Supporting Best Practices for Healthy Moms Act
This bill requires the Centers for Medicare & Medicaid Services to publish guidance on ways to reduce maternal mortality and morbidity under Medicaid and the Children's Health Insurance Program (CHIP) and to report on the Medicaid payment methodologies that apply to facility transfers of pregnant women.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4949 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
2d Session
S. 4949
To require the Secretary of Health and Human Services to publish
guidance for States on strategies for maternal care providers
participating in the Medicaid program to reduce maternal mortality and
severe morbidity with respect to individuals receiving medical
assistance under such program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 2, 2020
Mr. Toomey (for himself and Mr. Brown) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To require the Secretary of Health and Human Services to publish
guidance for States on strategies for maternal care providers
participating in the Medicaid program to reduce maternal mortality and
severe morbidity with respect to individuals receiving medical
assistance under such program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Supporting Best Practices for
Healthy Moms Act''.
SEC. 2. DEVELOPING GUIDANCE ON MATERNAL MORTALITY AND SEVERE MORBIDITY
REDUCTION FOR MATERNAL CARE PROVIDERS RECEIVING PAYMENT
UNDER THE MEDICAID PROGRAM.
(a) In General.--Subject to the availability of appropriations, not
later than 36 months after the date of enactment of this Act, the
Secretary of Health and Human Services (referred to in this section as
the ``Secretary'') shall publish on a public website of the Centers for
Medicare & Medicaid Services guidance for States on resources and
strategies for hospitals, freestanding birth centers (as defined in
section 1905(l)(3)(B) of the Social Security Act (42 U.S.C.
1396d(l)(3)(B))), and other maternal care providers as determined by
the Secretary for reducing maternal mortality and severe morbidity in
individuals who are eligible for and receiving medical assistance under
the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et
seq.) or child health assistance under the Children's Health Insurance
Program under title XXI of such Act (42 U.S.C. 1397aa et seq.).
(b) Updates.--The Secretary shall update the guidance and resources
described in subsection (a) at least once every 3 years.
(c) Consultation With Advisory Committee.--
(1) Establishment.--Subject to the availability of
appropriations, not later than 18 months after the date of
enactment of this Act, the Secretary shall establish an
advisory committee to be known as the ``National Advisory
Committee on Reducing Maternal Deaths'' (referred to in this
section as the ``Advisory Committee'').
(2) Duties.--The Advisory Committee shall provide consensus
advice and guidance to the Secretary on the development and
compilation of the guidance described in subsection (a) (and
any updates to such guidance).
(3) Membership.--
(A) In general.--The Secretary, in consultation
with such other heads of agencies, as the Secretary
deems appropriate and in accordance with this
paragraph, shall appoint not more than 41 members to
the Advisory Committee. In appointing such members, the
Secretary shall ensure that--
(i) the total number of members of the
Advisory Committee is an odd number; and
(ii) the total number of voting members who
are not Federal officials does not exceed the
total number of voting Federal members who are
Federal officials.
(B) Required members.--
(i) Federal officials.--The Advisory
Committee shall include as voting members the
following Federal officials, or their
designees:
(I) The Secretary of Health and
Human Services.
(II) The Administrator of the
Centers for Medicare & Medicaid
Services.
(III) The Director of the Centers
for Disease Control and Prevention.
(IV) The Associate Administrator of
the Maternal and Child Health Bureau of
the Health Resources and Services
Administration.
(V) The Director of the Agency for
Healthcare Research and Quality.
(VI) The National Coordinator for
Health Information Technology.
(VII) The Director of the National
Institutes of Health.
(VIII) The Secretary of Veterans
Affairs.
(IX) The Director of the Indian
Health Service.
(X) The Deputy Assistant Secretary
for Minority Health.
(XI) The Administrator of the
Substance Abuse and Mental Health
Services Administration.
(XII) The Deputy Assistant
Secretary for Women's Health.
(XIII) Such other Federal officials
or their designees as the Secretary
determines appropriate.
(ii) Non-federal officials.--
(I) In general.--The Advisory
Committee shall include the following
as voting members:
(aa) At least 1
representative from a
professional organization
representing hospitals and
health systems.
(bb) At least 1
representative from a medical
professional organization
representing primary care
providers.
(cc) At least 1
representative from a medical
professional organization
representing general
obstetrician-gynecologists.
(dd) At least 1
representative from a medical
professional organization
representing certified nurse-
midwives.
