HR 5807 IHCommentsClose CommentsPermalink

To promote optimal maternity outcomes by making evidence-based maternity care a national priority, and for other purposes.CommentsClose CommentsPermalink

July 21, 2010CommentsClose CommentsPermalink

Ms. ROYBAL-ALLARD (for herself, Ms. BALDWIN, Mrs. CAPPS, Ms. CASTOR of Florida, Mrs. CHRISTENSEN, Mr. COHEN, Mr. CONYERS, Mrs. DAVIS of California, Ms. DEGETTE, Ms. DELAURO, Mr. ENGEL, Mr. HINOJOSA, Ms. LEE of California, Ms. ZOE LOFGREN of California, Mrs. LOWEY, Mr. MCGOVERN, Mrs. MALONEY, Mr. MICHAUD, Ms. MOORE of Wisconsin, Mrs. NAPOLITANO, Ms. NORTON, Mr. REYES, Ms. VELAZQUEZ, Ms. WASSERMAN SCHULTZ, Ms. WOOLSEY, and Ms. SCHAKOWSKY) 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 concernedCommentsClose CommentsPermalink

To promote optimal maternity outcomes by making evidence-based maternity care a national priority, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 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’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents for this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Findings.CommentsClose CommentsPermalink

TITLE I--HHS FOCUS ON THE PROMOTION OF OPTIMAL MATERNITY CARE

Sec. 101. Additional focus area for the Office on Women’s Health.CommentsClose CommentsPermalink





Sec. 102. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes.CommentsClose CommentsPermalink

‘Sec. 229A. Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes.CommentsClose CommentsPermalink

Sec. 103. Consumer education campaign.CommentsClose CommentsPermalink





Sec. 104. Bibliographic database of systematic reviews for care of childbearing women and newborns.CommentsClose CommentsPermalink

TITLE II--RESEARCH AND DATA COLLECTION ON MATERNITY CARE

Sec. 201. Maternity care health professional shortage areas.CommentsClose CommentsPermalink





Sec. 202. Expansion of CDC Prevention Research Centers program to include Centers on Optimal Maternity Outcomes.CommentsClose CommentsPermalink





Sec. 203. Expanding models to be tested by Center for Medicare and Medicaid Innovation to include maternity care models.CommentsClose CommentsPermalink

TITLE III--ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, AND ETHNICALLY DIVERSE INTERDISCIPLINARY MATERNITY WORKFORCE

Sec. 301. Development of interdisciplinary maternity care provider core curricula.CommentsClose CommentsPermalink





Sec. 302. Interdisciplinary training of medical students, residents, and student midwives in academic health centers.CommentsClose CommentsPermalink





Sec. 303. Loan repayments for maternal care professionals.CommentsClose CommentsPermalink





Sec. 304. Grants to professional organizations to increase diversity in maternity care professionals.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

Congress finds the following:CommentsClose CommentsPermalink





(1) The United States spends more than double per capita on health care than other industrialized countries, but ranks far behind almost all developed countries in important perinatal outcomes. In the World Health Report 2005--CommentsClose CommentsPermalink





(A) the World Health Organization identified 29 nations with lower estimated maternal mortality ratios than the United States (14/100,000 live births);CommentsClose CommentsPermalink





(B) the World Health Organization identified 35 nations with lower early neonatal mortality rates (5/1,000 live births) and 33 with lower neonatal mortality rates (5/1,000 live births) than the United States;CommentsClose CommentsPermalink





(C) 23 countries (out of 30 reporting) had superior low birth weight rates than the United States; andCommentsClose CommentsPermalink





(D) 19 member countries (out of 23 reporting) had lower cesarean section rates than the United States.CommentsClose CommentsPermalink





(2) Despite maternity expenditures in the United States, childbirth continues to carry significant risks for mothers in this country, as demonstrated by the following:CommentsClose CommentsPermalink





(A) More than two women die every day in the United States from pregnancy-related causes.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(C) African-American women having nearly a four times greater risk of dying from pregnancy-related complications than White women, and these disparities have not improved in 20 years.CommentsClose CommentsPermalink





(3) In spite of the Nation’s considerable investment in maternity care, the United States is failing to ensure that all infants have a healthy start in life, as demonstrated by the following:CommentsClose CommentsPermalink





(A) The national rate of pre-term birth increased by 36 percent in the quarter-century from 1981 to 2006.CommentsClose CommentsPermalink





(B) The proportion of low birth weight babies increased by 22 percent between 1981 and 2006.CommentsClose CommentsPermalink





