II 

114TH CONGRESS 

1ST SESSION S. 674 

To expand programs with respect to women’s health. 

IN THE SENATE OF THE UNITED STATES 

MARCH 4, 2015 

Mrs. MURRAY (for herself, Ms. MIKULSKI, and Mrs. BOXER) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To expand programs with respect to women’s health. 

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 ‘‘21st Century Women’s 

5 Health Act of 2015’’. 

6 SEC. 2. PURPOSE. 

7 It is the purpose of this Act to provide women with 

8 affordable access to comprehensive health care, including 

9 preventive services (such as contraception and breast can10 cer screenings), to improve maternal health, and to ensure 

11 that a woman has the same benefits and services no matVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
2 

•S 674 IS

1 ter what part of the United States she lives in, all which 

2 is critical to improving the health and well-being of 

3 women, children, their families, society as a whole, and 

4 is an essential part of a woman’s economic security and 

5 opportunity. 

6 SEC. 3. STRENGTHENING FAMILY PLANNING. 

7 (a) IN GENERAL.—Title X of the Public Health Serv8 ice Act (42 U.S.C. 300 et seq.) is amended by inserting 

9 after section 1003 the following: 

10 ‘‘SEC. 1003A. GRANTS FOR FACILITIES IMPROVEMENTS. 

11 ‘‘(a) IN GENERAL.—The Secretary is authorized to 

12 make grants to and enter into contracts with public or 

13 nonprofit private entities to plan, develop, or make im14 provements to facilities carrying out family planning serv15 ice projects, and expand preventive health services, under 

16 section 1001. 

17 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

18 is authorized to be appropriated to carry out this section, 

19 $50,000,000 for each of fiscal years 2016 through 2019.’’. 

20 (b) FUNDING.—There is authorized to be appro21 priated to carry out programs under title X of the Public 

22 Health Service Act (42 U.S.C. 300 et seq.), $327,000,000 

23 for each of fiscal years 2016 through 2019. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
3 

•S 674 IS

1 SEC. 4. ENSURING PARITY IN WOMEN’S HEALTH COVERAGE 

2 UNDER MEDICAID. 

3 (a) STATE PLAN REQUIREMENT.—Section 1902(a) 

4 of the Social Security Act (42 U.S.C. 1396a(a)) is amend5 ed by inserting after paragraph (77) the following: 

6 ‘‘(78) provide that the State shall, at a min7 imum and in addition to any other preventive care 

8 and screenings required under this title, provide 

9 medical assistance for preventive care and screenings 

10 required under section 2713(a) of the Public Health 

11 Service Act, including evidence-based items or serv12 ices required under section 2713(a)(1) of such Act, 

13 evidence-informed preventive care and screenings re14 quired under section 2713(a)(3) of such Act, and 

15 additional preventive care and screenings required 

16 for women under section 2713(a)(4) of such Act and 

17 as provided for in comprehensive guidelines sup18 ported by the Health Resources and Services Admin19 istration, and shall not impose any copayment, coin20 surance, deductible, cost-sharing, or similar charge 

21 for such preventive care and screenings;’’. 

22 (b) APPLICATION TO MANAGED CARE.—Section 

23 1932(b) of such Act (42 U.S.C. 1396u–2(b)) is amended 

24 by adding at the end the following: 

25 ‘‘(9) PARITY IN WOMEN’S HEALTH COV26 ERAGE.—Each medicaid managed care organization 


asabaliauskas on DSK5VPTVN1PROD with BILLS
4 

•S 674 IS

1 shall at a minimum and in addition to any other 

2 preventive care and screenings required under a con3 tract with the State under section 1903(m), provide 

4 medical assistance for preventive care and screenings 

5 required under section 2713(a) of the Public Health 

6 Service Act, including evidence-based items or serv7 ices required under section 2713(a)(1) of such Act, 

8 evidence-informed preventive care and screenings re9 quired under section 2713(a)(3) of such Act, and 

10 additional preventive care and screenings required 

11 for women under section 2713(a)(4) of such Act and 

12 as provided for in comprehensive guidelines sup13 ported by the Health Resources and Services Admin14 istration, and shall not impose any copayment, coin15 surance, deductible, cost-sharing, or similar charge 

16 for such preventive care and screenings.’’. 

17 (c) APPLICATION TO BENCHMARK BENEFIT

18 PLANS.—Section 1937(b)(5) of such Act (42 U.S.C. 

19 1396u–7(b)(5)) is amended by inserting ‘‘and, effective 

20 January 1, 2016, must provide, at a minimum and in ad21 dition to any other preventive care and screenings required 

22 under this section, preventive care and screenings, re23 quired under section 2713(a) of the Public Health Service 

24 Act, including evidence-based items or services required 

25 under section 2713(a)(1) of such Act, evidence-informed 


asabaliauskas on DSK5VPTVN1PROD with BILLS
5 

•S 674 IS

1 preventive care and screenings required under section 

2 2713(a)(3) of such Act, and additional preventive care and 

3 screenings required for women under section 2713(a)(4) 

4 of such Act and as provided for in comprehensive guide5 lines supported by the Health Resources and Services Ad6 ministration, and shall not impose any copayment, coin7 surance, deductible, cost-sharing or similar charge for 

8 such preventive care and screenings’’ before the period. 

9 (d) PARITY IN COVERAGE OF ALL FDA-APPROVED

10 FORMS OF CONTRACEPTION.—Section 1905(a)(4)(C) of 

11 such Act (42 U.S.C. 1396d(a)(4)(C)) is amended by in12 serting ‘‘, including family planning services and supplies 

13 that are required under section 2713(a) of the Public 

14 Health Service Act and as provided for in comprehensive 

15 guidelines supported by the Health Resources and Serv16 ices Administration for purposes of section 2713(a)(4) of 

17 such Act,’’ before ‘‘furnished’’. 

18 (e) CONFORMING AMENDMENTS PROHIBITING COST19 SHARING.— 

20 (1) IN GENERAL.—Subsections (a)(2)(D) and 

21 (b)(2)(D) of section 1916 of such Act (42 U.S.C. 

22 1396o) are each amended by inserting ‘‘and items 

23 and services required under section 1902(a)(78),’’ 

24 before ‘‘or’’. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
6 

•S 674 IS

1 (2) ALTERNATIVE AUTHORITY.—Section 

2 1916A(b)(3)(B) of such Act (42 U.S.C. 1396o– 

3 1(b)(3)(B)) is amended by adding at the end the fol4 lowing: 

5 ‘‘(xi) Items and services required 

6 under section 1902(a)(78).’’. 

7 (f) APPLICATION TO WAIVERS.— 

8 (1) LIMITATION OF WAIVER AUTHORITY.—Not9 withstanding section 1115(a) of the Social Security 

10 Act (42 U.S.C. 1315(a)), subject to paragraph (2), 

11 the Secretary of Health and Human Services may 

12 not grant a waiver under section 1115 of the Social 

13 Security Act (42 U.S.C. 1315) or otherwise of the 

14 requirements imposed under the amendments made 

15 by this section. 

16 (2) EXCEPTION FOR CURRENT WAIVERS.—The 

17 amendments made by this section shall not apply to 

18 any waiver granted to a State under section 1115 of 

19 the Social Security Act (42 U.S.C. 1315) or other20 wise which relates to the provision of medical assist21 ance under a State plan under title XIX of such Act 

22 (42 U.S.C. 1396 et seq.) that is in effect as of the 

23 date of enactment of this Act before the expiration 

24 (determined without regard to any extensions) of the 


asabaliauskas on DSK5VPTVN1PROD with BILLS
7 

•S 674 IS

1 waiver to the extent such amendments are incon2 sistent with the waiver. 

3 (g) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—Except as provided in para5 graphs (2) and (3), the amendments made by this 

6 section shall be effective with respect to items or 

7 services furnished on or after the date of enactment 

8 of this Act. 

9 (2) BENCHMARK AND MANAGED CARE PLANS.— 

10 The amendments made by subsections (b) and (c) 

11 shall apply to plan years beginning on or after Janu12 ary 1, 2016. 

