I 

112TH CONGRESS 

1ST SESSION H. R. 2141 

To promote optimal maternity outcomes by making evidence-based maternity 

care a national priority, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 3, 2011 

Ms. ROYBAL-ALLARD 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’’. 

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

8 this Act is as follows: 


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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. 229A. 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 INTERDISCIPLINARY MATERNITY 

WORKFORCE 

Sec. 301. Development of interdisciplinary maternity care provider core curricula. 

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

midwives in academic health centers. 

Sec. 303. Loan repayments for maternal care professionals. 

Sec. 304. Grants to professional organizations to increase diversity in maternity 

care professionals. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Maternity expenditures in the United States 

4 surpass all other developed countries, but childbirth 

5 continues to carry significant risks for mothers in 

6 the United States, as demonstrated by the following: 

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

8 the United States from pregnancy-related 

9 causes. 


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

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

3 women each year) experience some type of com4 plication that has an adverse effect on their 

5 health. 

6 (C) Severe complications that result in 

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

8 or severe morbidity, increased by 25 percent be9 tween 1998 and 2005, to approximately 34,000 

10 cases a year. 

11 (D) African-American women have nearly 

12 a four times greater risk of dying from preg13 nancy-related complications than White women, 

14 and these disparities have not improved in 50 

15 years. 

16 (2) In spite of the considerable investment of 

17 the United States in maternity care, the United 

18 States is failing to ensure that all infants have a 

19 healthy start in life, as demonstrated by the fol20 lowing: 

21 (A) The national rate of pre-term birth in22 creased by 36 percent in the quarter-century 

23 from 1981 to 2006. Despite a very modest re24 duction in pre-term births between 2006 and 


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1 2008, rates remain 31 percent higher than in 

2 1981. 

3 (B) The proportion of low birth weight ba4 bies increased by 21 percent between 1981 and 

5 2008. 

6 (C) Non-Hispanic Black infants continue 

7 to experience significantly higher rates of both 

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

9 leading causes of infant mortality in this coun10 try. 

11 (3) Despite shortcomings in the United States 

12 statewide data collections systems, which make 

13 international comparisons more challenging, inter14 national health organizations have ranked the 

15 United States far behind almost all developed coun16 tries in important perinatal and maternal outcomes, 

17 as demonstrated by the following: 

18 (A) The World Health Organization identi19 fied 49 nations with lower rates of maternal 

20 deaths than the United States in 2008. 

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

22 World Health Organization identified 35 na23 tions with lower early neonatal mortality rates 

24 (4/1,000 live births) and 33 with lower neonatal 


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

2 United States. 

3 (C) According to data from the 

4 Organisation for Economic Co-operation and 

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

6 reporting) had low birthweight rates lower than 

7 that of the United States. 

8 (D) 21 OECD countries (out of 27 report9 ing) had lower cesarean section rates than the 

10 United States. 

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

12 escalating health care costs in the United States, as 

13 demonstrated by the following: 

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

15 vast majority of which occur in hospitals, ma16 ternity care for mothers and their newborns is 

17 the number one reason for hospitalization in the 

18 United States, exceeding such prevalent condi19 tions as pneumonia, cancer, fracture, and heart 

20 disease. Of those discharged from hospitals in 

21 the United States in 2008, nearly one in four 

22 were childbearing women and newborns. 

23 (B) Combined mother and baby charges 

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


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1 in 2008, far exceeded charges for any other 

2 hospital condition in the United States. 

3 (5) Maternity care also accounts for a signifi4 cant proportion of expenditures under the Medicaid 

5 program, which covers 42 percent of births in this 

6 country, as demonstrated by the following: 

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

8 charges for which payment was made under the 

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

10 was for birthing women and newborns. 

11 (B) The two most common conditions for 

12 which payments were made under the Medicaid 

13 program in 2007 were pregnancy and childbirth 

14 (constituting 28 percent of such payments) and 

15 newborns (constituting 26 percent of such pay16 ments), which together accounted for 53 per17 cent of hospital discharges billed to Medicaid. 

18 (C) The two most costly conditions for 

19 which payment was made under the Medicaid 

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

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

22 together accounted for 26 percent of all Med23 icaid expenditures. 

