I 

116TH CONGRESS 

1ST SESSION H. R. 4243 

To amend the Public Health Service Act to improve obstetric care in rural 

areas. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 9, 2019 

Ms. TORRES SMALL of New Mexico (for herself, Mr. NEWHOUSE, Ms. 

FINKENAUER, Mr. LATTA, Mr. LUJA ́N, and Mr. COLE) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to improve obstetric 

care in rural areas. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Maternal and 

5 Obstetric Modernization of Services Act’’ or the ‘‘Rural 

6 MOMS Act’’. 


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1 SEC. 2. IMPROVING RURAL MATERNAL AND OBSTETRIC 

2 CARE DATA. 

3 (a) MATERNAL MORTALITY AND MORBIDITY ACTIVI4 TIES.—Section 301 of the Public Health Service Act (42 

5 U.S.C. 241) is amended— 

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

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

8 (2) by inserting after subsection (d), the fol9 lowing: 

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

11 the Centers for Disease Control and Prevention, shall ex12 pand, intensify, and coordinate the activities of the Cen13 ters for Disease Control and Prevention with respect to 

14 maternal mortality and morbidity.’’. 

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

16 310A(b)(1) of the Public Health Service Act (42 U.S.C. 

17 242s(b)(1)) is amended by inserting ‘‘sociocultural (race, 

18 ethnicity, language, class, income), including among 

19 American Indians and Alaska Natives, as such terms are 

20 defined in section 4 of the Indian Health Care Improve21 ment Act, and geographic contexts,’’ after ‘‘biological,’’. 

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

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

24 amended— 

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

26 the end; 


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1 (2) by redesignating subparagraph (M) as sub2 paragraph (N); and 

3 (3) by inserting after subparagraph (L), the fol4 lowing: 

5 ‘‘(M) an examination of the relationship 

6 between maternal health services in rural areas 

7 and outcomes in delivery and postpartum care; 

8 and’’. 

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

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

11 287d) is amended— 

12 (1) in subsection (b)— 

13 (A) by redesignating paragraphs (4) 

14 through (9) as paragraphs (5) through (10), re15 spectively; 

16 (B) by inserting after paragraph (3) the 

17 following: 

18 ‘‘(4) carry out paragraphs (1) and (2) with re19 spect to pregnancy, with priority given to deaths re20 lated to pregnancy;’’; and 

21 (C) in paragraph (5) (as so redesignated), 

22 by striking ‘‘through (3)’’ and inserting 

23 ‘‘through (4)’’; and 


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

2 including maternal mortality and other maternal 

3 morbidity outcomes’’ before the semicolon. 

4 SEC. 3. RURAL OBSTETRIC NETWORK GRANTS. 

5 The Public Health Service Act is amended by insert6 ing after section 317L–1 (42 U.S.C. 247b–13a) the fol7 lowing: 

8 ‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 

9 ‘‘(a) IN GENERAL.—For the purpose of enabling the 

10 Secretary (through grants, contracts, or otherwise), acting 

11 through the Administrator of the Health Resources and 

12 Services Administration, to establish collaborative im13 provement and innovation networks (referred to in this 

14 section as ‘rural obstetric networks’) to improve outcomes 

15 in birth and maternal morbidity and mortality, there is 

16 appropriated to the Secretary, out of any money in the 

17 Treasury not otherwise appropriated, $3,000,000 for each 

18 of fiscal years 2020 through 2024. Such amounts shall 

19 remain available until expended. 

20 ‘‘(b) USE OF FUNDS.—Amount appropriated under 

21 subsection (a) shall be used for the establishment of col22 laborative improvement and innovation networks to im23 prove maternal health in rural areas by improving out24 comes in birth and maternal morbidity and mortality. 


