I 

111TH CONGRESS 

2D SESSION H. R. 5807 

To promote optimal maternity outcomes by making evidence-based maternity 

care a national priority, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 21, 2010 

Ms. ROYBAL-ALLARD (for herself, Ms. BALDWIN, Mrs. CAPPS, Ms. CASTOR

of Florida, Mrs. CHRISTENSEN, Mr. COHEN, Mr. CONYERS, Mrs. DAVIS

of California, Ms. DEGETTE, Ms. DELAURO, Mr. ENGEL, Mr. HINOJOSA, 

Ms. LEE of California, Ms. ZOE LOFGREN of California, Mrs. LOWEY, 

Mr. MCGOVERN, Mrs. MALONEY, Mr. MICHAUD, Ms. MOORE of Wisconsin, Mrs. NAPOLITANO, Ms. NORTON, Mr. REYES, Ms. VELA ́ZQUEZ, 

Ms. WASSERMAN SCHULTZ, Ms. WOOLSEY, and Ms. SCHAKOWSKY) 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, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Maximizing Optimal Maternity Services for the 21st 

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

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

6 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. 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. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 

9 (1) The United States spends more than double 

10 per capita on health care than other industrialized 


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1 countries, but ranks far behind almost all developed 

2 countries in important perinatal outcomes. In the 

3 World Health Report 2005— 

4 (A) the World Health Organization identi5 fied 29 nations with lower estimated maternal 

6 mortality ratios than the United States (14/ 

7 100,000 live births); 

8 (B) the World Health Organization identi9 fied 35 nations with lower early neonatal mor10 tality rates (5/1,000 live births) and 33 with 

11 lower neonatal mortality rates (5/1,000 live 

12 births) than the United States; 

13 (C) 23 countries (out of 30 reporting) had 

14 superior low birth weight rates than the United 

15 States; and 

16 (D) 19 member countries (out of 23 re17 porting) had lower cesarean section rates than 

18 the United States. 

19 (2) Despite maternity expenditures in the 

20 United States, childbirth continues to carry signifi21 cant risks for mothers in this country, as dem22 onstrated by the following: 

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

24 the United States from pregnancy-related 

25 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) African-American women having nearly 

7 a four times greater risk of dying from preg8 nancy-related complications than White women, 

9 and these disparities have not improved in 20 

10 years. 

11 (3) In spite of the Nation’s considerable invest12 ment in maternity care, the United States is failing 

13 to ensure that all infants have a healthy start in life, 

14 as demonstrated by the following: 

15 (A) The national rate of pre-term birth in16 creased by 36 percent in the quarter-century 

17 from 1981 to 2006. 

18 (B) The proportion of low birth weight ba19 bies increased by 22 percent between 1981 and 

20 2006. 

21 (C) Non-Hispanic Black infants continue 

22 to experience significantly higher rates of both 

23 pre-term birth and low birth weight, two of the 

24 leading causes of infant mortality in this coun25 try. 


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1 (4) Maternity Care is a major component of the 

2 escalating health care costs in this country, as dem3 onstrated by the following: 

4 (A) Maternity care for mothers and their 

5 newborns is the number one reason for hos6 pitalization in the United States, exceeding 

7 such prevalent conditions as pneumonia, cancer, 

8 fracture, and heart disease. Of those discharged 

9 from hospitals in the United States in 2007, 25 

10 percent were childbearing women and newborns. 

11 (B) Combined mother and baby charges 

12 for hospitalization, which was $86,000,000,000 

13 in 2006, far exceeded charges for any other 

14 hospital condition in the United States. 

15 (5) Maternity care also accounts for a signifi16 cant proportion of expenditures under the Medicaid 

17 program, as demonstrated by the following: 

18 (A) In 2006, 29 percent of all hospital 

19 charges under Medicaid ($39,000,000,000) 

20 were for birthing women and children. 

21 (B) Six of the 10 most common procedures 

22 reimbursed under the Medicaid program were 

23 maternity related, making ‘‘mother’s pregnancy 

24 and delivery’’ the most costly Medicaid expendi25 ture. 