24 (6) Maternity care facility charges vary signifi25 cantly by setting and type of birth. Part of the 


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1 charge differentials between facilities are attrib2 utable to high overhead of hospitals— 

3 (A) in 2008, the average charge for a hos4 pital cesarean birth with complications was 

5 $20,080, and without complications was 

6 $14,900; 

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

9 $11,410, and without complications was 

10 $8,920; and 

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

12 center vaginal birth was $2,277. 

13 (7) The procedure-intensity of birth-related hos14 pital stays also helps to explain the high costs of 

15 such hospital stays. In 2008, 6 of the 10 most com16 monly performed hospital procedures for all patients 

17 with all diagnoses involved childbirth and newborn 

18 care. Cesarean section was the most common oper19 ating room procedure. 

20 (8) Two non-invasive maternity practices, smok21 ing cessation programs in pregnancy and external 

22 version to turn breech babies at term, have strong 

23 proven correlation with considerable improvement in 

24 outcomes with no detrimental side effects, but are 

25 significantly underused in the United States. Other 


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1 non-invasive practices which are underused in cur2 rent practice and may be associated with improved 

3 outcomes include group model prenatal care, contin4 uous labor support, and non-supine positions for 

5 birth. 

6 (9) The growing shortage of maternity health 

7 care professionals and childbirth facilities is creating 

8 a serious obstacle to timely and adequate maternity 

9 health care for women, particularly in rural areas 

10 and the inner cities. 

11 (10) There are significant racial and ethnic dis12 parities across the maternity care workforce creating 

13 additional access barriers to culturally and linguis14 tically competent maternity services. 

15 TITLE I—HHS FOCUS ON THE 

16 PROMOTION OF OPTIMAL MA17 TERNITY CARE 

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

19 WOMEN’S HEALTH. 

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

21 U.S.C. 237a(b)) is amended— 

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

23 ‘‘and’’; 

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

25 period and inserting ‘‘; and’’; and 


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

2 paragraph: 

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

4 leaders and providers, consumers, and other stake5 holders in their understanding optimal maternity 

6 care and support for the provision of such care, in7 cluding the priorities of— 

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

9 the innate capacities of childbearing women and 

10 their newborns for childbirth, breast-feeding, 

11 and attachment; 

12 ‘‘(B) using obstetric interventions only 

13 when such interventions are supported by 

14 strong, high-quality evidence, and minimizing 

15 overuse of maternity practices that have been 

16 shown to have benefit in limited situations and 

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

18 of harm if used routinely and indiscriminately, 

19 including continuous electronic fetal monitoring, 

20 labor induction, epidural analgesia, primary ce21 sarean section, and routine repeat cesarean 

22 birth; 

23 ‘‘(C) reliably providing beneficial practices 

24 with no or minimal evidence of harm that are 

25 underused, including smoking cessation proVerDate Mar 15 2010 00:01 Jun 10, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2141.IH H2141

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1 grams in pregnancy, group model prenatal care, 

2 continuous labor support, non-supine positions 

3 for birth, and external version to turn breech 

4 babies at term; 

5 ‘‘(D) a shared understanding of the quali6 fications of licensed providers of maternity care 

7 and the best evidence about the safety, satisfac8 tion, outcomes, and costs of their care, and ap9 propriate deployment of such caregivers within 

10 the maternity care workforce to address the 

11 needs of childbearing women and newborns and 

12 the growing shortage of maternity caregivers; 

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

14 of the best available research comparing hos15 pital, birth center, and planned home births, in16 cluding information about each setting’s safety, 

17 satisfaction, outcomes, and costs; and 

18 ‘‘(F) informed decisionmaking by child19 bearing women.’’. 