(C) Non-Hispanic Black infants continue to experience significantly higher rates of both pre-term birth and low birth weight, two of the leading causes of infant mortality in this country.CommentsClose CommentsPermalink





(4) Maternity Care is a major component of the escalating health care costs in this country, as demonstrated by the following:CommentsClose CommentsPermalink





(A) 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 2007, 25 percent were childbearing women and newborns.CommentsClose CommentsPermalink





(B) Combined mother and baby charges for hospitalization, which was $86,000,000,000 in 2006, far exceeded charges for any other hospital condition in the United States.CommentsClose CommentsPermalink





(5) Maternity care also accounts for a significant proportion of expenditures under the Medicaid program, as demonstrated by the following:CommentsClose CommentsPermalink





(A) In 2006, 29 percent of all hospital charges under Medicaid ($39,000,000,000) were for birthing women and children.CommentsClose CommentsPermalink





(B) Six of the 10 most common procedures reimbursed under the Medicaid program were maternity related, making ‘mother’s pregnancy and delivery’ the most costly Medicaid expenditure.CommentsClose CommentsPermalink





(6) Maternity care charges vary significantly by setting and type of birth. In 2005--CommentsClose CommentsPermalink





(A) the average charge for a hospital cesarean birth with complications was $15,900, and without complications was $12,500;CommentsClose CommentsPermalink





(B) the average charge for a hospital vaginal birth with complications was $8,960, and without complications was $6,970; andCommentsClose CommentsPermalink





(C) the average charge for a birth center vaginal birth was $1,600.CommentsClose CommentsPermalink





(7) The procedure-intensity of birth-related hospital stays helps to explain their high costs. In 2005, 6 of the 15 most commonly performed hospital procedures for all patients with all diagnoses involved childbirth. Cesarean section was the most common operating room procedure for Medicaid, for private payers, and for all payers combined.CommentsClose CommentsPermalink





(8) There is a vast body of knowledge regarding best evidence-based practices in maternity care, but current practice is not following the research, as demonstrated by the following:CommentsClose CommentsPermalink





(A) A recent analysis of American College of Obstetrics and Gynecology obstetrical practice bulletins 1998 through 2004 found that only 23 percent of their practice recommendations were based on good, consistent scientific evidence, while 42 percent of recommendations were based on consensus and opinion.CommentsClose CommentsPermalink





(B) There is widespread overuse of maternity practices that have been shown to have benefit only in limited situations, 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.CommentsClose CommentsPermalink





(C) There are multiple non-invasive maternity practices that have been associated with considerable improvement in outcomes with no detrimental side effects, and are significantly underused in this country, 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.CommentsClose CommentsPermalink





(9) 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.CommentsClose CommentsPermalink





(10) There are significant racial and ethnic disparities across the maternity care workforce creating additional access barriers to culturally and linguistically competent maternity services.CommentsClose CommentsPermalink





(11) Although most women in the United States are healthy and at low risk for complications, Obstetrician-Gynecologist Surgeons are the lead caregivers for about 79 percent of women during pregnancy and labor, as compared to midwives who care for 8 percent to 9 percent of women, and Family Practice Physicians who care for 6 percent to 7 percent of women. Among developed nations, only the United States and Canada rely to this degree on specialists rather than midwives or family physicians to provide care to healthy birthing women.CommentsClose CommentsPermalink





(12) There is a growing shortage of Obstetrician-Gynecologists in the United States who provide maternity services. Data from the 2006 American College of Obstetricians and Gynecologists (ACOG) Survey on Professional Liability showed a negative trend in length of obstetrical practice, with the average age at which physicians stopped practicing obstetrics being 48 years. At one point this was the near midpoint of an Obstetrician-Gynecologist’s professional career.CommentsClose CommentsPermalink





(13) There is extensive research demonstrating that certified nurse midwives, when compared to Obstetrician-Gynecologists, provide high quality of care with comparable or better outcomes, high levels of patient satisfaction, and at lower costs due to fewer unnecessary, invasive, and expensive technologic interventions.CommentsClose CommentsPermalink





(14) Approximately 1 percent of births in the United States take place in non-hospital settings. Of such births, 27 percent occur in birth centers and 65 percent are home births. Hospitals remain the setting of delivery for 99 percent of all births despite the following findings:CommentsClose CommentsPermalink





