S.Amdt. 4740

SA 4740. Ms. SMITH (for herself and Ms. Murkowski) submitted an
amendment intended to be proposed to amendment SA 3867 submitted by Mr.
Reed and intended to be proposed to the bill H.R. 4350, to authorize
appropriations for fiscal year 2022 for military activities of the
Department of Defense, for military construction, and for defense
activities of the Department of Energy, to prescribe military personnel
strengths for such fiscal year, and for other purposes; which was
ordered to lie on the table; as follows:

At the end of title X, add the following:

Subtitle H--Rural Maternal and Obstetric Modernization of Services

SEC. 1071. IMPROVING RURAL MATERNAL AND OBSTETRIC CARE DATA.

(a) Maternal Mortality and Morbidity Activities.--Section
301(e) of the Public Health Service Act (42 U.S.C. 241) is
amended by inserting ``, preventable maternal mortality and
severe maternal morbidity,'' after ``delivery''.
(b) Office of Women's Health.--Section 310A(b)(1) of the
Public Health Service Act (42 U.S.C. 242s(b)(1)) is amended
by striking ``and sociocultural contexts,'' and inserting
``sociocultural (including among American Indians, Native
Hawaiians, and Alaska Natives), and geographical contexts,''.
(c) Safe Motherhood.--Section 317K of the Public Health
Service Act (42 U.S.C. 247b-12) is amended--
(1) in subsection (a)(2)(A), by inserting ``, including
improving disaggregation of data (in a manner consistent with
applicable State and Federal privacy laws)'' before the
period; and
(2) in subsection (b)(2)--
(A) in subparagraph (L), by striking ``and'' at the end;
(B) by redesignating subparagraph (M) as subparagraph (N);
and
(C) by inserting after subparagraph (L) the following:
``(M) an examination of the relationship between maternal
health and obstetric services in rural areas and outcomes in
delivery and postpartum care; and''.
(d) Office of Research on Women's Health.--Section
486(d)(4)(A)(iv) of the Public Health Service Act (42 U.S.C.
287d(d)(4)(A)(iv)) is amended by inserting ``, including
preventable maternal mortality and severe maternal
morbidity'' before the semicolon.

SEC. 1072. RURAL OBSTETRIC NETWORK GRANTS.

The Public Health Service Act is amended by inserting after
section 330A-1 of such Act (42 U.S.C. 254c-1a) the following:

``SEC. 330A-2. RURAL OBSTETRIC NETWORK GRANTS.

``(a) Program Established.--The Secretary shall award
grants or cooperative agreements to eligible entities to
establish collaborative improvement and innovation networks
(referred to in this section as `rural obstetric networks')
to improve maternal and infant health outcomes and reduce
preventable maternal mortality and severe maternal morbidity
by improving maternity care and access to care in rural
areas, frontier areas, maternity care health professional
target areas, or jurisdictions of Indian Tribes and Tribal
organizations.
``(b) Use of Funds.--Grants or cooperative agreements
awarded pursuant to this section shall be used for the
establishment or continuation of collaborative improvement
and innovation networks to improve maternal and infant health
outcomes and reduce preventable maternal mortality and severe
maternal morbidity by improving prenatal care, labor care,
birthing, and postpartum care services in rural areas. Rural
obstetric networks established in accordance with this
section may--
``(1) develop a network to improve coordination and
increase access to maternal health care and assist pregnant
women in the areas described in subsection (a) with accessing
and utilizing prenatal care, labor care, birthing, and
postpartum care services to improve outcomes in birth and
maternal mortality and morbidity;
``(2) identify and implement evidence-based and sustainable
delivery models for providing prenatal care, labor care,
birthing, and postpartum care services, including home
visiting programs and culturally appropriate care models that
reduce health disparities;
``(3) develop a model for maternal health care
collaboration between health care settings to improve access
to care in areas described in subsection (a), which may
include the use of telehealth;

[[Page S8358]]

