[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 466 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                 S. 466

 To amend title XI of the Social Security Act to improve the quality, 
  health outcomes, and value of maternity care under the Medicaid and 
    CHIP programs by developing maternity care quality measures and 
           supporting maternity care quality collaboratives.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 11, 2015

  Ms. Stabenow (for herself, Mr. Grassley, Mrs. Boxer, Mr. Casey, Mr. 
  Heinrich, Mr. Reed, and Mr. Schumer) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XI of the Social Security Act to improve the quality, 
  health outcomes, and value of maternity care under the Medicaid and 
    CHIP programs by developing maternity care quality measures and 
           supporting maternity care quality collaboratives.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Quality Care for 
Moms and Babies Act''.
    (b) Table of Contents.--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.

SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER MEDICAID AND CHIP.

    (a) In General.--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) In general.--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 comment.--Not later 
                than January 1, 2018, 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 measures.--Not 
                later than January 1, 2019, the Secretary shall 
                identify and publish the initial MIC quality measures.
            ``(3) Requirements.--
                    ``(A) In general.--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 measures.--The 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) Physiologic defined.--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) Construction.--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 entities.--Not later 
                than June 30, 2019, 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 
                defined.--For 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) eMeasures.--
                            ``(i) In general.--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) eMeasure defined.--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) Endorsement.--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) Adaption of surveys.--Not later than January 
                1, 2020, 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 effective.--The 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) Languages.--The surveys adapted under 
                subparagraph (A) shall be available in English and 
                Spanish.
                    ``(D) Endorsement.--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) Consultation.--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) Stakeholders.--
                    ``(A) In general.--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 organizations.--The stakeholders 
                identified under subparagraph (A) may include 
                representatives from relevant national medical 
                specialty and professional organizations and specialty 
                societies.
            ``(7) Authorization of appropriations.--There are 
        authorized to be appropriated $16,000,000 to carry out this 
        subsection. Funds appropriated under this paragraph shall 
        remain available until expended.''.
    (b) Conforming Amendments.--
            (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''.

SEC. 3. QUALITY COLLABORATIVES.

    (a) Grants.--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) Eligible Entity.--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 Programs.--In 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.--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) Special Rule for Births.--
            (1) In general.--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) Exception.--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) Use of Quality Measures.--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 Measures.--Any 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) Clearinghouse.--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) Evaluation.--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 Secretary.--A 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) Governance.--
            (1) In general.--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) Composition.--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) Consultation.--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 Appropriations.--There are authorized to be 
appropriated $15,000,000 to carry out this section. Funds appropriated 
under this subsection shall remain available until expended.
                                 <all>