,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #didi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #b1 #bjbj,mr4 
,toomey 7= himself & ,mr4 ,br[n7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to require !       
,secret>y ( ,heal? & ,human ,s]vices to 
publi% guidance = ,/ates on /rategies = 
mat]nal c>e provid]s p>ticipat+ 9 !     
,m$icaid program to r$uce mat]nal       
mortality & sev]e morbidity ) respect to
 individuals receiv+ m$ical assi/ance "u
 su* program4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,support+ ,be/         
,practices = ,heal?y ,moms ,act4  #b4   
,develop+ guidance on mat]nal mortality 
& sev]e morbidity r$uction = mat]nal c>e
 provid]s receiv+ paym5t "u ! ,m$icaid  
program  7a7 ,9 g5]al ,subject to !     
availability ( appropriations1 n lat]   
?an #cf mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y ( ,heal? & ,human 
,s]vices 7ref]r$ to 9 ?is section z !   
,secret>y7 %all publi% on a public      

website ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices guidance = ,/ates on res\rces &
 /rategies = hospitals1 free/&+ bir?    
c5t]s 7z def9$ 9 section                
#aije7l77#c77;,b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#acif;d7l77#c77;,b7771 & o!r mat]nal c>e
 provid]s z det]m9$ by ! ,secret>y =    
r$uc+ mat]nal mortality & sev]e         
morbidity 9 individuals :o are eligible 
= & receiv+ m$ical assi/ance "u !       
,m$icaid program "u title ,,xix ( su*   
,act 7#db ,u4,s4,c4 #acif et seq47 or   
*ild heal? assi/ance "u ! ,*ildr5's     
,heal? ,insurance ,program "u title     
,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa
 et seq474  7b7 ,updates ,! ,secret>y   
%all update ! guidance & res\rces       
describ$ 9 subsection 7a7 at lea/ once e
 #c ye>s4  7c7 ,consultation ) advisory 
committee  7#a7 ,e/abli%m5t ,subject to 
! availability ( appropriations1 n lat] 
?an #ah mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y %all e/abli% an   
advisory committee to be kn[n z !       

,national ,advisory ,committee on ,r$uc+
 ,mat]nal ,dea?s 7ref]r$ to 9 ?is       
section z ! ,advisory ,committee74  7#b7
 ,duties ,! ,advisory ,committee %all   
provide cons5sus advice & guidance to ! 
,secret>y on ! developm5t & compilation 
( ! guidance describ$ 9 subsection 7a7  
7& any updates to su* guidance74  7#c7  
,memb]%ip  7,a7 ,9 g5]al ,! ,secret>y1 9
 consultation ) su* o!r heads ( ag5cies1
 z ! ,secret>y deems appropriate & 9    
accordance ) ?is p>agraph1 %all appo9t n
 m ?an #da memb]s to ! ,advisory        
,committee4 ,9 appo9t+ su* memb]s1 !    
,secret>y %all ensure t-- 7i7 ! total   
numb] ( memb]s ( ! ,advisory ,committee 
is an odd numb]2 &  7ii7 ! total numb] (
 vot+ memb]s :o are n ,f$]al (ficials   
does n exce$ ! total numb] ( vot+ ,f$]al
 memb]s :o are ,f$]al (ficials4  7,b7   
,requir$ memb]s  7i7 ,f$]al (ficials ,! 
,advisory ,committee %all include z vot+
 memb]s ! foll[+ ,f$]al (ficials1 or _! 
designees3 7,i7 ,! ,secret>y ( ,heal? & 
,human ,s]vices4  7,,ii7 ,! ,adm9i/rator

 ( ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices4  7,,iii7 ,! ,director ( !     
,c5t]s = ,disease ,control & ,prev5tion4
  7,,iv7 ,! ,associate ,adm9i/rator ( ! 
,mat]nal & ,*ild ,heal? ,bureau ( !     
,heal? ,res\rces & ,s]vices             
,adm9i/ration4  7,v7 ,! ,director ( !   
,ag5cy = ,heal?c>e ,rese>* & ,quality4  
7,,vi7 ,! ,national ,coord9ator = ,heal?
 ,in=mation ,te*nology4  7,,vii7 ,!     
,director ( ! ,national ,in/itutes (    
,heal?4  7,,viii7 ,! ,secret>y (        
,vet]ans ,affairs4  7,,ix7 ,! ,director 
( ! ,indian ,heal? ,s]vice4  7,x7 ,!    
,deputy ,assi/ant ,secret>y = ,m9ority  
,heal?4  7,,xi7 ,! ,adm9i/rator ( !     
,sub/ance ,abuse & ,m5tal ,heal?        
,s]vices ,adm9i/ration4  7,,xii7 ,!     
,deputy ,assi/ant ,secret>y = ,wom5's   
,heal?4  7,,xiii7 ,su* o!r ,f$]al       
(ficials or _! designees z ! ,secret>y  
det]m9es appropriate4  7ii7 ,non-,f$]al 
(ficials  7,i7 ,9 g5]al ,! ,advisory    
,committee %all include ! foll[+ z vot+ 
memb]s3 7aa7 ,at lea/ #a repres5tative f

 a pr(essional organization repres5t+   
hospitals & heal? sy/ems4  7bb7 ,at lea/
 #a repres5tative f a m$ical pr(essional
 organization repres5t+ prim>y c>e      
provid]s4  7cc7 ,at lea/ #a             
repres5tative f a m$ical pr(essional    
organization repres5t+ g5]al            
ob/etrician-gynecologi/s4  7dd7 ,at lea/
 #a repres5tative f a m$ical pr(essional
 organization repres5t+ c]tifi$         
nurse-midwives4  7ee7 ,at lea/ #a       
repres5tative f a m$ical pr(essional    
organization repres5t+ o!r mat]nal fetal
 m$ic9e provid]s4  7ff7 ,at lea/ #a     
repres5tative f a m$ical pr(essional    
organization repres5t+ ane/hesiologi/s4 
7gg7 ,at lea/ #a repres5tative f a      
m$ical pr(essional organization         
repres5t+ em]g5cy m$ic9e physicians &   
urg5t c>e provid]s4  7hh7 ,at lea/ #a   
repres5tative f a m$ical pr(essional    
organization repres5t+ nurses4  7ii7 ,at
 lea/ #a repres5tative f a pr(essional  
organization repres5t+ community heal?  
work]s4  7jj7 ,at lea/ #a repres5tative 

f a pr(essional organization repres5t+  
d\las4  7kk7 ,at lea/ #a repres5tative f
 ,/ate-affiliat$ programs or exi/+      
collaboratives ) demon/rat$ exp]tise or 
success 9 improv+ mat]nal heal?4  7ll7  
,at lea/ #a director ( a ,/ate ,m$icaid 
ag5cy t has _h demon/rat$ success 9     
improv+ mat]nal heal?4  7mm7 ,at lea/ #a
 repres5tative f an accr$it+            
organization = mat]nal heal? quality &  
safety /&>ds4  7nn7 ,at lea/ #a         
repres5tative f a mat]nal pati5t        
advocacy organization ) liv$ exp]i5ce ( 
sev]e mat]nal morbidity4  7,,ii7        
,requirem5ts ,ea* individual select$ to 
be a memb] "u ?is clause %all-- 7aa7 h  
exp]tise 9 mat]nal heal?2  7bb7 n be a  
,f$]al (ficial2 &  7cc7 h exp]i5ce work+
 ) populations t are at high] risk =    
mat]nal mortality or sev]e morbidity1   
su* z populations t exp]i5ce racial1    
e?nic1 & geographic heal? disp>ities1   
pregnant & po/p>tum wom5 exp]i5c+ m5tal 
heal? disord]s or o!r comorbidities su* 
z sub/ance use disord]s1 hyp]t5sion1    

