113 S425 IS: Quality Care for Moms and Babies Act
U.S. Senate
2013-02-28
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short
title; table of contents
(a)This Act may be cited
as the Quality Care for Moms and
Babies Act
.
(b)The table of
contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Quality measures for maternity care under Medicaid and
CHIP.
Sec. 3. Quality collaboratives.
2.Quality measures
for maternity care under Medicaid and CHIP
(a)Section 1139A of the
Social Security Act (42 U.S.C. 1320b–9a) is amended by adding at the end the
following new subsection:
(j)Mother and
Infant care (MIC) quality measures
(1)As part of the pediatric quality measures program
established under subsection (b) and the Medicaid Quality Measurement Program
established under section 1139B(b)(5)(A), the Secretary shall—
(A)review quality
measures endorsed under section 1890(b)(2) that relate to the care of
childbearing women and newborns, particularly with respect to the application
of such measures to the Medicaid and CHIP programs under titles XIX and XXI,
and identify omissions and deficiencies in the application of those measures to
such programs;
(B)develop and
publish a set of maternity care quality measures for the Medicaid and CHIP
programs under titles XIX and XXI (in this subsection referred to as the
Mother and Infant Care (MIC) quality measures
) in accordance
with the requirements of paragraphs (2) and (3); and
(C)on an ongoing
basis, review the MIC quality measures and develop and publish any
modifications of, or additions or deletions to, such measures that reflect the
development, testing, validation, and consensus process described in paragraph
(4).
(2)Process for
initial review and publication
(A)Consultation
and public commentNot later
than January 1, 2016, the Secretary shall—
(i)solicit public comment on the proposed MIC
quality measures; and
(ii)consult with the
stakeholders identified in paragraph (6)(A) regarding such measures.
(B)Publication of
initial set of measuresNot
later than January 1, 2017, the Secretary shall identify and publish the
initial MIC quality measures.
(3)
(A)The MIC quality measures shall—
(i)be evidence-based;
(ii)utilize risk
adjustment or risk stratification methodologies, if appropriate;
(iii)utilize attribution methods to specify the
clinicians, facilities, and other entities that the measures are applicable
to;
(iv)be pilot-tested with regards to scientific
validity, feasibility, and attribution method; and
(v)include a balance
of each of the types of measures listed in
subparagraph (B).
(B)List of types of
measuresThe measures listed in this subparagraph are the
following:
(i)Measures of the
process, experience, efficiency, and outcomes of maternity care, including
postpartum outcomes.
(ii)Measures that
apply to—
(I)women and newborns who are healthy and at
low risk, including measures of appropriately low-intervention, physiologic
birth in low-risk women; and
(II)women and newborns at higher risk.
(iii)Measures that
apply to—
(I)childbearing
women; and
(II)newborns.
(iv)Measures that
apply to care during—
(I)pregnancy;
(II)the intrapartum
period; and
(III)the postpartum
period.
(v)Measures that
apply to—
(I)clinicians and
clinician groups;
(II)facilities;
(III)health plans;
and
(IV)accountable care organizations.
(vi)Measurement
of—
(I)disparities;
(II)care
coordination; and
(III)shared
decisionmaking.
(C)For purposes of this
paragraph, the term physiologic means characteristic of or
conforming to the normal functioning or state of the body or a tissue or organ,
normal, and not pathologic.
(D)Nothing in this paragraph shall be
construed as supporting the restriction of coverage, under title XIX or XXI or
otherwise, to only those services that are evidence-based, or in any way
limiting available services.
(4)Ongoing review
of the MIC measures;
eMeasures
(A)Contracts with
qualified entitiesNot later
than June 30, 2017, the Secretary, acting through the Agency for Healthcare
Research and Quality, in consultation with the Centers for Medicare &
Medicaid Services, shall enter into grants, contracts, or intergovernmental
agreements with qualified measure development entities for the purpose of
identifying quality of care issues that are not adequately addressed by the MIC
quality measures and developing, testing, and validating modifications of, or
additions or deletions to, the MIC quality measures, and creating eMeasures for
data collection related to the MIC quality measures.
(B)Qualified
measure development entity definedFor purposes of this
paragraph, the term qualified measure development entity means an
entity that—
(i)has demonstrated
expertise and capacity in the development and testing of quality
measures;
(ii)has adopted
procedures for quality measure development that ensure the inclusion of—
(I)the views of the individuals and entities
referred to in
paragraph (3)(B)(v) and whose
performance will be assessed by the measures; and
(II)the views of
other individuals and entities (including patients, consumers, and health care
purchasers) who will use the data generated as a result of the use of the
quality measures;
(iii)for the purpose of ensuring that the MIC
quality measures meet the requirements to be considered for endorsement under
section 1890(b)(2), has provided assurances to the Secretary that the measure
development entity will collaborate with—
(I)the
Secretary;
(II)the
consensus-based entity with a contract under section 1890(a)(1); and
(III)stakeholders
(including those stakeholders identified in
paragraph (6)(A)), as
practicable;
(iv)has transparent
policies regarding governance and conflicts of interest; and
(v)submits an
application to the Secretary at such time, and in such form and manner, as the
Secretary may require.
