II 118th CONGRESS 2d Session S. 4079 IN THE SENATE OF THE UNITED STATES April 9, 2024 Ms. Hassan (for herself, Ms. Collins , Mrs. Britt , and Ms. Smith ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To improve obstetric emergency care.

1. Short title This Act may be cited as the Rural Obstetrics Readiness Act . 2. Obstetric emergency training program Section 330O of the Public Health Service Act ( 42 U.S.C. 254c–21 ) is amended— (1) in subsection (a)— (A) in paragraph (3), by striking ; and and inserting a semicolon; (B) in paragraph (4), by striking the period and inserting ; and ; and (C) by adding at the end the following: (5) developing, and facilitating access to, an evidence-based program to train practitioners in rural health care facilities without dedicated obstetric units to provide emergency obstetric services during pregnancy, labor, delivery, or the postpartum period, including training on how to prepare for, identify, stabilize, and safely transfer, as appropriate and within the scope of practice of an individual practitioner, a woman experiencing labor, delivery, obstetric hemorrhage, severe hypertension, cardiac conditions, perinatal mental health conditions, substance use, sepsis, or other conditions, as appropriate. ; (2) by redesignating subsections (c) and (d) as subsections (d) and (e), respectively; (3) by inserting after subsection (b) the following: (c) Training program for eligible practitioners in rural health care facilities A training program described in subsection (a)(5) shall include an assessment of obstetric training needs for rural health care facilities without dedicated obstetric units. In developing the training program, a recipient of a grant under such subsection shall— (1) work in consultation with at least one representative from a national medical society that has experience or expertise in rural health care delivery in each of the fields of gynecology and obstetrics, emergency medicine, family medicine, and anesthesiology; and (2) facilitate access to obstetric readiness training via regional training partnerships and technical assistance to rural health care facilities. ; and (4) in subsection (e), as so redesignated, by adding at the end the following: In addition to amounts appropriated under the previous sentence, for grants for the purpose described in subsection (a)(5), there are authorized to be appropriated $5,000,000 for the period of fiscal years 2025 through 2027 . 3. Grant funding for equipment and supplies Part D of title III of the Public Health Service Act ( 42 U.S.C. 254b et seq. ) is amended by inserting after section 330A–2 the following: 330A–3. Program of support for obstetric services (a) In general The Secretary shall award grants, contracts, or cooperative agreements to eligible entities to integrate obstetric readiness training curriculum into rural health care settings, build workforce capacity, and purchase equipment necessary to manage obstetric emergencies. (b) Use of funds A recipient of funds under this section shall use such funds for the purpose described in subsection (a), which may include any of the following: (1) Purchasing or providing equipment and technical assistance to train practitioners who are not specialized in obstetrics in preparing for, identifying, stabilizing, and transferring, as appropriate and within the scope of practice of the practitioner, individuals experiencing obstetric emergencies. (2) Purchasing or providing equipment necessary to prepare for, identify, stabilize, or transfer, as appropriate, individuals experiencing obstetric emergencies. (3) Developing and carrying out protocols for transfer of patients to other facilities and network engagement with other facilities. (4) Hiring additional personnel or paying the salaries of personnel. (5) Establishing training opportunities to enable non-obstetric health professionals to gain exposure to, and expertise in, the delivery of obstetric services, including through clinical rotations, fellowships, or cross-training clinicians in other specialties. (6) Enabling clinical educators to coordinate, develop, and implement comprehensive interdisciplinary trainings, including team-based simulation training for providers who may need to respond to an obstetric emergency. (c) Eligible entities To be eligible to receive a grant under this section, an entity shall— (1) be— (A) a rural hospital, critical access hospital (as determined under section 1820(c)(2) of the Social Security Act), or a rural emergency hospital (as defined in section 1861(kkk)(2) of the Social Security Act) that is located in a maternity care health professional target area or a rural area (as defined by the Secretary); or (B) a consortium of 3 entities that includes at least 2 entities described in subparagraph (A); and (2) agree to carry out the program described in subsection (a), in coordination with other federally funded maternal and child health programs, to the extent practicable, and in consultation with other maternal and child health programs in the same geographic area. (d) Definitions In this section— (1) the term maternity care health professional target area means a primary care health professional shortage area that is experiencing a shortage of maternity health care professionals, as identified under section 332(k); and (2) the term rural area has the meaning given such term by the Federal Office of Rural Health Policy. (e) Authorization of appropriations To carry out this section, there is authorized to be appropriated $15,000,000 for the period of fiscal years 2025 through 2028. . 4. Pilot program for teleconsultation Part D of title III of the Public Health Service Act ( 42 U.S.C. 254b et seq. ), as amended by section 3, is further amended by inserting after section 330A–2 the following: 330A–4. Pilot program for teleconsultation (a) In general The Secretary, acting through the Administrator of the Health Resources and Services Administration and in consultation with the Administrator of the Centers for Medicare & Medicaid Services, shall award grants or cooperative agreements to States, political subdivisions of States, and Indian Tribes and Tribal organizations (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act ( 25 U.S.C. 5304 )) to support the provision of urgent maternal health care in rural facilities without a dedicated obstetric unit, including by— (1) supporting the development of statewide or regional maternal health care telehealth access programs; and (2) supporting the improvement of existing statewide or regional maternal health care telehealth access programs described in subsection (b). (b) Statewide or regional maternal health care telehealth access programs A maternal health care telehealth access program described in this section, with respect to which an award under subsection (a) may be used, shall— (1) be a statewide or regional network of maternal health care teams that provide urgent support to rural non-obstetric settings of care; (2) support and further develop organized State or regional networks of maternal health care teams to provide urgent consultative support to rural non-obstetric settings of care; (3) conduct an assessment of urgent maternal health consultation needs among providers in rural non-obstetric settings of care; (4) provide assurances that the physicians responsive to the tele-consultation line are credentialed within their employing facility and can provide consultation where the patient is receiving care consistent with State requirements to provide care to individuals experiencing labor, delivery, obstetric hemorrhage, severe hypertension in pregnancy and postpartum, cardiac conditions related to or exacerbated by pregnancy, perinatal mental health conditions, substance use during pregnancy or the postpartum period, sepsis during pregnancy or after pregnancy end, or other conditions, as appropriate; (5) provide rapid statewide or regional clinical telephone or telehealth consultations when requested between the maternal care teams and providers in rural emergency non-obstetric settings; and (6) provide information to health care providers about available maternal health services for people in the community and assist with referrals to specialty care and community or behavioral health resources. (c) Reporting An entity receiving an award under this section shall submit a report to the Secretary, in such manner and containing such information as the Secretary may require, not later than 18 months after initial receipt of the grant. (d) Authorization of appropriations To carry out this section, there is authorized to be appropriated $5,000,000 for the period of fiscal years 2025 through 2028. . 5. Study on obstetric units in rural areas The Secretary of Health and Human Services shall— (1) conduct a study that maps maternity ward closures and regional patterns of patient transport and examines models for regional partnerships for rural obstetric care; and (2) not later than 3 years after the date of enactment of this Act, submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce and the Committee on Education and the Workforce of the House of Representatives, a report on the results of the study conducted under paragraph (1).