I 
117TH CONGRESS 
1ST SESSION H. R. 4387 
To amend the Public Health Service Act to improve maternal health, to 
improve obstetric care in rural areas, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 9, 2021 
Ms. KELLY of Illinois (for herself, Mr. BUCSHON, Ms. ADAMS, Mr. BURGESS, 
Mrs. HAYES, and Mr. LATTA) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve maternal 
health, to improve obstetric care in rural areas, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE . 
This Act may be cited as the ‘‘Maternal Health Qual-
ity Improvement Act of 2021’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title . 
Sec. 2. Table of Contents. 
TITLE I—IMPROVEMENTS TO MATERNAL HEALTH CARE 
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Sec. 101. Innovation for maternal health. 
Sec. 102. Training for health care providers. 
Sec. 103. Study on improving training for health care providers. 
Sec. 104. Perinatal quality collaboratives. 
Sec. 105. Integrated services for pregnant and postpartum women. 
Sec. 106. Maternal vaccination awareness. 
TITLE II—RURAL MATERNAL AND OBSTETRIC MODERNIZATION 
OF SERVICES 
Sec. 201. Improving rural maternal and obstetric care data. 
Sec. 202. Rural obstetric network grants. 
Sec. 203. Telehealth network and telehealth resource centers grant programs. 
Sec. 204. Rural maternal and obstetric care training demonstration. 
TITLE I—IMPROVEMENTS TO 
MATERNAL HEALTH CARE 
SEC. 101. INNOVATION FOR MATERNAL HEALTH. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by inserting after section 330N 
of such Act, the following: 
‘‘SEC. 330O. INNOVATION FOR MATERNAL HEALTH. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with experts representing a variety of clinical specialties, 
State, Tribal, or local public health officials, researchers, 
epidemiologists, statisticians, and community organiza-
tions, shall establish or continue a program to award com-
petitive grants to eligible entities for the purpose of— 
‘‘(1) identifying, developing, or disseminating 
best practices to improve maternal health care qual-
ity and outcomes, improve maternal and infant 
health, and eliminate preventable maternal mortality 
and severe maternal morbidity, which may include— 
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‘‘(A) information on evidence-based prac-
tices to improve the quality and safety of ma-
ternal health care in hospitals and other health 
care settings of a State or health care system 
by addressing topics commonly associated with 
health complications or risks related to prenatal 
care, labor care, birthing, and postpartum care; 
‘‘(B) best practices for improving maternal 
health care based on data findings and reviews 
conducted by a State maternal mortality review 
committee that address topics of relevance to 
common complications or health risks related to 
prenatal 
care, 
labor 
care, 
birthing, 
and 
postpartum care; and 
‘‘(C) information on addressing deter-
minants of health that impact maternal health 
outcomes for women before, during, and after 
pregnancy; 
‘‘(2) collaborating with State maternal mor-
tality review committees to identify issues for the de-
velopment and implementation of evidence-based 
practices to improve maternal health outcomes and 
reduce preventable maternal mortality and severe 
maternal morbidity, consistent with section 317K; 
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‘‘(3) providing technical assistance and sup-
porting the implementation of best practices identi-
fied in paragraph (1) to entities providing health 
care services to pregnant and postpartum women; 
and 
‘‘(4) identifying, developing, and evaluating new 
models of care that improve maternal and infant 
health outcomes, which may include the integration 
of community-based services and clinical care. 
‘‘(b) ELIGIBLE ENTITIES.—To be eligible for a grant 
under subsection (a), an entity shall— 
‘‘(1) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require; and 
‘‘(2) demonstrate in such application that the 
entity is capable of carrying out data-driven mater-
nal safety and quality improvement initiatives in the 
areas of obstetrics and gynecology or maternal 
health. 
‘‘(c) REPORT.—Not later than September 30, 2024, 
and every 2 years thereafter, the Secretary shall submit 
a report to Congress on the practices described in para-
graphs (1) and (2) of subsection (a). Such report shall 
include a description of the extent to which such practices 
reduced preventable maternal mortality and severe mater-
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nal morbidity, and whether such practices improved ma-
ternal and infant health. The Secretary shall disseminate 
information on such practices, as appropriate. 
‘‘(d) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated $9,000,000 for each of fiscal years 2022 through 
2026.’’. 
SEC. 102. TRAINING FOR HEALTH CARE PROVIDERS. 
Title VII of the Public Health Service Act is amended 
by striking section 763 (42 U.S.C. 294p) and inserting 
the following: 
‘‘SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS. 