20 SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON 

21 THE PROMOTION OF OPTIMAL MATERNITY 

22 OUTCOMES. 

23 (a) IN GENERAL.—Part B of title II of the Public 

24 Health Service Act is amended by adding at the end the 

25 following new section: 


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

2 THE PROMOTION OF OPTIMAL MATERNITY 

3 OUTCOMES. 

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

5 Human Services, acting through the Deputy Assistant 

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

7 collaboration with the Federal officials specified in sub8 section (b), shall establish the Interagency Coordinating 

9 Committee on the Promotion of Optimal Maternity Out10 comes (referred to in this subsection as the ‘ICCPOM’). 

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

12 this subsection are the Secretary of Labor, the Secretary 

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

14 General, the Director of the Centers for Disease Control 

15 and Prevention, the Administrator of the Health Re16 sources and Services Agency, the Administrator of the 

17 Centers for Medicare & Medicaid Services, the Director 

18 of the Indian Health Service, the Administrator of the 

19 Substance Abuse and Mental Health Services Administra20 tion, the Director of the National Institute on Child 

21 Health and Development, the Director of the Agency for 

22 Healthcare Research and Quality, the Assistant Secretary 

23 for Children and Families, the Deputy Assistant Secretary 

24 for Minority Health, the Director of the Office of Per25 sonnel Management, and such other Federal officials as 


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1 the Secretary of Health and Human Services determines 

2 to be appropriate. 

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

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

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

6 program development across the Federal Government with 

7 respect to promotion of optimal maternity care, provided, 

8 however, that nothing in this section shall be construed 

9 as transferring regulatory or program authority from an 

10 Agency to the Coordinating Committee. 

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

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

13 and interested stakeholders, including State Health De14 partments, public health research and interest groups, 

15 foundations, childbearing women and their advocates, and 

16 maternity care professional associations and organiza17 tions, reflecting racially, ethnically, demographically, and 

18 geographically diverse communities. 

19 ‘‘(f) ANNUAL REPORT.— 

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

21 the ICCPOM, shall annually submit to Congress a 

22 report that summarizes— 

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

24 agencies (including the Medicare program 

25 under title XVIII of the Social Security Act and 


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1 the Medicaid program under title XIX of such 

2 Act) designed to promote optimal maternity 

3 care, focusing particularly on programs and 

4 policies that support the adoption of evidence 

5 based maternity care, as defined by timely, sci6 entifically sound systematic reviews; 

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

8 agencies (including the Medicare program 

9 under title XVIII of the Social Security Act and 

10 the Medicaid program under title XIX of such 

11 Act) designed to address the problems of mater12 nal mortality and infant mortality, prematurity, 

13 and low birth weight; 

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

15 maternal mortality and infant mortality, low 

16 birth weight, and prematurity at State and na17 tional levels; and 

18 ‘‘(D) such other information regarding op19 timal maternity care as the Secretary deter20 mines to be appropriate. 

21 The information specified in subparagraph (C) shall 

22 be included in each such report in a manner that 

23 disaggregates such information by race, ethnicity, 

24 and indigenous status in order to determine the exVerDate Mar 15 2010 00:01 Jun 10, 2011 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H2141.IH H2141

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1 tent of progress in reducing racial and ethnic dis2 parities and disparities related to indigenous status. 

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

4 under paragraph (1) shall include information 

5 (disaggregated by race, ethnicity, and indigenous 

6 status, as applicable) on the following rates and 

7 costs by State: 

8 ‘‘(A) The rate of primary cesarean deliv9 eries and repeat cesarean deliveries. 

10 ‘‘(B) The rate of vaginal births after cesar11 ean. 

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

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

14 ‘‘(E) The rate of birthing center births. 

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

16 home birth. 

17 ‘‘(G) The rate of attended births by pro18 vider, including by an obstetrician-gynecologist, 

19 family practice physician, obstetrician-gyne20 cologist physician assistant, certified nurse-mid21 wife, certified midwife, and certified profes22 sional midwife. 

23 ‘‘(H) The cost of maternity care 

24 disaggregated by place of birth and provider of 

25 care, including— 


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1 ‘‘(i) uncomplicated vaginal birth; 

2 ‘‘(ii) complicated vaginal birth; 

3 ‘‘(iii) uncomplicated cesarean birth; 

4 and 

5 ‘‘(iv) complicated cesarean birth. 

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

7 is authorized to be appropriated, in addition to such 

8 amounts authorized to be appropriated under section 

9 229(e), to carry out this section $1,000,000 for each of 

10 the fiscal years 2012 through 2016.’’. 