(ee) At least 1
representative from a medical
professional organization
representing other maternal
fetal medicine providers.
(ff) At least 1
representative from a medical
professional organization
representing anesthesiologists.
(gg) At least 1
representative from a medical
professional organization
representing emergency medicine
physicians and urgent care
providers.
(hh) At least 1
representative from a medical
professional organization
representing nurses.
(ii) At least 1
representative from a
professional organization
representing community health
workers.
(jj) At least 1
representative from a
professional organization
representing doulas.
(kk) At least 1
representative from State-
affiliated programs or existing
collaboratives with
demonstrated expertise or
success in improving maternal
health.
(ll) At least 1 director of
a State Medicaid agency that
has had demonstrated success in
improving maternal health.
(mm) At least 1
representative from an
accrediting organization for
maternal health quality and
safety standards.
(nn) At least 1
representative from a maternal
patient advocacy organization
with lived experience of severe
maternal morbidity.
(II) Requirements.--Each individual
selected to be a member under this
clause shall--
(aa) have expertise in
maternal health;
(bb) not be a Federal
official; and
(cc) have experience
working with populations that
are at higher risk for maternal
mortality or severe morbidity,
such as populations that
experience racial, ethnic, and
geographic health disparities,
pregnant and postpartum women
experiencing mental health
disorders or other
comorbidities such as substance
use disorders, hypertension,
thyroid disorders, and sickle
cell disease.
(C) Additional members.--
(i) In general.--In addition to the members
required to be appointed under subparagraph
(B), the Secretary may appoint as members to
the Advisory Committee such other individuals
with relevant expertise or experience as the
Secretary shall determine appropriate, which
may include individuals described in clause
(ii).
(ii) Suggested additional members.--The
individuals described in this clause are the
following:
(I) Representatives from State
maternal mortality review committees
and perinatal quality collaboratives.
(II) Medical providers who care for
women and infants during pregnancy and
the postpartum period, such as family
practice physicians, cardiologists,
pulmonology critical care specialists,
endocrinologists, pediatricians, and
neonatologists.
(III) Representatives from State
and local public health departments.
(IV) Subject matter experts in
conducting outreach to women who are
African American or belong to another
minority group.
(V) Directors of State agencies
responsible for administering a State's
maternal and child health services
program under title V of the Social
Security Act (42 U.S.C. 701 et seq.).
(VI) Experts in medical education
or physician training.
(VII) Representatives from Medicaid
managed care organizations.
(4) Applicability of faca.--The Federal Advisory Committee
Act (5 U.S.C. App.) shall apply to the committee established
under this subsection.
(d) Contents.--The guidance described in subsection (a) shall
include, with respect to hospitals, freestanding birth centers, and
other maternal care providers, the following:
(1) Best practices regarding evidence-based screening and
clinician education initiatives relating to screening and
treatment protocols for individuals who are at risk of
experiencing complications related to pregnancy, with an
emphasis on individuals with preconditions directly linked to
pregnancy complications and maternal mortality and severe
morbidity, including--
(A) methods to identify individuals who are at risk
of maternal mortality or severe morbidity, including
risk stratification;
(B) evidence-based risk factors associated with
maternal mortality or severe morbidity and racial,
ethnic, and geographic health disparities;
(C) evidence-based strategies to reduce risk
factors associated with maternal mortality or severe
morbidity through services which may be covered under
the Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) or the Children's
Health Insurance Program under title XXI of such Act
(42 U.S.C. 1397aa et seq.), including activities by
community health workers (as such term is defined in
section 2113 of such Act (42 U.S.C. 1397mm)) that are
funded by a grant awarded under such section;
(D) resources available to such individuals, such
as nutrition assistance and education, home visitation,
mental health and substance use disorder services,
smoking cessation programs, pre-natal care, and other
evidence-based maternal mortality or severe morbidity
reduction programs;
(E) examples of educational materials used by
providers of obstetrics services;
(F) methods for improving community centralized
care, including providing telehealth services or home
visits to increase and facilitate access to and
engagement in prenatal and postpartum care and
collaboration with home health agencies, community
health centers, local public health departments, or
clinics;
(G) guidance on medical record diagnosis codes
linked to maternal mortality and severe morbidity,
including, if applicable, codes related to social risk
factors, and methods for educating clinicians on the
proper use of such codes;
(H) risk appropriate transfer protocols during
pregnancy, childbirth, and the postpartum period; and
(I) any other information related to prevention and
treatment of at-risk individuals determined appropriate
by the Secretary.