13 (3) TRANSITION RULE.—In the case of a State 

14 plan under title XIX or XXI of the Social Security 

15 Act, which the Secretary of Health and Human 

16 Services determines requires State legislation in 

17 order for the respective plan to meet any require18 ment imposed by amendments made by this section, 

19 the respective plan shall not be regarded as failing 

20 to comply with the requirements of such title solely 

21 on the basis of its failure to meet such an additional 

22 requirement before the first day of the first calendar 

23 quarter beginning after the close of the first regular 

24 session of the State legislature that begins after the 

25 date of enactment of this section. For purposes of 


asabaliauskas on DSK5VPTVN1PROD with BILLS
8 

•S 674 IS

1 the previous sentence, in the case of a State that has 

2 a 2-year legislative session, each year of the session 

3 shall be considered to be a separate regular session 

4 of the State legislature. 

5 SEC. 5. ACCESS TO WOMEN’S HEALTH CARE PROVIDERS. 

6 Part B of title VIII of the Public Health Service Act 

7 (42 U.S.C. 296j et seq.) is amended by adding at the end 

8 the following: 

9 ‘‘SEC. 812. DEMONSTRATION GRANTS FOR NURSE PRACTI10 TIONER TRAINING PROGRAM. 

11 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 

12 shall establish a demonstration program (referred to in 

13 this section as the ‘program’) to award grants to eligible 

14 entities for the training of nurse practitioners specializing 

15 in women’s health care for careers as providers in health 

16 centers that receive assistance under title X (referred to 

17 in this section as ‘health centers’). 

18 ‘‘(b) PURPOSE.—The purpose of the program is to 

19 enable each grant recipient to— 

20 ‘‘(1) provide new nurse practitioners with clin21 ical training to enable such practitioners to serve as 

22 providers in health centers; 

23 ‘‘(2) train new nurse practitioners to work 

24 under a model of care that is consistent with the 

25 principles set forth by the Report Providing Quality 


asabaliauskas on DSK5VPTVN1PROD with BILLS
9 

•S 674 IS

1 Family Planning Services of the Centers for Disease 

2 Control and Prevention; and 

3 ‘‘(3) establish a model of training for nurse 

4 practitioners that specialize in women’s health care 

5 that may be replicated nationwide. 

6 ‘‘(c) GRANTS.—Under the program, the Secretary 

7 shall award 3-year grants to eligible entities that meet the 

8 requirements established by the Secretary, for the purpose 

9 of operating the nurse practitioner programs described in 

10 subsection (a) at such entities. 

11 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

12 a grant under this section, an entity shall be— 

13 ‘‘(1) a health center that receives funding under 

14 section 1001; and 

15 ‘‘(2) submit to the Secretary an application at 

16 such time, in such manner, and containing such in17 formation as the Secretary may require. 

18 ‘‘(e) ELIGIBILITY OF NURSE PRACTITIONERS.— 

19 ‘‘(1) IN GENERAL.—To be eligible for accept20 ance into a training program carried out by an eligi21 ble entity under a grant under this section, an indi22 vidual shall— 

23 ‘‘(A) be licensed, or eligible for licensure, 

24 in the State in which the program is being car25 ried out as an advanced practice registered 


asabaliauskas on DSK5VPTVN1PROD with BILLS
10 

•S 674 IS

1 nurse or advanced practice nurse and be eligible 

2 or board-certified as a nurse practitioner; and 

3 ‘‘(B) demonstrate commitment to a career 

4 as a provider in a health center. 

5 ‘‘(2) PREFERENCE.—In accepting individuals 

6 into a training program under this section, a grant 

7 recipient shall give preference to bilingual applicants 

8 that meet the requirements described in paragraph 

9 (1). 

10 ‘‘(f) GRANT AMOUNT.—Each grant awarded under 

11 this section shall be in an amount not to exceed $600,000 

12 per year. A grant recipient may carry over funds from 1 

13 fiscal year to another without obtaining approval from the 

14 Secretary. 

15 ‘‘(g) TECHNICAL ASSISTANCE GRANTS.—The Sec16 retary may award technical assistance grants to 1 or more 

17 health centers that have demonstrated expertise in estab18 lishing a nurse practitioner residency training program. 

19 Such technical assistance grants shall be for the purpose 

20 of providing technical assistance to other recipients of 

21 grants under subsection (c). 

22 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To 

23 carry out this section, there is authorized to be appro24 priated $10,000,000 for each of fiscal years 2016 through 

25 2019.’’. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
11 

•S 674 IS

1 SEC. 6. COMPASSIONATE ASSISTANCE AND AWARENESS 

2 FOR SURVIVORS OF RAPE. 

3 (a) DEFINITIONS.—In this section: 

4 (1) EMERGENCY CONTRACEPTION.—The term 

5 ‘‘emergency contraception’’ means a drug or device 

6 (as such terms are defined in section 201 of the 

7 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 

8 321)), or drug regimen that— 

9 (A) is used postcoitally; 

10 (B) prevents pregnancy primarily by pre11 venting or delaying ovulation, and does not ter12 minate an established pregnancy; and 

13 (C) is approved by the Food and Drug Ad14 ministration. 

15 (2) HEALTH CARE PROVIDER.—The term 

16 ‘‘health care provider’’ means an individual who is li17 censed or certified under State law to provide health 

18 care services and who is operating within the scope 

19 of such license. Such term shall include a phar20 macist. 

21 (3) HOSPITAL.—The term ‘‘hospital’’ means— 

22 (A) a hospital as defined in section 

23 1861(e) of the Social Security Act (42 U.S.C. 

24 1395x(e)); 


asabaliauskas on DSK5VPTVN1PROD with BILLS
12 

•S 674 IS

1 (B) a critical access hospital as defined in 

2 section 1861(mm)(1) of such Act (42 U.S.C. 

3 1395x(mm)(1)); and 

4 (C) a health clinic located on the campus 

5 of an institution of higher education. 

6 (4) INSTITUTION OF HIGHER EDUCATION.—The 

7 term ‘‘institution of higher education’’ has the 

8 meaning given such term in section 101(a) of the 

9 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

10 (5) NONPROFITS.—The term ‘‘nonprofits (other 

11 than institutions of higher education)’’ means a 

12 community-based organization, other than an insti13 tution of higher education, with experience in pro14 viding evidence-based effective programs, strategies, 

15 and policies to prevent sexual violence, intimate 

16 partner violence, and other forms of violence on the 

17 campus of institutions of higher education. 

18 (6) SECRETARY.—The term ‘‘Secretary’’ means 

19 the Secretary of Health and Human Services. 

20 (7) SEXUAL ASSAULT.— 

21 (A) IN GENERAL.—The term ‘‘sexual as22 sault’’ means a sexual act (as defined in sub23 paragraphs (A) through (C) of section 2246(2) 

24 of title 18, United States Code) where the vicVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
13 

•S 674 IS

1 tim involved does not consent or lacks the ca2 pacity to consent. 

3 (B) APPLICATION OF PROVISIONS.—The 

4 definition in subparagraph (A) shall apply to all 

5 individuals. 

6 (b) SURVIVORS OF SEXUAL ASSAULT; PROVISION BY

7 HOSPITALS OF EMERGENCY CONTRACEPTION WITHOUT

8 CHARGE.— 

9 (1) IN GENERAL.—Federal funds may not be 

10 provided to a hospital unless such hospital complies 

11 with the conditions specified in paragraph (2) in the 

12 case of— 

13 (A) any woman who arrives at the hospital 

14 and states that she is a victim of sexual assault, 

15 or is accompanied by someone who states she is 

16 a victim of sexual assault; and 

17 (B) any woman who arrives at the hospital 

18 whom hospital personnel have reason to believe 

19 is a victim of sexual assault. 

20 (2) ASSISTANCE FOR VICTIMS.—The conditions 

21 specified in this subsection regarding a hospital and 

22 a woman described in paragraph (1) are as follows: 

23 (A) The hospital promptly provides the 

24 woman with medically and factually accurate 

25 and unbiased written and oral information 


asabaliauskas on DSK5VPTVN1PROD with BILLS
14 

•S 674 IS

1 about emergency contraception, including infor2 mation explaining that— 

3 (i) some forms of emergency contra4 ception have been approved by the Food 

5 and Drug Administration as over-the6 counter medications for all women without 

7 age restrictions and such contraception is 

8 a safe and effective way to prevent preg9 nancy after unprotected intercourse or con10 traceptive failure if taken in a timely man11 ner; 

12 (ii) emergency contraception is more 

13 effective the sooner it is taken; and 

14 (iii) emergency contraception does not 

15 cause an abortion and cannot interrupt an 

16 established pregnancy. 

