I 
116TH CONGRESS 
1ST SESSION H. R. 4995 
To amend the Public Health Service Act to improve obstetric care and 
maternal health outcomes, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 8, 2019 
Mr. ENGEL (for himself, Mr. BUCSHON, Ms. TORRES SMALL of New Mexico, 
Mr. LATTA, Ms. ADAMS, and Mr. STIVERS) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to improve obstetric 
care and maternal health outcomes, 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 2019’’. 
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—IMPROVING OBSTETRIC CARE IN RURAL AREAS 
Sec. 101. Improving rural maternal and obstetric care data. 
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Sec. 102. Rural obstetric network grants. 
Sec. 103. Telehealth network and telehealth resource centers grant programs. 
Sec. 104. Rural maternal and obstetric care training demonstration. 
Sec. 105. GAO report. 
TITLE II—OTHER IMPROVEMENTS TO MATERNAL CARE 
Sec. 201. Innovation for maternal health. 
Sec. 202. Training for health care providers. 
Sec. 203. Study on training to reduce and prevent discrimination. 
Sec. 204. Perinatal quality collaboratives. 
Sec. 205. Integrated services for pregnant and postpartum women. 
TITLE 
I—IMPROVING 
OBSTET-
RIC CARE IN RURAL AREAS 
SEC. 101. IMPROVING RURAL MATERNAL AND OBSTETRIC 
CARE DATA. 
(a) MATERNAL MORTALITY AND MORBIDITY ACTIVI-
TIES.—Section 301 of the Public Health Service Act (42 
U.S.C. 241) is amended— 
(1) by redesignating subsections (e) through (h) 
as subsections (f) through (i), respectively; and 
(2) by inserting after subsection (d), the fol-
lowing: 
‘‘(e) The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall ex-
pand, intensify, and coordinate the activities of the Cen-
ters for Disease Control and Prevention with respect to 
maternal mortality and morbidity.’’. 
(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 inserting ‘‘sociocultural, includ-
ing among American Indians and Alaska Natives, as such 
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terms are defined in section 4 of the Indian Health Care 
Improvement Act, geographic,’’ after ‘‘biological,’’. 
(c) SAFE MOTHERHOOD.—Section 317K(b)(2) of the 
Public Health Service Act (42 U.S.C. 247b–12(b)(2)) is 
amended— 
(1) in subparagraph (L), by striking ‘‘and’’ at 
the end; 
(2) by redesignating subparagraph (M) as sub-
paragraph (N); and 
(3) by inserting after subparagraph (L), the fol-
lowing: 
‘‘(M) an examination of the relationship 
between maternal and obstetric services in rural 
areas and outcomes in delivery and postpartum 
care; and’’. 
(d) OFFICE OF RESEARCH ON WOMEN’S HEALTH.— 
Section 486 of the Public Health Service Act (42 U.S.C. 
287d) is amended— 
(1) in subsection (b)— 
(A) by amending paragraph (3) to read as 
follows: 
‘‘(3) carry out paragraphs (1) and (2) with re-
spect to— 
‘‘(A) the aging process in women, with pri-
ority given to menopause; and 
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‘‘(B) pregnancy, with priority given to 
deaths related to pregnancy;’’; and 
(2) in subsection (d)(4)(A)(iv), by inserting ‘‘, 
including maternal mortality and other maternal 
morbidity outcomes’’ before the semicolon. 
SEC. 102. 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, act-
ing through the Administrator of the Health Resources 
and Services Administration, shall award grants to eligible 
entities to establish collaborative improvement and innova-
tion networks (referred to in this section as ‘rural obstetric 
networks’) to improve birth outcomes and reduce maternal 
morbidity and mortality by improving maternity care and 
access to care in rural areas, frontier areas, maternity care 
health professional target areas, and Indian country and 
with Indian Tribes and tribal organizations. 