‘‘(a) GRANT PROGRAM.—The Secretary shall estab-
lish a program to award grants to accredited schools of 
allopathic medicine, osteopathic medicine, and nursing, 
and other health professional training programs for the 
training of health care professionals to improve the provi-
sion of prenatal care, labor care, birthing, and postpartum 
care for racial and ethnic minority populations, including 
with respect to perceptions and biases that may affect the 
approach to, and provision of, care. 
‘‘(b) ELIGIBILITY.—To be eligible for a grant under 
subsection (a), an entity described in such subsection shall 
submit to the Secretary an application at such time, in 
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such manner, and containing such information as the Sec-
retary may require. 
‘‘(c) REPORTING REQUIREMENTS.— 
‘‘(1) PERIODIC GRANTEE REPORTS.—Each enti-
ty awarded a grant under this section shall periodi-
cally submit to the Secretary a report on the status 
of activities conducted using the grant, including a 
description of the impact of such training on patient 
outcomes, as applicable. 
‘‘(2) REPORT TO CONGRESS.—Not later than 
September 30, 2025, the Secretary shall submit a 
report to Congress on the activities conducted using 
grants under subsection (a) and any best practices 
identified and disseminated under subsection (d). 
‘‘(d) BEST PRACTICES.—The Secretary may identify 
and disseminate best practices for the training described 
in subsection (a). 
‘‘(e) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated $5,000,000 for each of fiscal years 2022 through 
2026.’’. 
SEC. 103. STUDY ON IMPROVING TRAINING FOR HEALTH 
CARE PROVIDERS. 
Not later than 2 years after date of enactment of this 
Act, the Secretary of Health and Human Services shall, 
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through a contract with an independent research organiza-
tion, conduct a study and make recommendations for ac-
credited schools of allopathic medicine, osteopathic medi-
cine, and nursing, and other health professional training 
programs on best practices related to training to improve 
the provision of prenatal care, labor care, birthing, and 
postpartum care for racial and ethnic minority popu-
lations, including with respect to perceptions and biases 
that may affect the approach to, and provision of, care. 
SEC. 104. PERINATAL QUALITY COLLABORATIVES. 
(a) IN GENERAL.—Section 317K(a)(2) of the Public 
Health Service Act (42 U.S.C. 247b–12(a)(2)) is amended 
by adding at the end the following: 
‘‘(E)(i) The Secretary, acting through the Di-
rector of the Centers for Disease Control and Pre-
vention and in coordination with other offices and 
agencies, as appropriate, shall establish or continue 
a competitive grant program for the establishment 
or support of perinatal quality collaboratives to im-
prove perinatal care and perinatal health outcomes 
for pregnant and postpartum women and their in-
fants. A State, Indian Tribe, or Tribal organization 
may use funds received through such grant to— 
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‘‘(I) support the use of evidence-based or 
evidence-informed practices to improve out-
comes for maternal and infant health; 
‘‘(II) work with clinical teams; experts; 
State, local, and, as appropriate, Tribal public 
health officials; and stakeholders, including pa-
tients and families, to identify, develop, or dis-
seminate best practices to improve perinatal 
care and outcomes; and 
‘‘(III) employ strategies that provide op-
portunities for health care professionals and 
clinical teams to collaborate across health care 
settings and disciplines, including primary care 
and mental health, as appropriate, to improve 
maternal and infant health outcomes, which 
may include the use of data to provide timely 
feedback across hospital and clinical teams to 
inform responses, and to provide support and 
training to hospital and clinical teams for qual-
ity improvement, as appropriate. 
‘‘(ii) To be eligible for a grant under clause (i), 
an entity shall submit to the Secretary an applica-
tion in such form and manner and containing such 
information as the Secretary may require.’’. 
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(b) REPORT TO CONGRESS.—Not later than Sep-
tember 30, 2025, the Secretary of Health and Human 
Services shall submit to Congress a report regarding the 
activities conducted by recipients of grants under sub-
section (a)(2)(E) of section 317K of the Public Health 
Service Act (42 U.S.C. 247b–12). 
SEC. 105. INTEGRATED SERVICES FOR PREGNANT AND 
POSTPARTUM WOMEN. 
(a) GRANTS.—Title III of the Public Health Service 
Act (42 U.S.C. 241 et seq.) is amended by inserting after 
section 330O of such Act, as added by section 101, the 
following: 
‘‘SEC. 330P. INTEGRATED SERVICES FOR PREGNANT AND 
POSTPARTUM WOMEN. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
for the purpose of establishing or operating evidence-based 
or innovative, evidence-informed programs to deliver inte-
grated health care services to pregnant and postpartum 
women to optimize the health of women and their infants, 
including to reduce adverse maternal health outcomes, 
pregnancy-related deaths, and related health disparities 
(including such disparities associated with racial and eth-
nic minority populations), and, as appropriate, by address-
ing issues researched under subsection (b)(2) of section 
317K. 