11 (b) CONFORMING AMENDMENTS.— 

12 (1) INCLUSION AS DUTY OF HHS OFFICE ON

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

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

15 amended— 

16 (A) in paragraph (7), at the end, by strik17 ing ‘‘and’’; 

18 (B) in paragraph (8), at the end, by strik19 ing the period and inserting ‘‘; and’’; and 

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

21 paragraph: 

22 ‘‘(9) establish the Interagency Coordinating 

23 Committee on the Promotion of Optimal Maternity 

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


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1 (2) TREATMENT OF BIENNIAL REPORTS.—Sec2 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 

3 amended by inserting ‘‘(other than under subsection 

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

5 SEC. 103. CONSUMER EDUCATION CAMPAIGN. 

6 Section 229 of the Public Health Service Act (42 

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

8 further amended— 

9 (1) in subsection (b)— 

10 (A) in paragraph (8), at the end, by strik11 ing ‘‘and’’; 

12 (B) in paragraph (9), at the end, by strik13 ing the period and inserting ‘‘; and’’; and 

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

15 paragraph: 

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

17 the enactment of the MOMS for the 21st Century 

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

19 linguistically appropriate multi-media consumer edu20 cation campaign to promote understanding and ac21 ceptance of evidence based maternity practices and 

22 models of care for optimal maternity outcomes 

23 among women of childbearing ages and families of 

24 such women and that— 


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1 ‘‘(A) highlights the importance of pro2 tecting, promoting, and supporting the innate 

3 capacities of childbearing women and their 

4 newborns for childbirth, breast-feeding, and at5 tachment; 

6 ‘‘(B) promotes understanding of the impor7 tance of using obstetric interventions when 

8 medically necessary and when supported by 

9 strong, high-quality evidence; 

10 ‘‘(C) highlights the widespread overuse of 

11 maternity practices that have been shown to 

12 have benefit when used appropriately in situa13 tions of medical necessity, but which can expose 

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

15 routinely and indiscriminately, including contin16 uous fetal monitoring, labor induction, epidural 

17 anesthesia, elective primary cesarean section, 

18 and repeat cesarean delivery; 

19 ‘‘(D) emphasizes the non-invasive mater20 nity practices that have strong proven correla21 tion or may be associated with considerable im22 provement in outcomes with no detrimental side 

23 effects, and are significantly underused in the 

24 United States, including smoking cessation pro25 grams in pregnancy, group model prenatal care, 


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1 continuous labor support, non-supine positions 

2 for birth, and external version to turn breech 

3 babies at term; 

4 ‘‘(E) educates consumers about the quali5 fications of licensed providers of maternity care 

6 and the best evidence about their safety, satis7 faction, outcomes, and costs; 

8 ‘‘(F) informs consumers about the best 

9 available research comparing birth center 

10 births, planned home births, and hospital 

11 births, including information about each set12 ting’s safety, satisfaction, outcomes, and costs; 

13 ‘‘(G) fosters involvement in informed deci14 sionmaking among childbirth consumers; and 

15 ‘‘(H) is pilot tested for consumer com16 prehension, cultural sensitivity, and acceptance 

17 of the messages across geographically, racially, 

18 ethnically, and linguistically diverse popu19 lations.’’. 

20 SEC. 104. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE21 VIEWS FOR CARE OF CHILDBEARING WOMEN 

22 AND NEWBORNS. 

23 (a) IN GENERAL.—Not later than January 1, 2014, 

24 the Secretary of Health and Human Services, through the 

25 Agency for Healthcare Research and Quality, shall— 


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1 (1) make publicly available an online biblio2 graphic database identifying systematic reviews, in3 cluding an explanation of the level and quality of 

4 evidence, for care of childbearing women and 

5 newborns; and 

6 (2) initiate regular updates that incorporate 

7 newly issued and updated systematic reviews. 

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

9 of systematic reviews relevant to maternal and newborn 

10 care, the database shall identify reviews from diverse 

11 sources, including— 

12 (1) scientific peer-reviewed journals; 

13 (2) databases, including Cochrane Database of 

14 Systematic Reviews, Clinical Evidence, and Data15 base of Abstracts of Reviews of Effects; and 

16 (3) Internet Web sites of agencies and organi17 zations throughout the world that produce such sys18 tematic reviews. 