17 (B) The hospital promptly offers emer18 gency contraception to the woman, and prompt19 ly provides such contraception to her at the 

20 hospital on her request. 

21 (C) The information provided pursuant to 

22 subparagraph (A) is in clear and concise lan23 guage, is readily comprehensible, and meets 

24 such conditions regarding the provision of the 


asabaliauskas on DSK5VPTVN1PROD with BILLS
15 

•S 674 IS

1 information in languages other than English as 

2 the Secretary may establish. 

3 (D) The services described in subpara4 graphs (A) through (C) are not denied because 

5 of the inability of the woman or her family to 

6 pay for the services. 

7 (3) EFFECTIVE DATE; AGENCY CRITERIA.—This 

8 subsection shall take effect upon the expiration of 

9 the 180-day period beginning on the date of the en10 actment of this Act. Not later than 30 days prior to 

11 the expiration of such period, the Secretary shall 

12 publish in the Federal Register criteria for carrying 

13 out this section. 

14 (c) SURVIVORS OF CAMPUS SEXUAL ASSAULT; PRO15 VISION BY COMMUNITY-BASED ORGANIZATIONS AND

16 NONPROFITS (OTHER THAN INSTITUTIONS OF HIGHER

17 EDUCATION) OF EMERGENCY CONTRACEPTION AND SEX18 UAL ASSAULT PREVENTION PROGRAMS.—Nonprofits 

19 (other than institutions of higher education) shall provide 

20 for campus programs focused on effective prevention strat21 egies that include— 

22 (1) the implementation of a comprehensive pre23 vention strategy based on evidence-based research 

24 that identifies strategies to prevent sexually violent 

25 behavior; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
16 

•S 674 IS

1 (2) the use of risk and protective factors 

2 through the provision of training to students on sex3 ual violence and prevention and the provision of 

4 campus outreach on preventing sexual violence and 

5 information about emergency contraception; and 

6 (3) the coordination of activities with campus7 based health facilities to ensure prompt access to 

8 medically and factually accurate and unbiased writ9 ten and oral information about emergency contra10 ception and assistance as determined under sub11 section (b)(2). 

12 (d) EMERGENCY CONTRACEPTION EDUCATION AND

13 INFORMATION PROGRAMS.— 

14 (1) EMERGENCY CONTRACEPTION PUBLIC EDU15 CATION PROGRAM.— 

16 (A) IN GENERAL.—The Secretary, acting 

17 through the Director of the Centers for Disease 

18 Control and Prevention, shall develop and dis19 seminate to the public information on emer20 gency contraception. 

21 (B) DISSEMINATION.—The Secretary may 

22 disseminate information on emergency contra23 ception under subparagraph (A) directly or 

24 through arrangements with health agencies, 

25 professional and nonprofit organizations, conVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
17 

•S 674 IS

1 sumer groups, institutions of higher education, 

2 clinics, the media, and Federal, State, and local 

3 agencies. 

4 (C) INFORMATION.—The information on 

5 emergency contraception disseminated under 

6 subparagraph (A) shall include, at a minimum, 

7 the most current evidence-based and evidence8 informed standards of care with respect to 

9 emergency contraception and an explanation of 

10 the proper, use, safety, efficacy, and availability 

11 of such contraception, and the availability of 

12 counseling with respect to such contraception. 

13 (2) EMERGENCY CONTRACEPTION INFORMA14 TION PROGRAM FOR HEALTH CARE PROVIDERS.— 

15 (A) IN GENERAL.—The Secretary, acting 

16 through the Administrator of the Health Re17 sources and Services Administration and in con18 sultation with major medical and public health 

19 organizations, shall develop and disseminate to 

20 health care providers information on emergency 

21 contraception. 

22 (B) INFORMATION.—The information dis23 seminated under subparagraph (A) shall in24 clude, at a minimum— 


asabaliauskas on DSK5VPTVN1PROD with BILLS
18 

•S 674 IS

1 (i) information describing the most 

2 current evidence-based and evidence-in3 formed standards of care, proper use, safe4 ty, efficacy, and availability of emergency 

5 contraception, and the availability of coun6 seling with respect to such contraception; 

7 (ii) recommendations regarding the 

8 use of such contraception in appropriate 

9 cases; 

10 (iii) recommendations for health care 

11 providers working in emergency rooms to 

12 consult with survivors of sexual assault, 

13 once such survivors are clinically stable, re14 garding options for emergency contracep15 tion and to provide any necessary follow-up 

16 care and referral services; and 

17 (iv) information explaining how to ob18 tain copies of the information developed 

19 under paragraph (1) for distribution to the 

20 patients of the providers. 

21 (3) AUTHORIZATION OF APPROPRIATIONS.— 

22 There are authorized to be appropriated to carry out 

23 this section, such sums as may be necessary for each 

24 of the fiscal years 2016 through 2020. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
19 

•S 674 IS

1 (4) STUDY.—The Agency for Healthcare Re2 search and Quality shall conduct a study of access 

3 of survivors of sexual assault to emergency contra4 ception in each State and nationally, to make access 

5 and care safer, of higher quality, and more acces6 sible, equitable, and affordable. 

7 SEC. 7. IMPROVED CUSTOMER SERVICE AND PROTECTIONS 

8 FOR WOMEN. 

9 Title III of the Public Health Service Act (42 U.S.C. 

10 241 et seq.) is amended by adding at the end the fol11 lowing: 

12 ‘‘PART W—WOMEN’S HEALTH 

13 ‘‘SEC. 399OO. OFFICE OF THE OMBUDSPERSON ON WOM14 EN’S HEALTH. 

15 ‘‘(a) ESTABLISHMENT.—There is established within 

16 the Office of Secretary of the Department of Health and 

17 Human Services an Office of the Ombudsperson on Wom18 en’s Health (in this section referred to as the ‘Office’). 

19 The Office shall be headed by an Ombudsperson who is 

20 appointed by the Secretary and reports directly to the Sec21 retary. 

22 ‘‘(b) DEADLINE FOR DESIGNATION OF

23 OMBUDSPERSON.—Not later than 180 days after the date 

24 of the enactment of this Act, the Secretary shall designate 

25 an individual to serve as the Ombudsperson of the Office 


asabaliauskas on DSK5VPTVN1PROD with BILLS
20 

•S 674 IS

1 on Women’s Health (referred to in this part as the 

2 ‘Ombudsperson’). 

3 ‘‘(c) DUTIES OF OFFICE.— 

4 ‘‘(1) IN GENERAL.—The Ombudsperson, in co5 ordination (as defined in paragraph (4)) with major 

6 medical, public health, and legal organizations, agen7 cies within the Department of Health and Human 

8 Services, the Department of Labor, and consumer 

9 organizations shall develop recommendations to iden10 tify and better assist women in accessing health and 

11 human services. 

12 ‘‘(2) ADDITIONAL DUTIES.—The Office shall— 

13 ‘‘(A) serve as the coordinator for the De14 partment of Health and Human Services for 

15 complaints and issues with respect to the provi16 sion of health services to women that involve 

17 any administrative body within the Department 

18 of Health and Human Services, including the 

19 Office on Women’s Health, the Office of Popu20 lation Affairs, the Centers for Disease Control 

21 and Prevention, the National Institutes of 

22 Health, the Food and Drug Administration, the 

23 Office of Adolescent Health, the Health Re24 sources and Services Administration, the Office 

25 of Civil Rights, and the Center for Consumer 


asabaliauskas on DSK5VPTVN1PROD with BILLS
21 

•S 674 IS

1 Information and Insurance Oversight, and shall 

2 consult with the Department of Labor regard3 ing such complaints and issues, in order to 

4 refer women to the appropriate agency for her 

5 complaint and issue; 

6 ‘‘(B) collect data and information about 

7 the complaints concerning health services for 

8 women that are received across the Department 

9 by the Ombudsperson and other agencies; 

10 ‘‘(C) help to coordinate assistance for 

11 women among the various administrative bodies 

12 of the Department of Health and Human Serv13 ices; 

14 ‘‘(D) maintain and publicize a toll-free 

15 telephone number for women seeking assistance 

16 regarding issues related to a health service, and 

17 to report complaints; 

18 ‘‘(E) provide assistance within the Depart19 ment of Health and Human Services, and in 

20 consultation with the Secretary of Labor, when 

21 there are barriers to getting information about 

22 a complaint, or accessing services or benefits; 

23 ‘‘(F) issue reports on how women’s health 

24 care issues are addressed and handled within 

25 the Department of Health and Human Services 


asabaliauskas on DSK5VPTVN1PROD with BILLS
22 

•S 674 IS

1 and track what agencies are being responsive to 

2 complaints in order to improve customer service 

3 and improve women’s access to health services; 

4 ‘‘(G) work with other administrative bodies 

5 of the Department of Health and Human Serv6 ices to address issues identified through fact7 finding and inquiries; 

8 ‘‘(H) Work with external stakeholders, 

9 such as pharmacies, providers, community10 based organizations, clinics, and hospitals, to 

11 ensure that there is information regarding the 

12 cost-sharing and preventive services, including 

13 access to all Food and Drug Administration ap14 proved forms of contraception made available 

15 under the Patient Protection and Affordable 

16 Care Act (Public Law 111–148); and 

17 ‘‘(I) submit an annual report to Congress 

18 in accordance with subsection (e). 