(A) Multiple studies have demonstrated that for women who meet criteria to be considered at low risk for obstetrical complications, labor and delivery at a birth center can result in higher patient satisfaction and equivalent or better outcomes than in-hospital birth.CommentsClose CommentsPermalink





(B) Studies have consistently found that for low-risk mothers, planned home birth had the same outcomes as hospital births for similar risk women, but with fewer costly and often preventable interventions.CommentsClose CommentsPermalink





(C) In a nationwide comparison of birth center costs to hospital costs, it is estimated that if 100,000 births were attended in birth centers, access to care would be greatly improved, and annual savings would total more than $314,000,000.CommentsClose CommentsPermalink





(15) Midwives serve as faculty at many of the Nation’s most prominent academic health centers, however, the time they spend training medical students, residents, and midwifery students is not reimbursed as it is for physicians. As a result, medical students, residents, and midwifery students often fail to benefit from the practice experience and physiologic birth expertise of midwives.CommentsClose CommentsPermalink

TITLE I--HHS FOCUS ON THE PROMOTION OF OPTIMAL MATERNITY CARECommentsClose CommentsPermalink

SEC. 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--CommentsClose CommentsPermalink





(1) in paragraph (6), at the end, by striking ‘and’;CommentsClose CommentsPermalink





(2) in paragraph (7), at the end, by striking the period and inserting ‘; and’; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) protecting, promoting, and supporting the innate capacities of childbearing women and their newborns for childbirth, breast-feeding, and attachment;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(C) reliably providing beneficial practices with no or minimal evidence of harm that are underused, 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;CommentsClose CommentsPermalink





‘(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;CommentsClose CommentsPermalink





‘(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; andCommentsClose CommentsPermalink





‘(F) informed decisionmaking by childbearing women.’.CommentsClose CommentsPermalink

SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF OPTIMAL MATERNITY OUTCOMES.

(a) In General- Part B of title II of the Public Health Service Act is amended by adding at the end the following new section:CommentsClose CommentsPermalink

‘SEC. 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’).CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(c) Chair- The Deputy Assistant Secretary for Women’s Health shall serve as the chair of the ICCPOM.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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 focused primary care professional associations and organizations, reflecting racially, ethnically, demographically, and geographically diverse communities.CommentsClose CommentsPermalink





‘(f) Annual Report-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary, on behalf of the ICCPOM, shall annually submit to Congress a report that summarizes--CommentsClose CommentsPermalink





‘(A) all programs and policies of Federal agencies 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;CommentsClose CommentsPermalink





‘(B) all programs and policies of Federal agencies designed to address the problems of maternal mortality and infant mortality, prematurity, and low birth weight;CommentsClose CommentsPermalink





‘(C) the extent of progress in reducing maternal mortality and infant mortality, low birth weight, and prematurity at State and national levels; andCommentsClose CommentsPermalink





‘(D) such other information regarding optimal maternity care as the Secretary determines to be appropriate.CommentsClose CommentsPermalink





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.CommentsClose CommentsPermalink





‘(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:CommentsClose CommentsPermalink





‘(A) The rate of primary cesarean deliveries and repeat cesarean deliveries.CommentsClose CommentsPermalink





‘(B) The rate of vaginal births after cesarean.CommentsClose CommentsPermalink





‘(C) The rate of vaginal breech births.CommentsClose CommentsPermalink





‘(D) The rate of induction of labor.CommentsClose CommentsPermalink





‘(E) The rate of birthing center births.CommentsClose CommentsPermalink





‘(F) The rate of planned and unplanned home birth.CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(H) The cost of maternity care disaggregated by place of birth and provider of care, including--CommentsClose CommentsPermalink





‘(i) uncomplicated vaginal birth;CommentsClose CommentsPermalink





‘(ii) complicated vaginal birth;CommentsClose CommentsPermalink





‘(iii) uncomplicated cesarean birth; andCommentsClose CommentsPermalink





‘(iv) complicated cesarean birth.CommentsClose CommentsPermalink





‘(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 2011 through 2015.’.CommentsClose CommentsPermalink





(b) Conforming Amendments-CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(A) in paragraph (7), at the end, by striking ‘and’;CommentsClose CommentsPermalink





(B) in paragraph (8), at the end, by striking the period and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(9) establish the Interagency Coordinating Committee on the Promotion of Optimal Maternity Outcomes in accordance with section 229A.’.CommentsClose CommentsPermalink





(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’.CommentsClose CommentsPermalink

SEC. 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--CommentsClose CommentsPermalink