19 (c) FEATURES.—The database shall— 

20 (1) provide bibliographic citations for each 

21 record within the database; 

22 (2) include abstracts, as available; 

23 (3) provide reference to companion documents 

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


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1 and guidelines or consumer educational materials de2 veloped from the review; 

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

4 and to any companion documents; 

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

6 version or update of the review; 

7 (6) be searchable by intervention or other topic 

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

9 source; and 

10 (7) offer to users periodic electronic notification 

11 of database updates relating to users’ topics of inter12 est. 

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

14 database is made publicly available and periodically there15 after, the Secretary of Health and Human Services shall 

16 publicize the availability, features, and uses of the data17 base under this section to the stakeholders described in 

18 subsection (e). 

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

20 database under this section and maintaining and updating 

21 such database, the Secretary of Health and Human Serv22 ices shall convene and consult with an advisory committee 

23 composed of relevant stakeholders, including— 

24 (1) Federal Medicaid administrators and State 

25 agencies administrating State plans under title XIX 


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1 of the Social Security Act pursuant to section 

2 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

3 (2) providers of maternity and newborn care 

4 from both academic and community-based settings, 

5 including obstetrician-gynecologists, family physi6 cians, midwives, physician assistants, perinatal 

7 nurses, pediatricians, and nurse practitioners; 

8 (3) maternal-fetal medicine specialists; 

9 (4) neonatologists; 

10 (5) childbearing women and their advocates 

11 representing communities that are diverse in terms 

12 of race, ethnicity, indigenous status, and geographic 

13 area; 

14 (6) employers and purchasers; 

15 (7) health facility and system leaders, including 

16 both hospital and birth center facilities; 

17 (8) journalists; and 

18 (9) bibliographic informatics specialists. 

19 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

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

21 fiscal years 2012 through 2014 for the purpose of devel22 oping the database and such sums as may be necessary 

23 for each subsequent fiscal year for updating the database 

24 and providing outreach and notification to users, as de25 scribed in this section. 


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1 TITLE II—RESEARCH AND DATA 

2 COLLECTION ON MATERNITY 

3 CARE 

4 SEC. 201. MATERNITY CARE HEALTH PROFESSIONAL 

5 SHORTAGE AREAS. 

6 Section 332 of the Public Health Service Act (42 

7 U.S.C. 254e) is amended by adding at the end the fol8 lowing new subsection: 

9 ‘‘(k)(1) The Secretary, acting through the Adminis10 trator of the Health Resources and Services Administra11 tion, shall designate maternity care health professional 

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

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

14 public facilities so designated, and at least annually review 

15 and, as necessary, revise such designations. 

16 ‘‘(2) For purposes of paragraph (1), a complete de17 scriptive list shall be published in the Federal Register not 

18 later than July 1 of 2012 and each subsequent year. 

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

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

21 shall apply to the designation of a maternity care health 

22 professional shortage area in a similar manner and extent 

23 as such provisions apply to the designation of health pro24 fessional shortage areas, except in applying subsection 

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


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1 shall be deemed to be a reference to ‘physicians, obstetri2 cians, family practice physicians who practice full-scope 

3 maternity care, certified nurse-midwives, certified mid4 wives, and certified professional midwives’. 

5 ‘‘(4) For purposes of this subsection, the term ‘ma6 ternity care health professional shortage area’ means— 

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

8 need not conform to the geographic boundaries of a 

9 political subdivision and which is a rational area for 

10 the delivery of health services) which the Secretary 

11 determines has a shortage of providers of maternity 

12 care health services, including obstetricians, family 

13 practice physicians who practice full-scope maternity 

14 care, certified nurse-midwives, certified midwives, 

15 and certified professional midwives, and shall also 

16 include urban or rural areas that have lost a signifi17 cant number of local hospital labor and delivery 

18 units; 

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

20 need not conform to the geographic boundaries of a 

21 political subdivision and which is a rational area for 

22 the delivery of health services) which the Secretary 

23 determines has a shortage of hospital or birth center 

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1 cant number of these units in during the 10-year pe2 riod beginning with 2000; or 

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

4 determines has such a shortage of providers or fa5 cilities.’’. 

6 SEC. 202. EXPANSION OF CDC PREVENTION RESEARCH 

7 CENTERS PROGRAM TO INCLUDE CENTERS 

8 ON OPTIMAL MATERNITY OUTCOMES. 

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

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

11 and Human Services, shall support the establishment of 

12 2 additional Prevention Research Centers under the Pre13 vention Research Center Program administered by the 

14 Centers for Disease Control and Prevention. Such addi15 tional centers shall each be known as a Center for Excel16 lence on Optimal Maternity Outcomes. 

