What changed between these versions
A complete substitute amendment. v2 fundamentally restructures the approach to improving rural obstetric emergency care by integrating new provisions into existing sections of the Public Health Service Act (PHSA) rather than creating new, standalone programs as in v1. This includes shifting proposed training and grant programs into existing PHSA sections 330A-2 and 330O, and expanding telehealth provisions in sections 330I and 330N.
Overview
Extensive changes throughout the bill, constituting a complete substitute amendment. · v2 fundamentally restructures the legislative approach, integrating the goals of v1 into existing statutory frameworks and expanding the scope of some existing programs to include maternal health.
v2 is a complete substitute amendment that re-envisions the legislative strategy for improving rural obstetric emergency care. Instead of establishing new grant programs and a teleconsultation pilot under new sections of the Public Health Service Act (PHSA) as proposed in v1, v2 integrates these objectives by amending and expanding several existing PHSA sections, specifically 330A-2, 330O, 330I, and 330N. This shift consolidates the proposed initiatives within established federal health programs, while also extending authorizations for telehealth and health outcomes programs.
Major additions
Adds a new paragraph (7) to PHSA Section 330A-2(b) requiring the development of obstetric readiness programs in rural areas without specialty maternity care or dedicated obstetric units, providing technical assistance for stabilizing prenatal, labor, birthing, and postpartum care during obstetric emergencies.
This addition formalizes the creation of specific readiness programs, providing a structured approach to support rural facilities in managing obstetric emergencies, which was a core goal of v1's new grant program.
Adds a new subsection (e) to PHSA Section 330A-2, mandating the Secretary to award a total of not less than $2,000,000 per fiscal year in grants or cooperative agreements for activities described in paragraphs (3), (4), or (7) of subsection (b), subject to the availability of appropriations exceeding the amount appropriated for fiscal year 2026.
This creates a dedicated funding stream for rural obstetric emergency training and readiness programs, ensuring financial support for these critical initiatives. It provides a specific allocation for activities that were broadly funded under a new grant program in v1.
Adds a new reporting requirement to PHSA Section 330A-2(d) for a study that maps maternity ward closures and regional patterns of patient transport and examines models for regional partnerships for rural obstetric care.
This integrates the study on rural obstetric units, which was a standalone section in v1, into an existing reporting framework, ensuring its execution and regular updates.
Adds a new subparagraph (D) to PHSA Section 330O(a)(1) to include evidence-based best practices for health care professionals in rural health care settings without specialty maternity care or dedicated obstetric units to provide stabilizing prenatal, labor, birthing, and postpartum care services during obstetric emergencies.
This explicitly broadens the scope of PHSA Section 330O to include best practices for rural non-specialty settings, directly addressing a key objective of v1's proposed training program.
Amends PHSA Section 330I(h)(1)(B) to explicitly include 'prenatal care, labor care, birthing care, or postpartum care' in the list of services for which telehealth networks can be developed.
This broadens the scope of existing telehealth grant programs to specifically encompass maternal health care, providing a pathway for funding maternal teleconsultation services that were previously proposed as a new pilot program in v1.
Deletions
V1 added a new paragraph (a)(5) to Section 330O for developing an evidence-based program to train practitioners in rural health care facilities without dedicated obstetric units for emergency obstetric services. It also added a new subsection (c) detailing the training program's requirements and authorized $5,000,000 for FY2026-2028 for these grants.
The specific new training program and its dedicated subsection and authorization in v1 were removed. While the intent of training remains, it is now integrated differently into existing PHSA sections, rather than as a distinct new program under 330O.
V1 created an entirely new section, 330A-3, titled 'Program of Support for Obstetric Services.' This section authorized grants for integrating obstetric readiness training, building workforce capacity, and purchasing equipment for obstetric emergencies in rural settings. It detailed eligible entities, uses of funds (including equipment, protocols, personnel, training opportunities), definitions, and authorized $15,000,000 for FY2026-2029.
The complete removal of this new section means that the specific grant program for equipment, workforce capacity, and readiness training as envisioned in v1 no longer exists as a standalone program. Its objectives are now distributed and integrated into modifications of existing PHSA sections.
V1 created an entirely new section, 330A-4, titled 'Pilot Program for Teleconsultation.' This section authorized grants for States, political subdivisions, and Indian Tribes/organizations to support urgent maternal health care in rural facilities without dedicated obstetric units through telehealth access programs. It detailed program requirements, reporting, and authorized $5,000,000 for FY2026-2029.
The removal of this new pilot program means that the specific teleconsultation grant program as a distinct initiative is eliminated. While telehealth for maternal care is addressed in v2, it is through modifications to existing telehealth programs rather than a new, dedicated pilot.
V1 included a standalone section directing the Secretary of HHS to conduct a study that maps maternity ward closures and regional patterns of patient transport and examines models for regional partnerships for rural obstetric care, and to submit a report within 3 years.
This standalone directive for a study is removed. However, the study itself is re-introduced as a reporting requirement within an existing PHSA section (330A-2(d)(3)) in v2, changing its placement and integration into broader reporting.
Modifications
While both versions aim to improve training, v2's approach integrates these efforts into the broader scope of existing 330O activities, potentially leveraging existing infrastructure. The extended authorization provides longer-term funding for the program. Rural health care facilities without dedicated obstetric units will still benefit from enhanced training and best practices, but through a different statutory mechanism.
Before
V1 amended PHSA Section 330O to add a new paragraph (a)(5) for developing an evidence-based program to train practitioners in rural health care facilities without dedicated obstetric units for emergency obstetric services. It also added a new subsection (c) detailing the training program's requirements, including consultation with medical societies and regional partnerships, and authorized $5,000,000 for the period of fiscal years 2026 through 2028 for grants under (a)(5).
