[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 425 Introduced in Senate (IS)]
113th CONGRESS
1st Session
S. 425
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 28, 2013
Ms. Stabenow (for herself, Mr. Grassley, Ms. Cantwell, and Mr.
Menendez) 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, 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 measures.--Not
later than January 1, 2017, 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, 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
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, 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 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>