17 (b) RESEARCH.—Each Center for Excellence on Opti18 mal Maternity Outcomes shall— 

19 (1) conduct at least one focused program of re20 search to improve maternity outcomes, including the 

21 reduction of cesarean birth rates, elective inductions, 

22 prematurity rates, and low birth weight rates within 

23 an underserved population that has a disproportion24 ately large burden of suboptimal maternity outVerDate Mar 15 2010 00:01 Jun 10, 2011 Jkt 099200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H2141.IH H2141

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1 comes, including maternal mortality and morbidity, 

2 infant mortality, prematurity, or low birth weight; 

3 (2) work with partners on special interest 

4 projects, as specified by the Centers for Disease 

5 Control and Prevention and other relevant agencies 

6 within the Department of Health and Human Serv7 ices, and on projects funded by other sources; and 

8 (3) involve a minimum of two distinct birth set9 ting models, such as a hospital labor and delivery 

10 model and birth center model; or a hospital labor 

11 and delivery model and planned home birth model. 

12 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

13 for Excellence on Optimal Maternity Outcomes shall in14 clude the following interdisciplinary providers of maternity 

15 care: 

16 (1) Obstetrician-gynecologists. 

17 (2) Certified nurse midwives or certified mid18 wives. 

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

20 (A) Family practice physicians. 

21 (B) Women’s health nurse practitioners. 

22 (C) Obstetrician-gynecologists physician 

23 assistants. 

24 (D) Certified professional midwives. 


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

2 for Excellence on Optimal Maternity Outcomes shall in3 clude at least 2 (and preferably more) of the following sup4 portive provider services: 

5 (1) Mental health. 

6 (2) Doula labor support. 

7 (3) Nutrition education. 

8 (4) Childbirth education. 

9 (5) Social work. 

10 (6) Physical therapy or occupation therapy. 

11 (7) Substance abuse services. 

12 (8) Home visiting. 

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

14 each of the two Centers of Excellence on Optimal Mater15 nity Outcomes shall compliment and not replicate the 

16 work of the other. 

17 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $2,000,000 for each of the fiscal years 2012 through 

20 2016. 


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

2 FOR MEDICARE AND MEDICAID INNOVATION 

3 TO INCLUDE MATERNITY CARE MODELS. 

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

5 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

6 end the following new clause: 

7 ‘‘(xxi) Promoting evidence-based 

8 group prenatal care models, doula support, 

9 and out-of-hospital births, including births 

10 at home or a birthing center.’’. 

11 TITLE III—ENHANCEMENT OF A 

12 GEOGRAPHICALLY, RA13 CIALLY, AND ETHNICALLY DI14 VERSE INTERDISCIPLINARY 

15 MATERNITY WORKFORCE 

16 SEC. 301. DEVELOPMENT OF INTERDISCIPLINARY MATER17 NITY CARE PROVIDER CORE CURRICULA. 

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

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

20 and Human Services, acting in conjunction with the Ad21 ministrator of Health Resources and Services Administra22 tion, shall convene, for a 1-year period, a Maternity Cur23 riculum Commission to discuss and make recommenda24 tions for— 

25 (1) a shared core maternity care curriculum 

26 that takes into account the core competencies for 


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1 basic midwifery practice as developed by the Amer2 ican College of Nurse Midwives, and the educational 

3 objectives in obstetrics and gynecology as determined 

4 by the Council on Resident Education in Obstetrics 

5 and Gynecology; 

6 (2) strategies to integrate and coordinate edu7 cation across maternity care disciplines, including 

8 suggestions for multi-disciplinary use of the shared 

9 core curriculum; and 

10 (3) pilot demonstrations of interdisciplinary 

11 educational models. 

12 (b) PARTICIPANTS.—The Commission shall include 

13 maternity care educators, curriculum developers, service 

14 leaders, certification leaders, and accreditation leaders 

15 from the various professions that provide maternity care 

16 in this country. Such professions shall include obstetri17 cian-gynecologists, certified nurse midwives, certified mid18 wives, family practice physicians, women’s health nurse 

19 practitioners, obstetrician-gynecologists physician assist20 ants, certified professional midwives, and perinatal nurses. 