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1 (6) Maternity care charges vary significantly by 

2 setting and type of birth. In 2005— 

3 (A) the average charge for a hospital ce4 sarean birth with complications was $15,900, 

5 and without complications was $12,500; 

6 (B) the average charge for a hospital vag7 inal birth with complications was $8,960, and 

8 without complications was $6,970; and 

9 (C) the average charge for a birth center 

10 vaginal birth was $1,600. 

11 (7) The procedure-intensity of birth-related hos12 pital stays helps to explain their high costs. In 2005, 

13 6 of the 15 most commonly performed hospital pro14 cedures for all patients with all diagnoses involved 

15 childbirth. Cesarean section was the most common 

16 operating room procedure for Medicaid, for private 

17 payers, and for all payers combined. 

18 (8) There is a vast body of knowledge regarding 

19 best evidence-based practices in maternity care, but 

20 current practice is not following the research, as 

21 demonstrated by the following: 

22 (A) A recent analysis of American College 

23 of Obstetrics and Gynecology obstetrical prac24 tice bulletins 1998 through 2004 found that 

25 only 23 percent of their practice recommendaVerDate Mar 15 2010 02:59 Jul 22, 2010 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807

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1 tions were based on good, consistent scientific 

2 evidence, while 42 percent of recommendations 

3 were based on consensus and opinion. 

4 (B) There is widespread overuse of mater5 nity practices that have been shown to have 

6 benefit only in limited situations, which can ex7 pose women, infants, or both to risk of harm if 

8 used routinely and indiscriminately, including 

9 continuous fetal monitoring, labor induction, 

10 epidural anesthesia, elective primary cesarean 

11 section, and repeat cesarean delivery. 

12 (C) There are multiple non-invasive mater13 nity practices that have been associated with 

14 considerable improvement in outcomes with no 

15 detrimental side effects, and are significantly 

16 underused in this country, including smoking 

17 cessation programs in pregnancy, group model 

18 prenatal care, continuous labor support, non-su19 pine positions for birth, and external version to 

20 turn breech babies at term. 

21 (9) The growing shortage of maternity health 

22 care professionals and childbirth facilities is creating 

23 a serious obstacle to timely and adequate maternity 

24 health care for women, particularly in rural areas 

25 and the inner cities. 


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1 (10) There are significant racial and ethnic dis2 parities across the maternity care workforce creating 

3 additional access barriers to culturally and linguis4 tically competent maternity services. 

5 (11) Although most women in the United 

6 States are healthy and at low risk for complications, 

7 Obstetrician-Gynecologist Surgeons are the lead 

8 caregivers for about 79 percent of women during 

9 pregnancy and labor, as compared to midwives who 

10 care for 8 percent to 9 percent of women, and Fam11 ily Practice Physicians who care for 6 percent to 7 

12 percent of women. Among developed nations, only 

13 the United States and Canada rely to this degree on 

14 specialists rather than midwives or family physicians 

15 to provide care to healthy birthing women. 

16 (12) There is a growing shortage of Obstetri17 cian-Gynecologists in the United States who provide 

18 maternity services. Data from the 2006 American 

19 College of Obstetricians and Gynecologists (ACOG) 

20 Survey on Professional Liability showed a negative 

21 trend in length of obstetrical practice, with the aver22 age age at which physicians stopped practicing ob23 stetrics being 48 years. At one point this was the 

24 near midpoint of an Obstetrician-Gynecologist’s pro25 fessional career. 


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1 (13) There is extensive research demonstrating 

2 that certified nurse midwives, when compared to Ob3 stetrician-Gynecologists, provide high quality of care 

4 with comparable or better outcomes, high levels of 

5 patient satisfaction, and at lower costs due to fewer 

6 unnecessary, invasive, and expensive technologic 

7 interventions. 

8 (14) Approximately 1 percent of births in the 

9 United States take place in non-hospital settings. Of 

10 such births, 27 percent occur in birth centers and 65 

11 percent are home births. Hospitals remain the set12 ting of delivery for 99 percent of all births despite 

13 the following findings: 

14 (A) Multiple studies have demonstrated 

15 that for women who meet criteria to be consid16 ered at low risk for obstetrical complications, 

17 labor and delivery at a birth center can result 

18 in higher patient satisfaction and equivalent or 

19 better outcomes than in-hospital birth. 