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‘‘(b) INTEGRATED SERVICES FOR PREGNANT AND 
POSTPARTUM WOMEN.— 
‘‘(1) ELIGIBILITY.—To be eligible to receive a 
grant under subsection (a), a State, Indian Tribe, or 
Tribal organization (as such terms are defined in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act) shall work with relevant 
stakeholders that coordinate care to develop and 
carry out the program, including— 
‘‘(A) State, Tribal, and local agencies re-
sponsible for Medicaid, public health, social 
services, mental health, and substance use dis-
order treatment and services; 
‘‘(B) health care providers who serve preg-
nant and postpartum women; and 
‘‘(C) community-based health organiza-
tions and health workers, including providers of 
home visiting services and individuals rep-
resenting communities with disproportionately 
high rates of maternal mortality and severe ma-
ternal morbidity, and including those rep-
resenting racial and ethnic minority popu-
lations. 
‘‘(2) TERMS.— 
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‘‘(A) PERIOD.—A grant awarded under 
subsection (a) shall be made for a period of 5 
years. Any supplemental award made to a 
grantee under subsection (a) may be made for 
a period of less than 5 years. 
‘‘(B) PRIORITIES.—In awarding grants 
under subsection (a), the Secretary shall— 
‘‘(i) give priority to States, Indian 
Tribes, and Tribal organizations that have 
the highest rates of maternal mortality and 
severe maternal morbidity relative to other 
such States, Indian Tribes, or Tribal orga-
nizations, respectively; and 
‘‘(ii) shall consider health disparities 
related to maternal mortality and severe 
maternal morbidity, including such dispari-
ties associated with racial and ethnic mi-
nority populations. 
‘‘(C) EVALUATION.—The Secretary shall 
require grantees to evaluate the outcomes of the 
programs supported under the grant. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$10,000,000 for each of fiscal years 2022 through 2026.’’. 
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(b) REPORT ON GRANT OUTCOMES AND DISSEMINA-
TION OF BEST PRACTICES.— 
(1) REPORT.—Not later than February 1, 
2026, the Secretary of Health and Human Services 
shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House 
of Representatives a report that describes— 
(A) the outcomes of the activities sup-
ported by the grants awarded under the amend-
ments made by this section on maternal and 
child health; 
(B) best practices and models of care used 
by recipients of grants under such amendments; 
and 
(C) obstacles identified by recipients of 
grants under such amendments, and strategies 
used by such recipients to deliver care, improve 
maternal and child health, and reduce health 
disparities. 
(2) DISSEMINATION OF BEST PRACTICES.—Not 
later than August 1, 2026, the Secretary of Health 
and Human Services shall disseminate information 
on best practices and models of care used by recipi-
ents of grants under the amendments made by this 
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section (including best practices and models of care 
relating to the reduction of health disparities, includ-
ing such disparities associated with racial and ethnic 
minority populations, in rates of maternal mortality 
and severe maternal morbidity) to relevant stake-
holders, which may include health providers, medical 
schools, nursing schools, relevant State, Tribal, and 
local agencies, and the general public. 
SEC. 106. MATERNAL VACCINATION AWARENESS. 
In carrying out the public awareness initiative related 
to vaccinations pursuant to section 313 of the Public 
Health Service Act (42 U.S.C. 245), the Secretary of 
Health and Human Services shall take into consideration 
the importance of increasing awareness and knowledge of 
the safety and effectiveness of vaccines to prevent disease 
in pregnant and postpartum women and in infants and 
the need to improve vaccination rates in communities and 
populations with low rates of vaccination. 
TITLE 
II—RURAL 
MATERNAL 
AND OBSTETRIC MODERNIZA-
TION OF SERVICES 
SEC. 201. IMPROVING RURAL MATERNAL AND OBSTETRIC 
CARE DATA. 
(a) MATERNAL MORTALITY AND MORBIDITY ACTIVI-
TIES.—Section 301(e) of the Public Health Service Act 
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(42 U.S.C. 241) is amended by inserting ‘‘, preventable 
maternal mortality and severe maternal morbidity,’’ after 
‘‘delivery’’. 
(b) 
OFFICE
OF
WOMEN’S
HEALTH.—Section 
310A(b)(1) of the Public Health Service Act (42 U.S.C. 
242s(b)(1)) is amended by striking ‘‘and sociocultural con-
texts,’’ and inserting ‘‘sociocultural (including among 
American Indians, Native Hawaiians, and Alaska Na-
tives), and geographical contexts,’’. 