(2) Guidance on monitoring programs for individuals who
have been identified as at risk of complications related to
pregnancy.
(3) Best practices for such hospitals, freestanding birth
centers, and providers to make pregnant women aware of the
complications related to pregnancy.
(4) A fact sheet for providing pregnant women who are
receiving care on an outpatient basis with a notice during the
prenatal stage of pregnancy that--
(A) explains the risks associated with pregnancy,
birth, and the postpartum period (including the risks
of hemorrhage, preterm birth, sepsis, eclampsia,
obstructed labor), chronic conditions (including high
blood pressure, diabetes, heart disease, depression,
and obesity) correlated with adverse pregnancy
outcomes, risks associated with advanced maternal age,
and the importance of adhering to a personalized plan
of care;
(B) highlights multimodal and evidence-based
prevention and treatment techniques;
(C) provides for a method (through signature or
otherwise) for such an individual, or a person acting
on such individual's behalf, to acknowledge receipt of
such fact sheet;
(D) is worded in an easily understandable manner
and made available in multiple languages and accessible
formats determined appropriate by the Secretary; and
(E) includes any other information determined
appropriate by the Secretary.
(5) A template for a voluntary clinician checklist that
outlines the minimum responsibilities that clinicians, such as
physicians, certified nurse-midwives, emergency room and urgent
care providers, nurses and others, are expected to meet in
order to promote quality and safety in the provision of
obstetric services.
(6) A template for a voluntary checklist that outlines the
minimum responsibilities that hospital leadership responsible
for direct patient care, such as the institution's president,
chief medical officer, chief nursing officer, or other hospital
leadership that directly report to the president or chief
executive officer of the institution, should meet to promote
hospital-wide initiatives that improve quality and safety in
the provision of obstetric services.
(7) Information on multi-stakeholder quality improvement
initiatives, such as the Alliance for Innovation on Maternal
Health, State perinatal quality improvement initiatives, and
other similar initiatives determined appropriate by the
Secretary, including--
(A) information about such improvement initiatives
and how to join;
(B) information about public maternal data
collection centers;
(C) information about quality metrics used and
outcomes achieved by such improvement initiatives;
(D) information about data sharing techniques used
by such improvement initiatives;
(E) information about data sources used by such
improvement initiatives to identify maternal mortality
and severe morbidity risks;
(F) information about interventions used by such
improvement initiatives to mitigate risks of maternal
mortality and severe morbidity;
(G) information about data collection techniques on
race, ethnicity, geography, age, income, and other
demographic information used by such improvement
initiatives; and
(H) any other information determined appropriate by
the Secretary.
(e) Inclusion of Best Practices.--Not later than 18 months after
the date of the publication of the guidance required under subsection
(a), the Secretary shall update such guidance to include best practices
identified by the Secretary for such hospitals, freestanding birth
centers, and providers to track maternal mortality and severe morbidity
trends by clinicians at such hospitals, freestanding birth centers, and
providers including--
(1) ways to establish scoring systems, which may include
quality triggers and safety and quality metrics to score case
and patient outcome metrics, for such clinicians;
(2) methods to identify, educate, and improve such
clinicians who may have higher rates of maternal mortality or
severe morbidity compared to their regional or State peers
(taking into account differences in patient risk for adverse
outcomes, which may include social risk factors);
(3) methods for using such data and tracking to enhance
research efforts focused on maternal health, while also
improving patient outcomes, clinician education and training,
and coordination of care; and
(4) any other information determined appropriate by the
Secretary.
(f) Cultural Appropriateness.--To the extent practicable, the
Secretary should develop the guidance, best practices, fact sheets,
templates, and other materials that are required under this section in
a trauma-informed, culturally and linguistically appropriate manner.
SEC. 3. REPORT ON PAYMENT METHODOLOGIES FOR TRANSFERRING PREGNANT WOMEN
BETWEEN FACILITIES BEFORE, DURING, AND AFTER CHILDBIRTH.
(a) In General.--Subject to the availability of appropriations, not
later than 36 months after the date of enactment of this Act, the
Secretary of Health and Human Services (referred to in this section as
the ``Secretary'') shall submit to Congress a report on the payment
methodologies under the Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) for the antepartum, intrapartum,
and postpartum transfer of pregnant women from one health care facility
to another, including any potential disincentives or regulatory
barriers to such transfers.
(b) Consultation.--In developing the report required under
subsection (a), the Secretary shall consult with the advisory committee
established under section 2(c).
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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