,,ii #aafth ,,congress #b;d ,session ,s4 #didi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #b1 #bjbj,mr4 ,toomey 7for himself and ,mr4 ,brown7 introduced the following bill2 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 program4 #a4 ,short title ,this ,act may be cited as the ,supporting ,best ,practices for ,healthy ,moms ,act4 #b4 ,developing guidance on maternal mortality and severe morbidity reduction for maternal care providers receiving payment under the ,medicaid program 7a7 ,in general ,subject to the availability of appropriations1 not later than #cf months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall publish on a public website of the ,centers for ,medicare ,medicaid ,services guidance for ,states on resources and strategies for hospitals1 freestanding birth centers 7as defined in section #aije7l77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#c77;,b7771 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 7#db ,u4,s4,c4 #acif et seq47 or child health assistance under the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq474 7b7 ,updates ,the ,secretary shall update the guidance and resources described in subsection 7a7 at least once every #c years4 7c7 ,consultation with advisory committee 7#a7 ,establishment ,subject to the availability of appropriations1 not later than #ah months after the date of enactment of this ,act1 the ,secretary shall establish an advisory committee to be known as the ,national ,advisory ,committee on ,reducing ,maternal ,deaths 7referred to in this section as the ,advisory ,committee74 7#b7 ,duties ,the ,advisory ,committee shall provide consensus advice and guidance to the ,secretary on the development and compilation of the guidance described in subsection 7a7 7and any updates to such guidance74 7#c7 ,membership 7,a7 ,in general ,the ,secretary1 in consultation with such other heads of agencies1 as the ,secretary deems appropriate and in accordance with this paragraph1 shall appoint not more than #da members to the ,advisory ,committee4 ,in appointing such members1 the ,secretary shall ensure that-- 7i7 the total number of members of the ,advisory ,committee is an odd number2 and 7ii7 the total number of voting members who are not ,federal officials does not exceed the total number of voting ,federal members who are ,federal officials4 7,b7 ,required members 7i7 ,federal officials ,the ,advisory ,committee shall include as voting members the following ,federal officials1 or their designees3 7,i7 ,the ,secretary of ,health and ,human ,services4 7,,ii7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7,,iii7 ,the ,director of the ,centers for ,disease ,control and ,prevention4 7,,iv7 ,the ,associate ,administrator of the ,maternal and ,child ,health ,bureau of the ,health ,resources and ,services ,administration4 7,v7 ,the ,director of the ,agency for ,healthcare ,research and ,quality4 7,,vi7 ,the ,national ,coordinator for ,health ,information ,technology4 7,,vii7 ,the ,director of the ,national ,institutes of ,health4 7,,viii7 ,the ,secretary of ,veterans ,affairs4 7,,ix7 ,the ,director of the ,indian ,health ,service4 7,x7 ,the ,deputy ,assistant ,secretary for ,minority ,health4 7,,xi7 ,the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration4 7,,xii7 ,the ,deputy ,assistant ,secretary for ,women's ,health4 7,,xiii7 ,such other ,federal officials or their designees as the ,secretary determines appropriate4 7ii7 ,non-,federal officials 7,i7 ,in general ,the ,advisory ,committee shall include the following as voting members3 7aa7 ,at least #a representative from a professional organization representing hospitals and health systems4 7bb7 ,at least #a representative from a medical professional organization representing primary care providers4 7cc7 ,at least #a representative from a medical professional organization representing general obstetrician-gynecologists4 7dd7 ,at least #a representative from a medical professional organization representing certified nurse-midwives4 7ee7 ,at least #a representative from a medical professional organization representing other maternal fetal medicine providers4 7ff7 ,at least #a representative from a medical professional organization representing anesthesiologists4 7gg7 ,at least #a representative from a medical professional organization representing emergency medicine physicians and urgent care providers4 7hh7 ,at least #a representative from a medical professional organization representing nurses4 7ii7 ,at least #a representative from a professional organization representing community health workers4 7jj7 ,at least #a representative from a professional organization representing doulas4 7kk7 ,at least #a representative from ,state-affiliated programs or existing collaboratives with demonstrated expertise or success in improving maternal health4 7ll7 ,at least #a director of a ,state ,medicaid agency that has had demonstrated success in improving maternal health4 7mm7 ,at least #a representative from an accrediting organization for maternal health quality and safety standards4 7nn7 ,at least #a representative from a maternal patient advocacy organization with lived experience of severe maternal morbidity4 7,,ii7 ,requirements ,each individual selected to be a member under this clause shall-- 7aa7 have expertise in maternal health2 7bb7 not be a ,federal official2 and 7cc7 have experience working with populations that are at higher risk for maternal mortality or severe morbidity1 such as populations that experience racial1 ethnic1 and geographic health disparities1 pregnant and postpartum women experiencing mental health disorders or other comorbidities such as substance use disorders1 hypertension1 thyroid disorders1 and sickle cell disease4 7,c7 ,additional members 7i7 ,in general ,in addition to the members required to be appointed under subparagraph 7,b71 the ,secretary may appoint as members to the ,advisory ,committee such other individuals with relevant expertise or experience as the ,secretary shall determine appropriate1 which may include individuals described in clause 7ii74 7ii7 ,suggested additional members ,the individuals described in this clause are the following3 7,i7 ,representatives from ,state maternal mortality review committees and perinatal quality collaboratives4 7,,ii7 ,medical providers who care for women and infants during pregnancy and the postpartum period1 such as family practice physicians1 cardiologists1 pulmonology critical care specialists1 endocrinologists1 pediatricians1 and neonatologists4 7,,iii7 ,representatives from ,state and local public health departments4 7,,iv7 ,subject matter experts in conducting outreach to women who are ,african ,american or belong to another minority group4 7,v7 ,directors of ,state agencies responsible for administering a ,state's maternal and child health services program under title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq474 7,,vi7 ,experts in medical education or physician training4 7,,vii7 ,representatives from ,medicaid managed care organizations4 7#d7 ,applicability of ,,faca ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall apply to the committee established under this subsection4 7d7 ,contents ,the guidance described in subsection 7a7 shall include1 with respect to hospitals1 freestanding birth centers1 and other maternal care providers1 the following3 7#a7 ,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 pregnancy1 with an emphasis on individuals with preconditions directly linked to pregnancy complications and maternal mortality and severe morbidity1 including-- 7,a7 methods to identify individuals who are at risk of maternal mortality or severe morbidity1 including risk stratification2 7,b7 evidence-based risk factors associated with maternal mortality or severe morbidity and racial1 ethnic1 and geographic health disparities2 7,c7 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 7#db ,u4,s4,c4 #acif et seq47 or the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq471 including activities by community health workers 7as such term is defined in section #baac of such ,act 7#db ,u4,s4,c4 #acigmm77 that are funded by a grant awarded under such section2 7,d7 resources available to such individuals1 such as nutrition assistance and education1 home visitation1 mental health and substance use disorder services1 smoking cessation programs1 pre-natal care1 and other evidence-based maternal mortality or severe morbidity reduction programs2 7,e7 examples of educational materials used by providers of obstetrics services2 7,f7 methods for improving community centralized care1 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 agencies1 community health centers1 local public health departments1 or clinics2 7,g7 guidance on medical record diagnosis codes linked to maternal mortality and severe morbidity1 including1 if applicable1 codes related to social risk factors1 and methods for educating clinicians on the proper use of such codes2 7,h7 risk appropriate transfer protocols during pregnancy1 childbirth1 and the postpartum period2 and 7,i7 any other information related to prevention and treatment of at-risk individuals determined appropriate by the ,secretary4 7#b7 ,guidance on monitoring programs for individuals who have been identified as at risk of complications related to pregnancy4 7#c7 ,best practices for such hospitals1 freestanding birth centers1 and providers to make pregnant women aware of the complications related to pregnancy4 7#d7 ,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-- 7,a7 explains the risks associated with pregnancy1 birth1 and the postpartum period 7including the risks of hemorrhage1 preterm