(c) SAFE MOTHERHOOD.—Section 317K of the Pub-
lic Health Service Act (42 U.S.C. 247b–12) is amended— 
(1) in subsection (a)(2)(A), by inserting ‘‘, in-
cluding improving disaggregation of data (in a man-
ner consistent with applicable State and Federal pri-
vacy laws)’’ before the period; and 
(2) in subsection (b)(2)— 
(A) in subparagraph (L), by striking 
‘‘and’’ at the end; 
(B) by redesignating subparagraph (M) as 
subparagraph (N); and 
(C) by inserting after subparagraph (L) 
the following: 
‘‘(M) an examination of the relationship 
between maternal health and obstetric services 
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in rural areas and outcomes in delivery and 
postpartum care; and’’. 
(d) OFFICE OF RESEARCH ON WOMEN’S HEALTH.— 
Section 486(d)(4)(A)(iv) of the Public Health Service Act 
(42 U.S.C. 287d(d)(4)(A)(iv)) is amended by inserting ‘‘, 
including preventable maternal mortality and severe ma-
ternal morbidity’’ before the semicolon. 
SEC. 202. RURAL OBSTETRIC NETWORK GRANTS. 
The Public Health Service Act is amended by insert-
ing after section 330A–1 of such Act (42 U.S.C. 254c– 
1a) the following: 
‘‘SEC. 330A–2. RURAL OBSTETRIC NETWORK GRANTS. 
‘‘(a) PROGRAM ESTABLISHED.—The Secretary shall 
award grants or cooperative agreements to eligible entities 
to establish collaborative improvement and innovation net-
works (referred to in this section as ‘rural obstetric net-
works’) to improve maternal and infant health outcomes 
and reduce preventable maternal mortality and severe ma-
ternal morbidity by improving maternity care and access 
to care in rural areas, frontier areas, maternity care health 
professional target areas, or jurisdictions of Indian Tribes 
and Tribal organizations. 
‘‘(b) USE OF FUNDS.—Grants or cooperative agree-
ments awarded pursuant to this section shall be used for 
the establishment or continuation of collaborative improve-
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ment and innovation networks to improve maternal and 
infant health outcomes and reduce preventable maternal 
mortality and severe maternal morbidity by improving pre-
natal care, labor care, birthing, and postpartum care serv-
ices in rural areas. Rural obstetric networks established 
in accordance with this section may— 
‘‘(1) develop a network to improve coordination 
and increase access to maternal health care and as-
sist pregnant women in the areas described in sub-
section (a) with accessing and utilizing prenatal 
care, labor care, birthing, and postpartum care serv-
ices to improve outcomes in birth and maternal mor-
tality and morbidity; 
‘‘(2) identify and implement evidence-based and 
sustainable delivery models for providing prenatal 
care, labor care, birthing, and postpartum care serv-
ices, including home visiting programs and culturally 
appropriate care models that reduce health dispari-
ties; 
‘‘(3) develop a model for maternal health care 
collaboration between health care settings to improve 
access to care in areas described in subsection (a), 
which may include the use of telehealth; 
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‘‘(4) provide training for professionals in health 
care settings that do not have specialty maternity 
care; 
‘‘(5) collaborate with academic institutions that 
can provide regional expertise and help identify bar-
riers to providing maternal health care, including 
strategies for addressing such barriers; and 
‘‘(6) assess and address disparities in infant 
and maternal health outcomes, including among ra-
cial and ethnic minority populations and underserved 
populations in such areas described in subsection 
(a). 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible 
entities’ means entities providing prenatal care, 
labor care, birthing, and postpartum care services in 
rural areas, frontier areas, or medically underserved 
areas, or to medically underserved populations or In-
dian Tribes or Tribal organizations. 
‘‘(2) FRONTIER
AREA.—The term ‘frontier 
area’ means a frontier county, as defined in section 
1886(d)(3)(E)(iii)(III) of the Social Security Act. 
‘‘(3) INDIAN TRIBES; TRIBAL ORGANIZATION.— 
The terms ‘Indian Tribe’ and ‘Tribal organization’ 
have the meanings given the terms ‘Indian tribe’ and 
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‘tribal organization’ in section 4 of the Indian Self- 
Determination and Education Assistance Act. 
‘‘(4) MATERNITY CARE HEALTH PROFESSIONAL 
TARGET
AREA.—The term ‘maternity care health 
professional target area’ has the meaning described 
in section 332(k)(2). 
