I 
116TH CONGRESS 
1ST SESSION H. R. 4243 
To amend the Public Health Service Act to improve obstetric care in rural 
areas. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 9, 2019 
Ms. TORRES SMALL of New Mexico (for herself, Mr. NEWHOUSE, Ms. 
FINKENAUER, Mr. LATTA, Mr. LUJA´N, and Mr. COLE) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To amend the Public Health Service Act to improve obstetric 
care in rural areas. 
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 ‘‘Rural Maternal and 
Obstetric Modernization of Services Act’’ or the ‘‘Rural 
MOMS Act’’. 
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SEC. 2. 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 (race, 
ethnicity, language, class, income), including among 
American Indians and Alaska Natives, as such terms are 
defined in section 4 of the Indian Health Care Improve-
ment Act, and geographic contexts,’’ 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; 
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(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 health 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 
redesignating 
paragraphs 
(4) 
through (9) as paragraphs (5) through (10), re-
spectively; 
(B) by inserting after paragraph (3) the 
following: 
‘‘(4) carry out paragraphs (1) and (2) with re-
spect to pregnancy, with priority given to deaths re-
lated to pregnancy;’’; and 
(C) in paragraph (5) (as so redesignated), 
by striking ‘‘through (3)’’ and inserting 
‘‘through (4)’’; and 
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(2) in subsection (d)(4)(A)(iv), by inserting ‘‘, 
including maternal mortality and other maternal 
morbidity outcomes’’ before the semicolon. 
SEC. 3. RURAL OBSTETRIC NETWORK GRANTS. 
The Public Health Service Act is amended by insert-
ing after section 317L–1 (42 U.S.C. 247b–13a) the fol-
lowing: 
‘‘SEC. 317L–2. RURAL OBSTETRIC NETWORK GRANTS. 
‘‘(a) IN GENERAL.—For the purpose of enabling the 
Secretary (through grants, contracts, or otherwise), acting 
through the Administrator of the Health Resources and 
Services Administration, to establish collaborative im-
provement and innovation networks (referred to in this 
section as ‘rural obstetric networks’) to improve outcomes 
in birth and maternal morbidity and mortality, there is 
appropriated to the Secretary, out of any money in the 
Treasury not otherwise appropriated, $3,000,000 for each 
of fiscal years 2020 through 2024. Such amounts shall 
remain available until expended. 
‘‘(b) USE OF FUNDS.—Amount appropriated under 
subsection (a) shall be used for the establishment of col-
laborative improvement and innovation networks to im-
prove maternal health in rural areas by improving out-
comes in birth and maternal morbidity and mortality. 
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Rural obstetric networks established in accordance with 
this section shall— 
‘‘(1) assist pregnant women and individuals in 
rural areas connect with prenatal, labor and birth, 
and postpartum care to improve outcomes in birth 
and maternal mortality and morbidity; 
‘‘(2) identify successful prenatal, labor and 
birth, and postpartum health delivery models for in-
dividuals in rural areas, including evidence-based 
home visiting programs and successful, culturally 
competent models with positive maternal health out-
comes that advance health equity; 
‘‘(3) develop a model for collaboration between 
health facilities that have an obstetric health unit 
and health facilities that do not have an obstetric 
health unit; 
‘‘(4) provide training and guidance for health 
facilities that do not have obstetric health units; 
‘‘(5) collaborate with academic institutions that 
can provide regional expertise and research on ac-
cess, outcomes, needs assessments, and other identi-
fied data; and 
‘‘(6) measure and address inequities in birth 
outcomes among rural residents, with an emphasis 
on Black and American Indians and Alaska Native 
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‘‘(F) TRIBAL
ORGANIZATION.—The term 
‘tribal organization’ has the meaning given such 
term in the Indian Self-Determination Act. 
‘‘(G) STATE.—The term ‘State’ has the 
meaning given that term for purposes of title V 
of the Social Security Act.’’. 
SEC. 4. 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 operation obstetric care units.’’; 
(2) in subsection (i)(1)(B), by inserting ‘‘labor 
and birth, postpartum,’’ before ‘‘or prenatal’’; and 
(3) in subsection (k)(1)(B), by inserting ‘‘equip-
ment useful for caring for pregnant women and indi-
viduals, including ultrasound machines and fetal 
monitoring equipment,’’ before ‘‘and other equip-
ment’’. 