20 (B) Studies have consistently found that 

21 for low-risk mothers, planned home birth had 

22 the same outcomes as hospital births for similar 

23 risk women, but with fewer costly and often 

24 preventable interventions. 


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1 (C) In a nationwide comparison of birth 

2 center costs to hospital costs, it is estimated 

3 that if 100,000 births were attended in birth 

4 centers, access to care would be greatly im5 proved, and annual savings would total more 

6 than $314,000,000. 

7 (15) Midwives serve as faculty at many of the 

8 Nation’s most prominent academic health centers, 

9 however, the time they spend training medical stu10 dents, residents, and midwifery students is not reim11 bursed as it is for physicians. As a result, medical 

12 students, residents, and midwifery students often 

13 fail to benefit from the practice experience and phys14 iologic birth expertise of midwives. 

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 02:59 Jul 22, 2010 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5807.IH H5807

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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 focused primary care professional associations 

17 and organizations, reflecting racially, ethnically, demo18 graphically, and 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 designed to promote optimal maternity 

25 care, focusing particularly on programs and 


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1 policies that support the adoption of evidence 

2 based maternity care, as defined by timely, sci3 entifically sound systematic reviews; 

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

5 agencies designed to address the problems of 

6 maternal mortality and infant mortality, pre7 maturity, and low birth weight; 

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

9 maternal mortality and infant mortality, low 

10 birth weight, and prematurity at State and na11 tional levels; and 

12 ‘‘(D) such other information regarding op13 timal maternity care as the Secretary deter14 mines to be appropriate. 

15 The information specified in subparagraph (C) shall 

16 be included in each such report in a manner that 

17 disaggregates such information by race, ethnicity, 

18 and indigenous status in order to determine the ex19 tent of progress in reducing racial and ethnic dis20 parities and disparities related to indigenous status. 

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

22 under paragraph (1) shall include information 

23 (disaggregated by race, ethnicity, and indigenous 

24 status, as applicable) on the following rates and 

25 costs by State: 


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1 ‘‘(A) The rate of primary cesarean deliv2 eries and repeat cesarean deliveries. 

3 ‘‘(B) The rate of vaginal births after cesar4 ean. 

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

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

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

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

9 home birth. 

10 ‘‘(G) The rate of attended births by pro11 vider, including by an obstetrician-gynecologist, 

12 family practice physician, obstetrician-gyne13 cologist physician assistant, certified nurse-mid14 wife, certified midwife, and certified profes15 sional midwife. 

16 ‘‘(H) The cost of maternity care 

17 disaggregated by place of birth and provider of 

18 care, including— 

19 ‘‘(i) uncomplicated vaginal birth; 

20 ‘‘(ii) complicated vaginal birth; 

21 ‘‘(iii) uncomplicated cesarean birth; 

22 and 

23 ‘‘(iv) complicated cesarean birth. 

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

25 is authorized to be appropriated, in addition to such 


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1 amounts authorized to be appropriated under section 

2 229(e), to carry out this section $1,000,000 for each of 

3 the fiscal years 2011 through 2015.’’. 

4 (b) CONFORMING AMENDMENTS.— 

5 (1) INCLUSION AS DUTY OF HHS OFFICE ON

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

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

8 amended— 

9 (A) in paragraph (7), at the end, by strik10 ing ‘‘and’’; 

11 (B) in paragraph (8), at the end, by strik12 ing the period and inserting ‘‘; and’’; and 

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

14 paragraph: 

15 ‘‘(9) establish the Interagency Coordinating 

16 Committee on the Promotion of Optimal Maternity 

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

18 (2) TREATMENT OF BIENNIAL REPORTS.—Sec19 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 

20 amended by inserting ‘‘(other than under subsection 

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

22 SEC. 103. CONSUMER EDUCATION CAMPAIGN. 

23 Section 229 of the Public Health Service Act (42 

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

25 further amended— 


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1 (1) in subsection (b)— 

2 (A) in paragraph (8), at the end, by strik3 ing ‘‘and’’; 

4 (B) in paragraph (9), at the end, by strik5 ing the period and inserting ‘‘; and’’; and 

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

7 paragraph: 

