Human Services an application in 

24 such form and manner as specified by the Secretary. 

25 Each such application shall contain information on 


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1 the capability of the organization to carry out a 

2 strategy described in paragraph (1), involvement of 

3 partners or coalitions, plans for developing sustain4 ability of the efforts after the culmination of the 

5 grant cycle, and any other information specified by 

6 the Secretary. 

7 (3) AMOUNT.—Each grant awarded under this 

8 subsection shall be for an amount not to exceed 

9 $500,000 each year during the 4-year period of the 

10 grant. 

11 (4) REPORTS.—For each of the first 3 years for 

12 which an eligible health professional organization is 

13 awarded a grant under this subsection, the organiza14 tion shall submit to the Secretary of Health and 

15 Human Services a report on the activities carried 

16 out by such organization through the grant during 

17 such year and objectives for the subsequent year. 

18 For the fourth year for which an eligible health pro19 fessional organization is awarded a grant under this 

20 subsection, the organization shall submit to the Sec21 retary a report that includes an analysis of all the 

22 activities carried out by the organization through the 

23 grant and a detailed plan for continuation of out24 reach efforts. 


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1 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA2 TION DEFINED.—For purposes of this section, the term 

3 ‘‘eligible health professional organization’’ means a profes4 sional organization representing obstetrician-gyne5 cologists, certified nurse midwives, certified midwives, 

6 family practice physicians, nurse practitioners whose scope 

7 of practice includes maternity care, physician assistants 

8 whose scope of practice includes obstetrical care, or cer9 tified professional midwives. 

10 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

11 authorized to be appropriated to carry out this section 

12 $2,000,000 for fiscal year 2014 and $3,000,000 for each 

13 of the fiscal years 2015 through 2018. 

Æ 


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