(C)
(i)A qualified measure
development entity with a grant, contract, or intergovernmental agreement under
subparagraph (A) shall consult with
the voluntary consensus standards setting organizations and other organizations
involved in the advancement of evidence-based measures of health care that the
Secretary consults with under subsection (b)(3)(H) and section 1139B(b)(5)(A)
to create, as part of the MIC quality measures, eMeasures that are aligned with
the measures developed under the pediatric quality measures program established
under subsection (b) and the Medicaid Quality Measurement Program established
under section 1139B(b)(5)(A).
(ii)For purposes of this subparagraph, the term
eMeasure means a measure for which measurement data (including
clinical data) will be collected electronically, including through the use of
electronic health records and other electronic data sources.
(D)Any modifications of, or additions or
deletions to, the MIC quality measures shall be submitted by the qualified
measure development entity to the consensus-based entity with a contract under
section 1890(a)(1) to be considered for endorsement under section
1890(b)(2).
(5)Maternity
consumer assessment of health care providers and systems surveys
(A)Not later than January 1, 2018, for the purpose of
measuring the care experiences of childbearing women and newborns, the Agency
for Healthcare Research and Quality shall adapt the Consumer Assessment of
Healthcare Providers and Systems program surveys of—
(i)providers;
(ii)facilities;
and
(iii)health
plans.
(B)Surveys must be
effectiveThe Agency for
Healthcare Research and Quality shall ensure that the surveys adapted under
subparagraph (A) are effective in
measuring aspects of care that childbearing women and newborns experience,
which may include—
(i)various types of
care settings;
(ii)various types of
caregivers;
(iii)considerations
relating to pain;
(iv)shared
decisionmaking;
(v)supportive care
around the time of birth; and
(vi)other topics
relevant to the quality of the experience of childbearing women and
newborns.
(C)The
surveys adapted under
subparagraph (A) shall be available
in English and Spanish.
(D)The
Agency for Healthcare Research and Quality shall submit any Consumer Assessment
of Healthcare Providers and Systems surveys adapted under this paragraph to the
consensus-based entity with a contract under section 1890(a)(1) to be
considered for endorsement under section 1890(b)(2).
(E)The adaption of (and process for applying)
the surveys under
subparagraph (A) shall be conducted
in consultation with the stakeholders identified in
paragraph (6)(A).
(6)
(A)The stakeholders identified in this subparagraph
are—
(i)the various
clinical disciplines and specialties involved in providing maternity
care;
(ii)State Medicaid
administrators;
(iii)maternity care
consumers and their advocates;
(iv)technical
experts in quality measurement;
(v)hospital,
facility and health system leaders;
(vi)employers and
purchasers; and
(vii)other
individuals who are involved in the advancement of evidence-based maternity
care quality measures.
(B)Professional
organizationsThe
stakeholders identified under
subparagraph (A) may include
representatives from relevant national medical specialty and professional
organizations and specialty societies.
(7)Authorization of
appropriationsThere are
authorized to be appropriated $16,000,000 to carry out this subsection. Funds
appropriated under this paragraph shall remain available until
expended.
.
(b)
(1)Section 1139A of
the Social Security Act (42 U.S.C. 1320b–9a) is amended—
(A)in subsection
(a)(6), in the matter preceding subparagraph (A), by inserting and the
Medicaid and CHIP Payment and Access Commission
after
Congress
; and
(B)in subsection
(i), by striking subsection (e)
and inserting subsections
(e) and (j)
.
(2)Section
1139B(b)(4) of such Act (42 U.S.C. 1320b–9b(b)(4)) is amended by inserting
and the Medicaid and CHIP Payment and Access Commission
after
Congress
.
3.
(a)The Secretary of Health and Human Services
(in this section referred to as the Secretary) may make grants to
eligible entities to support—
(1)the development of
new State and regional maternity care quality collaboratives;
(2)expanded activities of existing maternity
care quality collaboratives; and
(3)maternity care initiatives within
established State and regional quality collaboratives that are not focused
exclusively on maternity care.
(b)The following entities
shall be eligible for a grant under
subsection (a):
(1)Quality collaboratives that focus entirely,
or in part, on maternity care initiatives, to the extent that such
collaboratives use such grant only for such initiatives.
(2)Entities seeking
to establish a maternity care quality collaborative.
(3)State Medicaid
agencies.
(4)State departments
of health.
(5)Health insurance
issuers (as such term is defined in section 2791 of the Public Health Service
Act (42 U.S.C. 300gg–91)).
(6)Provider organizations, including
associations representing—
(A)health
professionals; and
(B)hospitals.