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

9 the enactment of the MOMS for the 21st Century 

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

11 linguistically appropriate multi-media consumer edu12 cation campaign to promote understanding and ac13 ceptance of evidence based maternity practices and 

14 models of care for optimal maternity outcomes 

15 among women of childbearing ages and families of 

16 such women and that— 

17 ‘‘(A) highlights the importance of pro18 tecting, promoting, and supporting the innate 

19 capacities of childbearing women and their 

20 newborns for childbirth, breast-feeding, and at21 tachment; 

22 ‘‘(B) promotes understanding of the impor23 tance of using obstetric interventions only when 

24 supported by strong, high-quality evidence; 


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1 ‘‘(C) highlights the widespread overuse of 

2 maternity practices that have been shown to 

3 have benefit only in limited situations, and 

4 which can expose women, infants, or both to 

5 risk of harm if used routinely and indiscrimi6 nately, including continuous fetal monitoring, 

7 labor induction, epidural anesthesia, elective 

8 primary cesarean section, and repeat cesarean 

9 delivery; 

10 ‘‘(D) emphasizes the multiple non-invasive 

11 maternity practices that have been associated 

12 with considerable improvement in outcomes 

13 with no detrimental side effects, and are signifi14 cantly underused in the United States, includ15 ing smoking cessation programs in pregnancy, 

16 group model prenatal care, continuous labor 

17 support, non-supine positions for birth, and ex18 ternal version to turn breech babies at term; 

19 ‘‘(E) educates consumers about the quali20 fications of licensed providers of maternity care 

21 and the best evidence about their safety, satis22 faction, outcomes, and costs; 

23 ‘‘(F) informs consumers about the best 

24 available research comparing birth center births 

25 and planned home births with hospital births, 


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1 including information about each setting’s safe2 ty, satisfaction, outcomes, and costs; 

3 ‘‘(G) fosters involvement in informed deci4 sionmaking among childbirth consumers; and 

5 ‘‘(H) is pilot tested for consumer com6 prehension, cultural sensitivity, and acceptance 

7 of the messages across geographically, racially, 

8 ethnically, and linguistically diverse popu9 lations.’’. 

10 SEC. 104. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE11 VIEWS FOR CARE OF CHILDBEARING WOMEN 

12 AND NEWBORNS. 

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

14 the Secretary of Health and Human Services, through the 

15 Agency for Healthcare Research and Quality, shall— 

16 (1) make publicly available an online biblio17 graphic database identifying systematic reviews for 

18 care of childbearing women and newborns; and 

19 (2) initiate regular updates that incorporate 

20 newly issued and updated systematic reviews. 

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

22 of systematic reviews relevant to maternal and newborn 

23 care, the database shall identify reviews from diverse 

24 sources, including— 

25 (1) scientific journals; 


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1 (2) databases, including Cochrane Database of 

2 Systematic Reviews, Clinical Evidence, and Data3 base of Abstracts of Reviews of Effects; and 

4 (3) Internet Web sites of agencies and organi5 zations throughout the world that produce such sys6 tematic reviews. 

7 (c) FEATURES.—The database shall— 

8 (1) provide bibliographic citations for each 

9 record within the database; 

10 (2) include abstracts, as available; 

11 (3) provide reference to companion documents 

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

13 and guidelines or consumer educational materials de14 veloped from the review; 

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

16 and to any companion documents; 

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

18 version or update of the review; 

19 (6) be searchable by intervention or other topic 

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

21 source; and 

22 (7) offer to users periodic electronic notification 

23 of database updates relating to users’ topics of inter24 est. 


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

2 database is made publicly available and periodically there3 after, the Secretary of Health and Human Services shall 

4 publicize the availability, features, and uses of the data5 base under this section to the stakeholders described in 

6 subsection (e). 