``(4) provide training for professionals in health care
settings that do not have specialty maternity care;
``(5) collaborate with academic institutions that can
provide regional expertise and help identify barriers to
providing maternal health care, including strategies for
addressing such barriers; and
``(6) assess and address disparities in infant and maternal
health outcomes, including among racial and ethnic minority
populations and underserved populations in such areas
described in subsection (a).
``(c) Definitions.--In this section:
``(1) Eligible entities.--The term `eligible entities'
means entities providing prenatal care, labor care, birthing,
and postpartum care services in rural areas, frontier areas,
or medically underserved areas, or to medically underserved
populations or Indian Tribes or Tribal organizations.
``(2) Frontier area.--The term `frontier area' means a
frontier county, as defined in section
1886(d)(3)(E)(iii)(III) of the Social Security Act.
``(3) Indian tribes; tribal organization.--The terms
`Indian Tribe' and `Tribal organization' have the meanings
given the terms `Indian tribe' and `tribal organization' in
section 4 of the Indian Self-Determination and Education
Assistance Act.
``(4) Maternity care health professional target area.--The
term `maternity care health professional target area' has the
meaning described in section 332(k)(2).
``(d) Report to Congress.--Not later than September 30,
2025, the Secretary shall submit to Congress a report on
activities supported by grants awarded under this section,
including--
``(1) a description of activities conducted pursuant to
paragraphs (1) through (6) of subsection (b); and
``(2) an analysis of the effects of rural obstetric
networks on improving maternal and infant health outcomes.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$3,000,000 for each of fiscal years 2022 through 2026.''.

SEC. 1073. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS
GRANT PROGRAMS.

Section 330I of the Public Health Service Act (42 U.S.C.
254c-14) is amended--
(1) in subsection (f)(3), by adding at the end the
following:
``(M) Providers of prenatal, labor care, birthing, and
postpartum care services, including hospitals that operate
obstetric care units.''; and
(2) in subsection (h)(1)(B), by striking ``or prenatal care
for high-risk pregnancies'' and inserting ``prenatal care,
labor care, birthing care, or postpartum care''.

SEC. 1074. RURAL MATERNAL AND OBSTETRIC CARE TRAINING
DEMONSTRATION.

Subpart 1 of part E of title VII of the Public Health
Service Act (42 U.S.C. 294n et seq.) is amended by adding at
the end the following:

``SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAINING
DEMONSTRATION.

``(a) In General.--The Secretary shall award grants to
accredited schools of allopathic medicine, osteopathic
medicine, and nursing, and other appropriate health
professional training programs, to establish a training
demonstration program to support--
``(1) training for physicians, medical residents, fellows,
nurse practitioners, physician assistants, nurses, certified
nurse midwives, relevant home visiting workforce
professionals and paraprofessionals, or other professionals
who meet relevant State training and licensing requirements,
as applicable, to reduce preventable maternal mortality and
severe maternal morbidity by improving prenatal care, labor
care, birthing, and postpartum care in rural community-based
settings; and
``(2) developing recommendations for such training
programs.
``(b) Application.--To be eligible to receive a grant under
subsection (a), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
``(c) Activities.--
``(1) Training for health care professionals.-- A recipient
of a grant under subsection (a)--
``(A) shall use the grant funds to plan, develop, and
operate a training program to provide prenatal care, labor
care, birthing, and postpartum care in rural areas; and
``(B) may use the grant funds to provide additional support
for the administration of the program or to meet the costs of
projects to establish, maintain, or improve faculty
development, or departments, divisions, or other units
necessary to implement such training.
``(2) Training program requirements.--The recipient of a
grant under subsection (a) shall ensure that training
programs carried out under the grant are evidence-based and
address improving prenatal care, labor care, birthing, and
postpartum care in rural areas, and such programs may include
training on topics such as--
``(A) maternal mental health, including perinatal
depression and anxiety;
``(B) substance use disorders;
``(C) social determinants of health that affect individuals
living in rural areas; and
``(D) improving the provision of prenatal care, labor care,
birthing, and postpartum care for racial and ethnic minority
populations, including with respect to perceptions and biases
that may affect the approach to, and provision of, care.
``(d) Evaluation and Report.--
``(1) Evaluation.--
``(A) In general.--The Secretary shall evaluate the
outcomes of the demonstration program under this section.
``(B) Data submission.--Recipients of a grant under
subsection (a) shall submit to the Secretary performance
metrics and other related data in order to evaluate the
program for the report described in paragraph (2).
``(2) Report to congress.--Not later than January 1, 2025,
the Secretary shall submit to Congress a report that
includes--
``(A) an analysis of the effects of the demonstration
program under this section on the quality, quantity, and
distribution of maternal health care services, including
prenatal care, labor care, birthing, and postpartum care
services, and the demographics of the recipients of those
services;
``(B) an analysis of maternal and infant health outcomes
(including quality of care, morbidity, and mortality) before
and after implementation of the program in the communities
served by entities participating in the demonstration; and
``(C) recommendations on whether the demonstration program
should be continued.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$5,000,000 for each of fiscal years 2022 through 2026.''.
______