?yroid disord]s1 & sickle cell disease4 
7,c7 ,additional memb]s  7i7 ,9 g5]al ,9
 addition to ! memb]s requir$ to be     
appo9t$ "u subp>agraph 7,b71 ! ,secret>y
 may appo9t z memb]s to ! ,advisory     
,committee su* o!r individuals )        
relevant exp]tise or exp]i5ce z !       
,secret>y %all det]m9e appropriate1 :i* 
may include individuals describ$ 9      
clause 7ii74  7ii7 ,sugge/$ additional  
memb]s ,! individuals describ$ 9 ?is    
clause are ! foll[+3 7,i7               
,repres5tatives f ,/ate mat]nal         
mortality review committees & p]9atal   
quality collaboratives4  7,,ii7 ,m$ical 
provid]s :o c>e = wom5 & infants dur+   
pregnancy & ! po/p>tum p]iod1 su* z     
family practice physicians1 c>diologi/s1
 pulmonology critical c>e speciali/s1   
endocr9ologi/s1 p$iatricians1 &         
neonatologi/s4  7,,iii7 ,repres5tatives 
f ,/ate & local public heal? dep>tm5ts4 
7,,iv7 ,subject matt] exp]ts 9 conduct+ 
outrea* to wom5 :o are ,african ,am]ican
 or belong to ano!r m9ority gr\p4  7,v7 

,directors ( ,/ate ag5cies responsible =
 adm9i/]+ a ,/ate's mat]nal & *ild heal?
 s]vices program "u title ,v ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #gja et  
seq474  7,,vi7 ,exp]ts 9 m$ical         
education or physician tra9+4  7,,vii7  
,repres5tatives f ,m$icaid manag$ c>e   
organizations4  7#d7 ,applicability (   
,,faca ,! ,f$]al ,advisory ,committee   
,act 7#e ,u4,s4,c4 ,app47 %all apply to 
! committee e/abli%$ "u ?is subsection4 
7d7 ,cont5ts ,! guidance describ$ 9     
subsection 7a7 %all include1 ) respect  
to hospitals1 free/&+ bir? c5t]s1 & o!r 
mat]nal c>e provid]s1 ! foll[+3 7#a7    
,be/ practices reg>d+ evid5ce-bas$      
scre5+ & cl9ician education initiatives 
relat+ to scre5+ & treatm5t protocols = 
individuals :o are at risk ( exp]i5c+   
complications relat$ to pregnancy1 ) an 
emphasis on individuals ) preconditions 
directly l9k$ to pregnancy complications
 & mat]nal mortality & sev]e morbidity1 
includ+-- 7,a7 me?ods to id5tify        
individuals :o are at risk ( mat]nal    

mortality or sev]e morbidity1 includ+   
risk /ratification2  7,b7 evid5ce-bas$  
risk factors associat$ ) mat]nal        
mortality or sev]e morbidity & racial1  
e?nic1 & geographic heal? disp>ities2   
7,c7 evid5ce-bas$ /rategies to r$uce    
risk factors associat$ ) mat]nal        
mortality or sev]e morbidity ?r\gh      
s]vices :i* may be cov]$ "u ! ,m$icaid  
program "u title ,,xix ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 or ! ,*ildr5's ,heal? ,insurance  
,program "u title ,,xxi ( su* ,act 7#db 
,u4,s4,c4 #acig;aa et seq471 includ+    
activities by community heal? work]s 7z 
su* t]m is def9$ 9 section #baac ( su*  
,act 7#db ,u4,s4,c4 #acigmm77 t are     
fund$ by a grant aw>d$ "u su* section2  
7,d7 res\rces available to su*          
individuals1 su* z nutrition assi/ance &
 education1 home visitation1 m5tal heal?
 & sub/ance use disord] s]vices1 smok+  
cessation programs1 pre-natal c>e1 & o!r
 evid5ce-bas$ mat]nal mortality or sev]e
 morbidity r$uction programs2  7,e7     

