I 113th CONGRESS 1st Session H. R. 2286 IN THE HOUSE OF REPRESENTATIVES June 6, 2013 Ms. Roybal-Allard (for herself, Mrs. Capps , Mrs. Christensen , Ms. Lee of California , Ms. McCollum , Ms. Pingree of Maine , and Mr. Rangel ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To promote optimal maternity outcomes by making evidence-based maternity care a national priority, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Maximizing Optimal Maternity Services for the 21st Century or the MOMS for the 21st Century Act . (b) Table of contents The table of contents for this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. Title I—HHS Focus on the Promotion of Optimal Maternity Care Sec. 101. Additional focus area for the Office on Women’s Health. Sec. 102. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes. Sec. 103. Consumer education campaign. Sec. 104. Bibliographic database of systematic reviews for care of childbearing women and newborns. Title II—Research and data collection on Maternity Care Sec. 201. Maternity care health professional shortage areas. Sec. 202. Expansion of CDC Prevention Research Centers program to include Centers on Optimal Maternity Outcomes. Sec. 203. Expanding models to be tested by Center for Medicare and Medicaid Innovation to include maternity care models. Title III—Enhancement of a Geographically, Racially, and Ethnically Diverse Interprofessional Maternity Workforce Sec. 301. Development of interprofessional maternity care educational models and tools. Sec. 302. Interprofessional training of medical students, residents, and student midwives in academic health centers and freestanding birth centers. Sec. 303. Grants to professional organizations to increase diversity in maternity care professionals. 2. Findings Congress finds the following: (1) Maternity expenditures in the United States surpass all other developed countries, but childbirth continues to carry significant risks for mothers in the United States, as demonstrated by the following: (A) More than two women die every day in the United States from pregnancy-related causes and the maternal mortality rate in the United States has roughly doubled in the past 25 years. According to data released in 2010, the maternal mortality ratio was 12.7 percent as compared to 6.6 percent in 1987. (B) More than one-third of all women who give birth in the United States (1,700,000 women each year) experience some type of complication that has an adverse effect on their health. (C) Severe complications that result in women nearly dying, known as a near miss or severe morbidity, increased by 25 percent between 1998 and 2005, to approximately 34,000 cases a year. (D) African-American women have nearly a four times greater risk of dying from pregnancy-related complications than White women, and these disparities have not improved in 50 years. (2) In spite of the considerable investment of the United States in maternity care, the United States is failing to ensure that all infants have a healthy start in life, as demonstrated by the following: (A) Despite five years of modest reduction in pre-term births between 2006 and 2011, the United States continues to lag behind most other countries in pre-term birth rates, ranking 131 out of 184 countries, according to a 2011 report by the March of Dimes and the World Health Organization. (B) The proportion of low birth weight babies increased by 21 percent between 1981 and 2008. (C) Non-Hispanic Black infants continue to experience significantly higher rates of both pre-term birth and low birthweight, two of the leading causes of infant mortality in this country. (3) Despite shortcomings in the United States statewide data collections systems, which make international comparisons more challenging, international health organizations have ranked the United States far behind almost all developed countries in important perinatal and maternal outcomes, as demonstrated by the following: (A) The World Health Organization identified 49 nations with lower rates of maternal deaths than the United States in 2008. (B) In the World Health Report 2005, the World Health Organization identified 35 nations with lower early neonatal mortality rates (4/1,000 live births) and 33 with lower neonatal mortality rates (5/1,000 live births) than the United States. (C) According to data from the Organisation for Economic Co-operation and Development (OECD), 26 countries (out of 29 reporting) had low birthweight rates lower than that of the United States. (D) 21 OECD countries (out of 27 reporting) had lower cesarean section rates than the United States. (4) Maternity care is a major component of the escalating health care costs in the United States, as demonstrated by the following: (A) With 4,000,000 deliveries yearly, the vast majority of which occur in hospitals, maternity care for mothers and their newborns is the number one reason for hospitalization in the United States, exceeding such prevalent conditions as pneumonia, cancer, fracture, and heart disease. Of those discharged from hospitals in the United States in 2009, nearly one in four were childbearing women and newborns. (B) Combined mother and baby charges for hospitalization, which was $98,000,000,000 in 2008, far exceeded charges for any other