After
V2 amends PHSA Section 330O by modifying existing paragraph (a)(1) to include 'and training' in best practices and adding a new subparagraph (D) for evidence-based best practices for rural non-specialty settings in stabilizing prenatal, labor, birthing, and postpartum care during obstetric emergencies. It also modifies paragraph (a)(3) to include rural health care settings without dedicated obstetric units. The authorization in subsection (d) is extended to include ', and $17,300,000 for each of fiscal years 2028 through 2032'.
This modification directs existing maternal health care collaboration and training programs under 330A-2 to specifically address obstetric emergencies and the full spectrum of maternal care, including telehealth, in rural settings. This ensures that the objectives of v1's proposed new programs are integrated into an existing, broader framework.
Before
V1 of the bill did not propose any changes to PHSA Section 330A-2. The original PHSA Section 330A-2(b)(3) focused on developing a model for maternal health care collaboration to improve access to care, and (b)(4) focused on providing training for professionals in areas described in subsection (a).
After
V2 amends PHSA Section 330A-2(b)(3) to specifically include stabilizing prenatal care, labor care, birthing, and postpartum care services during obstetric emergencies, and explicitly mentions the use of telehealth. It amends (b)(4) to specify training for professionals in areas without specialty maternity care or dedicated obstetric units in stabilizing prenatal, labor, birthing, and postpartum care during obstetric emergencies.
This ensures more frequent and ongoing oversight of the activities under 330A-2 and integrates the rural obstetric unit study into this existing reporting mechanism, providing regular updates on critical issues affecting rural maternal care.
Before
V1 of the bill did not propose any changes to PHSA Section 330A-2. The original PHSA Section 330A-2(d) required a report by 2026 on activities under subsection (b).
After
V2 amends PHSA Section 330A-2(d) by changing the reporting frequency from '2026' to '2028, and every 2 years thereafter,' and by adding a new reporting requirement for a study on maternity ward closures and regional patterns of patient transport.
This provides significant, extended funding for the activities under 330A-2, including the newly expanded maternal health and obstetric emergency readiness programs, ensuring long-term support for these initiatives.
Before
V1 of the bill did not propose any changes to PHSA Section 330A-2. The original PHSA Section 330A-2(e) (redesignated as (f) in v2) contained an authorization of appropriations.
After
V2 amends PHSA Section 330A-2(f) (formerly (e)) by inserting ', and $15,000,000 for each of fiscal years 2028 through 2032' before the period at the end.
This provides continued funding for existing telehealth programs, which are now explicitly broadened to include maternal health services, ensuring their long-term operation and ability to support rural maternal care.
Before
V1 of the bill did not propose any changes to PHSA Section 330I. The original PHSA Section 330I(q) authorized appropriations for fiscal years 2021 through 2025.
After
V2 amends PHSA Section 330I(q) by striking '2021 through 2025' and inserting '2027 through 2031'.
This provides continued funding for the ECHO program, which supports health outcomes through tele-mentoring, allowing it to continue its work, potentially including new maternal health applications.
Before
V1 of the bill did not propose any changes to PHSA Section 330N. The original PHSA Section 330N(k) authorized appropriations for fiscal years 2022 through 2026.
After
V2 amends PHSA Section 330N(k) by striking '2022 through 2026' and inserting '2027 through 2031'.
Scope
Complete substitute — Changes are scattered throughout the Public Health Service Act, affecting multiple existing sections (330A-2, 330O, 330I, 330N) rather than creating new, isolated programs. — While the overarching policy goal of improving rural obstetric emergency care remains consistent, v2 represents a meaningful change in the legislative strategy and implementation mechanism, shifting from creating new programs to expanding and adapting existing ones. — The changes in v2 directly interact with and expand the scope of several existing Public Health Service Act provisions, integrating maternal health care objectives into broader telehealth and health workforce development programs.
Impact analysis
Rural health care facilities without dedicated obstetric units and their practitioners
Procedural change and continued support. The mechanisms for receiving support are different, but the overall intent to provide training and resources for obstetric emergencies in rural settings is maintained and reinforced through different statutory avenues.
V1 proposed a new, dedicated training program (PHSA 330O(a)(5) and (c)) and a new grant program for equipment and workforce (PHSA 330A-3). V2 integrates these objectives by modifying existing PHSA sections 330A-2 and 330O, adding specific requirements for obstetric readiness programs, training, and best practices within these existing frameworks, along with a dedicated funding allocation under 330A-2.
States, political subdivisions, Indian Tribes, and Tribal organizations seeking to establish or improve maternal health care telehealth access programs
Procedural change. The direct funding mechanism for a dedicated maternal teleconsultation pilot is removed, but the opportunity to develop and fund maternal telehealth services is incorporated into existing, larger telehealth infrastructure programs, potentially offering broader integration.
V1 proposed a new, dedicated pilot program for teleconsultation (PHSA 330A-4). V2 removes this standalone pilot program. Instead, it amends the existing PHSA Section 330I (Telehealth Network; Telehealth Resource Centers Grant Program) to explicitly include prenatal, labor, birthing, and postpartum care services in the scope of telehealth networks, and extends its authorization.
Programs funded under PHSA Sections 330I (Telehealth Network) and 330N (Expanding Capacity for Health Outcomes)
Gain. These programs receive extended authorization for appropriations, ensuring their continued operation and funding for a longer period.
V1 did not address these sections. V2 extends the authorization of appropriations for both sections, from '2021 through 2025' to '2027 through 2031' for 330I, and from '2022 through 2026' to '2027 through 2031' for 330N.