19 ‘‘(3) RESPONSIBILITIES OF THE

20 OMBUDSPERSON.—In carrying out the duties of the 

21 Office, the Ombudsperson shall— 

22 ‘‘(A) evaluate each complaint received by 

23 the Office objectively; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
23 

•S 674 IS

1 ‘‘(B) maintain confidentiality of any mat2 ter related to complaints, including the identi3 ties of the complainants and witnesses; and 

4 ‘‘(C) ensure that any action taken by the 

5 Ombudsperson, and other offices of the Depart6 ment of Health and Human Services, with re7 spect to such a matter does not negatively af8 fect the ability of any woman to receive health 

9 care or benefits under a law administered by 

10 the Secretary. 

11 ‘‘(4) COORDINATION.—To better identify and 

12 address issues related to health care for women, the 

13 Ombudsperson shall coordinate efforts with respect 

14 to such issues among— 

15 ‘‘(A) all entities within the Department of 

16 Health and Human Services; 

17 ‘‘(B) the Department of Labor; and 

18 ‘‘(C) any other Federal agency with juris19 diction over matters related to access to health 

20 care services for women. 

21 ‘‘(5) PUBLIC MEETINGS.—The Ombudsperson 

22 shall convene a public meeting quarterly to ensure 

23 communication and coordination of services for 

24 women. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
24 

•S 674 IS

1 ‘‘(d) CONSULTATION.—In carrying out the duties of 

2 the Office, the Ombudsperson, as appropriate, shall con3 sult with State offices of health insurance consumer assist4 ance and health insurance ombudsman programs for 

5 which a State has received a grant under section 2793. 

6 ‘‘(e) ANNUAL REPORTS.— 

7 ‘‘(1) IN GENERAL.—Not later than September 

8 30 of each year, the Office shall submit a report to 

9 Congress on the actions taken by the Office over the 

10 preceding year and the objectives of those actions. 

11 Such report shall be provided by the Ombudsperson 

12 directly to Congress without any prior comment or 

13 amendment by the Secretary. 

14 ‘‘(2) CONTENTS.—Each report submitted under 

15 paragraph (1) shall include, with respect to the pre16 ceding year— 

17 ‘‘(A) statistical information, by region, on 

18 the volume of complaints received by the Office, 

19 the general nature of complaints, general infor20 mation on complainants, and the percentage of 

21 complaints that resulted in a fact-finding in22 quiry; 

23 ‘‘(B) a summary of problems encountered 

24 by complainants, including information on the 

25 most pervasive or serious types of problems enVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
25 

•S 674 IS

1 countered by complainants, including an enu2 meration of actions that the Office has taken in 

3 response to such problems; 

4 ‘‘(C) policy recommendations that the Of5 fice made to the Department of Health and 

6 Human Services and the Department of Labor 

7 to remedy continual problems or address areas 

8 of concerns that are reported to the Office to 

9 better inform policymaking, including an enu10 meration of actions that the Office has taken in 

11 response to such problems or concerns; and 

12 ‘‘(D) such other information as the Office 

13 considers relevant. 

14 ‘‘(3) REPORT FROM THE SECRETARY.—The 

15 Ombudsperson shall seek comment from the Sec16 retary on the report prepared for submission under 

17 paragraph (1), and the Ombudsperson shall submit 

18 to Congress the comments of the Secretary together 

19 with the annual report under paragraph (1). 

20 ‘‘(4) OTHER REPORTS.—Nothing in this sub21 section shall be construed to preclude the Office 

22 from issuing additional reports on the activities of 

23 the Office. 

24 ‘‘(f) NETWORK ADEQUACY STUDY.— 


asabaliauskas on DSK5VPTVN1PROD with BILLS
26 

•S 674 IS

1 ‘‘(1) STUDY.—The Ombudsperson shall conduct 

2 a study on the network adequacy for women’s health 

3 services. Such study shall include— 

4 ‘‘(A) an analysis of the number of in-net5 work providers for women’s health services 

6 across the United States, including State-by7 State information on waiting times and distance 

8 traveled; 

9 ‘‘(B) an analysis of the availability of wom10 en’s health services, including contraception 

11 counseling and reproductive health services; 

12 ‘‘(C) the identification of geographic areas 

13 in which there may be a shortage of providers, 

14 clinics, and hospitals that are able to provide 

15 women with the full reproductive services; 

16 ‘‘(D) a comparison of information provided 

17 to women concerning in-network and out-of-net18 work providers; 

19 ‘‘(E) an analysis of factors related to wom20 en’s health care access that identifies geo21 graphic gaps, health center availability, and 

22 barriers to providing such care in training, ex23 pertise, and stocking of drugs; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
27 

•S 674 IS

1 ‘‘(F) information on a State’s balance bill2 ing policies as related to consumers and pro3 viders; and 

4 ‘‘(G) a State-by-State comparison of acces5 sibility, essential community providers, and 

6 transparency of information. 

7 ‘‘(2) REPORT.—Not later than January 1, 

8 2017, the Ombudsperson shall submit a report to 

9 Congress on the study conducted under paragraph 

10 (1). The report shall include the recommendations of 

11 the Ombudsperson with respect to network adequacy 

12 for women.’’. 

13 SEC. 8. NATIONAL WOMEN’S HEALTH AWARENESS CAM14 PAIGN. 

15 Title III of the Public Health Service Act (42 U.S.C. 

16 241g et seq.), as amended by section 7, is further amended 

17 by adding at the end the following: 

18 ‘‘SEC. 399OO–1. WOMEN’S PREVENTIVE HEALTH AWARE19 NESS CAMPAIGN. 

20 ‘‘(a) IN GENERAL.—The Secretary, in cooperation 

21 with the Director of the Centers for Disease Control and 

22 Prevention, the Administrator of the Health Resources 

23 and Services Administration, the Director of the Center 

24 for Consumer Information and Insurance Oversight, the 

25 Director of the Office of Women’s Health, the Director 


asabaliauskas on DSK5VPTVN1PROD with BILLS
28 

•S 674 IS

1 of the National Institutes of Health, the Commissioner of 

2 Food and Drugs, and the Ombudsperson of the Office of 

3 Women’s Health, shall coordinate and provide for a na4 tional public outreach and education campaign to raise 

5 public awareness, including among providers, of preventive 

6 health services for women and families, including contra7 ception coverage made available under the Patient Protec8 tion and Affordable Care Act (Public Law 111–148). 

9 ‘‘(b) DISSEMINATION OF INFORMATION.—The out10 reach and awareness campaign shall include the media 

11 campaign under subsection (c) and the Internet website 

12 under subsection (d), and shall provide for the dissemina13 tion of information that— 

14 ‘‘(1) describes the guidelines for preventive 

15 services for women, including the most up-to-date 

16 recommendations on domestic violence screenings 

17 and counseling, breast cancer, cervical cancer, and 

18 other diseases that disproportionately impact 

19 women, available from the United States Preventive 

20 Services Task Force and major medical and public 

21 health organizations; 

22 ‘‘(2) promotes well-woman visits for health as23 sessments which include screenings, evaluations, 

24 counseling, immunizations, breastfeeding services 

25 and supplies, and prenatal visits, as appropriate; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
29 

•S 674 IS

1 ‘‘(3) increases awareness of domestic violence 

2 screenings and counseling made available, and en3 sure that women are able to access and utilize such 

4 screenings and counseling; 

5 ‘‘(4) explains the preventive services for women 

6 that are required under section 2713 to be covered 

7 without cost-sharing by a group health plan or a 

8 health insurance issuer offering group or individual 

9 health insurance coverage that is not a grand10 fathered plan (as defined in section 1251(e) of the 

11 Patient Protection and Affordable Care Act); 

12 ‘‘(5) provides broad information for women, 

13 pharmacists, pharmacies, and providers to ensure 

14 full access to all Food and Drug Administration-ap15 proved forms of contraception and preventive serv16 ices that are covered in accordance with section 

17 2713 without cost-sharing; 

18 ‘‘(6) addresses health disparities in preventive 

19 care for women; 

20 ‘‘(7) informs women about what to do if they 

21 are denied entitled benefits and services by making 

22 them aware of the Office of the Ombudsperson of 

23 the Office on Women’s Health under section 399OO; 

24 and 


asabaliauskas on DSK5VPTVN1PROD with BILLS
30 

•S 674 IS

1 ‘‘(8) provides robust information about access 

2 to health care providers through both private and 

3 public health insurance programs, including informa4 tion regarding an employer’s contraceptive coverage 

5 policy. 