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

8 database under this section and maintaining and updating 

9 such database, the Secretary of Health and Human Serv10 ices shall convene and consult with an advisory committee 

11 composed of relevant stakeholders, including— 

12 (1) Federal Medicaid administrators and State 

13 agencies administrating State plans under title XIX 

14 of the Social Security Act pursuant to section 

15 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

16 (2) providers of maternity and newborn care 

17 from both academic and community-based settings, 

18 including obstetrician-gynecologists, family physi19 cians, midwives, physician assistants, perinatal 

20 nurses, pediatricians, and nurse practitioners; 

21 (3) maternal-fetal medicine specialists; 

22 (4) neonatologists; 

23 (5) childbearing women and their advocates 

24 representing communities that are diverse in terms 


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1 of race, ethnicity, indigenous status, and geographic 

2 area; 

3 (6) employers and purchasers; 

4 (7) health facility and system leaders, including 

5 both hospital and birth center facilities; 

6 (8) journalists; and 

7 (9) bibliographic informatics specialists. 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

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

10 fiscal years 2011 through 2013 for the purpose of devel11 oping the database and such sums as may be necessary 

12 for each subsequent fiscal year for updating the database 

13 and providing outreach and notification to users, as de14 scribed in this section. 

15 TITLE II—RESEARCH AND DATA 

16 COLLECTION ON MATERNITY 

17 CARE 

18 SEC. 201. MATERNITY CARE HEALTH PROFESSIONAL 

19 SHORTAGE AREAS. 

20 Section 332 of the Public Health Service Act (42 

21 U.S.C. 254e) is amended by adding at the end the fol22 lowing new subsection: 

23 ‘‘(k)(1) The Secretary, acting through the Adminis24 trator of the Health Resources and Services Administra25 tion, shall designate maternity care health professional 


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

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

3 public facilities so designated, and at least annually review 

4 and, as necessary, revise such designations. 

5 ‘‘(2) For purposes of paragraph (1), a complete de6 scriptive list shall be published in the Federal Register not 

7 later than July 1 of 2011 and each subsequent year. 

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

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

10 shall apply to the designation of a maternity care health 

11 professional shortage area in a similar manner and extent 

12 as such provisions apply to the designation of health pro13 fessional shortage areas, except in applying subsection 

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

15 shall be deemed to be a reference to ‘physicians, obstetri16 cians, family practice physicians who practice full-scope 

17 maternity care, certified nurse-midwives, certified mid18 wives, and certified professional midwives’. 

19 ‘‘(4) For purposes of this subsection, the term ‘ma20 ternity care health professional shortage area’ means— 

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

22 need not conform to the geographic boundaries of a 

23 political subdivision and which is a rational area for 

24 the delivery of health services) which the Secretary 

25 determines has a shortage of providers of maternity 


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1 care health services, including obstetricians, family 

2 practice physicians who practice full-scope maternity 

3 care, certified nurse-midwives, certified midwives, 

4 and certified professional midwives, and shall also 

5 include urban or rural areas that have lost a signifi6 cant number of local hospital labor and delivery 

7 units; 

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 birth center 

13 labor and delivery units, or areas that lost a signifi14 cant number of these units in during the 10-year pe15 riod beginning with 2000; or 

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

17 determines has such a shortage of providers or fa18 cilities.’’. 

19 SEC. 202. EXPANSION OF CDC PREVENTION RESEARCH 

20 CENTERS PROGRAM TO INCLUDE CENTERS 

21 ON OPTIMAL MATERNITY OUTCOMES. 

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

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

24 and Human Services, shall support the establishment of 

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1 vention Research Center Program administered by the 

2 Centers for Disease Control and Prevention. Such addi3 tional centers shall each be known as a Center for Excel4 lence on Optimal Maternity Outcomes. 

5 (b) RESEARCH.—Each Center for Excellence on Opti6 mal Maternity Outcomes shall— 

7 (1) conduct at least one focused program of re8 search to improve maternity outcomes, including the 

9 reduction of cesarean birth rates, prematurity rates, 

10 and low birth weight rates within an underserved 

11 population that has a disproportionately large bur12 den of suboptimal maternity outcomes, including 

13 maternal mortality and morbidity, cesarean section 

14 rates, infant mortality, prematurity, or low birth 

15 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 birth center model; or a hospital labor 

24 and delivery model and planned home 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) Women’s health nurse practitioners. 

11 (C) Obstetrician-gynecologists physician 

12 assistants. 

13 (D) Certified professional midwives. 

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

15 for Excellence on Optimal Maternity Outcomes shall in16 clude at least 2 (and preferably more) of the following sup17 portive provider services: 

18 (1) Mental health. 

19 (2) Doula labor support. 

20 (3) Nutrition education. 