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SEC. 5. RURAL MATERNAL AND OBSTETRIC CARE TRAIN-
ING DEMONSTRATION. 
Part D of title VII of the Public Health Service Act 
is amended by inserting after section 760 (42 U.S.C. 
294k) the following: 
‘‘SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE 
TRAINING 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 licensed and accredited nurse 
practitioners, physician assistants, certified nurse 
midwives, certified midwives, certified professional 
midwives, home visiting nurses, or non-clinical pro-
fessionals such as doulas and community health 
workers, to provide maternal care services in rural 
community-based settings; and 
‘‘(3) establishing, maintaining, or improving 
academic units or programs that— 
‘‘(A) provide training for students or fac-
ulty, including through clinical experiences and 
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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 
‘‘(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-
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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) ACADEMIC UNITS OR PROGRAMS.—A re-
cipient of a grant under subsection (a)(3) shall enter 
into a partnership with organizations such as an 
education accrediting organization (such as the Liai-
son Committee on Medical Education, the Accredita-
tion Council for Graduate Medical Education, the 
Commission on Osteopathic College Accreditation, 
the Accreditation Commission for Education in 
Nursing, the Commission on Collegiate Nursing 
Education, the Accreditation Commission for Mid-
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wifery Education, or the Accreditation Review Com-
mission on Education for the Physician Assistant) to 
carry out activities under subsection (a)(3). 
‘‘(4) 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 include instruction on— 
‘‘(A) maternal mental health, including 
perinatal 
depression 
and 
anxiety 
and 
postpartum depression; 
‘‘(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 
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‘‘(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 
‘‘(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); 
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‘‘(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); 
‘‘(F) a health center operated by the In-
dian Health Service, an Indian tribe, a tribal 
organization, or a Native Hawaiian Health Care 
System (as such terms are defined in section 4 
of the Indian Health Care Improvement Act 
and section 12 of the Native Hawaiian Health 
Care Improvement Act); or 
‘‘(G) an entity with a demonstrated record 
of success in providing academic training for 
nurse practitioners, physician assistants, cer-
tified nurse-midwives, certified midwives, cer-
tified professional midwives, home visiting 
nurses, or non-clinical professionals, such as 
doulas and community health workers. 
‘‘(3) ACADEMIC UNITS OR PROGRAMS.—To be 
eligible to receive a grant under subsection (a)(3), 
an entity shall be a school of medicine or osteopathic 
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medicine, a nursing school, a physician assistant 
training program, an accredited public or nonprofit 
private hospital, an accredited medical residency pro-
gram, a school accredited by the Midwifery Edu-
cation and Accreditation Council, or a public or pri-
vate nonprofit entity which the Secretary has deter-
mined 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 
under the grant (including ancillary and administra-
tive costs). 
‘‘(d) DURATION.—Grants awarded under this section 
shall be for a minimum of 5 years. 
‘‘(e) 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. 
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‘‘(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 Congress a re-
port that includes— 
‘‘(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 
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‘‘(C) recommendations on whether the 
demonstration program should be expanded. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$5,000,000 for each of fiscal years 2020 through 2024.’’. 
SEC. 6. GAO REPORT. 
Not later than 1 year after the date of enactment 
of this Act, the Comptroller General of the United States 
shall submit to the appropriate committees of Congress 
a report on the maternal, including prenatal, labor and 
birth, and postpartum care in rural areas. Such report 
shall include the following: 
(1) The location of gaps in maternal and ob-
stetric clinicians and health professionals, including 
non-clinical professionals such as doulas and com-
munity health workers. 
(2) The location of gaps in facilities able to pro-
vide maternal, 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 
recommendations to standardize the format on col-
lecting data related to maternal mortality and mor-
bidity. 
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(4) The gaps in maternal health by race and 
ethnicity in rural communities, with a focus on ra-
cial inequities for Black residents and among Indian 
Tribes and American Indian/Alaska Native rural 
residents (as such terms are defined in section 4 of 
the Indian Health Care Improvement Act). 
(5) A list of specific activities that the Sec-
retary of Health and Human Services plans to con-
duct on maternal, including prenatal, labor and 
birth, and postpartum care. 
(6) A plan for completing such activities. 
(7) An explanation of Federal agency involve-
ment and coordination needed to conduct such ac-
tivities. 
(8) A budget for conducting such activities. 
(9) Other information that the Comptroller 
General determines appropriate. 
Æ 
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