hospital condition in the United States. (5) Maternity care also accounts for a significant proportion of expenditures under the Medicaid program, which covers 42 percent of births in this country, as demonstrated by the following: (A) In 2008, 26 percent of all hospital charges for which payment was made under the Medicaid program (totaling $41,000,000,000) was for birthing women and newborns. (B) The two most common conditions for which payments were made under the Medicaid program in 2007 were pregnancy and childbirth (constituting 28 percent of such payments) and newborns (constituting 26 percent of such payments), which together accounted for 53 percent of hospital discharges billed to Medicaid. (C) The two most costly conditions for which payment was made under the Medicaid program in 2008 were mother’s pregnancy and delivery and care for newborn infants , which together accounted for 26 percent of all Medicaid expenditures. (6) Maternity care facility charges vary significantly by setting and type of birth. Part of the charge differentials between facilities are attributable to high overhead of hospitals— (A) in 2008, the average charge for a hospital cesarean birth with complications was $20,080, and without complications was $14,900; (B) in 2008, the average charge for a hospital vaginal birth with complications was $11,410, and without complications was $8,920; and (C) in 2010, the average charge for a birth center vaginal birth was $2,277. (7) The procedure-intensity of birth-related hospital stays also helps to explain the high costs of such hospital stays. In 2008, 6 of the 10 most commonly performed hospital procedures for all patients with all diagnoses involved childbirth and newborn care. Cesarean section was the most common operating room procedure. (8) Two non-invasive maternity practices, smoking cessation programs during pregnancy and external version to turn breech babies at term, have strong proven correlation with considerable improvement in outcomes with no detrimental side effects, but are significantly underused in the United States. (9) There is a growing body of evidence that other non-invasive practices which are underused in current practice may also be associated with improved outcomes. These non-invasive practices include group model prenatal care (such as the CenteringPregnancy model), continuous labor support, and non-supine positions for birth. (10) The growing shortage of maternity health care professionals and childbirth facilities is creating a serious obstacle to timely and adequate maternity health care for women, particularly in rural areas and the inner cities. (11) There are significant racial and ethnic disparities across the maternity care workforce creating additional access barriers to culturally and linguistically competent maternity services. I HHS Focus on the Promotion of Optimal Maternity Care 101. Additional focus area for the Office on Women’s Health Section 229(b) of the Public Health Service Act ( 42 U.S.C. 237a(b) ) is amended— (1) in paragraph (6), at the end, by striking and ; (2) in paragraph (7), at the end, by striking the period and inserting ; and ; and (3) by adding at the end the following new paragraph: (8) facilitate policy makers, health system leaders and providers, consumers, and other stakeholders in their understanding optimal maternity care and support for the provision of such care, including the priorities of— (A) protecting, promoting, and supporting the innate capacities of childbearing women and their newborns for childbirth, breast-feeding, and attachment; (B) using obstetric interventions only when such interventions are supported by strong, high-quality evidence, and minimizing overuse of maternity practices that have been shown to have benefit in limited situations and that can expose women, infants, or both to risk of harm if used routinely and indiscriminately, including continuous electronic fetal monitoring, labor induction, epidural analgesia, primary cesarean section, and routine repeat cesarean birth; (C) reliably incorporating non-invasive, evidence-based practices that have documented correlation with considerable improvement in outcomes with no detrimental side effects, such as smoking cessation programs in pregnancy and proven models of group prenatal care that integrate health assessment, education, and support into a unified program; (D) a shared understanding of the qualifications of licensed providers of maternity care and the best evidence about the safety, satisfaction, outcomes, and costs of their care, and appropriate deployment of such caregivers within the maternity care workforce to address the needs of childbearing women and newborns and the growing shortage of maternity caregivers; (E) a shared understanding of the results of the best available research comparing hospital, birth center, and planned home births, including information about each setting’s safety, satisfaction, outcomes, and costs; and (F) high-quality, evidence-based childbirth education that promotes a natural, healthy, and safe approach to pregnancy, childbirth, and early parenting; is taught by certified educators, peer counselors, and health professionals; and promotes informed decisionmaking by childbearing women. . 102. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes (a) In general Part A of title II of the Public Health Service Act (42 U.S.C. 202 et seq.) is amended by adding at the end the following new section: 229A. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes (a) In general The Secretary of Health and Human Services, acting through the Deputy Assistant Secretary for Women’s Health under section 229 and in collaboration with the Federal officials specified in subsection (b), shall establish the Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes (referred to in this subsection as the ICCPOM ). (b) Other agencies The officials specified in this subsection are the Secretary of Labor, the Secretary of Defense, the Secretary of Veterans Affairs, the Surgeon General, the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Agency, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the Indian Health Service, the Administrator of the Substance Abuse and Mental Health Services Administration, the Director of the National Institute on Child Health and Development, the Director of the Agency for Healthcare Research and Quality, the Assistant Secretary for Children and Families, the Deputy Assistant Secretary for Minority Health, the Director of the Office of Personnel Management, and such other Federal officials as the Secretary of Health and Human Services determines to be appropriate. (c) Chair The Deputy Assistant Secretary for Women’s Health shall serve as the chair of the ICCPOM. (d) Duties The ICCPOM shall guide policy and program development across the Federal Government with respect to promotion of optimal maternity care, provided, however, that nothing in this section shall be construed as transferring regulatory or program authority from an Agency to the Coordinating Committee. (e) Consultations The ICCPOM shall actively seek the input of, and shall consult with, all appropriate and interested stakeholders, including State Health Departments, public health research and interest groups, foundations, childbearing women and their advocates, and maternity care professional associations and organizations, reflecting racially, ethnically, demographically, and geographically diverse communities. (f) Annual report (1) In general The Secretary, on behalf of the ICCPOM, shall annually submit to Congress a report that summarizes— (A) all programs and policies of Federal agencies (including the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act) designed to promote optimal maternity care, focusing particularly on programs and policies that support the adoption of evidence based maternity care, as defined by timely, scientifically sound systematic reviews; (B) all programs and policies of Federal agencies (including the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act) designed to address the problems of maternal mortality and morbidity, infant mortality, prematurity, and low birth weight, including such programs and policies designed to address racial and ethnic disparities with respect to each of such problems; (C) the extent of progress in reducing maternal mortality and infant mortality, low birth weight, and prematurity at State and national levels; and (D) such other information regarding optimal maternity care as the Secretary determines to be appropriate. The information specified in subparagraph (C) shall be included in each such report in a manner that disaggregates such information by race, ethnicity, and indigenous status in order to determine the extent of progress in reducing racial and ethnic disparities and disparities related to indigenous status. (2) Certain information Each report under paragraph (1) shall include information (disaggregated by race, ethnicity, and indigenous status, as applicable) on the following rates and costs by State: (A) The rate of primary cesarean deliveries and repeat cesarean deliveries. (B) The rate of vaginal births after cesarean. (C) The rate of vaginal breech births. (D) The rate of induction of labor. (E) The rate of freestanding birth center births. (F) The rate of planned and unplanned home birth. (G) The rate of attended births by provider, including by an obstetrician-gynecologist, family practice physician, obstetrician-gynecologist physician assistant, certified nurse-midwife, certified midwife, and certified professional midwife. (H) The cost of maternity care disaggregated by place of birth and provider of care, including— (i) uncomplicated vaginal birth; (ii) complicated vaginal birth; (iii) uncomplicated cesarean birth; and (iv) complicated cesarean birth. (g) Authorization of appropriations There is authorized to be appropriated, in addition to such amounts authorized to be appropriated under section 229(e), to carry out this section $1,000,000 for each of the fiscal years 2014 through 2018. . (b) Conforming amendments (1) Inclusion as duty of HHS Office on Women’s Health Section 229(b) of such Act (42 U.S.C. 237a(b)), as amended by section 101, is amended— (A) in paragraph (7), at the end, by striking and ; (B) in paragraph (8), at the end, by striking the period and inserting ; and ; and (C) by adding at the end the following new paragraph: (9) establish the Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes in accordance with section 229A. . (2) Treatment of biennial reports Section 229(d) of such Act ( 42 U.S.C. 237a(d) ) is amended by inserting (other than under subsection (b)(9)) after under this section . 