[House Report 114-802]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-802
======================================================================
IMPROVING ACCESS TO MATERNITY CARE ACT
_______
November 14, 2016.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 1209]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1209) to amend the Public Health Service Act to
provide for the designation of maternity care health
professional shortage areas, having considered the same, report
favorably thereon with amendments and recommend that the bill
as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 3
Statement of General Performance Goals and Objectives............ 3
New Budget Authority, Entitlement Authority, and Tax Expenditures 3
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 3
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 4
Duplication of Federal Programs.................................. 4
Disclosure of Directed Rule Makings.............................. 4
Advisory Committee Statement..................................... 4
Applicability to Legislative Branch.............................. 4
Section-by-Section Analysis of the Legislation................... 4
Changes in Existing Law Made by the Bill, as Reported............ 5
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Access to Maternity Care
Act''.
SEC. 2. MATERNITY CARE HEALTH PROFESSIONAL TARGET AREAS.
Section 332 of the Public Health Service Act (42 U.S.C. 254e) is
amended by adding at the end the following new subsection:
``(k)(1) The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall identify, based on
the data collected under paragraph (3), maternity care health
professional target areas that satisfy the criteria described in
paragraph (2) for purposes of, in connection with receipt of assistance
under this title, assigning to such identified areas maternity care
health professionals who, without application of this subsection, would
otherwise be eligible for such assistance. The Secretary shall
distribute maternity care health professionals within health
professional shortage areas using the maternity care health
professional target areas so identified.
``(2) For purposes of paragraph (1), the Secretary shall establish
criteria for maternity care health professional target areas that
identify geographic areas within health professional shortage areas
that have a shortage of maternity care health professionals.
``(3) For purposes of this subsection, the Secretary shall collect
and publish in the Federal Register data comparing the availability and
need of maternity care health services in health professional shortage
areas and in areas within such health professional shortage areas.
``(4) In carrying out paragraph (1), the Secretary shall seek input
from relevant provider organizations, including medical societies,
organizations representing medical facilities, and other organizations
with expertise in maternity care.
``(5) For purposes of this subsection, the term `full scope maternity
care health services' includes during labor care, birthing, prenatal
care, and postpartum care.
``(6) Nothing in this subsection shall be construed as--
``(A) requiring the identification of a maternity care health
professional target area in an area not otherwise already
designated as a health professional shortage area; or
``(B) affecting the types of health professionals, without
application of this subsection, otherwise eligible for
assistance, including a loan repayment or scholarship, pursuant
to the application of this section.''.
Amend the title so as to read:
A bill to amend the Public Health Service Act to distribute
maternity care health professionals to health professional
shortage areas identified as in need of maternity care health
services.
Purpose and Summary
H.R. 1209 was introduced on March 3, 2015 by Rep. Michael
Burgess (R-TX), Rep. Lois Capps (D-CA), and Rep. Tammy
Duckworth (D-IL). H.R. 1209 improves data collection to better
place maternity health care professionals in existing primary
care health professional shortage areas (HPSAs).
Background and Need for Legislation
Currently, maternity health care professionals may
participate in the National Health Service Corps (NHSC) Loan
Repayment Program in which eligible licensed health care
providers may earn up to $50,000 toward student loans in
exchange for a two-year commitment at a NHSC approved site in a
HPSA. They also can participate in the NHSC Scholarship Program
while in medical school. The NHSC Scholarship Program pays
tuition, fees, other educational costs, and provides a living
stipend in return for at least a two-year commitment at NHSC
approved site in a HPSA. Maternity health care professionals
participate in the NHSC under the primary care designation.
This legislation is needed to improve data collection under the
existing HPSA to better place maternity health care
professionals in areas with the greatest need for their
services.
Hearings
The Subcommittee on Health held a hearing on H.R. 1209 on
December 9, 2015. The hearing was entitled ``Examining
Legislation to Improve Health Care and Treatment'' and
witnesses included the following:
Chad Asplund, Director, Athletic Medicine
and Head Team Physician, Georgia Southern University;
Ovidio Bermudez, Chief Clinical Officer and
Medical Director of Child and Adolescent Services,
Eating Recovery Center;
Ginger Breedlove, President, American
College of Nurse Midwives;
Anthony Gregg, Professor and Chief, Division
of Maternal-Fetal Medicine, University of Florida
Department of Obstetrics and Gynecology;
Jonathan Reiner, Director, Cardiac
Catheterization Laboratory, George Washington
University Hospital;
Deborah Trautman, President and CEO,
American Association of Colleges of Nursing.
Committee Consideration
On December 9, 2015, the Subcommittee on Health met in open
markup session and forwarded H.R. 1209 to the full Committee,
without amendment, by a voice vote.