6 ‘‘(c) MEDIA CAMPAIGN.— 

7 ‘‘(1) IN GENERAL.—Not later than 180 days 

8 after the date of enactment of the 21st Century 

9 Women’s Health Act of 2015, the Secretary shall es10 tablish and implement a national media campaign to 

11 disseminate the information described in subsection 

12 (b). 

13 ‘‘(2) REQUIREMENTS.—The campaign described 

14 in paragraph (1)— 

15 ‘‘(A) shall provide information about the 

16 updated guidelines for women’s preventive serv17 ices described in subsection (b)(1), promote 

18 well-woman visits described in subsection 

19 (b)(2), and provide information on the preven20 tive services for women described in subsection 

21 (b)(3); and 

22 ‘‘(B) may include the use of television, 

23 radio, Internet, and other commercial mar24 keting venues. 

25 ‘‘(d) INTERNET WEBSITE.— 


asabaliauskas on DSK5VPTVN1PROD with BILLS
31 

•S 674 IS

1 ‘‘(1) IN GENERAL.—The Secretary, in consulta2 tion with private sector experts, or through a con3 tract with a private entity such as a medical associa4 tion or non-profit organization, shall establish an 

5 Internet website to— 

6 ‘‘(A) disseminate information on preventive 

7 health services for women and families directly 

8 or through health agencies, professional and 

9 nonprofit organizations, consumer groups, insti10 tutions of higher education, clinics, the media, 

11 or Federal, State, and local agencies; and 

12 ‘‘(B) provide information and resources 

13 about the updated guidelines for women’s pre14 ventive services, promote well-woman visits, and 

15 provide information on women’s preventive serv16 ices. 

17 ‘‘(2) REPORTING TOOL.—The Secretary, acting 

18 through the Ombudsperson on Women’s Health ap19 pointed under section 399OO, shall develop and op20 erate a consumer-focused reporting tool on the 

21 Internet website established under paragraph (1) 

22 that enables women and families to report instances 

23 of being inappropriately charged for, or not being 

24 provided, benefits under section 2713. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
32 

•S 674 IS

1 ‘‘(3) GUIDANCE AND POLICY.—The 

2 Ombudsperson shall use information obtained 

3 through the website to develop recommendations on 

4 policy and implementation with respect to the bene5 fits and services under section 2713, to ensure that 

6 women and families receive such benefits and serv7 ices as afforded by the law. 

8 ‘‘(e) FUNDING.—From any funds otherwise made 

9 available to the Department of Health and Human Serv10 ices, the Secretary may allocate such sums as may be nec11 essary to carry out this section.’’. 

12 SEC. 9. REPRODUCTIVE HEALTH SERVICES ACCESS. 

13 Title III of the Public Health Service Act (42 U.S.C. 

14 241g et seq.), as amended by section 8, is further amended 

15 by adding at the end the following: 

16 ‘‘SEC. 399OO–2. STUDY AND REPORT ON WOMEN’S HEALTH 

17 CARE ACCESS TO THE FULL RANGE OF RE18 PRODUCTIVE HEALTH CARE SERVICES. 

19 ‘‘(a) IN GENERAL.—The Secretary shall conduct a 

20 study on women’s access to the full range of reproductive 

21 health care services across the United States, and, not 

22 later than January 1, 2017, and every 5 years thereafter, 

23 the Secretary shall submit a report to Congress on such 

24 study. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
33 

•S 674 IS

1 ‘‘(b) CONTENTS.—The study and report under sub2 section (a) shall include— 

3 ‘‘(1) identification and analysis of how State 

4 laws regarding abortion access, including facility re5 quirements including admitting privileges, insurance 

6 coverage limitations, mandatory delays, gestational 

7 limits, medication restrictions, and parental notifica8 tion and consent impact a women’s access to repro9 ductive family planning services; 

10 ‘‘(2) identification of geographic areas in which 

11 such State laws and practices have a strong impact 

12 on access to family planning services for women and 

13 their families; 

14 ‘‘(3) analysis of factors related to reproductive 

15 health services that impact women, children, and 

16 families, such as the ability to work, children’s ac17 cess to health insurance, access to health coverage, 

18 and the State’s role in making these services avail19 able to women and families; 

20 ‘‘(4) analysis of how women’s access to family 

21 planning services in such geographic areas correlate 

22 with maternity-related health outcomes, including 

23 the rates of infant mortality, premature births, birth 

24 weight, burden of sexually transmitted infections, 

25 and other measures deemed appropriate; and 


asabaliauskas on DSK5VPTVN1PROD with BILLS
34 

•S 674 IS

1 ‘‘(5) the recommendations of the Secretary with 

2 respect to the necessary coverage of services to en3 sure full access to reproductive services and best 

4 practices for States.’’. 

5 SEC. 10. MATERNAL HEALTH ACCOUNTABILITY. 

6 (a) PURPOSES.—The purposes of this section are the 

7 following: 

8 (1) To establish governmental accountability 

9 and a shared responsibility between States and the 

10 Federal Government to identify opportunities for im11 provement in quality of care and system changes, 

12 and to educate and inform health institutions and 

13 professionals, women, and families about preventing 

14 pregnancy-related deaths and complications and re15 ducing disparities. 

16 (2) To develop a model for States to operate 

17 maternal mortality reviews and assess the various 

18 factors that may have contributed to maternal mor19 tality, including quality of care, racial disparities, 

20 and systemic problems in the delivery of health care, 

21 and to develop appropriate interventions to reduce 

22 and prevent such deaths. 

23 (b) UNIFORM STATE MATERNAL MORTALITY RE24 VIEW COMMITTEES ON PREGNANCY-RELATED DEATHS.— 


asabaliauskas on DSK5VPTVN1PROD with BILLS
35 

•S 674 IS

1 (1) CONDITION OF RECEIPT OF PAYMENTS

2 FROM ALLOTMENT UNDER MATERNAL AND CHILD

3 HEALTH SERVICE BLOCK GRANT.—Title III of the 

4 Public Health Service Act (42 U.S.C. 241g et seq.), 

5 as amended by section 9, is further amended by add6 ing at the end the following: 

7 ‘‘SEC. 399OO–3. UNIFORM STATE MATERNAL MORTALITY 

8 REVIEW COMMITTEES ON PREGNANCY-RE9 LATED DEATHS. 

10 ‘‘(a) GRANTS.— 

11 ‘‘(1) IN GENERAL.—For each of fiscal years 

12 2016 through 2022, the Secretary shall, subject to 

13 paragraph (3) and in accordance with the criteria 

14 established under paragraph (2), award grants to 

15 States to— 

16 ‘‘(A) carry out the activities described in 

17 subsection (b)(1); 

18 ‘‘(B) establish a State maternal mortality 

19 review committee, in accordance with subsection 

20 (b)(2), to carry out the activities described in 

21 subsection (b)(2)(A), and to establish the proc22 esses described in subsection (b)(1); 

23 ‘‘(C) ensure the State department of 

24 health carries out the applicable activities de25 scribed in subsection (b)(3), with respect to 


asabaliauskas on DSK5VPTVN1PROD with BILLS
36 

•S 674 IS

1 pregnancy-related deaths occurring within the 

2 State during such fiscal year; 

3 ‘‘(D) provide for public disclosure of infor4 mation, in accordance with subsection (c); and 

5 ‘‘(E) collect, analyze, and report to the 

6 Secretary cases of maternal morbidity, includ7 ing reports of maternal morbidity data on ad8 missions to an intensive care unit or the trans9 fusion of more than three units of blood prod10 ucts. 