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1 Rural obstetric networks established in accordance with 

2 this section shall— 

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

4 rural areas connect with prenatal, labor and birth, 

5 and postpartum care to improve outcomes in birth 

6 and maternal mortality and morbidity; 

7 ‘‘(2) identify successful prenatal, labor and 

8 birth, and postpartum health delivery models for in9 dividuals in rural areas, including evidence-based 

10 home visiting programs and successful, culturally 

11 competent models with positive maternal health out12 comes that advance health equity; 

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

14 health facilities that have an obstetric health unit 

15 and health facilities that do not have an obstetric 

16 health unit; 

17 ‘‘(4) provide training and guidance for health 

18 facilities that do not have obstetric health units; 

19 ‘‘(5) collaborate with academic institutions that 

20 can provide regional expertise and research on ac21 cess, outcomes, needs assessments, and other identi22 fied data; and 

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

24 outcomes among rural residents, with an emphasis 

25 on Black and American Indians and Alaska Native 


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1 residents, as such terms are defined in section 4 of 

2 the Indian Health Care Improvement Act. 

3 ‘‘(c) REQUIREMENTS.— 

4 ‘‘(1) ESTABLISHMENT.—Not later than October 

5 1, 2020, the Secretary shall establish rural obstetric 

6 health networks in at least 5 regions. 

7 ‘‘(2) DEFINITIONS.—In this section: 

8 ‘‘(A) FRONTIER AREA.—The term ‘frontier 

9 area’ means a frontier county, as defined in sec10 tion 1886(d)(3)(E)(iii)(III) of the Social Secu11 rity Act. 

12 ‘‘(B) INDIAN TRIBE.—The term ‘Indian 

13 tribe’ has the meaning given such term in sec14 tion 4 of the Indian Health Care Improvement 

15 Act. 

16 ‘‘(C) NATIVE HAWAIIAN HEALTH CARE

17 SYSTEM.—The term ‘Native Hawaiian Health 

18 Care System’ has the meaning given such term 

19 in section 12 of the Native Hawaiian Health 

20 Care Improvement Act. 

21 ‘‘(D) REGION.—The term ‘region’ means a 

22 State, Indian tribe, rural area, or frontier area. 

23 ‘‘(E) RURAL AREA.—The term ‘rural area’ 

24 has the meaning given that term in section 

25 1886(d)(2)(D) of the Social Security Act. 


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1 ‘‘(F) TRIBAL ORGANIZATION.—The term 

2 ‘tribal organization’ has the meaning given such 

3 term in the Indian Self-Determination Act. 

4 ‘‘(G) STATE.—The term ‘State’ has the 

5 meaning given that term for purposes of title V 

6 of the Social Security Act.’’. 

7 SEC. 4. TELEHEALTH NETWORK AND TELEHEALTH RE8 SOURCE CENTERS GRANT PROGRAMS. 

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

10 U.S.C. 254c–14) is amended— 

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

12 end the following: 

13 ‘‘(XIII) Providers of maternal, 

14 including prenatal, labor and birth, 

15 and postpartum care services and en16 tities operation obstetric care units.’’; 

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

18 and birth, postpartum,’’ before ‘‘or prenatal’’; and 

19 (3) in subsection (k)(1)(B), by inserting ‘‘equip20 ment useful for caring for pregnant women and indi21 viduals, including ultrasound machines and fetal 

22 monitoring equipment,’’ before ‘‘and other equip23 ment’’. 


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1 SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAIN2 ING DEMONSTRATION. 

3 Part D of title VII of the Public Health Service Act 

4 is amended by inserting after section 760 (42 U.S.C. 

5 294k) the following: 

6 ‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 

7 TRAINING DEMONSTRATION. 

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

9 training demonstration program to award grants to eligi10 ble entities to support— 

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

12 including family medicine and obstetrics and gyne13 cology residents, and fellows to practice maternal 

14 and obstetric medicine in rural community-based 

15 settings; 

16 ‘‘(2) training for licensed and accredited nurse 

17 practitioners, physician assistants, certified nurse 

18 midwives, certified midwives, certified professional 

19 midwives, home visiting nurses, or non-clinical pro20 fessionals such as doulas and community health 

21 workers, to provide maternal care services in rural 

22 community-based settings; and 

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

24 academic units or programs that— 

25 ‘‘(A) provide training for students or fac26 ulty, including through clinical experiences and 


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1 research, to improve maternal care in rural 

2 areas; or 

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

4 recommendations for the design of the units or 

5 programs described in subparagraph (A), in6 cluding curriculum content standards. 

