[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1551 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 1551
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 HOUSE OF REPRESENTATIVES
March 6, 2019
Mr. Engel (for himself and Mr. Stivers) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
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 for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Quality measures for maternal and infant health.
Sec. 3. Quality collaboratives.
Sec. 4. Facilitation of increased coordination and alignment between
the public and private sector with respect
to quality and efficiency measures.
SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT HEALTH.
(a) In General.--Title XI of the Social Security Act (42 U.S.C.
1301 et seq.) is amended by inserting after section 1139B the following
new section:
``SEC. 1139C. MATERNAL AND INFANT QUALITY MEASURES.
``(a) Development of Core Set of Health Care Quality Measures for
Maternal and Infant Health.--
``(1) In general.--The Secretary shall identify and publish
a recommended core set of maternal and infant health quality
measures for women and children described in subparagraphs (A)
and (B) of section 1902(l)(1) in the same manner as the
Secretary identifies and publishes a core set of child health
quality measures under section 1139A, including with respect to
identifying and publishing existing maternal and infant health
quality measures that are in use under public and privately
sponsored health care coverage arrangements, or that are part
of reporting systems that measure both the presence and
duration of health insurance coverage over time, that may be
applicable to Medicaid and CHIP eligible mothers and infants.
``(2) Alignment with existing core sets.--In identifying
and publishing the recommended core set of maternal and infant
health quality measures required under paragraph (1), the
Secretary shall ensure that, to the extent possible, such
measures align with and do not duplicate--
``(A) the core set of child health quality measures
identified, published, and revised under section 1139A;
or
``(B) the core set of adult health quality measures
identified, published, and revised under section 1139B.
``(3) Process for maternal and infant quality measures
program.--In identifying gaps in existing maternal and infant
measures and establishing priorities for the development and
advancement of such measures, the Secretary shall consult
with--
``(A) States;
``(B) physicians, including physicians in the
fields of general obstetrics, maternal-fetal medicine,
family medicine, neonatology, and pediatrics;
``(C) nurse practitioners and nurses;
``(D) certified nurse-midwives and certified
midwives;
``(E) health facilities and health systems;
``(F) national organizations representing mothers
and infants;
``(G) national organizations representing consumers
and purchasers of health care;
``(H) national organizations and individuals with
expertise in maternal and infant health quality
measurement; and
``(I) voluntary consensus standard-setting
organizations and other organizations involved in the
advancement of evidence-based measures of health care.
``(b) Deadlines.--
``(1) Recommended measures.--Not later than January 1,
2021, the Secretary shall identify and publish for comment a
recommended core set of maternal and infant health quality
measures that includes the following:
``(A) Measures of the process, experience,
efficiency, and outcomes of maternity care, including
postpartum outcomes.
``(B) Measures that apply to childbearing women and
newborns at healthy, low, and high risk, including
measures of low-intervention birth.
``(C) Measures that apply to care during pregnancy,
the intrapartum period, and the postpartum period.
``(D) Measures that apply to a variety of settings
and provider types, such as clinics, facilities, health
plans, and accountable care organizations.
``(E) Measures that address disparities, care
coordination, and shared decisionmaking.
``(2) Dissemination.--Not later than January 1, 2022, the
Secretary shall publish an initial core set of maternal and
infant health quality measures that are applicable to Medicaid
and CHIP eligible mothers and infants.
``(3) Standardized reporting.--Not later than January 1,
2023, the Secretary, in consultation with States, shall develop
a standardized format for reporting information based on the
initial core set of maternal and infant health quality measures
and create procedures to encourage States to use such measures
to voluntarily report information regarding the quality of
health care for Medicaid and CHIP eligible mothers and infants.
``(4) Reports to congress.--Not later than January 1, 2024,
and every 3 years thereafter, the Secretary shall include in
the report to Congress required under section 1139A(a)(6)
information similar to the information required under that
section with respect to the measures established under this
section.
``(5) Establishment of maternal and infant quality
measurement program.--
``(A) In general.--Not later than 12 months after
the release of the recommended core set of maternal and
infant health quality measures under paragraph (1), the
Secretary shall establish a Maternal and Infant Quality
Measurement Program in the same manner as the Secretary
established the pediatric quality measures program
under section 1139A(b).
``(B) Revising, strengthening, and improving
initial core measures.--Beginning not later than 24
months after the establishment of the Maternal and
Infant Quality Measurement Program, and annually
thereafter, the Secretary shall publish recommended
changes to the initial core set of maternal and infant
health quality measures that shall reflect the results
of the testing, validation, and consensus process for
the development of maternal and infant health quality
measures.
``(C) eMeasures.--
``(i) In general.--An entity awarded a
grant or contract by the Secretary to develop
emerging and innovative evidence-based measures
under the Maternal and Infant Quality
Measurement Program shall work to advance
eMeasures that are aligned with the measures
developed under the Pediatric Quality Measures
Program established under section 1139A(b) and
the Medicaid Quality Measurement Program
established under section 1139B(b)(5).