103. Consumer education campaign Section 229 of the Public Health Service Act ( 42 U.S.C. 237a ), as amended by sections 101 and 102, is further amended— (1) in subsection (b)— (A) in paragraph (8), at the end, by striking and ; (B) in paragraph (9), at the end, by striking the period and inserting ; and ; and (C) by adding at the end the following new paragraph: (10) not later than one year after the date of the enactment of the MOMS for the 21st Century Act, develop and implement a 4-year culturally and linguistically appropriate multi-media consumer education campaign to promote understanding and acceptance of evidence based maternity practices and models of care for optimal maternity outcomes among women of childbearing ages and families of such women and that— (A) highlights the importance of protecting, promoting, and supporting the innate capacities of childbearing women and their newborns for childbirth, breast-feeding, and attachment; (B) promotes understanding of the importance of using obstetric interventions when medically necessary and when supported by strong, high-quality evidence; (C) highlights the widespread overuse of maternity practices that have been shown to have benefit when used appropriately in situations of medical necessity, but which can expose women, infants, or both to risk of harm if used routinely and indiscriminately, including continuous fetal monitoring, labor induction, epidural anesthesia, elective primary cesarean section, and repeat cesarean delivery; (D) emphasizes the non-invasive maternity practices that have strong proven correlation or may be associated with considerable improvement in outcomes with no detrimental side effects, and are significantly underused in the United States, including smoking cessation programs in pregnancy, group model prenatal care, continuous labor support, non-supine positions for birth, and external version to turn breech babies at term; (E) educates consumers about the qualifications of licensed providers of maternity care and the best evidence about their safety, satisfaction, outcomes, and costs; (F) informs consumers about the best available research comparing birth center births, planned home births, and hospital births, including information about each setting’s safety, satisfaction, outcomes, and costs; (G) fosters participation in high-quality, evidence-based childbirth education that promotes a natural, healthy, and safe approach to pregnancy, childbirth, and early parenting; is taught by certified educators, peer counselors, and health professionals; and promotes informed decisionmaking by childbearing women; and (H) is pilot tested for consumer comprehension, cultural sensitivity, and acceptance of the messages across geographically, racially, ethnically, and linguistically diverse populations. . 104. Bibliographic database of systematic reviews for care of childbearing women and newborns (a) In general Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services, through the Agency for Healthcare Research and Quality, shall— (1) make publicly available an online bibliographic database identifying systematic reviews, including an explanation of the level and quality of evidence, for care of childbearing women and newborns; and (2) initiate regular updates that incorporate newly issued and updated systematic reviews. (b) Sources To aim for a comprehensive inventory of systematic reviews relevant to maternal and newborn care, the database shall identify reviews from diverse sources, including— (1) scientific peer-reviewed journals; (2) databases, including Cochrane Database of Systematic Reviews, Clinical Evidence, and Database of Abstracts of Reviews of Effects; and (3) Internet Web sites of agencies and organizations throughout the world that produce such systematic reviews. (c) Features The database shall— (1) provide bibliographic citations for each record within the database, and for each such citation include an explanation of the level and quality of evidence; (2) include abstracts, as available; (3) provide reference to companion documents as may exist for each review, such as evidence tables and guidelines or consumer educational materials developed from the review; (4) provide links to the source of the full review and to any companion documents; (5) provide links to the source of a previous version or update of the review; (6) be searchable by intervention or other topic of the review, reported outcomes, author, title, and source; and (7) offer to users periodic electronic notification of database updates relating to users’ topics of interest. (d) Outreach Not later than the first date the database is made publicly available and periodically thereafter, the Secretary of Health and Human Services shall publicize the availability, features, and uses of the database under this section to the stakeholders described in subsection (e). (e) Consultation For purposes of developing the database under this section and maintaining and updating such database, the Secretary of Health and Human Services shall convene and consult with an advisory