7 ‘‘(b) ACTIVITIES.— 

8 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND

9 FELLOWS.—A recipient of a grant under subsection 

10 (a)(1)— 

11 ‘‘(A) shall use the grant funds— 

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

13 training program to provide obstetric care 

14 in rural areas for family practice or obstet15 rics and gynecology residents and fellows; 

16 or 

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

18 obstetrics and gynecology residents and fel19 lows in maternal and obstetric health care 

20 to provide and expand access to maternal 

21 and obstetric health care in rural areas; 

22 and 

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

24 additional support for the administration of the 

25 program or to meet the costs of projects to esVerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243

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1 tablish, maintain, or improve faculty develop2 ment, or departments, divisions, or other units 

3 necessary to implement such training. 

4 ‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re5 cipient of a grant under subsection (a)(2)— 

6 ‘‘(A) shall use the grant funds to plan, de7 velop, or operate a training program to provide 

8 maternal health care services in rural, commu9 nity-based settings; and 

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

11 additional support for the administration of the 

12 program or to meet the costs of projects to es13 tablish, maintain, or improve faculty develop14 ment, or departments, divisions, or other units 

15 necessary to implement such program. 

16 ‘‘(3) ACADEMIC UNITS OR PROGRAMS.—A re17 cipient of a grant under subsection (a)(3) shall enter 

18 into a partnership with organizations such as an 

19 education accrediting organization (such as the Liai20 son Committee on Medical Education, the Accredita21 tion Council for Graduate Medical Education, the 

22 Commission on Osteopathic College Accreditation, 

23 the Accreditation Commission for Education in 

24 Nursing, the Commission on Collegiate Nursing 

25 Education, the Accreditation Commission for MidVerDate Sep 11 2014 01:11 Sep 10, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4243.IH H4243

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1 wifery Education, or the Accreditation Review Com2 mission on Education for the Physician Assistant) to 

3 carry out activities under subsection (a)(3). 

4 ‘‘(4) TRAINING PROGRAM REQUIREMENTS.— 

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

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

7 out under the grant include instruction on— 

8 ‘‘(A) maternal mental health, including 

9 perinatal depression and anxiety and 

10 postpartum depression; 

11 ‘‘(B) maternal substance use disorder; 

12 ‘‘(C) social determinants of health that im13 pact individuals living in rural communities, in14 cluding poverty, social isolation, access to nutri15 tion, education, transportation, and housing; 

16 and 

17 ‘‘(D) implicit bias. 

18 ‘‘(c) ELIGIBLE ENTITIES.— 

19 ‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND

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

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

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

23 ‘‘(i) at least one teaching health cen24 ter; or 


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1 ‘‘(ii) the sponsoring institution (or 

2 parent institution of the sponsoring insti3 tution) of— 

4 ‘‘(I) an obstetrics and gynecology 

5 or family medicine residency program 

6 that is accredited by the Accreditation 

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

9 such a program); or 

10 ‘‘(II) a fellowship in maternal or 

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

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

15 medical residents or fellows to train in rural 

16 community-based settings. 