(1) in subsection (b)--CommentsClose CommentsPermalink





(A) in paragraph (8), at the end, by striking ‘and’;CommentsClose CommentsPermalink





(B) in paragraph (9), at the end, by striking the period and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) highlights the importance of protecting, promoting, and supporting the innate capacities of childbearing women and their newborns for childbirth, breast-feeding, and attachment;CommentsClose CommentsPermalink





‘(B) promotes understanding of the importance of using obstetric interventions only when supported by strong, high-quality evidence;CommentsClose CommentsPermalink





‘(C) highlights the widespread overuse of maternity practices that have been shown to have benefit only in limited situations, and 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;CommentsClose CommentsPermalink





‘(D) emphasizes the multiple non-invasive maternity practices that have been 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;CommentsClose CommentsPermalink





‘(E) educates consumers about the qualifications of licensed providers of maternity care and the best evidence about their safety, satisfaction, outcomes, and costs;CommentsClose CommentsPermalink





‘(F) informs consumers about the best available research comparing birth center births and planned home births with hospital births, including information about each setting’s safety, satisfaction, outcomes, and costs;CommentsClose CommentsPermalink





‘(G) fosters involvement in informed decisionmaking among childbirth consumers; andCommentsClose CommentsPermalink





‘(H) is pilot tested for consumer comprehension, cultural sensitivity, and acceptance of the messages across geographically, racially, ethnically, and linguistically diverse populations.’.CommentsClose CommentsPermalink

SEC. 104. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC REVIEWS FOR CARE OF CHILDBEARING WOMEN AND NEWBORNS.

(a) In General- Not later than January 1, 2014, the Secretary of Health and Human Services, through the Agency for Healthcare Research and Quality, shall--CommentsClose CommentsPermalink





(1) make publicly available an online bibliographic database identifying systematic reviews for care of childbearing women and newborns; andCommentsClose CommentsPermalink





(2) initiate regular updates that incorporate newly issued and updated systematic reviews.CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(1) scientific journals;CommentsClose CommentsPermalink





(2) databases, including Cochrane Database of Systematic Reviews, Clinical Evidence, and Database of Abstracts of Reviews of Effects; andCommentsClose CommentsPermalink





(3) Internet Web sites of agencies and organizations throughout the world that produce such systematic reviews.CommentsClose CommentsPermalink





(c) Features- The database shall--CommentsClose CommentsPermalink





(1) provide bibliographic citations for each record within the database;CommentsClose CommentsPermalink





(2) include abstracts, as available;CommentsClose CommentsPermalink





(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;CommentsClose CommentsPermalink





(4) provide links to the source of the full review and to any companion documents;CommentsClose CommentsPermalink





(5) provide links to the source of a previous version or update of the review;CommentsClose CommentsPermalink





(6) be searchable by intervention or other topic of the review, reported outcomes, author, title, and source; andCommentsClose CommentsPermalink





(7) offer to users periodic electronic notification of database updates relating to users’ topics of interest.CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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--CommentsClose CommentsPermalink





(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));CommentsClose CommentsPermalink





(2) providers of maternity and newborn care from both academic and community-based settings, including obstetrician-gynecologists, family physicians, midwives, physician assistants, perinatal nurses, pediatricians, and nurse practitioners;CommentsClose CommentsPermalink





(3) maternal-fetal medicine specialists;CommentsClose CommentsPermalink





(4) neonatologists;CommentsClose CommentsPermalink





(5) childbearing women and their advocates representing communities that are diverse in terms of race, ethnicity, indigenous status, and geographic area;CommentsClose CommentsPermalink





(6) employers and purchasers;CommentsClose CommentsPermalink





(7) health facility and system leaders, including both hospital and birth center facilities;CommentsClose CommentsPermalink





(8) journalists; andCommentsClose CommentsPermalink





(9) bibliographic informatics specialists.CommentsClose CommentsPermalink





(f) Authorization of Appropriations- There is authorized to be appropriated $2,500,000 for each of the fiscal years 2011 through 2013 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.CommentsClose CommentsPermalink

TITLE II--RESEARCH AND DATA COLLECTION ON MATERNITY CARECommentsClose CommentsPermalink

SEC. 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:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(2) For purposes of paragraph (1), a complete descriptive list shall be published in the Federal Register not later than July 1 of 2011 and each subsequent year.CommentsClose CommentsPermalink





‘(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 ‘physicians, obstetricians, family practice physicians who practice full-scope maternity care, certified nurse-midwives, certified midwives, and certified professional midwives’.CommentsClose CommentsPermalink