committee composed of relevant stakeholders, including— (1) Federal Medicaid administrators and State agencies administrating State plans under title XIX of the Social Security Act pursuant to section 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); (2) providers of maternity and newborn care from both academic and community-based settings, including obstetrician-gynecologists, family physicians, certified nurse midwives, certified midwives, certified professional midwives, physician assistants, perinatal nurses, pediatricians, and nurse practitioners; (3) maternal-fetal medicine specialists; (4) neonatologists; (5) childbearing women and advocates for such women, including childbirth educators certified by a nationally accredited program, representing communities that are diverse in terms of race, ethnicity, indigenous status, and geographic area; (6) employers and purchasers; (7) health facility and system leaders, including both hospital and birth center facilities; (8) journalists; and (9) bibliographic informatics specialists. (f) Authorization of appropriations There is authorized to be appropriated $2,500,000 for each of the fiscal years 2014 through 2016 for the purpose of developing the database and such sums as may be necessary for each subsequent fiscal year for updating the database and providing outreach and notification to users, as described in this section. II Research and data collection on Maternity Care 201. Maternity care health professional shortage areas Section 332 of the Public Health Service Act ( 42 U.S.C. 254e ) is amended by adding at the end the following new subsection: (k) (1) The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall designate maternity care health professional shortage areas in the States, publish a descriptive list of the area’s population groups, medical facilities, and other public facilities so designated, and at least annually review and, as necessary, revise such designations. (2) For purposes of paragraph (1), a complete descriptive list shall be published in the Federal Register not later than one year after the date of the enactment of the MOMS for the 21st Century Act and annually thereafter. (3) The provisions of subsections (b), (c), (e), (f), (g), (h), (i), and (j) (other than (j)(1)(B)) of this section shall apply to the designation of a maternity care health professional shortage area in a similar manner and extent as such provisions apply to the designation of health professional shortage areas, except in applying subsection (b)(3), the reference in such subsection to physicians shall be deemed to be a reference to nationally certified and State licensed obstetricians, family practice physicians who practice full-scope maternity care, certified nurse-midwives, certified midwives, certified professional midwives, and physician’s assistants who practice full scope maternity care. (4) For purposes of this subsection, the term maternity care health professional shortage area means— (A) an area in an urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a shortage of providers of maternity care health services including those referenced in paragraph (3) or an urban or rural area that the Secretary determines has lost a significant number of such providers during the 10-year period beginning with 2004 or has no obstetrical providers licensed to provide operative obstetrical services; (B) an area in an urban or rural area (which need not conform to the geographic boundaries of a political subdivision and which is a rational area for the delivery of health services) which the Secretary determines has a shortage of hospital or labor and delivery units, hospital birth center units, or freestanding birth centers or an area that lost a significant number of these units during the 10-year period beginning with 2003; or (C) a population group which the Secretary determines has such a shortage of providers or facilities. . 202. Expansion of CDC Prevention Research Centers program to include Centers on Optimal Maternity Outcomes (a) In general Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services, shall support the establishment of 2 additional Prevention Research Centers under the Prevention Research Center Program administered by the Centers for Disease Control and Prevention. Such additional centers shall each be known as a Center for Excellence on Optimal Maternity Outcomes. (b) Research Each Center for Excellence on Optimal Maternity Outcomes shall— (1) conduct at least one focused program of research to improve maternity outcomes, including the reduction of cesarean birth rates, elective inductions, prematurity rates, and low birth weight rates within an underserved population that has a disproportionately large burden of suboptimal maternity outcomes, including maternal mortality and morbidity, infant mortality, prematurity, or low birth weight; (2) work with partners on special interest projects, as specified by the Centers for Disease Control and Prevention and other relevant agencies within the Department of Health and Human Services, and on projects funded by other sources; and (3) involve a minimum of two distinct birth setting models, such as a hospital labor and delivery model and freestanding birth center model; or a hospital