11 ‘‘(2) CRITERIA.—The Secretary shall establish 

12 criteria for determining eligibility for and the 

13 amount of a grant awarded to a State under para14 graph (1). Such criteria shall provide that in the 

15 case of a State that receives such a grant for a fiscal 

16 year and is determined by the Secretary to have not 

17 used such grant in accordance with this section, 

18 such State shall not be eligible for such a grant for 

19 any subsequent fiscal year. 

20 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

21 For purposes of carrying out the grant program 

22 under this section, including for administrative pur23 poses, there is authorized to be appropriated 

24 $10,000,000 for each of fiscal years 2016 through 

25 2022. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
37 

•S 674 IS

1 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 

2 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH

3 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 

4 purposes of subsection (a), with respect to a State 

5 that receives a grant under subsection (a), the fol6 lowing shall apply: 

7 ‘‘(A) MANDATORY REPORTING OF PREG8 NANCY-RELATED DEATHS.— 

9 ‘‘(i) IN GENERAL.—The State shall, 

10 through the State maternal mortality re11 view committee, develop a process, sepa12 rate from any reporting process established 

13 by the State department of health prior to 

14 the date of the enactment of this section, 

15 that provides for mandatory and confiden16 tial case reporting by individuals and enti17 ties described in clause (ii) of pregnancy18 related deaths to the State department of 

19 health. 

20 ‘‘(ii) INDIVIDUALS AND ENTITIES DE21 SCRIBED.—Individuals and entities de22 scribed in this clause include each of the 

23 following: 

24 ‘‘(I) Health care providers. 

25 ‘‘(II) Medical examiners. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
38 

•S 674 IS

1 ‘‘(III) Medical coroners. 

2 ‘‘(IV) Hospitals. 

3 ‘‘(V) Free-standing birth centers. 

4 ‘‘(VI) Other health care facilities. 

5 ‘‘(VII) Any other individuals re6 sponsible for completing death certifi7 cates. 

8 ‘‘(VIII) Any other appropriate in9 dividuals or entities specified by the 

10 Secretary. 

11 ‘‘(B) VOLUNTARY REPORTING OF PREG12 NANCY-RELATED AND PREGNANCY-ASSOCIATED

13 DEATHS.— 

14 ‘‘(i) The State shall, through the 

15 State maternal mortality review committee, 

16 develop a process for and encourage, sepa17 rate from any reporting process established 

18 by the State department of health prior to 

19 the date of the enactment of this section, 

20 voluntary and confidential case reporting 

21 by individuals described in clause (ii) of 

22 pregnancy-associated deaths to the State 

23 department of health. 

24 ‘‘(ii) The State shall, through the 

25 State maternal mortality review committee, 


asabaliauskas on DSK5VPTVN1PROD with BILLS
39 

•S 674 IS

1 develop a process for voluntary and con2 fidential reporting by family members of 

3 the deceased and by other individuals on 

4 possible pregnancy-related and pregnancy5 associated deaths to the State department 

6 of health. Such process shall include— 

7 ‘‘(I) making publicly available on 

8 the Internet website of the State de9 partment of health a telephone num10 ber, Internet Web link, and email ad11 dress for such reporting; and 

12 ‘‘(II) publicizing to local profes13 sional organizations, community orga14 nizations, and social services agencies 

15 the availability of the telephone num16 ber, Internet Web link, and email ad17 dress made available under subclause 

18 (I). 

19 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 

20 The State, through the vital statistics unit of 

21 the State, shall annually identify pregnancy-re22 lated and pregnancy-associated deaths occur23 ring in such State during the year involved 

24 by— 


asabaliauskas on DSK5VPTVN1PROD with BILLS
40 

•S 674 IS

1 ‘‘(i) matching all death records, with 

2 respect to such year, for women of child3 bearing age to live birth certificates and in4 fant death certificates to identify deaths of 

5 women that occurred during pregnancy 

6 and within one year after the end of a 

7 pregnancy; 

8 ‘‘(ii) identifying deaths reported dur9 ing such year as having an underlying or 

10 contributing cause of death related to 

11 pregnancy, regardless of the time that has 

12 passed between the end of the pregnancy 

13 and the death; 

14 ‘‘(iii) collecting data from medical ex15 aminer and coroner reports; and 

16 ‘‘(iv) any other methods the States 

17 may devise to identify maternal deaths, 

18 such as through review of a random sam19 ple of reported deaths of women of child20 bearing age to ascertain cases of preg21 nancy-related and pregnancy-associated 

22 deaths that are not discernable from a re23 view of death certificates alone. 

24 When feasible and for purposes of effectively 

25 collecting and obtaining data on pregnancy-reVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
41 

•S 674 IS

1 lated and pregnancy-associated deaths, the 

2 State shall adopt the most recent standardized 

3 birth and death certificates, as issued by the 

4 National Center for Vital Health Statistics, in5 cluding the recommended checkbox section for 

6 pregnancy on the death certificates. 

7 ‘‘(D) CASE INVESTIGATION AND DEVELOP8 MENT OF CASE SUMMARIES.—Following receipt 

9 of reports by the State department of health 

10 pursuant to subparagraph (A) or (B) and col11 lection by the vital statistics unit of the State 

12 of possible cases of pregnancy-related and preg13 nancy-associated deaths pursuant to subpara14 graph (C), the State, through the State mater15 nal mortality review committee established 

16 under subsection (a), shall investigate each 

17 case, utilizing the case abstraction form de18 scribed in subsection (c), and prepare de-identi19 fied case summaries, which shall be reviewed by 

20 the committee and included in applicable re21 ports. For purposes of subsection (a), under the 

22 processes established under subparagraphs (A), 

23 (B), and (C), a State department of health or 

24 vital statistics unit of a State shall provide to 

25 the State maternal mortality review committee 


asabaliauskas on DSK5VPTVN1PROD with BILLS
42 

•S 674 IS

1 access to information collected pursuant to such 

2 subparagraphs as necessary to carry out this 

3 subparagraph. Data and information collected 

4 for the case summary and review are for pur5 poses of public health activities, in accordance 

6 with HIPAA privacy and security law (as de7 fined in section 3009(a)(2)). Such case inves8 tigations shall include data and information ob9 tained through— 

10 ‘‘(i) medical examiner and autopsy re11 ports of the woman involved; 

12 ‘‘(ii) medical records of the woman, 

13 including such records related to health 

14 care prior to pregnancy, prenatal and post15 natal care, labor and delivery care, emer16 gency room care, hospital discharge 

17 records, and any care delivered up until 

18 the time of death of the woman for pur19 poses of public health activities, in accord20 ance with HIPAA privacy and security law 

21 (as defined in section 3009(a)(2)); 

22 ‘‘(iii) oral and written interviews of in23 dividuals directly involved in the maternal 

24 care of the woman during and immediately 

25 following the pregnancy of the woman, inVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
43 

•S 674 IS

1 cluding health care, mental health, and so2 cial service providers, as applicable; 

3 ‘‘(iv) optional oral or written inter4 views of the family of the woman; 

5 ‘‘(v) socioeconomic and other relevant 

6 background information about the woman; 

7 ‘‘(vi) information collected in subpara8 graph (C)(i); and 

9 ‘‘(vii) other information on the cause 

10 of death of the woman, such as social serv11 ices and child welfare reports. 

12 ‘‘(2) STATE MATERNAL MORTALITY REVIEW

13 COMMITTEES.— 

14 ‘‘(A) DUTIES.— 

15 ‘‘(i) REQUIRED COMMITTEE ACTIVI16 TIES.—For purposes of subsection (a), a 

17 maternal mortality review committee estab18 lished by a State pursuant to a grant 

19 under such subsection shall carry out the 

20 following pregnancy-related death and 

21 pregnancy-associated death review activi22 ties: 

23 ‘‘(I) With respect to a case of 

24 pregnancy-related or pregnancy-asso25 ciated death of a woman, review the 


asabaliauskas on DSK5VPTVN1PROD with BILLS
44 

•S 674 IS

1 case summaries prepared under sub2 paragraphs (A), (B), (C), and (D) of 

3 paragraph (1). 