(c)Eligible
projects and programsIn
order for a project or program of an eligible entity to be eligible for funding
under
subsection (a), the project or program must
have goals that are designed to improve the quality of maternity care
delivered, such as—
(1)improving the
appropriate use of cesarean section;
(2)reducing maternal
and newborn morbidity rates;
(3)improving
breast-feeding rates;
(4)reducing hospital readmission rates;
(5)identifying improvement priorities through
shared peer review and third-party reviews of qualitative and quantitative
data, and developing and carrying out projects or programs to address such
priorities; or
(6)delivering
risk-appropriate levels of care.
(d)Activities
that may be supported by the funding under
subsection (a) include the following:
(1)Facilitating
performance data collection and feedback reports to providers with respect to
their performance, relative to peers and benchmarks, if any.
(2)Developing,
implementing, and evaluating protocols and checklists to foster safe,
evidence-based practice.
(3)Developing, implementing, and evaluating
programs that translate into practice clinical recommendations supported by
high-quality evidence in national guidelines, systematic reviews, or other
well-conducted clinical studies.
(4)Developing
underlying infrastructure needed to support quality collaborative activities
under this subsection.
(5)Providing technical assistance to providers
and institutions to build quality improvement capacity and facilitate
participation in collaborative activities.
(6)Developing the capability to access the
following data sources:
(A)A mother’s
prenatal, intrapartum, and postpartum records.
(B)A mother’s medical
records.
(C)An infant’s
medical records since birth.
(D)Birth and death
certificates.
(E)Any other relevant
State-level generated data (such as data from the pregnancy risk assessment
management system (PRAMS)).
(7)Developing access to blinded liability
claims data, analyzing the data, and using the results of such analysis to
improve practice.
(e)
(1)Subject to paragraph (2), if a grant under
subsection (a) is for a project or program
that focuses on births, at least 25 percent of the births addressed by such
project or program must occur in health facilities that perform fewer than
1,000 births per year.
(2)In
the case of a grant under subsection (a) for a project or program located in a
State in which less than 25 percent of the health facilities in the State
perform less than 1,000 births per year, the percentage of births in such
facilities addressed by such project or program shall be commensurate with the
Statewide percentage of births performed at such facilities.
(f)Projects and
programs for which such a grant is made shall—
(1)include data collection with rapid analysis
and feedback to participants with a focus on improving practice and health
outcomes;
(2)develop a plan to
identify and resolve data collection problems;
(3)identify and
document evidence-based strategies that will be used to improve performance on
quality measures and other metrics; and
(4)exclude from
quality measure collection and reporting physicians and midwives who attend
fewer than 30 births per year.
(g)Reporting on
quality measuresAny reporting requirements established by a
project or program funded under
subsection (a) shall be designed to—
(1)minimize costs and
administrative effort; and
(2)use existing data
resources when feasible.
(h)The Secretary shall establish an online,
open-access clearinghouse to make protocols, procedures, reports, tools, and
other resources of individual collaboratives available to collaboratives and
other entities that are working to improve maternity care quality.
(i)A quality collaborative (or other entity
receiving a grant under
subsection (a)) shall—
(1)develop and carry out plans for evaluating
its maternity care quality improvement programs and projects; and
(2)publish its
experiences and results in articles, technical reports, or other formats for
the benefit of others working on maternity care quality improvement
activities.
(j)Annual reports
to SecretaryA quality collaborative or other eligible entity
that receives a grant under
subsection (a) shall submit an annual report
to the Secretary containing the following:
(1)A
description of the activities carried out using the funding from such
grant.
(2)A description of any barriers that limited
the ability of the collaborative or entity to achieve its goals.
(3)The achievements of the collaborative or
entity under the grant with respect to the quality, health outcomes, and value
of maternity care.
(4)A
list of lessons learned from the grant.
Such
reports shall be made available to the public.(k)
(1)A maternity care
quality collaborative or a maternity care program within a broader quality
collaborative that is supported under subsection (a) shall be governed by a
multi-stakeholder executive committee.
(2)Such
executive committee shall include individuals who represent—
(A)physicians,
including physicians in the fields of general obstetrics, maternal-fetal
medicine, family medicine, neonatology, and pediatrics;
(B)nurse-practitioners
and nurses;
(C)certified
nurse-midwives and certified midwives;
(D)health facilities
and health systems;
(E)consumers;
(F)employers and
other private purchasers;
(G)Medicaid programs;
and
(H)other public
health agencies and organizations, as appropriate.
Such
committee also may include other individuals, such as individuals with
expertise in health quality measurement and other types of expertise as
recommended by the Secretary. Such committee also may be composed of a
combination of general collaborative executive committee members and maternity
specific project executive committee members.(l)A quality collaborative or other eligible
entity that receives a grant under
subsection (a) shall engage in regular
ongoing consultation with—
(1)regional and State public health agencies
and organizations;
(2)public and private
health insurers; and
(3)regional and State
organizations representing physicians, midwives, and nurses who provide
maternity services.
(m)Authorization of
appropriationsThere are authorized to be appropriated
$15,000,000 to carry out this section. Funds appropriated under this subsection
shall remain available until expended.