,,ii #aafth ,,congress #ast ,session ,s4 #aifj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #be1 #bjai,ms4 ,stabenow 7for herself and ,ms4 ,collins7 introduced the following bill2 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 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 for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,quality measures for maternal and infant health4,sec4 #c4 ,quality collaboratives4,sec4 #d4 ,facilitation of increased coordination and alignment between the public and private sector with respect to quality and efficiency measures4 #b4 ,quality measures for maternal and infant health 7a7 ,in general ,title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is amended by inserting after section #aaci;,b the following new section3 #aaci;,c4 ,maternal and infant quality measures 7a7 ,development of core set of health care quality measures for maternal and infant health 7#a7 ,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 7,a7 and 7,b7 of section #aijb7l77#a7 in the same manner as the ,secretary identifies and publishes a core set of child health quality measures under section #aaci;,a1 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 arrangements1 or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time1 that may be applicable to ,medicaid and ,,chip eligible mothers and infants4 7#b7 ,alignment with existing core sets ,in identifying and publishing the recommended core set of maternal and infant health quality measures required under paragraph 7#a71 the ,secretary shall ensure that1 to the extent possible1 such measures align with and do not duplicate-- 7,a7 the core set of child health quality measures identified1 published1 and revised under section #aaci;,a2 or 7,b7 the core set of adult health quality measures identified1 published1 and revised under section #aaci;,b4 7#c7 ,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 measures1 the ,secretary shall consult with-- 7,a7 ,states2 7,b7 physicians1 including physicians in the fields of general obstetrics1 maternal-fetal medicine1 family medicine1 neonatology1 and pediatrics2 7,c7 nurse practitioners and nurses2 7,d7 certified nurse-midwives and certified midwives2 7,e7 health facilities and health systems2 7,f7 national organizations representing mothers and infants2 7,g7 national organizations representing consumers and purchasers of health care2 7,h7 national organizations and individuals with expertise in maternal and infant health quality measurement2 and 7,i7 voluntary consensus standard-setting organizations and other organizations involved in the advancement of evidence-based measures of health care4 7b7 ,deadlines 7#a7 ,recommended measures ,not later than ,january #a1 #bjba1 the ,secretary shall identify and publish for comment a recommended core set of maternal and infant health quality measures that includes the following3 7,a7 ,measures of the process1 experience1 efficiency1 and outcomes of maternity care1 including postpartum outcomes4 7,b7 ,measures that apply to childbearing women and newborns at healthy1 low1 and high risk1 including measures of low-intervention birth4 7,c7 ,measures that apply to care during pregnancy1 the intrapartum period1 and the postpartum period4 7,d7 ,measures that apply to a variety of settings and provider types1 such as clinics1 facilities1 health plans1 and accountable care organizations4 7,e7 ,measures that address disparities1 care coordination1 and shared decisionmaking4 7#b7 ,dissemination ,not later than ,january #a1 #bjbb1 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 infants4 7#c7 ,standardized reporting ,not later than ,january #a1 #bjbc1 the ,secretary1 in consultation with ,states1 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 infants4 7#d7 ,reports to ,congress ,not later than ,january #a1 #bjbd1 and every #c years thereafter1 the ,secretary shall include in the report to ,congress required under section #aaci;,a7a77#f7 information similar to the information required under that section with respect to the measures established under this section4 7#e7 ,establishment of ,maternal and ,infant ,quality ,measurement ,program 7,a7 ,in general ,not later than #ab months after the release of the recommended core set of maternal and infant health quality measures under paragraph 7#a71 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 #aaci;,a7b74 7,b7 ,revising1 strengthening1 and improving initial core measures ,beginning not later than #bd months after the establishment of the ,maternal and ,infant ,quality ,measurement ,program1 and annually thereafter1 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 testing1 validation1 and consensus process for the development of maternal and infant health quality measures4 7,c7 e,measures 7i7 ,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 e,measures that are aligned with the measures developed under the ,pediatric ,quality ,measures ,program established under section #aaci;,a7b7 and the ,medicaid ,quality ,measurement ,program established under section #aaci;,b7b77#e74 7ii7 ,definition ,for purposes of this subparagraph1 the term e,measure means an