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

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

19 an entity shall be— 

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

21 in section 749A(f)); 

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

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

24 Security Act); 


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

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

3 Security Act); 

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

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

6 ‘‘(E) a freestanding birth center (as de7 fined in section 1905(l)(3) of the Social Secu8 rity Act); 

9 ‘‘(F) a health center operated by the In10 dian Health Service, an Indian tribe, a tribal 

11 organization, or a Native Hawaiian Health Care 

12 System (as such terms are defined in section 4 

13 of the Indian Health Care Improvement Act 

14 and section 12 of the Native Hawaiian Health 

15 Care Improvement Act); or 

16 ‘‘(G) an entity with a demonstrated record 

17 of success in providing academic training for 

18 nurse practitioners, physician assistants, cer19 tified nurse-midwives, certified midwives, cer20 tified professional midwives, home visiting 

21 nurses, or non-clinical professionals, such as 

22 doulas and community health workers. 

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

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

25 an entity shall be a school of medicine or osteopathic 


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1 medicine, a nursing school, a physician assistant 

2 training program, an accredited public or nonprofit 

3 private hospital, an accredited medical residency pro4 gram, a school accredited by the Midwifery Edu5 cation and Accreditation Council, or a public or pri6 vate nonprofit entity which the Secretary has deter7 mined is capable of carrying out such grant. 

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

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

10 the Secretary an application at such time, in such 

11 manner, and containing such information as the Sec12 retary may require, including an estimate of the 

13 amount to be expended to conduct training activities 

14 under the grant (including ancillary and administra15 tive costs). 

16 ‘‘(d) DURATION.—Grants awarded under this section 

17 shall be for a minimum of 5 years. 

18 ‘‘(e) STUDY AND REPORT.— 

19 ‘‘(1) STUDY.— 

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

21 through the Administrator of the Health Re22 sources and Services Administration, shall con23 duct a study on the results of the demonstra24 tion program under this section. 


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

2 90 days after the completion of the first year 

3 of the training program, and each subsequent 

4 year for the duration of the grant, that the pro5 gram is in effect, each recipient of a grant 

6 under subsection (a) shall submit to the Sec7 retary such data as the Secretary may require 

8 for analysis for the report described in para9 graph (2). 

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

11 year after receipt of the data described in paragraph 

12 (1)(B), the Secretary shall submit to Congress a re13 port that includes— 

14 ‘‘(A) an analysis of the effect of the dem15 onstration program under this section on the 

16 quality, quantity, and distribution of maternal, 

17 including prenatal, labor and birth, and 

18 postpartum care services and the demographics 

19 of the recipients of those services; 

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

21 health outcomes (including quality of care, mor22 bidity, and mortality) before and after imple23 mentation of the program in the communities 

24 served by entities participating in the dem25 onstration; and 


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1 ‘‘(C) recommendations on whether the 

2 demonstration program should be expanded. 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section, 

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

6 SEC. 6. GAO REPORT. 

7 Not later than 1 year after the date of enactment 

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

9 shall submit to the appropriate committees of Congress 

10 a report on the maternal, including prenatal, labor and 

11 birth, and postpartum care in rural areas. Such report 

12 shall include the following: 

13 (1) The location of gaps in maternal and ob14 stetric clinicians and health professionals, including 

15 non-clinical professionals such as doulas and com16 munity health workers. 

17 (2) The location of gaps in facilities able to pro18 vide maternal, including prenatal, labor and birth, 

19 and postpartum care in rural areas, including care 

20 for high-risk pregnancies. 

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

22 recommendations to standardize the format on col23 lecting data related to maternal mortality and mor24 bidity. 


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1 (4) The gaps in maternal health by race and 

2 ethnicity in rural communities, with a focus on ra3 cial inequities for Black residents and among Indian 

4 Tribes and American Indian/Alaska Native rural 

5 residents (as such terms are defined in section 4 of 

6 the Indian Health Care Improvement Act). 

7 (5) A list of specific activities that the Sec8 retary of Health and Human Services plans to con9 duct on maternal, including prenatal, labor and 

10 birth, and postpartum care. 

11 (6) A plan for completing such activities. 

12 (7) An explanation of Federal agency involve13 ment and coordination needed to conduct such ac14 tivities. 

15 (8) A budget for conducting such activities. 

16 (9) Other information that the Comptroller 

17 General determines appropriate. 

Æ 


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