labor and delivery model and planned home birth model. (c) Interdisciplinary providers Each Center for Excellence on Optimal Maternity Outcomes shall include the following interdisciplinary providers of maternity care: (1) Obstetrician-gynecologists. (2) Certified nurse midwives or certified midwives. (3) At least two of the following providers: (A) Family practice physicians. (B) Nurse practitioners. (C) Physician assistants. (D) Certified professional midwives. (d) Services Research conducted by each Center for Excellence on Optimal Maternity Outcomes shall include at least 2 (and preferably more) of the following supportive provider services: (1) Mental health. (2) Doula labor support. (3) Nutrition education. (4) Childbirth education. (5) Social work. (6) Physical therapy or occupation therapy. (7) Substance abuse services. (8) Home visiting. (e) Coordination The programs of research at each of the two Centers of Excellence on Optimal Maternity Outcomes shall compliment and not replicate the work of the other. (f) Authorization of appropriations There is authorized to be appropriated to carry out this section $2,000,000 for each of the fiscal years 2014 through 2018. 203. Expanding models to be tested by Center for Medicare and Medicaid Innovation to include maternity care models Section 1115A(b)(2)(B) of the Social Security Act ( 42 U.S.C. 1315a(b)(2)(B) ) is amended by adding at the end the following new clause: (xxi) Promoting evidence-based models of prenatal care that have been associated with reductions in maternal and infant health disparities; incorporating the use of doula and promotoras support; and advancing out-of-hospital births, including births at home and in freestanding birth centers. . III Enhancement of a Geographically, Racially, and Ethnically Diverse Interprofessional Maternity Workforce 301. Development of interprofessional maternity care educational models and tools (a) In general Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services, acting in conjunction with the Administrator of Health Resources and Services Administration, shall convene, for a 1-year period, an Interprofessional Maternity Provider Education Commission to discuss and make recommendations for— (1) a consensus standard physiologic maternity care curriculum that takes into account the core competencies for basic midwifery practice such as those developed by the American College of Nurse Midwives and the North American Registry of Midwives, and the educational objectives for physicians practicing in obstetrics and gynecology as determined by the Council on Resident Education in Obstetrics and Gynecology; (2) suggestions for multi-disciplinary use of the consensus physiologic curriculum; (3) strategies to integrate and coordinate education across maternity care disciplines, including recommendations to increase medical and midwifery student exposure to out-of-hospital birth; and (4) pilot demonstrations of interprofessional educational models. (b) Participants The Commission shall include maternity care educators, curriculum developers, service leaders, certification leaders, and accreditation leaders from the various professions that provide maternity care in this country. Such professions shall include obstetrician-gynecologists, certified nurse midwives or certified midwives, family practice physicians, nurse practitioners, physician assistants, certified professional midwives, and perinatal nurses. Additionally, the Commission shall include representation from maternity care consumer advocates. (c) Curriculum The consensus standard physiologic maternity care curriculum described in subsection (a)(1) shall— (1) have a public health focus with a foundation in health promotion and disease prevention; (2) foster physiologic childbearing and woman and family centered care; (3) integrate strategies to reduce maternal and infant morbidity and mortality; (4) incorporate recommendations to ensure respectful, safe, and seamless consultation, referral, transport, and transfer of care when necessary; and (5) include cultural sensitivity and strategies to decrease disparities in maternity outcomes. (d) Report Not later than 6 months after the final day of the summit, the Secretary of Health and Human Services shall— (1) submit to Congress a report containing the recommendations made by the summit under this section; and (2) make such report publicly available. (e) Authorization of appropriations There is authorized to be appropriated to carry out this section $1,000,000 for each of the fiscal years 2014 and 2015, and such sums as are necessary for each of the fiscal years 2016 through 2018. 