On September 20 and 21, 2016, the full Committee on Energy
and Commerce met in open markup session and ordered H.R. 1209
reported to the House, as amended, by a voice vote.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 1209 reported.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held a hearing and made
findings that are reflected in this report.
Statement of General Performance Goals and Objectives
This legislation improves data collection for placing
maternity care providers in HPSAs through the NHSC.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
1209 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI
of the Rules of the House of Representatives, the Committee
finds that H.R. 1209 contains no earmarks, limited tax
benefits, or limited tariff benefits.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974. At the
time this report was filed, the estimate was not available.
Congressional Budget Office Estimate
At the time this report was filed, the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of 1974
was not available.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Duplication of Federal Programs
No provision of H.R. 1209 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 1209
specifically directs to be completed no rule making within the
meaning of 5 U.S.C. 551.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 provides that the Act may be cited as the
``Improving Access to Maternity Care Act''.
Section 2. Maternity care health professional target areas
Section 2 directs the Secretary of Health and Human
Services, acting through the Administrator of the Health
Resources and Services Administration, to identify maternity
health professional target areas. These are to be geographic
areas within HPSAs that have a shortage of maternity health
care professionals.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italic and existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part D--Primary Health Care
* * * * * * *
Subpart II--National Health Service Corps Program
* * * * * * *
designation of health professional shortage areas
Sec. 332. (a)(1) For purposes of this subpart the term
``health professional shortage area'' means (A) an area in an
urban or rural area (which need not conform to the geographic
boundaries of a political subdivision and which is a rational
area for the delivery of health services) which the Secretary
determines has a health manpower shortage, (B) a population
group which the Secretary determines has such a shortage, or
(C) a public or nonprofit private medical facility or other
public facility which the Secretary determines has such a
shortage. All Federally qualified health centers and rural
health clinics, as defined in section 1861(aa) of the Social
Security Act (42 U.S.C. 1395x(aa)), that meet the requirements
of section 334 shall be automatically designated as having such
a shortage. The Secretary shall not remove an area from the
areas determined to be health professional shortage areas under
subparagraph (A) of the preceding sentence until the Secretary
has afforded interested persons and groups in such area an
opportunity to provide data and information in support of the
designation as a health professional shortage area or a
population group described in subparagraph (B) of such sentence
or a facility described in subparagraph (C) of such sentence,
and has made a determination on the basis of the data and
information submitted by such persons and groups and other data
and information available to the Secretary.
(2) For purposes of this subsection, the term ``medical
facility'' means a facility for the delivery of health services
and includes--
(A) a hospital, State mental hospital, public health
center, outpatient medical facility, rehabilitation
facility, facility for long-term care, community mental
health center, migrant health center, facility operated
by a city or county health department, and community
health center and which is not reasonably accessible to
an adequately served area;
(B) such a facility of a State correctional
institution or of the Indian Health Service, and a
health program or facility operated by a tribe or
tribal organization under the Indian Self-Determination
Act;
(C) such a facility used in connection with the
delivery of health services under section 321 (relating
to hospitals), 322 (relating to care and treatment of
persons under quarantine and others), 323 (relating to
care and treatment of Federal prisoners), 324 (relating
to examination and treatment of certain Federal
employees), 325 (relating to examination of aliens),
326 (relating to services to certain Federal
employees), 320 (relating to services for persons with
Hansen's disease), or 330(h) (relating to the provision
of health services to homeless individuals); and
(D) a Federal medical facility.
(3) Homeless individuals (as defined in section 330(h)(5)),
seasonal agricultural workers (as defined in section 330(g)(3))
and migratory agricultural workers (as so defined)), and
residents of public housing (as defined in section 3(b)(1) of
the United States Housing Act of 1937 (42 U.S.C. 1437a(b)(1)))
may be population groups under paragraph (1).
(b) The Secretary shall establish by regulation criteria for
the designation of areas, population groups, medical
facilities, and other public facilities, in the States, as
health professional shortage areas. In establishing such
criteria, the Secretary shall take into consideration the
following:
(1) The ratio of available health manpower to the
number of individuals in an area or population group,
or served by a medical facility or other public
facility under consideration for designation.
(2) Indicators of a need, notwithstanding the supply
of health manpower, for health services for the
individuals in an area or population group or served by
a medical facility or other public facility under
consideration for designation.
(3) The percentage of physicians serving an area,
population group, medical facility, or other public
facility under consideration for designation who are
employed by hospitals and who are graduates of foreign
medical schools.
(c) In determining whether to make a designation, the
Secretary shall take into consideration the following:
(1) The recommendations of the Governor of each State
in which the area, population group, medical facility,
or other public facility under consideration for
designation is in whole or part located.