‘(4) For purposes of this subsection, the term ‘maternity care health professional shortage area’ means--CommentsClose CommentsPermalink





‘(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 obstetricians, family practice physicians who practice full-scope maternity care, certified nurse-midwives, certified midwives, and certified professional midwives, and shall also include urban or rural areas that have lost a significant number of local hospital labor and delivery units;CommentsClose CommentsPermalink





‘(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 birth center labor and delivery units, or areas that lost a significant number of these units in during the 10-year period beginning with 2000; orCommentsClose CommentsPermalink





‘(C) a population group which the Secretary determines has such a shortage of providers or facilities.’.CommentsClose CommentsPermalink

SEC. 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.CommentsClose CommentsPermalink





(b) Research- Each Center for Excellence on Optimal Maternity Outcomes shall--CommentsClose CommentsPermalink





(1) conduct at least one focused program of research to improve maternity outcomes, including the reduction of cesarean birth rates, 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, cesarean section rates, infant mortality, prematurity, or low birth weight;CommentsClose CommentsPermalink





(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; andCommentsClose CommentsPermalink





(3) involve a minimum of two distinct birth setting models, such as a hospital labor and delivery model and birth center model; or a hospital labor and delivery model and planned home birth model.CommentsClose CommentsPermalink





(c) Interdisciplinary Providers- Each Center for Excellence on Optimal Maternity Outcomes shall include the following interdisciplinary providers of maternity care:CommentsClose CommentsPermalink





(1) Obstetrician-gynecologists.CommentsClose CommentsPermalink





(2) Certified nurse midwives or certified midwives.CommentsClose CommentsPermalink





(3) At least two of the following providers:CommentsClose CommentsPermalink





(A) Family practice physicians.CommentsClose CommentsPermalink





(B) Women’s health nurse practitioners.CommentsClose CommentsPermalink





(C) Obstetrician-gynecologists physician assistants.CommentsClose CommentsPermalink





(D) Certified professional midwives.CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





(1) Mental health.CommentsClose CommentsPermalink





(2) Doula labor support.CommentsClose CommentsPermalink





(3) Nutrition education.CommentsClose CommentsPermalink





(4) Childbirth education.CommentsClose CommentsPermalink





(5) Social work.CommentsClose CommentsPermalink





(6) Physical therapy or occupation therapy.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(f) Authorization of Appropriations- There is authorized to be appropriated to carry out this section $2,000,000 for each of the fiscal years 2011 through 2015.CommentsClose CommentsPermalink

SEC. 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:CommentsClose CommentsPermalink





‘(xxi) Promoting evidence-based group prenatal care models, doula support, and out-of-hospital births, including births at home or a birthing center.’.CommentsClose CommentsPermalink

TITLE III--ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, AND ETHNICALLY DIVERSE INTERDISCIPLINARY MATERNITY WORKFORCECommentsClose CommentsPermalink

SEC. 301. DEVELOPMENT OF INTERDISCIPLINARY MATERNITY CARE PROVIDER CORE CURRICULA.

(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, a Maternity Curriculum Commission to discuss and make recommendations for--CommentsClose CommentsPermalink





(1) a shared core maternity care curriculum;CommentsClose CommentsPermalink





(2) strategies to integrate and coordinate education across maternity care disciplines, including suggestions for multi-disciplinary use of the shared core curriculum; andCommentsClose CommentsPermalink





(3) pilot demonstrations of interdisciplinary educational models.CommentsClose CommentsPermalink





(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, certified midwives, family practice physicians, women’s health nurse practitioners, obstetrician-gynecologists physician assistants, certified professional midwives, and perinatal nurses.CommentsClose CommentsPermalink





(c) Curriculum- The shared core maternity care curriculum described in subsection (A) shall--CommentsClose CommentsPermalink





(1) have a public health focus with a foundation in health promotion and disease prevention;CommentsClose CommentsPermalink





(2) foster physiologic childbearing and patient and family centered care; andCommentsClose CommentsPermalink





(3) include cultural sensitivity and strategies to decrease disparities in maternity outcomes.CommentsClose CommentsPermalink





(d) Report- Not later than 6 months after the final day of the summit, the Secretary of Health and Human Services shall--CommentsClose CommentsPermalink





(1) submit to Congress a report containing the recommendations made by the summit under this section; andCommentsClose CommentsPermalink





(2) make such report publicly available.CommentsClose CommentsPermalink





(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section $1,000,000 for each of the fiscal years 2011 and 2012, and such sums as are necessary for each of the fiscal years 2013 through 2015.CommentsClose CommentsPermalink

SEC. 302. INTERDISCIPLINARY TRAINING OF MEDICAL STUDENTS, RESIDENTS, AND STUDENT MIDWIVES IN ACADEMIC HEALTH 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--CommentsClose CommentsPermalink





(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;’;CommentsClose CommentsPermalink





(2) in paragraph (7), by striking the period at the end and inserting ‘; or’; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

SEC. 303. LOAN REPAYMENTS FOR MATERNAL CARE PROFESSIONALS.