21 (c) CURRICULUM.—The shared core maternity care 

22 curriculum described in subsection (A) 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 patient 

2 and family centered care; 

3 (3) incorporate strategies to reduce maternal 

4 mortality and infant mortality; and 

5 (4) include cultural sensitivity and strategies to 

6 decrease disparities in maternity outcomes. 

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

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

9 Services shall— 

10 (1) submit to Congress a report containing the 

11 recommendations made by the summit under this 

12 section; and 

13 (2) make such report publicly available. 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section 

16 $1,000,000 for each of the fiscal years 2012 and 2013, 

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

18 2014 through 2016. 

19 SEC. 302. INTERDISCIPLINARY TRAINING OF MEDICAL STU20 DENTS, RESIDENTS, AND STUDENT MIDWIVES 

21 IN ACADEMIC HEALTH CENTERS. 

22 (a) INCLUDING WITHIN INPATIENT HOSPITAL SERV23 ICES UNDER MEDICARE SERVICES FURNISHED BY CER24 TAIN STUDENTS, INTERNS, AND RESIDENTS SUPERVISED

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


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1 the Social Security Act (42 U.S.C. 1395x(b)) is amend2 ed— 

3 (1) in paragraph (6), by striking ‘‘; or’’ and in4 serting ‘‘, or in the case of services in a hospital or 

5 osteopathic hospital by a student midwife or an in6 tern or resident-in-training under a teaching pro7 gram previously described in this paragraph who is 

8 in the field of obstetrics and gynecology, if such stu9 dent midwife, intern, or resident-in-training is super10 vised by a certified nurse-midwife to the extent per11 mitted under applicable State law and as may be au12 thorized by the hospital;’’; 

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

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

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

16 paragraph: 

17 ‘‘(8) a certified nurse-midwife where the hos18 pital has a teaching program approved as specified 

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

20 any payment due under this title for reasonable 

21 costs of such services, and (B) all certified nurse22 midwives in such hospital agree not to bill charges 

23 for professional services rendered in such hospital to 

24 individuals covered under the insurance program es25 tablished by this title.’’. 


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

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

3 the date of the enactment of this Act. 

4 SEC. 303. LOAN REPAYMENTS FOR MATERNAL CARE PRO5 FESSIONALS. 

6 (a) PURPOSE.—It is the purpose of this section to 

7 alleviate critical shortages of maternal care professionals. 

8 (b) LOAN REPAYMENTS.—The Secretary of Health 

9 and Human Services, acting through the Administrator of 

10 the Health Resources and Services Administration, shall 

11 establish a program of entering into contracts with eligible 

12 individuals under which— 

13 (1) the individual agrees to serve full-time— 

14 (A) as a physician in the field of obstetrics 

15 and gynecology; as a certified nurse midwife, 

16 certified midwife or certified professional mid17 wife; or as a family practice physician who 

18 agrees to practice full-scope maternity care; and 

19 (B) in an area that is either a health pro20 fessional shortage area (as designated under 

21 section 332 of the Public Health Service Act) or 

22 a maternity care health professional shortage 

23 area (as designated under subsection (k) of 

24 such section, as added by section 201 of this 

25 Act); and 


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1 (2) the Secretary agrees to pay, for each year 

2 of such full-time service, not more than $50,000 of 

3 the principal and interest of the undergraduate or 

4 graduate educational loans of the individual. 

5 (c) SERVICE REQUIREMENT.—A contract entered 

6 into under this section shall allow the individual receiving 

7 the loan repayment to satisfy the service requirement de8 scribed in subsection (a)(1) through employment in a solo 

9 or group practice, a clinic, a public or private nonprofit 

10 hospital, a freestanding birth center, or any other appro11 priate health care entity. 

12 (d) APPLICATION OF CERTAIN PROVISIONS.—The 

13 provisions of subpart III of part D of title III of the Public 

14 Health Service Act shall, except as inconsistent with this 

15 section, apply to the program established in subsection (a) 

16 in the same manner and to the same extent as such provi17 sions apply to the National Health Service Corps Scholar18 ship Program established in such subpart. 