(2) The extent to which individuals who are (A)
residents of the area, members of the population group,
or patients in the medical facility or other public
facility under consideration for designation, and (B)
entitled to have payment made for medical services
under title XVIII, XIX, or XXI of the Social Security
Act, cannot obtain such services because of suspension
of physicians from the programs under such titles.
(d)(1) In accordance with the criteria established under
subsection (b) and the considerations listed in subsection (c),
the Secretary shall designate health professional shortage
areas in the States, publish a descriptive list of the areas,
population groups, medical facilities, and other public
facilities so designated, and at least annually review and, as
necessary, revise such designations.
(2) For purposes of paragraph (1), a complete descriptive
list shall be published in the Federal Register not later than
July 1 of 1991 and each subsequent year.
(e)(1) Prior to the designation of a public facility,
including a Federal medical facility, as a health professional
shortage area, the Secretary shall give written notice of such
proposed designation to the chief administrative officer of
such facility and request comments within 30 days with respect
to such designation.
(2) Prior to the designation of a health professional
shortage area under this section, the Secretary shall, to the
extent practicable, give written notice of the proposed
designation of such area to appropriate public or private
nonprofit entities which are located or have a demonstrated
interest in such area and request comments from such entities
with respect to the proposed designation of such area.
(f) The Secretary shall give written notice of the
designation of a health professional shortage area, not later
than 60 days from the date of such designation, to--
(1) the Governor of each State in which the area,
population group, medical facility, or other public
facility so designated is in whole or part located; and
(2) appropriate public or nonprofit private entities
which are located or which have a demonstrated interest
in the area so designated.
(g) Any person may recommend to the Secretary the designation
of an area, population group, medical facility, or other public
facility as a health professional shortage area.
(h) The Secretary may conduct such information programs in
areas, among population groups, and in medical facilities and
other public facilities designated under this section as health
professional shortage areas as may be necessary to inform
public and nonprofit private entities which are located or have
a demonstrated interest in such areas of the assistance
available under this title by virtue of the designation of such
areas.
(i) Dissemination.--The Administrator of the Health Resources
and Services Administration shall disseminate information
concerning the designation criteria described in subsection (b)
to--
(1) the Governor of each State;
(2) the representative of any area, population group,
or facility selected by any such Governor to receive
such information;
(3) the representative of any area, population group,
or facility that requests such information; and
(4) the representative of any area, population group,
or facility determined by the Administrator to be
likely to meet the criteria described in subsection
(b).
(j)(1) The Secretary shall submit the report described in
paragraph (2) if the Secretary, acting through the
Administrator of the Health Resources and Services
Administration, issues--
(A) a regulation that revises the definition of a
health professional shortage area for purposes of this
section; or
(B) a regulation that revises the standards
concerning priority of such an area under section 333A.
(2) On issuing a regulation described in paragraph (1), the
Secretary shall prepare and submit to the Committee on Energy
and Commerce of the House of Representatives and the Committee
on Health, Education, Labor, and Pensions of the Senate a
report that describes the regulation.
(3) Each regulation described in paragraph (1) shall take
effect 180 days after the committees described in paragraph (2)
receive a report referred to in such paragraph describing the
regulation.
(k)(1) The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall identify,
based on the data collected under paragraph (3), maternity care
health professional target areas that satisfy the criteria
described in paragraph (2) for purposes of, in connection with
receipt of assistance under this title, assigning to such
identified areas maternity care health professionals who,
without application of this subsection, would otherwise be
eligible for such assistance. The Secretary shall distribute
maternity care health professionals within health professional
shortage areas using the maternity care health professional
target areas so identified.
(2) For purposes of paragraph (1), the Secretary shall
establish criteria for maternity care health professional
target areas that identify geographic areas within health
professional shortage areas that have a shortage of maternity
care health professionals.
(3) For purposes of this subsection, the Secretary shall
collect and publish in the Federal Register data comparing the
availability and need of maternity care health services in
health professional shortage areas and in areas within such
health professional shortage areas.
(4) In carrying out paragraph (1), the Secretary shall seek
input from relevant provider organizations, including medical
societies, organizations representing medical facilities, and
other organizations with expertise in maternity care.
(5) For purposes of this subsection, the term ``full scope
maternity care health services'' includes during labor care,
birthing, prenatal care, and postpartum care.
(6) Nothing in this subsection shall be construed as--
(A) requiring the identification of a maternity care
health professional target area in an area not
otherwise already designated as a health professional
shortage area; or
(B) affecting the types of health professionals,
without application of this subsection, otherwise
eligible for assistance, including a loan repayment or
scholarship, pursuant to the application of this
section.
* * * * * * *
[all]