‘‘(b) USE OF FUNDS.—Rural obstetric networks re-
ceiving funds pursuant to this section may use such funds 
to— 
‘‘(1) assist pregnant women and individuals in 
areas and within populations referenced in sub-
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section (a) with accessing and utilizing maternal and 
obstetric care, including preconception, pregnancy, 
labor and delivery, postpartum, and interconception 
services to improve outcomes in birth and maternal 
mortality and morbidity; 
‘‘(2) identify successful delivery models for ma-
ternal and obstetric care (including preconception, 
pregnancy, labor and delivery, postpartum, and 
interconception services) for individuals in areas and 
within populations referenced by subsection (a), in-
cluding evidence-based home visiting programs and 
successful, culturally competent models with positive 
maternal health outcomes that advance health eq-
uity; 
‘‘(3) develop a model for collaboration between 
health facilities that have an obstetric care unit and 
health facilities that do not have an obstetric care 
unit to improve access to and the delivery of obstet-
ric services in communities lacking these services; 
‘‘(4) provide training and guidance on obstetric 
care for health facilities that do not have obstetric 
care units; 
‘‘(5) collaborate with academic institutions that 
can provide regional expertise and research on ac-
cess, outcomes, needs assessments, and other identi-
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fied data and measurement activities needed to in-
form rural obstetric network efforts to improve ob-
stetric care; and 
‘‘(6) measure and address inequities in birth 
outcomes among rural residents, with an emphasis 
on racial and ethnic minorities and underserved pop-
ulations. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITIES.—The term ‘eligible 
entities’ 
means 
entities 
providing 
obstetric, 
gynecologic, and other maternal health care services 
in rural areas, frontier areas, or medically under-
served areas, or to medically underserved popu-
lations or Native Americans, including Indian 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
COUNTRY.—The term ‘Indian 
country’ has the meaning given such term in section 
1151 of title 18, United States Code. 
‘‘(4) MATERNITY CARE HEALTH PROFESSIONAL 
TARGET
AREA.—The term ‘maternity care health 
professional target area’ has the meaning of such 
term as used in section 332(k)(2). 
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‘‘(5) RURAL AREA.—The term ‘rural area’ has 
the meaning given that term in section 1886(d)(2) 
of the Social Security Act. 
‘‘(6) INDIAN TRIBES; TRIBAL ORGANIZATION.— 
The terms ‘Indian Tribe’ and ‘tribal organization’ 
have the meaning given such terms in section 4 of 
the Indian Self-Determination and Education Assist-
ance Act. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$3,000,000 for each of fiscal years 2020 through 2024.’’. 
SEC. 103. 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)(1)(B)(iii), by adding at the 
end the following: 
‘‘(XIII) Providers of maternal, 
including prenatal, labor and birth, 
and postpartum care services and en-
tities operating obstetric care units.’’; 
and 
(2) in subsection (i)(1)(B), by inserting ‘‘labor 
and birth, postpartum,’’ before ‘‘or prenatal’’. 
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SEC. 104. RURAL MATERNAL AND OBSTETRIC CARE TRAIN-
ING DEMONSTRATION. 
Subpart 1 of part E of title VII of the Public Health 
Service Act is amended by inserting after section 760 (42 
U.S.C. 294n et seq.), as amended by section 202, 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 establish a 
training demonstration program to award grants to eligi-
ble entities to support— 
‘‘(1) training for physicians, medical residents, 
including family medicine and obstetrics and gyne-
cology residents, and fellows to practice maternal 
and obstetric medicine in rural community-based 
settings; 
‘‘(2) training for nurse practitioners, physician 
assistants, nurses, certified nurse midwives, home 
visiting nurses and non-clinical home visiting work-
force professionals and paraprofessionals, or non- 
clinical professionals, who meet applicable State 
training and licensing requirements, to provide ma-
ternal care services in rural community-based set-
tings; and 
‘‘(3) establishing, maintaining, or improving 
academic units or programs that— 
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‘‘(A) provide training for students or fac-
ulty, including through clinical experiences and 
research, to improve maternal care in rural 
areas; or 
‘‘(B) develop evidence-based practices or 
recommendations for the design of the units or 
programs described in subparagraph (A), in-
cluding curriculum content standards. 
‘‘(b) ACTIVITIES.— 
‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 
FELLOWS.—A recipient of a grant under subsection 
(a)(1)— 
‘‘(A) shall use the grant funds— 
‘‘(i) to plan, develop, and operate a 
training program to provide obstetric care 
in rural areas for family practice or obstet-
rics and gynecology residents and fellows; 
or 
‘‘(ii) to train new family practice or 
obstetrics and gynecology residents and fel-
lows in maternal and obstetric health care 
to provide and expand access to maternal 
and obstetric health care in rural areas; 
and 
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‘‘(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. 
‘‘(2) TRAINING FOR OTHER PROVIDERS.—A re-
cipient of a grant under subsection (a)(2)— 
‘‘(A) shall use the grant funds to plan, de-
velop, or operate a training program to provide 
maternal health care services in rural, commu-
nity-based settings; 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 program. 