4 ‘‘(II) Review aggregate statistical 

5 reports developed by the vital statis6 tics unit of the State under paragraph 

7 (1)(C) regarding pregnancy-related 

8 and pregnancy-associated deaths to 

9 identify trends, patterns, and dispari10 ties in adverse outcomes and address 

11 medical, non-medical, and system-re12 lated factors that may have contrib13 uted to such pregnancy-related and 

14 pregnancy-associated deaths and dis15 parities. 

16 ‘‘(III) Develop recommendations, 

17 based on the review of the case sum18 maries under paragraph (1)(D) and 

19 aggregate statistical reports under 

20 subclause (II), to improve maternal 

21 care, social and health services, and 

22 public health policy and institutions, 

23 including with respect to improving 

24 access to maternal care, improving the 

25 availability of social services, and 


asabaliauskas on DSK5VPTVN1PROD with BILLS
45 

•S 674 IS

1 eliminating disparities in maternal 

2 care and outcomes. 

3 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI4 TIES.—For purposes of subsection (a), a 

5 maternal mortality review committee estab6 lished by a State under such subsection 

7 may present findings and recommendations 

8 regarding a specific case or set of cir9 cumstances directly to a health care facil10 ity or its local or State professional organi11 zation for the purpose of instituting policy 

12 changes, educational activities, or other13 wise improving the quality of care provided 

14 by the facilities. 

15 ‘‘(B) COMPOSITION OF MATERNAL MOR16 TALITY REVIEW COMMITTEES.— 

17 ‘‘(i) IN GENERAL.—Each State mater18 nal mortality review committee established 

19 pursuant to a grant under subsection (a) 

20 shall be multi-disciplinary, consisting of 

21 health care and social service providers, 

22 public health officials, other persons with 

23 professional expertise on maternal health 

24 and mortality, and patient and community 

25 advocates who represent those communities 


asabaliauskas on DSK5VPTVN1PROD with BILLS
46 

•S 674 IS

1 within such State that are the most af2 fected by maternal mortality. Membership 

3 on such a committee of a State shall be re4 viewed annually by the State department 

5 of health to ensure that membership rep6 resentation requirements are being fulfilled 

7 in accordance with this paragraph. 

8 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 

9 such review committee shall include— 

10 ‘‘(I) representatives from medical 

11 specialties providing care to pregnant 

12 and postpartum patients, including 

13 obstetricians (including generalists 

14 and maternal fetal medicine special15 ists), and family practice physicians; 

16 ‘‘(II) certified nurse midwives, 

17 certified midwives, and advanced prac18 tice nurses; 

19 ‘‘(III) hospital-based registered 

20 nurses; 

21 ‘‘(IV) representatives of the State 

22 department of health maternal and 

23 child health department; 

24 ‘‘(V) social service providers or 

25 social workers; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
47 

•S 674 IS

1 ‘‘(VI) the chief medical exam2 iners or designees; 

3 ‘‘(VII) facility representatives, 

4 such as from hospitals or free-stand5 ing birth centers; and 

6 ‘‘(VIII) community or patient ad7 vocates who represent those commu8 nities within the State that are the 

9 most affected by maternal mortality. 

10 ‘‘(iii) ADDITIONAL MEMBERS.—Each 

11 such review committee may also include 

12 representatives from other relevant aca13 demic, health, social service, or policy pro14 fessions, or community organizations, on 

15 an ongoing basis, or as needed, as deter16 mined beneficial by the review committee, 

17 including— 

18 ‘‘(I) anesthesiologists; 

19 ‘‘(II) emergency physicians; 

20 ‘‘(III) pathologists; 

21 ‘‘(IV) epidemiologists or biostat22 isticians; 

23 ‘‘(V) intensivists; 

24 ‘‘(VI) vital statistics officers; 

25 ‘‘(VII) nutritionists; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
48 

•S 674 IS

1 ‘‘(VIII) mental health profes2 sionals; 

3 ‘‘(IX) substance abuse treatment 

4 specialists; 

5 ‘‘(X) representatives of relevant 

6 advocacy groups; 

7 ‘‘(XI) academics; 

8 ‘‘(XII) representatives of bene9 ficiaries of the State plan under the 

10 Medicaid program under title XIX; 

11 ‘‘(XIII) paramedics; 

12 ‘‘(XIV) lawyers; 

13 ‘‘(XV) risk management special14 ists; 

15 ‘‘(XVI) representatives of the de16 partments of health or public health 

17 of major cities in the State involved; 

18 and 

19 ‘‘(XVII) policymakers. 

20 ‘‘(iv) DIVERSE COMMUNITY MEMBER21 SHIP.—The composition of such a com22 mittee, with respect to a State, shall in23 clude— 

24 ‘‘(I) representatives from diverse 

25 communities, particularly those comVerDate Sep 11 2014 21:03 Mar 12, 2015 Jkt 049200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S674.IS S674

asabaliauskas on DSK5VPTVN1PROD with BILLS
49 

•S 674 IS

1 munities within such State most se2 verely affected by pregnancy-related 

3 deaths or pregnancy-associated deaths 

4 and by a lack of access to relevant 

5 maternal care services, from commu6 nity maternal child health organiza7 tions, and from minority advocacy 

8 groups; 

9 ‘‘(II) members, including health 

10 care providers, from different geo11 graphic regions in the State, including 

12 any rural, urban, and tribal areas; 

13 and 

14 ‘‘(III) health care and social serv15 ice providers who work in commu16 nities that are diverse with regard to 

17 race, ethnicity, immigration status, 

18 Indigenous status, and English pro19 ficiency. 

20 ‘‘(v) MATERNAL MORTALITY REVIEW

21 STAFF.—Staff of each such review com22 mittee shall include— 

23 ‘‘(I) vital health statisticians, ma24 ternal child health statisticians, or 

25 epidemiologists; 


asabaliauskas on DSK5VPTVN1PROD with BILLS
50 

•S 674 IS

1 ‘‘(II) a coordinator of the State 

2 maternal mortality review committee, 

3 to be designated by the State; and 

4 ‘‘(III) administrative staff. 

5 ‘‘(C) OPTION FOR STATES TO FORM RE6 GIONAL MATERNAL MORTALITY REVIEWS.— 

7 States with a low rate of occurrence of preg8 nancy-associated or pregnancy-related deaths 

9 may choose to partner with one or more neigh10 boring States to fulfill the activities described in 

11 paragraph (1)(C). In such a case, with respect 

12 to States in such a partnership, any require13 ment under this section relating to the report14 ing of information related to such activities 

15 shall be deemed to be fulfilled by each such 

16 State if a single such report is submitted for 

17 the partnership. 

18 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI19 TIES.—For purposes of subsection (a), a State de20 partment of health of a State receiving a grant 

21 under such subsection shall— 

22 ‘‘(A) in consultation with the maternal 

23 mortality review committee of the State and in 

24 conjunction with relevant professional organiza25 tions, develop a plan for ongoing health care 


asabaliauskas on DSK5VPTVN1PROD with BILLS
51 

•S 674 IS

1 provider education, based on the findings and 

2 recommendations of the committee, in order to 

3 improve the quality of maternal care; and 

4 ‘‘(B) take steps to widely disseminate the 

5 findings and recommendations of the State ma6 ternal mortality review committees of the State 

7 and to implement the recommendations of such 

8 committee. 

9 ‘‘(c) PUBLIC DISCLOSURE OF INFORMATION.— 

10 ‘‘(1) IN GENERAL.—For fiscal year 2016 or a 

11 subsequent fiscal year, each State receiving a grant 

12 under this section for such year shall, subject to 

13 paragraph (3), provide for the public disclosure, and 

14 submission to the information clearinghouse estab15 lished under paragraph (2), of the information relat16 ing to the findings for such year of the State mater17 nal mortality review committee established by the 

18 State under this section. 

19 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 

20 Secretary shall establish an information clearing21 house, that shall be administered by the Director of 

22 the Centers for Disease Control and Prevention, that 

23 will maintain findings and recommendations sub24 mitted pursuant to paragraph (1) and provide such 

25 findings and recommendations for public review and 


asabaliauskas on DSK5VPTVN1PROD with BILLS
52 

•S 674 IS

1 research purposes by State health departments, ma2 ternal mortality review committees, and health pro3 viders and institutions. 

4 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 

5 no case shall any individually identifiable health in6 formation be provided to the public, or submitted to 

7 the information clearinghouse, under paragraph (1). 