``(ii) Definition.--For purposes of this
subparagraph, the term `eMeasure' means an
electronic 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) Amount available for grants and contracts.--
The aggregate amount of funds that may be awarded as
grants and contracts under the Maternal and Infant
Quality Measurement Program for the development,
testing, and validation of emerging and innovative
evidence-based measures shall not exceed the aggregate
amount of funds awarded as grants and contracts under
section 1139A(b)(4)(A).
``(c) Construction.--Nothing in this section 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.
``(d) Maternity Consumer Assessment of Health Care Providers and
Systems Surveys.--
``(1) Adaption of surveys.--Not later than January 1, 2022,
for the purpose of measuring the care experiences of
childbearing women and newborns, where appropriate, the Agency
for Healthcare Research and Quality shall adapt Consumer
Assessment of Healthcare Providers and Systems program surveys
of--
``(A) providers;
``(B) facilities; and
``(C) health plans.
``(2) Surveys must be effective.--The Agency for Healthcare
Research and Quality shall ensure that the surveys adapted
under paragraph (1) are effective in measuring aspects of care
that childbearing women and newborns experience, which may
include--
``(A) various types of care settings;
``(B) various types of caregivers;
``(C) considerations relating to pain;
``(D) shared decisionmaking;
``(E) supportive care around the time of birth; and
``(F) other topics relevant to the quality of the
experience of childbearing women and newborns.
``(3) Languages.--The surveys adapted under paragraph (1)
shall be available in English and Spanish.
``(4) 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).
``(5) Consultation.--The adaption of (and process for
applying) the surveys under paragraph (1) 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.
``(e) Annual State Reports Regarding State-Specific Maternal and
Infant Quality of Care Measures Applied Under Medicaid or CHIP.--
``(1) In general.--Each State with a plan or waiver
approved under title XIX or XXI shall annually report
(separately or as part of the annual report required under
section 1139A(c)) to the Secretary on--
``(A) the State-specific maternal and infant health
quality measures applied by the State under such plan
or waiver, including measures described in subsection
(b)(5)(B); and
``(B) the State-specific information on the quality
of health care furnished to Medicaid and CHIP eligible
mothers and infants under such plan or waiver,
including information collected through external
quality reviews of managed care organizations under
section 1932 and benchmark plans under section 1937.
``(2) Publication.--Not later than September 30, 2024, and
annually thereafter, the Secretary shall collect, analyze, and
make publicly available the information reported by States
under paragraph (1).
``(f) Authorization of Appropriations.--There are authorized to be
appropriated $16,000,000 to carry out this section. Funds appropriated
under this subsection shall remain available until expended.''.
(b) Technical Amendment.--Section 1139B(d)(1)(A) of the Social
Security Act (42 U.S.C. 1320b-9b(d)(1)(A)) is amended by striking
``subsection (a)(5)'' and inserting ``subsection (b)(5)''.
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 and
infant care quality collaboratives;
(2) expanded activities of existing maternity and infant
care quality collaboratives; and
(3) maternity and infant 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 and infant care initiatives, to the extent that
such collaboratives use such grant only for such initiatives.
(2) Entities seeking to establish a maternity and infant
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 caesarean 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
Monitoring 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
and infant 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 and infant 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 and infant 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 and infant 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 and infant care quality
collaborative or a maternity and infant 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 and
infant 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 and
infant 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.
SEC. 4. FACILITATION OF INCREASED COORDINATION AND ALIGNMENT BETWEEN
THE PUBLIC AND PRIVATE SECTOR WITH RESPECT TO QUALITY AND
EFFICIENCY MEASURES.
(a) In General.--Section 1890(b) of the Social Security Act (42
U.S.C. 1395aaa(b)) is amended by inserting after paragraph (3) the
following new paragraph:
``(4) Facilitation of increased coordination and alignment
between the public and private sector with respect to quality
and efficiency measures.--
``(A) In general.--The entity shall facilitate
increased coordination and alignment between the public
and private sector with respect to quality and
efficiency measures.
``(B) Annual reports.--The entity shall prepare and
make available to the public its findings under this
paragraph in its annual report. Such public
availability shall include posting each report on the
Internet website of the entity.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of enactment of this Act.
<all>
Quality Care for Moms and Babies Act
#1551 | HR Congress #116
Policy Area: Health
Subjects: Child healthGovernment information and archivesHealth care costs and insuranceHealth care qualityHealth facilities and institutionsHealth information and medical recordsHealth programs administration and fundingMedicaidPerformance measurementState and local government operationsWomen's health
Last Action: Referred to the Subcommittee on Health. (3/7/2019)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text