,i #aacth ,,congress #ast ,session ,h4 ,r4 #hif ,,in ,,the ,,house ,,of ,,representatives ,february #bh1 #bjac ,mr4 ,engel introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xi of the ,social ,security ,act to improve the quality1 health outcomes1 and value of maternity care under the ,medicaid and ,,chip programs by developing maternity care quality measures and supporting maternity care quality collaboratives4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,quality ,care for ,moms and ,babies ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,quality measures for maternity care under ,medicaid and ,,chip4 ,sec4 #c4 ,quality collaboratives4 #b4 ,quality measures for maternity care under ,medicaid and ,,chip 7a7 ,in general ,section #aaci;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7 is amended by adding at the end the following new subsection3 7j7 ,mother and ,infant care 7,,mic7 quality measures 7#a7 ,in general ,as part of the pediatric quality measures program established under subsection 7b7 and the ,medicaid ,quality ,measurement ,program established under section #aaci;,b7b77#e77;,a71 the ,secretary shall-- 7,a7 review quality measures endorsed under section #ahij7;b77#b7 that relate to the care of childbearing women and newborns1 particularly with respect to the application of such measures to the ,medicaid and ,,chip programs under titles ,,xix and ,,xxi1 and identify omissions and deficiencies in the application of those measures to such programs2 7,b7 develop and publish a set of maternity care quality measures for the ,medicaid and ,,chip programs under titles ,,xix and ,,xxi 7in this subsection referred to as the ,mother and ,infant ,care 7,,mic7 quality measures7 in accordance with the requirements of paragraphs 7#b7 and 7#c72 and 7,c7 on an ongoing basis1 review the ,,mic quality measures and develop and publish any modifications of1 or additions or deletions to1 such measures that reflect the development1 testing1 validation1 and consensus process described in paragraph 7#d74 7#b7 ,process for initial review and publication 7,a7 ,consultation and public comment ,not later than ,january #a1 #bjaf1 the ,secretary shall-- 7i7 solicit public comment on the proposed ,,mic quality measures2 and 7ii7 consult with the stakeholders identified in paragraph 7#f77;,a7 regarding such measures4 7,b7 ,publication of initial set of measures ,not later than ,january #a1 #bjag1 the ,secretary shall identify and publish the initial ,,mic quality measures4 7#c7 ,requirements 7,a7 ,in general ,the ,,mic quality measures shall-- 7i7 be evidence-based2 7ii7 utilize risk adjustment or risk stratification methodologies1 if appropriate2 7iii7 utilize attribution methods to specify the clinicians1 facilities1 and other entities that the measures are applicable to2 7iv7 be pilot-tested with regard to scientific validity1 feasibility1 and attribution method2 and 7v7 include a balance of each of the types of measures listed in subparagraph 7,b74 7,b7 ,list of types of measures ,the measures listed in this subparagraph are the following3 7i7 ,measures of the process1 experience1 efficiency1 and outcomes of maternity care1 including postpartum outcomes4 7ii7 ,measures that apply to-- 7,i7 women and newborns who are healthy and at low risk1 including measures of appropriately low-intervention1 physiologic birth in low-risk women2 and 7,,ii7 women and newborns at higher risk4 7iii7 ,measures that apply to-- 7,i7 childbearing women2 and 7,,ii7 newborns4 7iv7 ,measures that apply to care during-- 7,i7 pregnancy2 7,,ii7 intrapartum period2 and 7,,iii7 the postpartum period4 7v7 ,measures that apply to-- 7,i7 clinicians and clinician groups2 7,,ii7 facilities2 7,,iii7 health plans2 and 7,,iv7 accountable care organizations4 7vi7 ,measurement of-- 7,i7 disparities2 7,,ii7 care coordination2 and 7,,iii7 shared decisionmaking4 7,c7 ,physiologic defined ,for purposes of this paragraph1 the term physiologic means characteristic of or conforming to the normal functioning or state of the body or a tissue or organ1 normal1 and not pathologic4 7,d7 ,construction ,nothing in this paragraph shall be construed as supporting the restriction of coverage1 under title ,,xix or ,,xxi or otherwise1 to only those services that are evidence-based1 or in any way limiting available services4 7#d7 ,ongoing review of the ,,mic measures2 e,measures 7,a7 ,contracts with qualified entities ,not later than ,june #cj1 #bjag1 the ,secretary1 acting through the ,agency for ,healthcare ,research and ,quality1 in consultation with the ,centers for ,medicare ,medicaid ,services1 shall enter into grants1 contracts1 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 developing1 testing1 and validating modifications of1 or additions or deletions to1 the ,,mic quality measures1 and creating e,measures for data collection related to the ,,mic quality measures4 7,b7 ,qualified measure development entity defined ,for purposes of this paragraph1 the term qualified measure development entity means an entity that-- 7i7 has demonstrated expertise and capacity in the development and testing of quality measures2 7ii7 has adopted procedures for quality measure development that ensure the inclusion of-- 7,i7 the views of the individuals and entities referred to in paragraph 7#c77;,b77v7 and whose performance will be assessed by the measures2 and 7,,ii7 the views of other individuals and entities 7including patients1 consumers1 and health care purchasers7 who will use the data generated as a result of the use of the quality measures2 7iii7 for the purpose of ensuring that the ,,mic quality measures meet the requirements to be considered for endorsement under section #ahij7;b77#b71 has provided assurances to the ,secretary that the measure development entity will collaborate with-- 7,i7 the ,secretary2 7,,ii7 the consensus-based entity with a contract under section #ahij7;a77#a72 and 7,,iii7 stakeholders 7including those stakeholders identified in paragraph 7#f77;,a771 as practicable2 7iv7 has transparent policies regarding governance and conflicts of interest2 and 7v7 submits an application to the ,secretary at such time1 and in such form and manner1 as the ,secretary may require4 7,c7 e,measures 7i7 ,in general ,a qualified measure development entity with a grant1 contract1 or intergovernmental agreement under subparagraph 7,a7 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 7b77#c77;,h7 and section #aaci;,b7b77#e77;,a7 to create1 as part of the ,,mic quality measures1 e,measures that are aligned with the measures developed under the pediatric quality measures program established under subsection 7b7 and the ,medicaid ,quality ,measurement ,program established under section #aaci;,b7b77#e77;,a74 7ii7 e,measure defined ,for purposes of this subparagraph1 the term e,measure means a measure for which measurement data 7including clinical data7 will be collected electronically1 including through the use of electronic health records and other electronic data sources4 7,d7 ,endorsement ,any modifications of1 or additions or deletions to1 the ,,mic quality measures shall be submitted by the qualified measure development entity to the consensus-based entity with a contract under section #ahij7;a77#a7 to be considered for endorsement under section #ahij7;b77#b74 7#e7 ,maternity consumer assessment of health care providers and systems surveys 7,a7 ,adaption of surveys ,not later than ,january #a1 #bjah1 for the purpose of measuring the care experiences of childbearing women and newborns1 the ,agency for ,healthcare ,research and ,quality shall adapt the ,consumer ,assessment of ,healthcare ,providers and ,systems program surveys of-- 7i7 providers2 7ii7 facilities2 and 7iii7 health plans4 7,b7 ,surveys must be effective ,the ,agency for ,healthcare ,research and ,quality shall ensure that the surveys adapted under subparagraph 7,a7 are effective in measuring aspects of care that childbearing women and newborns experience1 which may include-- 7i7 various types of care settings2 7ii7 various types of caregivers2 7iii7 considerations relating to pain2 7iv7 shared decisionmaking2 7v7 supportive care around the time of birth2 and 7vi7 other topics relevant to the quality of the experience of childbearing women and newborns4 7,c7 ,languages ,the surveys adapted under subparagraph 7,a7 shall be available in ,english and ,spanish4 7,d7 ,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 #ahij7;a77#a7 to be considered for endorsement under section #ahij7;b77#b74 7,e7 ,consultation ,the adaption of 7and process for applying7 the surveys under subparagraph 7,a7 shall be conducted in consultation with the stakeholders identified in paragraph 7#f77;,a74 7#f7 ,stakeholders 7,a7 ,in general ,the stakeholders identified in this subparagraph are-- 7i7 the various clinical disciplines and specialties involved in providing maternity care2 7ii7 ,state ,medicaid administrators2 7iii7 maternity care consumers and their advocates2 7iv7 technical experts in quality measurement2 7v7 hospital1 facility and health system leaders2 7vi7 employers and purchasers2 and 7vii7 other individuals who are involved in the advancement of evidence-based maternity care quality measures4 7,b7 ,professional organizations ,the stakeholders identified under subparagraph 7,a7 may include representatives from relevant national medical specialty and professional organizations and specialty societies4 7#g7 ,authorization of appropriations ,there are authorized to be appropriated #af1jjj1jjj to carry out this subsection4 ,funds appropriated under this paragraph shall remain available until expended4 4 7b7 ,conforming amendments 7#a7 ,section #aaci;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7 is amended-- 7,a7 in subsection 7a77#f71 in the matter preceding subparagraph 7,a71 by inserting and the ,medicaid and ,,chip ,payment and ,access ,commission after ,congress2 and 7,b7 in subsection 7i71 by striking subsection 7e7 and inserting subsections 7e7 and 7j74 7#b7 ,section #aaci;,b7b77#d7 of such ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7b77#d77 is amended by inserting and the ,medicaid and ,,chip ,payment and ,access ,commission after ,congress4 #c4 ,quality collaboratives 7a7 ,grants ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 may make grants to eligible entities to support-- 7#a7 the development of new ,state and regional maternity care quality collaboratives2 7#b7 expanded activities of existing maternity care quality collaboratives2 and 7#c7 maternity care initiatives within established ,state and regional quality collaboratives that are not focused exclusively on maternity care4 7b7 ,eligible entity ,the following entities shall be eligible for a grant under subsection 7a73 7#a7 ,quality collaboratives that focus entirely1 or in part1 on maternity care initiatives1 to the extent that such collaboratives use such grant only for such initiatives4 7#b7 ,entities seeking to establish a maternity care quality collaborative4 7#c7 ,state ,medicaid agencies4 7#d7 ,state departments of health4 7#e7 ,health insurance issuers 7as such term is defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 7#f7 ,provider organizations1 including associations representing-- 7,a7 health professionals2 and 7,b7 hospitals4 7c7 ,eligible projects and programs ,in order for a project or program of an eligible entity to be eligible for funding under subsection 7a71 the project or program must have goals that are designed to improve the quality of maternity care delivered1 such as-- 7#a7 improving the appropriate use of cesarean section2 7#b7 reducing maternal and newborn morbidity rates2 7#c7 improving breast-feeding rates2 7#d7 reducing hospital readmission rates2 7#e7 identifying improvement priorities through shared peer review and third-party reviews of qualitative and quantitative data1 and developing and carrying out projects or programs to address such priorities2 or 7#f7 delivering risk-appropriate levels of care4 7d7 ,activities ,activities that may be supported by the funding under subsection 7a7 include the following3 7#a7 ,facilitating performance data collection and feedback reports to providers with respect to their performance1 relative to peers and benchmarks1 if any4 7#b7 ,developing1 implementing1 and evaluating protocols and checklists to foster safe1 evidence-based practice4 7#c7 ,developing1 implementing1 and evaluating programs that translate into practice clinical recommendations supported by high-quality evidence in national guidelines1 systematic reviews1 or other well-conducted clinical studies4 7#d7 ,developing underlying infrastructure needed to support quality collaborative activities under this subsection4 7#e7 ,providing technical assistance to providers and institutions to build quality improvement capacity and facilitate participation in collaborative activities4 7#f7 ,developing the capability to access the following data sources3 7,a7 ,a mother's prenatal1 intrapartum1 and postpartum records4 7,b7 ,a mother's medical records4 7,c7 ,an infant's medical records since birth4 7,d7 ,birth and death certificates4 7,e7 ,any other relevant ,state-level generated data 7such as data from the pregnancy risk assessment management system 7,,prams774 7#g7 ,developing access to blinded liability claims data1 analyzing the data1 and using