302. Interprofessional training of medical students, residents, and student midwives in academic health centers and freestanding birth centers (a) Including within inpatient hospital services under Medicare services furnished by certain students, interns, and residents supervised by certified nurse midwives Section 1861(b) of the Social Security Act (42 U.S.C. 1395x(b)) is amended— (1) in paragraph (6), by striking ; or and inserting , or in the case of services in a hospital or osteopathic hospital by a student midwife or an intern or resident-in-training under a teaching program previously described in this paragraph who is in the field of obstetrics and gynecology, if such student midwife, intern, or resident-in-training is supervised by a certified nurse-midwife to the extent permitted under applicable State law and as may be authorized by the hospital; ; (2) in paragraph (7), by striking the period at the end and inserting ; or ; and (3) by adding at the end the following new paragraph: (8) a certified nurse-midwife where the hospital has a teaching program approved as specified in paragraph (6), if (A) the hospital elects to receive any payment due under this title for reasonable costs of such services, and (B) all certified nurse-midwives in such hospital agree not to bill charges for professional services rendered in such hospital to individuals covered under the insurance program established by this title. . (b) Effective date The amendments made by subsection (a) shall apply to services furnished on or after the date of the enactment of this Act. 303. Grants to professional organizations to increase diversity in maternity care professionals (a) In general The Secretary of Health and Human Services, through the Administrator of the Health Resources and Services Administration, shall carry out a grant program under which the Secretary may make to eligible health professional organizations— (1) for fiscal year 2014, planning grants described in subsection (b); and (2) for the subsequent 4-year period, implementation grants described in subsection (c). (b) Planning grants (1) In general Planning grants described in this subsection are grants for the following purposes: (A) To collect data and identify any workforce disparities, with respect to a health profession, at each of the following areas along the health professional continuum: (i) Pipeline availability with respect to students at the high school and college or university levels considering and working toward entrance in the profession. (ii) Entrance into the training program for the profession. (iii) Graduation from such training program. (iv) Entrance into practice. (v) Retention in practice for more than a 5-year period. (B) To develop one or more strategies to address the workforce disparities within the health profession, as identified under (and in response to the findings pursuant to) subparagraph (A). (2) Application To be eligible to receive a grant under this subsection, an eligible health professional organization shall submit to the Secretary of Health and Human Services an application in such form and manner and containing such information as specified by the Secretary. (3) Amount Each grant awarded under this subsection shall be for an amount not to exceed $300,000. (4) Report Each recipient of a grant under this subsection shall submit to the Secretary of Health and Human Services a report containing— (A) information on the extent and distribution of workforce disparities identified through the grant; and (B) reasonable objectives and strategies developed to address such disparities within a 5-, 10-, and 25-year period. (c) Implementation grants (1) In general Implementation grants described in this subsection are grants to implement one or more of the strategies developed pursuant to a planning grant awarded under subsection (b). (2) Application To be eligible to receive a grant under this subsection, an eligible health professional organization shall submit to the Secretary of Health and Human Services an application in such form and manner as specified by the Secretary. Each such application shall contain information on the capability of the organization to carry out a strategy described in paragraph (1), involvement of partners or coalitions, plans for developing sustainability of the efforts after the culmination of the grant cycle, and any other information specified by the Secretary. (3) Amount Each grant awarded under this subsection shall be for an amount not to exceed $500,000 each year during the 4-year period of the grant. (4) Reports For each of the first 3 years for which an eligible health professional organization is awarded a grant under this subsection, the organization shall submit to the Secretary of Health and Human Services a report on the activities carried out by such organization through the grant during such year and objectives for the subsequent year. For the fourth year for which an eligible health professional organization is awarded a grant under this subsection, the organization shall submit to the Secretary a report that includes an analysis of all the activities carried out by the organization through the grant and a detailed plan for continuation of outreach efforts. (d) Eligible health professional organization defined For purposes of this section, the term eligible health professional organization means a professional organization representing obstetrician-gynecologists, certified nurse midwives, certified midwives, family practice physicians, nurse practitioners whose scope of practice includes maternity care, physician assistants whose scope of practice includes obstetrical care, or certified professional midwives. (e) Authorization of appropriations There is authorized to be appropriated to carry out this section $2,000,000 for fiscal year 2014 and $3,000,000 for each of the fiscal years 2015 through 2018.