‘‘(d) REPORT TO CONGRESS.—Not later than Sep-
tember 30, 2025, the Secretary shall submit to Congress 
a report on activities supported by grants awarded under 
this section, including— 
‘‘(1) a description of activities conducted pursu-
ant to paragraphs (1) through (6) of subsection (b); 
and 
‘‘(2) an analysis of the effects of rural obstetric 
networks on improving maternal and infant health 
outcomes. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$3,000,000 for each of fiscal years 2022 through 2026.’’. 
SEC. 203. TELEHEALTH NETWORK AND TELEHEALTH RE-
SOURCE CENTERS GRANT PROGRAMS. 
Section 330I of the Public Health Service Act (42 
U.S.C. 254c–14) is amended— 
(1) in subsection (f)(3), by adding at the end 
the following: 
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‘‘(M) Providers of prenatal, labor care, 
birthing, and postpartum care services, includ-
ing hospitals that operate obstetric care units.’’; 
and 
(2) in subsection (h)(1)(B), by striking ‘‘or pre-
natal care for high-risk pregnancies’’ and inserting 
‘‘prenatal care, labor care, birthing care, or 
postpartum care’’. 
SEC. 204. RURAL MATERNAL AND OBSTETRIC CARE TRAIN-
ING DEMONSTRATION. 
Subpart 1 of part E of title VII of the Public Health 
Service Act (42 U.S.C. 294n et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAIN-
ING DEMONSTRATION. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants to accredited schools of allopathic medicine, osteo-
pathic medicine, and nursing, and other appropriate 
health professional training programs, to establish a train-
ing demonstration program to support— 
‘‘(1) training for physicians, medical residents, 
fellows, nurse practitioners, physician assistants, 
nurses, certified nurse midwives, relevant home vis-
iting workforce professionals and paraprofessionals, 
or other professionals who meet relevant State train-
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ing and licensing requirements, as applicable, to re-
duce preventable maternal mortality and severe ma-
ternal morbidity by improving prenatal care, labor 
care, birthing, and postpartum care in rural commu-
nity-based settings; and 
‘‘(2) developing recommendations for such 
training programs. 
‘‘(b) APPLICATION.—To be eligible to receive a grant 
under subsection (a), an entity shall submit to the Sec-
retary an application at such time, in such manner, and 
containing such information as the Secretary may require. 
‘‘(c) ACTIVITIES.— 
‘‘(1) TRAINING
FOR
HEALTH
CARE
PROFES-
SIONALS.— A recipient of a grant under subsection 
(a)— 
‘‘(A) shall use the grant funds to plan, de-
velop, and operate a training program to pro-
vide prenatal care, labor care, birthing, and 
postpartum care in rural areas; and 
‘‘(B) may use the grant funds to provide 
additional support for the administration of the 
program or to meet the costs of projects to es-
tablish, maintain, or improve faculty develop-
ment, or departments, divisions, or other units 
necessary to implement such training. 
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‘‘(2) TRAINING
PROGRAM
REQUIREMENTS.— 
The recipient of a grant under subsection (a) shall 
ensure that training programs carried out under the 
grant are evidence-based and address improving pre-
natal care, labor care, birthing, and postpartum care 
in rural areas, and such programs may include 
training on topics such as— 
‘‘(A) maternal mental health, including 
perinatal depression and anxiety; 
‘‘(B) substance use disorders; 
‘‘(C) social determinants of health that af-
fect individuals living in rural areas; and 
‘‘(D) improving the provision of prenatal 
care, labor care, birthing, and postpartum care 
for racial and ethnic minority populations, in-
cluding with respect to perceptions and biases 
that may affect the approach to, and provision 
of, care. 
‘‘(d) EVALUATION AND REPORT.— 
‘‘(1) EVALUATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
evaluate the outcomes of the demonstration 
program under this section. 
‘‘(B) DATA SUBMISSION.—Recipients of a 
grant under subsection (a) shall submit to the 
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Secretary performance metrics and other re-
lated data in order to evaluate the program for 
the report described in paragraph (2). 
‘‘(2) REPORT TO CONGRESS.—Not later than 
January 1, 2025, the Secretary shall submit to Con-
gress a report that includes— 
‘‘(A) an analysis of the effects of the dem-
onstration program under this section on the 
quality, quantity, and distribution of maternal 
health care services, including prenatal care, 
labor care, birthing, and postpartum care serv-
ices, and the demographics of the recipients of 
those services; 
‘‘(B) an analysis of maternal and infant 
health outcomes (including quality of care, mor-
bidity, and mortality) before and after imple-
mentation of the program in the communities 
served by entities participating in the dem-
onstration; and 
‘‘(C) recommendations on whether the 
demonstration program should be continued. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2022 through 2026.’’. 
Æ 
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