21 (4) Childbirth education. 

22 (5) Social work. 

23 (6) Physical therapy or occupation therapy. 

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

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1 nity Outcomes shall compliment and not replicate the 

2 work of the other. 

3 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section 

5 $2,000,000 for each of the fiscal years 2011 through 

6 2015. 

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

8 FOR MEDICARE AND MEDICAID INNOVATION 

9 TO INCLUDE MATERNITY CARE MODELS. 

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

11 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

12 end the following new clause: 

13 ‘‘(xxi) Promoting evidence-based 

14 group prenatal care models, doula support, 

15 and out-of-hospital births, including births 

16 at home or a birthing center.’’. 

17 TITLE III—ENHANCEMENT OF A 

18 GEOGRAPHICALLY, RA19 CIALLY, AND ETHNICALLY DI20 VERSE INTERDISCIPLINARY 

21 MATERNITY WORKFORCE 

22 SEC. 301. DEVELOPMENT OF INTERDISCIPLINARY MATER23 NITY CARE PROVIDER CORE CURRICULA. 

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

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


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1 and Human Services, acting in conjunction with the Ad2 ministrator of Health Resources and Services Administra3 tion, shall convene, for a 1-year period, a Maternity Cur4 riculum Commission to discuss and make recommenda5 tions for— 

6 (1) a shared core maternity care curriculum; 

7 (2) strategies to integrate and coordinate edu8 cation across maternity care disciplines, including 

9 suggestions for multi-disciplinary use of the shared 

10 core curriculum; and 

11 (3) pilot demonstrations of interdisciplinary 

12 educational models. 

13 (b) PARTICIPANTS.—The Commission shall include 

14 maternity care educators, curriculum developers, service 

15 leaders, certification leaders, and accreditation leaders 

16 from the various professions that provide maternity care 

17 in this country. Such professions shall include obstetri18 cian-gynecologists, certified nurse midwives, certified mid19 wives, family practice physicians, women’s health nurse 

20 practitioners, obstetrician-gynecologists physician assist21 ants, certified professional midwives, and perinatal nurses. 

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

23 curriculum described in subsection (A) shall— 

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

25 in health promotion and disease prevention; 


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1 (2) foster physiologic childbearing and patient 

2 and family centered care; and 

3 (3) include cultural sensitivity and strategies to 

4 decrease disparities in maternity outcomes. 

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

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

7 Services shall— 

8 (1) submit to Congress a report containing the 

9 recommendations made by the summit under this 

10 section; and 

11 (2) make such report publicly available. 

12 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section 

14 $1,000,000 for each of the fiscal years 2011 and 2012, 

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

16 2013 through 2015. 

17 SEC. 302. INTERDISCIPLINARY TRAINING OF MEDICAL STU18 DENTS, RESIDENTS, AND STUDENT MIDWIVES 

19 IN ACADEMIC HEALTH CENTERS. 

20 (a) INCLUDING WITHIN INPATIENT HOSPITAL SERV21 ICES UNDER MEDICARE SERVICES FURNISHED BY CER22 TAIN STUDENTS, INTERNS, AND RESIDENTS SUPERVISED

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

24 the Social Security Act (42 U.S.C. 1395x(b)) is amend25 ed— 


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1 (1) in paragraph (6), by striking ‘‘; or’’ and in2 serting ‘‘, or in the case of services in a hospital or 

3 osteopathic hospital by a student midwife or an in4 tern or resident-in-training under a teaching pro5 gram previously described in this paragraph who is 

6 in the field of obstetrics and gynecology, if such stu7 dent midwife, intern, or resident-in-training is super8 vised by a certified nurse-midwife to the extent per9 mitted under applicable State law and as may be au10 thorized by the hospital;’’; 

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

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

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

14 paragraph: 

15 ‘‘(8) a certified nurse-midwife where the hos16 pital has a teaching program approved as specified 

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

18 any payment due under this title for reasonable 

19 costs of such services, and (B) all certified nurse20 midwives in such hospital agree not to bill charges 

21 for professional services rendered in such hospital to 

22 individuals covered under the insurance program es23 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 2011, 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 2011 and $3,000,000 for each 

7 of the fiscal years 2012 through 2015. 

Æ 


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