8 ‘‘(d) CONFIDENTIALITY OF REVIEW COMMITTEE

9 PROCEEDINGS.— 

10 ‘‘(1) IN GENERAL.—All proceedings and activi11 ties of a State maternal mortality review committee 

12 under this section, opinions of members of such a 

13 committee formed as a result of such proceedings 

14 and activities, and records obtained, created, or 

15 maintained pursuant to this section, including 

16 records of interviews, written reports, and state17 ments procured by the Department of Health and 

18 Human Services or by any other person, agency, or 

19 organization acting jointly with the Department, in 

20 connection with morbidity and mortality reviews 

21 under this section, shall be confidential, and not sub22 ject to discovery, subpoena, or introduction into evi23 dence in any civil, criminal, legislative, or other pro24 ceeding. Such records shall not be open to public in25 spection. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
53 

•S 674 IS

1 ‘‘(2) TESTIMONY OF MEMBERS OF COM2 MITTEE.— 

3 ‘‘(A) IN GENERAL.—Members of a State 

4 maternal mortality review committee under this 

5 section may not be questioned in any civil, 

6 criminal, legislative, or other proceeding regard7 ing information presented in, or opinions 

8 formed as a result of, a meeting or communica9 tion of the committee. 

10 ‘‘(B) CLARIFICATION.—Nothing in this 

11 subsection shall be construed to prevent a mem12 ber of such a committee from testifying regard13 ing information that was obtained independent 

14 of such member’s participation on the com15 mittee, or that is public information. 

16 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE17 SEARCH PURPOSES.—Nothing in this subsection 

18 shall prohibit the publishing by such a committee or 

19 the Department of Health and Human Services of 

20 statistical compilations and research reports that— 

21 ‘‘(A) are based on confidential information, 

22 relating to morbidity and mortality review; and 

23 ‘‘(B) do not contain identifying informa24 tion or any other information that could be 


asabaliauskas on DSK5VPTVN1PROD with BILLS
54 

•S 674 IS

1 used to ultimately identify the individuals con2 cerned. 

3 ‘‘(e) DEFINITIONS.—For purposes of this section: 

4 ‘‘(1) PREGNANCY-ASSOCIATED DEATH.—The 

5 term ‘pregnancy-associated death’ means the death 

6 of a woman while pregnant or during the one-year 

7 period following the date of the end of pregnancy, ir8 respective of the cause of such death. 

9 ‘‘(2) PREGNANCY-RELATED DEATH.—The term 

10 ‘pregnancy-related death’ means the death of a 

11 woman while pregnant or during the one-year period 

12 following the date of the end of pregnancy, irrespec13 tive of the duration or site of the pregnancy, from 

14 any cause related to or aggravated by the pregnancy 

15 or its management, but not from any accidental or 

16 incidental cause. 

17 ‘‘(3) WOMAN OF CHILDBEARING AGE.—The 

18 term ‘woman of childbearing age’ means a woman 

19 who is at least 10 years of age and not more than 

20 54 years of age.’’. 

21 (c) NIH WORKSHOP AND RESEARCH PLAN DEVEL22 OPMENT ON SEVERE MATERNAL MORBIDITY.— 

23 (1) WORKSHOP.—The Secretary of Health and 

24 Human Services, acting through the Director of 

25 NIH and in consultation with the Administrator of 


asabaliauskas on DSK5VPTVN1PROD with BILLS
55 

•S 674 IS

1 the Health Resources and Services Administration, 

2 the Director of the Centers for Disease Control and 

3 Prevention, the heads of other Federal agencies that 

4 administer Federal health programs, and relevant 

5 national professional organizations dealing with ma6 ternal morbidity, shall organize a national workshop 

7 to identify definitions for severe maternal morbidity 

8 and make recommendations for a research plan to 

9 identify and monitor severe maternal morbidity in 

10 the United States. 

11 (2) RESEARCH PLAN AND DATA COLLECTION

12 PROTOCOLS.—The Secretary, taking into account 

13 the findings of the workshop under paragraph (1), 

14 shall develop uniform definitions of severe maternal 

15 morbidity, a research plan on severe maternal mor16 bidity, and possible data collection protocols to assist 

17 States in identifying and monitoring cases of severe 

18 maternal morbidity and to develop recommendations 

19 on addressing such cases. 

20 (3) REPORT.—Not later than 2 years after the 

21 date of enactment of this Act, the Secretary shall 

22 prepare and submit to the appropriate committees of 

23 Congress a report concerning the definitions and re24 search plan developed under this section. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
56 

•S 674 IS

1 (4) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated for fiscal 

3 year 2016— 

4 (A) $50,000 to carry out paragraph (1); 

5 and 

6 (B) $100,000 to carry out paragraph (2). 

7 (d) ELIMINATING DISPARITIES IN MATERNITY

8 HEALTH OUTCOMES.—Part B of title III of the Public 

9 Health Service Act is amended by inserting after section 

10 317T of such Act (42 U.S.C. 247b–22) the following new 

11 section: 

12 ‘‘SEC. 317U. ELIMINATING DISPARITIES IN MATERNITY 

13 HEALTH OUTCOMES. 

14 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta15 tion with relevant national stakeholder organizations, such 

16 as national medical specialty organizations, national ma17 ternal child health organizations, and national health dis18 parity organizations, carry out the following activities to 

19 eliminate disparities in maternal health outcomes: 

20 ‘‘(1) Conduct research into the determinants 

21 and the distribution of disparities in maternal care, 

22 health risks, and health outcomes, and improve the 

23 capacity of the performance measurement infrastruc24 ture to measure such disparities. 


asabaliauskas on DSK5VPTVN1PROD with BILLS
57 

•S 674 IS

1 ‘‘(2) Expand access to services that have been 

2 demonstrated to improve the quality and outcomes 

3 of maternity care for vulnerable populations. 

4 ‘‘(3) Establish a demonstration project to com5 pare the effectiveness of interventions to reduce dis6 parities in maternity services and outcomes, and im7 plement and assessing effective interventions. 

8 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM9 ONSTRATION PROJECT.—The demonstration project 

10 under subsection (a)(3) shall be conducted in no more 

11 than 8 States, which shall be selected by the Secretary 

12 based on— 

13 ‘‘(1) applications submitted by States, which 

14 specify which regions and populations the State in15 volved will serve under the demonstration project; 

16 ‘‘(2) criteria designed by the Secretary to en17 sure that, as a whole, the demonstration project is, 

18 to the greatest extent possible, representative of the 

19 demographic and geographic composition of commu20 nities most affected by disparities; 

21 ‘‘(3) criteria designed by the Secretary to en22 sure that a variety of type of models are tested 

23 through the demonstration project and that such 

24 models include interventions that have an existing 

25 evidence base for effectiveness; and 


asabaliauskas on DSK5VPTVN1PROD with BILLS
58 

•S 674 IS

1 ‘‘(4) criteria designed by the Secretary to as2 sure that the demonstration projects and models will 

3 be carried out in consultation with local and regional 

4 provider organizations, such as community health 

5 centers, hospital systems, and medical societies rep6 resenting providers of maternity services. 

7 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 

8 The demonstration project under subsection (a)(3) shall 

9 begin on January 1, 2015, and end on December 31, 

10 2019. 

11 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 

12 The Secretary may make grants to States and health care 

13 providers participating in the demonstration project under 

14 subsection (a)(3) for the purpose of collecting data nec15 essary for the evaluation and monitoring of such project. 

16 ‘‘(e) REPORTS.— 

17 ‘‘(1) STATE REPORTS.—Each State that par18 ticipates in the demonstration project under sub19 section (a)(3) shall report to the Secretary, in a 

20 time, form, and manner specified by the Secretary, 

21 the data necessary to— 

22 ‘‘(A) monitor the— 

23 ‘‘(i) outcomes of the project; 

24 ‘‘(ii) costs of the project; and 


asabaliauskas on DSK5VPTVN1PROD with BILLS
59 

•S 674 IS

1 ‘‘(iii) quality of maternity care pro2 vided under the project; and 

3 ‘‘(B) evaluate the rationale for the selec4 tion of the items and services included in any 

5 bundled payment made by the State under the 

6 project. 

7 ‘‘(2) FINAL REPORT.—Not later than December 

8 31, 2020, the Secretary shall submit to Congress a 

9 report on the results of the demonstration project 

10 under subsection (a)(3).’’. 

Æ 


asabaliauskas on DSK5VPTVN1PROD with BILLS