[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).
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