birth1 sepsis1 eclampsia1 obstructed labor71 chronic conditions 7including high blood pressure1 diabetes1 heart disease1 depression1 and obesity7 correlated with adverse pregnancy outcomes1 risks associated with advanced maternal age1 and the importance of adhering to a personalized plan of care2 7,b7 highlights multimodal and evidence-based prevention and treatment techniques2 7,c7 provides for a method 7through signature or otherwise7 for such an individual1 or a person acting on such individual's behalf1 to acknowledge receipt of such fact sheet2 7,d7 is worded in an easily understandable manner and made available in multiple languages and accessible formats determined appropriate by the ,secretary2 and 7,e7 includes any other information determined appropriate by the ,secretary4 7#e7 ,a template for a voluntary clinician checklist that outlines the minimum responsibilities that clinicians1 such as physicians1 certified nurse-midwives1 emergency room and urgent care providers1 nurses and others1 are expected to meet in order to promote quality and safety in the provision of obstetric services4 7#f7 ,a template for a voluntary checklist that outlines the minimum responsibilities that hospital leadership responsible for direct patient care1 such as the institution's president1 chief medical officer1 chief nursing officer1 or other hospital leadership that directly report to the president or chief executive officer of the institution1 should meet to promote hospital-wide initiatives that improve quality and safety in the provision of obstetric services4 7#g7 ,information on multi-stakeholder quality improvement initiatives1 such as the ,alliance for ,innovation on ,maternal ,health1 ,state perinatal quality improvement initiatives1 and other similar initiatives determined appropriate by the ,secretary1 including-- 7,a7 information about such improvement initiatives and how to join2 7,b7 information about public maternal data collection centers2 7,c7 information about quality metrics used and outcomes achieved by such improvement initiatives2 7,d7 information about data sharing techniques used by such improvement initiatives2 7,e7 information about data sources used by such improvement initiatives to identify maternal mortality and severe morbidity risks2 7,f7 information about interventions used by such improvement initiatives to mitigate risks of maternal mortality and severe morbidity2 7,g7 information about data collection techniques on race1 ethnicity1 geography1 age1 income1 and other demographic information used by such improvement initiatives2 and 7,h7 any other information determined appropriate by the ,secretary4 7e7 ,inclusion of best practices ,not later than #ah months after the date of the publication of the guidance required under subsection 7a71 the ,secretary shall update such guidance to include best practices identified by the ,secretary for such hospitals1 freestanding birth centers1 and providers to track maternal mortality and severe morbidity trends by clinicians at such hospitals1 freestanding birth centers1 and providers including-- 7#a7 ways to establish scoring systems1 which may include quality triggers and safety and quality metrics to score case and patient outcome metrics1 for such clinicians2 7#b7 methods to identify1 educate1 and improve such clinicians who may have higher rates of maternal mortality or severe morbidity compared to their regional or ,state peers 7taking into account differences in patient risk for adverse outcomes1 which may include social risk factors72 7#c7 methods for using such data and tracking to enhance research efforts focused on maternal health1 while also improving patient outcomes1 clinician education and training1 and coordination of care2 and 7#d7 any other information determined appropriate by the ,secretary4 7f7 ,cultural appropriateness ,to the extent practicable1 the ,secretary should develop the guidance1 best practices1 fact sheets1 templates1 and other materials that are required under this section in a trauma-informed1 culturally and linguistically appropriate manner4 #c4 ,report on payment methodologies for transferring pregnant women between facilities before1 during1 and after childbirth 7a7 ,in general ,subject to the availability of appropriations1 not later than #cf months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall submit to ,congress a report on the payment methodologies under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 for the antepartum1 intrapartum1 and postpartum transfer of pregnant women from one health care facility to another1 including any potential disincentives or regulatory barriers to such transfers4 7b7 ,consultation ,in developing the report required under subsection 7a71 the ,secretary shall consult with the advisory committee established under section #b7;c74