the results of such analysis to improve practice4 7e7 ,special rule for births 7#a7 ,in general ,subject to paragraph 7#b71 if a grant under subsection 7a7 is for a project or program that focuses on births1 at least #be percent of the births addressed by such project or program must occur in health facilities that perform fewer than #a1jjj births per year4 7#b7 ,exception ,in the case of a grant under subsection 7a7 for a project or program located in a ,state in which less than #be percent of the health facilities in the ,state perform less than #a1jjj births per year1 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 facilities4 7f7 ,use of quality measures ,projects and programs for which such a grant is made shall-- 7#a7 include data collection with rapid analysis and feedback to participants with a focus on improving practice and health outcomes2 7#b7 develop a plan to identify and resolve data collection problems2 7#c7 identify and document evidence-based strategies that will be used to improve performance on quality measures and other metrics2 and 7#d7 exclude from quality measure collection and reporting physicians and midwives who attend fewer than #cj births per year4 7g7 ,reporting on quality measures ,any reporting requirements established by a project or program funded under subsection 7a7 shall be designed to-- 7#a7 minimize costs and administrative effort2 and 7#b7 use existing data resources when feasible4 7h7 ,clearinghouse ,the ,secretary shall establish an online1 open-access clearinghouse to make protocols1 procedures1 reports1 tools1 and other resources of individual collaboratives available to collaboratives and other entities that are working to improve maternity care quality4 7i7 ,evaluation ,a quality collaborative 7or other entity receiving a grant under subsection 7a77 shall-- 7#a7 develop and carry out plans for evaluating its maternity care quality improvement programs and projects2 and 7#b7 publish its experiences and results in articles1 technical reports1 or other formats for the benefit of others working on maternity care quality improvement activities4 7j7 ,annual reports to ,secretary ,a quality collaborative or other eligible entity that receives a grant under subsection 7a7 shall submit an annual report to the ,secretary containing the following3 7#a7 ,a description of the activities carried out using the funding from such grant4 7#b7 ,a description of any barriers that limited the ability of the collaborative or entity to achieve its goals4 7#c7 ,the achievements of the collaborative or entity under the grant with respect to the quality1 health outcomes1 and value of maternity care4 7#d7 ,a list of lessons learned from the grant4 ,such reports shall be made available to the public4 7k7 ,governance 7#a7 ,in general ,a maternity care quality collaborative or a maternity care program within a broader quality collaborative that is supported under subsection 7a7 shall be governed by a multi-stakeholder executive committee4 7#b7 ,composition ,such executive committee shall include individuals who represent-- 7,a7 physicians1 including physicians in the fields of general obstetrics1 maternal-fetal medicine1 family medicine1 neonatology1 and pediatrics2 7,b7 nurse-practitioners and nurses2 7,c7 certified nurse-midwives and certified midwives2 7,d7 health facilities and health systems2 7,e7 consumers2 7,f7 employers and other private purchasers2 7,g7 ,medicaid programs2 and 7,h7 other public health agencies and organizations1 as appropriate4 ,such committee also may include other individuals1 such as individuals with expertise in health quality measurement and other types of expertise as recommended by the ,secretary4 ,such committee also may be composed of a combination of general collaborative executive committee members and maternity specific project executive committee members4 7l7 ,consultation ,a quality collaborative or other eligible entity that receives a grant under subsection 7a7 shall engage in regular ongoing consultation with-- 7#a7 regional and ,state public health agencies and organizations2 7#b7 public and private health insurers2 and 7#c7 regional and ,state organizations representing physicians1 midwives1 and nurses who provide maternity services4 7m7 ,authorization of appropriations ,there are authorized to be appropriated #ae1jjj1jjj to carry out this section4 ,funds appropriated under this subsection shall remain available until expended4