‘‘(3) TRAINING
PROGRAM
REQUIREMENTS.— 
The recipient of a grant under subsection (a)(1) or 
(a)(2) shall ensure that training programs carried 
out under the grant are evidence-based and include 
instruction on— 
‘‘(A) maternal mental health, including 
perinatal depression and anxiety; 
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‘‘(B) maternal substance use disorder; 
‘‘(C) social determinants of health that im-
pact individuals living in rural communities, in-
cluding poverty, social isolation, access to nutri-
tion, education, transportation, and housing; 
and 
‘‘(D) implicit bias. 
‘‘(c) ELIGIBLE ENTITIES.— 
‘‘(1) TRAINING FOR MEDICAL RESIDENTS AND 
FELLOWS.—To be eligible to receive a grant under 
subsection (a)(1), an entity shall— 
‘‘(A) be a consortium consisting of— 
‘‘(i) at least one teaching health cen-
ter; or 
‘‘(ii) the sponsoring institution (or 
parent institution of the sponsoring insti-
tution) of— 
‘‘(I) an obstetrics and gynecology 
or family medicine residency program 
that is accredited by the Accreditation 
Council of Graduate Medical Edu-
cation (or the parent institution of 
such a program); or 
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‘‘(II) a fellowship in maternal or 
obstetric medicine, as determined ap-
propriate by the Secretary; or 
‘‘(B) be an entity described in subpara-
graph (A)(ii) that provides opportunities for 
medical residents or fellows to train in rural 
community-based settings. 
‘‘(2) TRAINING FOR OTHER PROVIDERS.—To be 
eligible to receive a grant under subsection (a)(2), 
an entity shall be— 
‘‘(A) a teaching health center (as defined 
in section 749A(f)); 
‘‘(B) a federally qualified health center (as 
defined in section 1905(l)(2)(B) of the Social 
Security Act); 
‘‘(C) a community mental health center (as 
defined in section 1861(ff)(3)(B) of the Social 
Security Act); 
‘‘(D) a rural health clinic (as defined in 
section 1861(aa) of the Social Security Act); 
‘‘(E) a freestanding birth center (as de-
fined in section 1905(l)(3) of the Social Secu-
rity Act); or 
‘‘(F) an Indian Health Program or a Na-
tive Hawaiian health care system (as such 
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terms are defined in section 4 of the Indian 
Health Care Improvement Act and section 12 
of the Native Hawaiian Health Care Improve-
ment Act, respectively). 
‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 
eligible to receive a grant under subsection (a)(3), 
an entity shall be a school of medicine, a school of 
osteopathic medicine, a school of nursing (as defined 
in section 801), a physician assistant education pro-
gram, an accredited public or nonprofit private hos-
pital, an accredited medical residency training pro-
gram, a school accredited by the Midwifery Edu-
cation and Accreditation Council, by the Accredita-
tion Commission for Midwifery Education, or by the 
American Midwifery Certification Board, or a public 
or private nonprofit educational entity which the 
Secretary has determined is capable of carrying out 
such grant. 
‘‘(4) APPLICATION.—To be eligible to receive a 
grant under subsection (a), an entity shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require, including an estimate of the 
amount to be expended to conduct training activities 
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under the grant (including ancillary and administra-
tive costs). 
‘‘(d) STUDY AND REPORT.— 
‘‘(1) STUDY.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator of the Health Re-
sources and Services Administration, shall con-
duct a study on the results of the demonstra-
tion program under this section. 
‘‘(B) DATA SUBMISSION.—Not later than 
90 days after the completion of the first year 
of the training program, and each subsequent 
year for the duration of the grant, that the pro-
gram is in effect, each recipient of a grant 
under subsection (a) shall submit to the Sec-
retary such data as the Secretary may require 
for analysis for the report described in para-
graph (2). 
‘‘(2) REPORT TO CONGRESS.—Not later than 1 
year after receipt of the data described in paragraph 
(1)(B), the Secretary shall submit to the Committee 
on Energy and Commerce of the House of Rep-
resentatives and the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate a report 
that includes— 
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‘‘(A) an analysis of the effect of the dem-
onstration program under this section on the 
quality, quantity, and distribution of maternal 
(including prenatal, labor and birth, and 
postpartum) care services 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 expanded. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$5,000,000 for each of fiscal years 2020 through 2024.’’. 
SEC. 105. GAO REPORT. 