(a) Purpose- It is the purpose of this section to alleviate critical shortages of maternal care professionals.CommentsClose CommentsPermalink





(b) Loan Repayments- The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall establish a program of entering into contracts with eligible individuals under which--CommentsClose CommentsPermalink





(1) the individual agrees to serve full-time--CommentsClose CommentsPermalink





(A) as a physician in the field of obstetrics and gynecology; as a certified nurse midwife, certified midwife or certified professional midwife; or as a family practice physician who agrees to practice full-scope maternity care; andCommentsClose CommentsPermalink





(B) in an area that is either a health professional shortage area (as designated under section 332 of the Public Health Service Act) or a maternity care health professional shortage area (as designated under subsection (k) of such section, as added by section 201 of this Act); andCommentsClose CommentsPermalink





(2) the Secretary agrees to pay, for each year of such full-time service, not more than $50,000 of the principal and interest of the undergraduate or graduate educational loans of the individual.CommentsClose CommentsPermalink





(c) Service Requirement- A contract entered into under this section shall allow the individual receiving the loan repayment to satisfy the service requirement described in subsection (a)(1) through employment in a solo or group practice, a clinic, a public or private nonprofit hospital, a freestanding birth center, or any other appropriate health care entity.CommentsClose CommentsPermalink





(d) Application of Certain Provisions- The provisions of subpart III of part D of title III of the Public Health Service Act shall, except as inconsistent with this section, apply to the program established in subsection (a) in the same manner and to the same extent as such provisions apply to the National Health Service Corps Scholarship Program established in such subpart.CommentsClose CommentsPermalink





(e) Definition- In this section, the term ‘eligible individual’ means--CommentsClose CommentsPermalink





(1) a physician in the field of obstetrics and gynecology; orCommentsClose CommentsPermalink





(2) a certified nurse-midwife or certified midwife;CommentsClose CommentsPermalink





(3) a family practice physician who practices full scope maternity care; orCommentsClose CommentsPermalink





(4) a certified professional midwife who has graduated from an accredited midwifery education program.CommentsClose CommentsPermalink

SEC. 304. 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--CommentsClose CommentsPermalink





(1) for fiscal year 2011, planning grants described in subsection (b); andCommentsClose CommentsPermalink





(2) for the subsequent 4-year period, implementation grants described in subsection (c).CommentsClose CommentsPermalink





(b) Planning Grants-CommentsClose CommentsPermalink





(1) IN GENERAL- Planning grants described in this subsection are grants for the following purposes:CommentsClose CommentsPermalink





(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:CommentsClose CommentsPermalink





(i) Pipeline availability with respect to students at the high school and college or university levels considering and working toward entrance in the profession.CommentsClose CommentsPermalink





(ii) Entrance into the training program for the profession.CommentsClose CommentsPermalink





(iii) Graduation from such training program.CommentsClose CommentsPermalink





(iv) Entrance into practice.CommentsClose CommentsPermalink





(v) Retention in practice for more than a 5-year period.CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(3) AMOUNT- Each grant awarded under this subsection shall be for an amount not to exceed $300,000.CommentsClose CommentsPermalink





(4) REPORT- Each recipient of a grant under this subsection shall submit to the Secretary of Health and Human Services a report containing--CommentsClose CommentsPermalink





(A) information on the extent and distribution of workforce disparities identified through the grant; andCommentsClose CommentsPermalink





(B) reasonable objectives and strategies developed to address such disparities within a 5-, 10-, and 25-year period.CommentsClose CommentsPermalink





(c) Implementation Grants-CommentsClose CommentsPermalink





(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).CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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, women’s health nurse practitioners, obstetrician-gynecologist physician assistants, or certified professional midwives.CommentsClose CommentsPermalink





(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section $2,000,000 for fiscal year 2011 and $3,000,000 for each of the fiscal years 2012 through 2015.CommentsClose CommentsPermalink