examples ( educational mat]ials us$ by  
provid]s ( ob/etrics s]vices2  7,f7     
me?ods = improv+ community c5traliz$    
c>e1 includ+ provid+ teleheal? s]vices  
or home visits to increase & facilitate 
access to & engagem5t 9 pr5atal &       
po/p>tum c>e & collaboration ) home     
heal? ag5cies1 community heal? c5t]s1   
local public heal? dep>tm5ts1 or cl9ics2
  7,g7 guidance on m$ical record        
diagnosis codes l9k$ to mat]nal         
mortality & sev]e morbidity1 includ+1 if
 applicable1 codes relat$ to social risk
 factors1 & me?ods = educat+ cl9icians  
on ! prop] use ( su* codes2  7,h7 risk  
appropriate transf] protocols dur+      
pregnancy1 *ildbir?1 & ! po/p>tum p]iod2
 &  7,i7 any o!r in=mation relat$ to    
prev5tion & treatm5t ( at-risk          
individuals det]m9$ appropriate by !    
,secret>y4  7#b7 ,guidance on monitor+  
programs = individuals :o h be5 id5tifi$
 z at risk ( complications relat$ to    
pregnancy4  7#c7 ,be/ practices = su*   
hospitals1 free/&+ bir? c5t]s1 &        

provid]s to make pregnant wom5 aw>e ( ! 
complications relat$ to pregnancy4  7#d7
 ,a fact %eet = provid+ pregnant wom5 :o
 are receiv+ c>e on an outpati5t basis )
 a notice dur+ ! pr5atal /age (         
pregnancy t-- 7,a7 expla9s ! risks      
associat$ ) pregnancy1 bir?1 & !        
po/p>tum p]iod 7includ+ ! risks (       
hemorrhage1 pret]m bir?1 sepsis1        
eclampsia1 ob/ruct$ labor71 *ronic      
conditions 7includ+ high blood pressure1
 diabetes1 he>t disease1 depression1 &  
obesity7 correlat$ ) adv]se pregnancy   
outcomes1 risks associat$ ) advanc$     
mat]nal age1 & ! importance ( adh]+ to a
 p]sonaliz$ plan ( c>e2  7,b7 highlights
 multimodal & evid5ce-bas$ prev5tion &  
treatm5t te*niques2  7,c7 provides = a  
me?od 7?r\gh signature or o!rwise7 = su*
 an individual1 or a p]son act+ on su*  
individual's behalf1 to ackn[l$ge       
receipt ( su* fact %eet2  7,d7 is word$ 
9 an easily und]/&able mann] & made     
available 9 multiple languages &        
accessible =mats det]m9$ appropriate by 

! ,secret>y2 &  7,e7 includes any o!r   
in=mation det]m9$ appropriate by !      
,secret>y4  7#e7 ,a template = a        
volunt>y cl9ician *eckli/ t outl9es !   
m9imum responsibilities t cl9icians1 su*
 z physicians1 c]tifi$ nurse-midwives1  
em]g5cy room & urg5t c>e provid]s1      
nurses & o!rs1 are expect$ to meet 9    
ord] to promote quality & safety 9 !    
provision ( ob/etric s]vices4  7#f7 ,a  
template = a volunt>y *eckli/ t outl9es 
! m9imum responsibilities t hospital    
lead]%ip responsible = direct pati5t    
c>e1 su* z ! in/itution's presid5t1 *ief
 m$ical (fic]1 *ief nurs+ (fic]1 or o!r 
hospital lead]%ip t directly report to !
 presid5t or *ief executive (fic] ( !   
in/itution1 %\ld meet to promote        
hospital-wide initiatives t improve     
quality & safety 9 ! provision (        
ob/etric s]vices4  7#g7 ,in=mation on   
multi-/akehold] quality improvem5t      
initiatives1 su* z ! ,alliance =        
,innovation on ,mat]nal ,heal?1 ,/ate   
p]9atal quality improvem5t initiatives1 