Not later than 18 months after the date of enactment 
of this Act, the Comptroller General of the United States 
shall submit to the Committee on Energy and Commerce 
of the House of Representatives and the Committee on 
Health, Education, Labor, and Pensions of the Senate a 
report on maternal care in rural areas, including prenatal, 
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labor and birth, and postpartum care in rural areas. Such 
report shall include the following: 
(1) Trends in data that may identify potential 
gaps in maternal and obstetric clinicians and health 
professionals, including non-clinical professionals. 
(2) Trends in the number of facilities able to 
provide maternal care, including prenatal, labor and 
birth, and postpartum care, in rural areas, including 
care for high-risk pregnancies. 
(3) The gaps in data on maternal mortality and 
morbidity and recommendations to standardize the 
format on collecting data related to maternal mor-
tality and morbidity. 
(4) The gaps in maternal health outcomes by 
race and ethnicity in rural communities, with a focus 
on racial inequities for residents who are racial and 
ethnic minorities or members of underserved popu-
lations. 
(5) An examination of— 
(A) activities which the Secretary of 
Health and Human Services plans to conduct to 
improve maternal care in rural areas, including 
prenatal, labor and birth, and postpartum care; 
and 
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(B) the extent to which the Secretary has 
a plan for completing these activities, has iden-
tified the lead agency responsible for each activ-
ity, has identified any needed coordination 
among agencies, and has developed a budget for 
conducting such activities. 
(6) Other information that the Comptroller 
General determines appropriate. 
TITLE 
II—OTHER 
IMPROVE-
MENTS TO MATERNAL CARE 
SEC. 201. INNOVATION FOR MATERNAL HEALTH. 
The Public Health Service Act is amended— 
(1) in the section designation of section 330M 
(42 U.S.C. 254c–19) by inserting a period after 
‘‘330M’’; and 
(2) by inserting after such section 330M the 
following: 
‘‘SEC. 330N. 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— 
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‘‘(1) identifying, developing, or disseminating 
best practices to improve maternal health care qual-
ity and outcomes, eliminate preventable maternal 
mortality and severe maternal morbidity, and im-
prove infant health outcomes, which may include— 
‘‘(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, 
including by addressing topics commonly associ-
ated 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 post-
partum care; and 
‘‘(C) information on addressing deter-
minants of health that impact maternal health 
outcomes for women before, during, and after 
pregnancy; 
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‘‘(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; 
‘‘(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. 
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‘‘(c) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $10,000,000 for each of fiscal years 2020 through 
2024.’’. 
SEC. 202. 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 reduce and prevent 
discrimination (including training related to implicit and 
explicit biases) in the provision of health care services re-
lated to prenatal care, labor care, birthing, and 
postpartum 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 
such manner, and containing such information as the Sec-
retary may require. 
‘‘(c) 
REPORTING
REQUIREMENT.—Each 
entity 
awarded a grant under this section shall periodically sub-
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mit 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. 
‘‘(d) BEST PRACTICES.—The Secretary may identify 
and disseminate best practices for the training of health 
care professionals to reduce and prevent discrimination 
(including training related to implicit and explicit biases) 
in the provision of health care services related to prenatal 
care, labor care, birthing, and postpartum care. 
‘‘(e) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there is authorized to be appro-
priated $5,000,000 for each of fiscal years 2020 through 
2024.’’. 
SEC. 203. STUDY ON TRAINING TO REDUCE AND PREVENT 
DISCRIMINATION. 
Not later than 2 years after date of enactment of this 
Act, the Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’) shall, through 
a contract with an independent research organization, con-
duct a study and make recommendations for accredited 
schools of allopathic medicine, osteopathic medicine, and 
nursing, and other health professional training programs, 
on best practices related to training to reduce and prevent 
discrimination, including training related to implicit and 
explicit biases, in the provision of health care services re-
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lated to prenatal care, labor care, birthing, and 
postpartum care. 
SEC. 204. PERINATAL QUALITY COLLABORATIVES. 
(a) GRANTS.—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 
Director of the Centers for Disease Control and 
Prevention and in coordination with other of-
fices and agencies, as appropriate, shall estab-
lish or continue a competitive grant program 
for the establishment or support of perinatal 
quality collaboratives to improve perinatal care 
and perinatal health outcomes for pregnant and 
postpartum women and their infants. A State, 
Indian Tribe, or tribal organization may use 
funds received through such grant to— 
‘‘(I) support the use of evidence-based 
or evidence-informed practices to improve 
outcomes for maternal and infant health; 
‘‘(II) work with clinical teams; ex-
perts; State, local, and, as appropriate, 
tribal public health officials; and stake-
holders, including patients and families, to 
identify, develop, or disseminate best prac-
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