19 (e) DEFINITION.—In this section, the term ‘‘eligible 

20 individual’’ means— 

21 (1) a physician in the field of obstetrics and 

22 gynecology; or 

23 (2) a certified nurse-midwife or certified mid24 wife; 


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1 (3) a family practice physician who practices 

2 full scope maternity care; or 

3 (4) a certified professional midwife who has 

4 graduated from an accredited midwifery education 

5 program. 

6 SEC. 304. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 

7 INCREASE DIVERSITY IN MATERNITY CARE 

8 PROFESSIONALS. 

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

10 Human Services, through the Administrator of the Health 

11 Resources and Services Administration, shall carry out a 

12 grant program under which the Secretary may make to 

13 eligible health professional organizations— 

14 (1) for fiscal year 2012, planning grants de15 scribed in subsection (b); and 

16 (2) for the subsequent 4-year period, implemen17 tation grants described in subsection (c). 

18 (b) PLANNING GRANTS.— 

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

20 this subsection are grants for the following purposes: 

21 (A) To collect data and identify any work22 force disparities, with respect to a health pro23 fession, at each of the following areas along the 

24 health professional continuum: 


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1 (i) Pipeline availability with respect to 

2 students at the high school and college or 

3 university levels considering and working 

4 toward entrance in the profession. 

5 (ii) Entrance into the training pro6 gram for the profession. 

7 (iii) Graduation from such training 

8 program. 

9 (iv) Entrance into practice. 

10 (v) Retention in practice for more 

11 than a 5-year period. 

12 (B) To develop one or more strategies to 

13 address the workforce disparities within the 

14 health profession, as identified under (and in 

15 response to the findings pursuant to) subpara16 graph (A). 

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

18 grant under this subsection, an eligible health pro19 fessional organization shall submit to the Secretary 

20 of Health and Human Services an application in 

21 such form and manner and containing such informa22 tion as specified by the Secretary. 

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

24 subsection shall be for an amount not to exceed 

25 $300,000. 


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

2 this subsection shall submit to the Secretary of 

3 Health and Human Services a report containing— 

4 (A) information on the extent and distribu5 tion of workforce disparities identified through 

6 the grant; and 

7 (B) reasonable objectives and strategies 

8 developed to address such disparities within a 

9 5-, 10-, and 25-year period. 

10 (c) IMPLEMENTATION GRANTS.— 

11 (1) IN GENERAL.—Implementation grants de12 scribed in this subsection are grants to implement 

13 one or more of the strategies developed pursuant to 

14 a planning grant awarded under subsection (b). 

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

16 grant under this subsection, an eligible health pro17 fessional organization shall submit to the Secretary 

18 of Health and Human Services an application in 

19 such form and manner as specified by the Secretary. 

20 Each such application shall contain information on 

21 the capability of the organization to carry out a 

22 strategy described in paragraph (1), involvement of 

23 partners or coalitions, plans for developing sustain24 ability of the efforts after the culmination of the 


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1 grant cycle, and any other information specified by 

2 the Secretary. 

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

4 subsection shall be for an amount not to exceed 

5 $500,000 each year during the 4-year period of the 

6 grant. 

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

8 which an eligible health professional organization is 

9 awarded a grant under this subsection, the organiza10 tion shall submit to the Secretary of Health and 

11 Human Services a report on the activities carried 

12 out by such organization through the grant during 

13 such year and objectives for the subsequent year. 

14 For the fourth year for which an eligible health pro15 fessional organization is awarded a grant under this 

16 subsection, the organization shall submit to the Sec17 retary a report that includes an analysis of all the 

18 activities carried out by the organization through the 

19 grant and a detailed plan for continuation of out20 reach efforts. 

21 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA22 TION DEFINED.—For purposes of this section, the term 

23 ‘‘eligible health professional organization’’ means a profes24 sional organization representing obstetrician-gyne25 cologists, certified nurse midwives, certified midwives, 


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1 family practice physicians, women’s health nurse practi2 tioners, obstetrician-gynecologist physician assistants, or 

3 certified professional midwives. 

4 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

5 authorized to be appropriated to carry out this section 

6 $2,000,000 for fiscal year 2012 and $3,000,000 for each 

7 of the fiscal years 2013 through 2016. 

Æ 


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