electronic 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 ,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 development1 testing1 and validation of emerging and innovative evidence-based measures shall not exceed the aggregate amount of funds awarded as grants and contracts under section #aaci;,a7b77#d77;,a74 7c7 ,construction ,nothing in this section 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 7d7 ,maternity consumer assessment of health care providers and systems surveys 7#a7 ,adaption of surveys ,not later than ,january #a1 #bjbb1 for the purpose of measuring the care experiences of childbearing women and newborns1 where appropriate1 the ,agency for ,healthcare ,research and ,quality shall adapt ,consumer ,assessment of ,healthcare ,providers and ,systems program surveys of-- 7,a7 providers2 7,b7 facilities2 and 7,c7 health plans4 7#b7 ,surveys must be effective ,the ,agency for ,healthcare ,research and ,quality shall ensure that the surveys adapted under paragraph 7#a7 are effective in measuring aspects of care that childbearing women and newborns experience1 which may include-- 7,a7 various types of care settings2 7,b7 various types of caregivers2 7,c7 considerations relating to pain2 7,d7 shared decisionmaking2 7,e7 supportive care around the time of birth2 and 7,f7 other topics relevant to the quality of the experience of childbearing women and newborns4 7#c7 ,languages ,the surveys adapted under paragraph 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 paragraph 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 facility1 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 7e7 ,annual ,state reports regarding ,state-,specific maternal and infant quality of care measures applied under ,medicaid or ,,chip 7#a7 ,in general ,each ,state with a plan or waiver approved under title ,,xix or ,,xxi shall annually report 7separately or as part of the annual report required under section #aaci;,a7c77 to the ,secretary on-- 7,a7 the ,state-specific maternal and infant health quality measures applied by the ,state under such plan or waiver1 including measures described in subsection 7b77#e77;,b72 and 7,b7 the ,state-specific information on the quality of health care furnished to ,medicaid and ,,chip eligible mothers and infants under such plan or waiver1 including information collected through external quality reviews of managed care organizations under section #aicb and benchmark plans under section #aicg4 7#b7 ,publication ,not later than ,september #cj1 #bjbd1 and annually thereafter1 the ,secretary shall collect1 analyze1 and make publicly available the information reported by ,states under paragraph 7#a74 7f7 ,authorization of appropriations ,there are authorized to be appropriated #af1jjj1jjj to carry out this section4 ,funds appropriated under this subsection shall remain available until expended4 4 7b7 ,technical amendment ,section #aaci;,b7d77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7d77#a77;,a77 is amended by striking subsection 7a77#e7 and inserting subsection 7b77#e74 #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 and infant care quality collaboratives2 7#b7 expanded activities of existing maternity and infant care quality collaboratives2 and 7#c7 maternity and infant 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 and infant care initiatives1 to the extent that such collaboratives use such grant only for such initiatives4 7#b7 ,entities seeking to establish a maternity and infant 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-#ia774 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 caesarean 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 ,monitoring ,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 and infant 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 and infant 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 and infant 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 and infant 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 and infant care quality collaborative or a maternity and infant 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 and infant 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 and infant 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 #d4 ,facilitation of increased coordination and alignment between the public and private sector with respect to quality and efficiency measures 7a7 ,in general ,section #ahij7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77 is amended by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,facilitation of increased coordination and alignment between the public and private sector with respect to quality and efficiency measures 7,a7 ,in general ,the entity shall facilitate increased coordination and alignment between the public and private sector with respect to quality and efficiency measures4 7,b7 ,annual reports ,the entity shall prepare and make available to the public its findings under this paragraph in its annual report4 ,such public availability shall include posting each report on the ,internet website of the entity4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date of enactment of this ,act4