& o!r simil> initiatives det]m9$        
appropriate by ! ,secret>y1 includ+--   
7,a7 in=mation ab\t su* improvem5t      
initiatives & h[ to jo92  7,b7 in=mation
 ab\t public mat]nal data collection    
c5t]s2  7,c7 in=mation ab\t quality     
metrics us$ & outcomes a*iev$ by su*    
improvem5t initiatives2  7,d7 in=mation 
ab\t data %>+ te*niques us$ by su*      
improvem5t initiatives2  7,e7 in=mation 
ab\t data s\rces us$ by su* improvem5t  
initiatives to id5tify mat]nal mortality
 & sev]e morbidity risks2  7,f7         
in=mation ab\t int]v5tions us$ by su*   
improvem5t initiatives to mitigate risks
 ( mat]nal mortality & sev]e morbidity2 
7,g7 in=mation ab\t data collection     
te*niques on race1 e?nicity1 geography1 
age1 income1 & o!r demographic in=mation
 us$ by su* improvem5t initiatives2 &   
7,h7 any o!r in=mation det]m9$          
appropriate by ! ,secret>y4  7e7        
,inclusion ( be/ practices ,n lat] ?an  
#ah mon?s aft] ! date ( ! publication ( 
! guidance requir$ "u subsection 7a71 ! 

,secret>y %all update su* guidance to   
include be/ practices id5tifi$ by !     
,secret>y = su* hospitals1 free/&+ bir? 
c5t]s1 & provid]s to track mat]nal      
mortality & sev]e morbidity tr5ds by    
cl9icians at su* hospitals1 free/&+ bir?
 c5t]s1 & provid]s includ+-- 7#a7 ways  
to e/abli% scor+ sy/ems1 :i* may include
 quality trigg]s & safety & quality     
metrics to score case & pati5t outcome  
metrics1 = su* cl9icians2  7#b7 me?ods  
to id5tify1 educate1 & improve su*      
cl9icians :o may h high] rates ( mat]nal
 mortality or sev]e morbidity comp>$ to 
_! regional or ,/ate pe]s 7tak+ into    
acc\nt diff]5ces 9 pati5t risk = adv]se 
outcomes1 :i* may include social risk   
factors72  7#c7 me?ods = us+ su* data & 
track+ to enhance rese>* ef=ts focus$ on
 mat]nal heal?1 :ile also improv+ pati5t
 outcomes1 cl9ician education & tra9+1 &
 coord9ation ( c>e2 &  7#d7 any o!r     
in=mation det]m9$ appropriate by !      
,secret>y4  7f7 ,cultural appropriat5ess
 ,to ! ext5t practicable1 ! ,secret>y   

%\ld develop ! guidance1 be/ practices1 
fact %eets1 templates1 & o!r mat]ials t 
are requir$ "u ?is section 9 a          
trauma-in=m$1 culturally & l+ui/ically  
appropriate mann]4  #c4 ,report on      
paym5t me?odologies = transf]r+ pregnant
 wom5 betwe5 facilities be=e1 dur+1 &   
aft] *ildbir?  7a7 ,9 g5]al ,subject to 
! availability ( appropriations1 n lat] 
?an #cf mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y ( ,heal? & ,human 
,s]vices 7ref]r$ to 9 ?is section z !   
,secret>y7 %all submit to ,congress a   
report on ! paym5t me?odologies "u !    
,m$icaid program "u title ,,xix ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 = ! antep>tum1           
intrap>tum1 & po/p>tum transf] (        
pregnant wom5 f "o heal? c>e facility to
 ano!r1 includ+ any pot5tial dis9c5tives
 or regulatory b>ri]s to su* transf]s4  
7b7 ,consultation ,9 develop+ ! report  
requir$ "u subsection 7a71 ! ,secret>y  
%all consult ) ! advisory committee     
e/abli%$ "u section #b7;c74