H.R.2141 - Maximizing Optimal Maternity Services for the 21st Century
To promote optimal maternity outcomes by making evidence-based maternity care a national priority, and for other purposes.
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Ms. ROYBAL-ALLARD 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
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
TITLE I--HHS FOCUS ON THE PROMOTION OF OPTIMAL MATERNITY CARE
TITLE II--RESEARCH AND DATA COLLECTION ON MATERNITY CARE
TITLE III--ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, AND ETHNICALLY DIVERSE INTERDISCIPLINARY MATERNITY WORKFORCE
SEC. 2. FINDINGS.
(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: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) 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.CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(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:CommentsClose CommentsPermalink
(A) The national rate of pre-term birth increased by 36 percent in the quarter-century from 1981 to 2006. Despite a very modest reduction in pre-term births between 2006 and 2008, rates remain 31 percent higher than in 1981.CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(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:CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(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 2008, nearly one in four were childbearing women and newborns.CommentsClose CommentsPermalink
(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:CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(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--CommentsClose CommentsPermalink
(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.CommentsClose CommentsPermalink
(8) Two non-invasive maternity practices, smoking cessation programs in 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. Other non-invasive practices which are underused in current practice and may be associated with improved outcomes include group model prenatal care, continuous labor support, and non-supine positions for birth.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
SEC. 101. ADDITIONAL FOCUS AREA FOR THE OFFICE ON WOMEN’S HEALTH.
‘(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
‘(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
SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF OPTIMAL MATERNITY OUTCOMES.
‘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
‘(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 care professional associations and organizations, reflecting racially, ethnically, demographically, and geographically diverse communities.CommentsClose CommentsPermalink
‘(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;CommentsClose CommentsPermalink
‘(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 infant mortality, prematurity, and low birth weight;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
‘(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
‘(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 2012 through 2016.’.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.
‘(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
‘(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;CommentsClose CommentsPermalink
‘(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;CommentsClose CommentsPermalink
‘(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;CommentsClose 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.
(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; andCommentsClose 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
(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
(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 (
(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
(f) Authorization of Appropriations- There is authorized to be appropriated $2,500,000 for each of the fiscal years 2012 through 2014 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
SEC. 201. MATERNITY CARE HEALTH PROFESSIONAL SHORTAGE AREAS.
‘(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
‘(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
‘(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
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
(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;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
(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
(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
SEC. 203. EXPANDING MODELS TO BE TESTED BY CENTER FOR MEDICARE AND MEDICAID INNOVATION TO INCLUDE MATERNITY CARE MODELS.
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 that takes into account the core competencies for basic midwifery practice as developed by the American College of Nurse Midwives, and the educational objectives in obstetrics and gynecology as determined by the Council on Resident Education in Obstetrics and Gynecology;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
(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
(e) Authorization of Appropriations- There is authorized to be appropriated to carry out this section $1,000,000 for each of the fiscal years 2012 and 2013, and such sums as are necessary for each of the fiscal years 2014 through 2016.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 (
(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
‘(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
SEC. 303. LOAN REPAYMENTS FOR MATERNAL CARE PROFESSIONALS.
(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
(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
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
(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
(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
(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 2012 and $3,000,000 for each of the fiscal years 2013 through 2016.CommentsClose CommentsPermalink