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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3620 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 3620

 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 a maternity care quality measurement 
    program, evaluating maternity care home models, and supporting 
                 maternity care quality collaboratives.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            December 8, 2011

  Mr. Engel introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 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 a maternity care quality measurement 
    program, evaluating maternity care home models, 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 of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Quality measures for maternity care under Medicaid and CHIP.
Sec. 3. Quality collaboratives.
Sec. 4. Woman- and family-centered maternity care home demonstration 
                            program.

SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER MEDICAID AND CHIP.

    (a) In General.--Title XI of the Social Security Act is amended by 
inserting after section 1139B (42 U.S.C. 1320b-9b) the following new 
section:

``SEC. 1139C. MATERNITY CARE QUALITY MEASUREMENT.

    ``(a) In General.--The Secretary shall develop a maternity care 
quality measurement program for care provided to childbearing women and 
newborns for voluntary use by--
            ``(1) a State in administering a State plan under title XIX 
        or a State child health plan under title XXI;
            ``(2) health insurance issuers (as such term is defined in 
        section 2791 of the Public Health Service Act (42 U.S.C. 300gg-
        91)) and managed care entities that enter into contracts with 
        States for the purpose of administering such plans; and
            ``(3) providers of items and services (including 
        accountable care organizations) with respect to items and 
        services provided under such plans.
    ``(b) Coordination With Other Quality Measures.--
            ``(1) Medicaid quality measurement program.--The maternity 
        care quality measurement program under subsection (a) shall be 
        developed, administered, and evaluated on an ongoing basis as 
        part of, and in coordination with, the Medicaid Quality 
        Measurement Program established under section 1139B(b)(5)(A) 
        and the pediatric quality measures program established under 
        section 1139A(b). In coordination with the publication 
        requirements under section 1139A(b)(5) and 1139B(b)(5)(B), the 
        Secretary annually shall publish recommended changes to the 
        core set of maternity care quality measures published under 
        subsection (c) that shall reflect the development, testing, 
        validation, and consensus process described in subsection (d).
            ``(2) Identification of measurement gaps.--The maternity 
        care quality measurement program under subsection (a) shall 
        include procedures for identifying quality measure gaps and 
        establishing priorities for the development and advancement of 
        new or modified quality measures under the maternity care 
        quality measurement program, the Medicaid Quality Measurement 
        Program established under section 1139B(b)(5)(A) and the 
        pediatric quality measures program established under section 
        1139A(b).
            ``(3) Reports to congress and macpac.--Not later than 
        January 1, 2017, and every 3 years thereafter, the Secretary 
        shall include in the reports required under sections 
        1139A(a)(6) and 1139B(b)(4) to Congress and the Medicaid and 
        CHIP Payment and Access Commission information similar to the 
        information required under such sections with respect to the 
        measures established under this section.
    ``(c) Identification of an Initial Set of Maternity Care Quality 
Measures.--
            ``(1) Consultation and public comment.--Not later than 
        January 1, 2014, the Secretary shall--
                    ``(A) solicit public comment on a recommended 
                initial core set of maternity care quality measures; 
                and
                    ``(B) consult with stakeholders identified in 
                subsection (i)(1) regarding such measures.
            ``(2) Publication.--Not later than January 1, 2015, the 
        Secretary shall identify, and publish, from maternity care 
        quality measures endorsed under section 1890(b)(2), an initial 
        core set of maternity care quality measures.
            ``(3) Standardized reporting.--The Secretary shall develop 
        a standardized format for reporting information based on the 
        initial core set of maternity care quality measure for 
        voluntary use in data collection and reporting by--
                    ``(A) a State in administering a State plan under 
                title XIX or a State Child Health Plan under title XXI;
                    ``(B) health insurance issuers and managed care 
                entities that enter into contracts with States for the 
                purpose of administering such plans; and
                    ``(C) providers of items and services (including 
                accountable care organizations) with respect to items 
                and services provided under such plans.
    ``(d) Development of Additional Quality Measures.--
            ``(1) Contracts with qualified entities.--Not later than 
        the end of the 6-month period beginning on the date the 
        Secretary publishes the initial measures under subsection 
        (c)(2), subject to subsection (b), the Secretary, acting 
        through the Agency for Healthcare Research and Quality, in 
        consultation with the Centers for Medicare & Medicaid Services, 
        shall enter into grants, contracts, or intergovernmental 
        agreements with qualified measure development entities for the 
        purpose of developing, testing, and validating maternity care 
        quality measures in areas that are not adequately covered by 
        the measures so published.
            ``(2) Qualified measure development entity defined.--For 
        purposes of this subsection, the term `qualified measure 
        development entity' means an entity that--
                    ``(A) has demonstrated expertise and capacity in 
                the development and testing of quality measures;
                    ``(B) has adopted procedures for quality measure 
                development that ensure the inclusion of--
                            ``(i) the views of the individuals and 
                        entities referred to in subsection (e)(2)(E) 
                        and whose performance will be assessed by the 
                        measures; and
                            ``(ii) the views of other individuals and 
                        entities (including patients, consumers, and 
                        health care purchasers) who will use the data 
                        generated as a result of the use of the quality 
                        measures;
                    ``(C) for the purpose of ensuring that the quality 
                measures developed under this subsection meet the 
                requirements to be considered for endorsement under 
                section 1890(b)(2), has provided assurances to the 
                Secretary that the measure development entity will 
                collaborate with--
                            ``(i) the Secretary;
                            ``(ii) the consensus-based entity with a 
                        contract under section 1890(a)(1); and
                            ``(iii) stakeholders (including those 
                        stakeholders identified in subsection (i)(1)), 
                        as practicable;
                    ``(D) has transparent policies regarding governance 
                and conflicts of interest; and
                    ``(E) submits an application to the Secretary at 
                such time, and in such form and manner, as the 
                Secretary may require.
            ``(3) eMeasures.--
                    ``(A) In general.--A qualified measure development 
                entity with a grant, contract, or intergovernmental 
                agreement under paragraph (1), in developing quality 
                measures, shall consult with the voluntary consensus 
                standards setting organizations and other organizations 
                involved in the advancement of evidence-based measures 
                of health care as the Secretary consults with under 
                sections 1139A(b)(3)(H) and 1139B(b)(5)(A) to create 
                eMeasures that are aligned with the measures developed 
                under the Medicaid Quality Measurement Program 
                established under section 1139B(b)(5)(A) and the 
                pediatric quality measures program established under 
                section 1139A(b).
                    ``(B) eMeasure defined.--For purposes of this 
                section, the term `eMeasure' means a 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.
            ``(4) Endorsement.--Any maternity care quality measures 
        developed under this subsection by a qualified measure 
        development entity shall be submitted by the qualified measure 
        development entity to the consensus-based entity with a 
        contract under section 1890(a)(1) to be considered for 
        endorsement under section 1890(b)(2).
    ``(e) Types of Measures.--
            ``(1) In general.--The maternity quality measures 
        identified under subsection (c) and the measures developed 
        under subsection (d) shall--
                    ``(A) be evidence-based;
                    ``(B) utilize risk adjustment or risk 
                stratification methodologies, if appropriate;
                    ``(C) utilize attribution methods to specify the 
                clinicians, facilities, and other entities that the 
                measures are applicable to;
                    ``(D) be pilot-tested with regards to scientific 
                validity, feasibility, and attribution method; and
                    ``(E) include a balance of each of the types of 
                measures listed in paragraph (2).
            ``(2) List of types of measures.--The measures listed in 
        this paragraph are the following:
                    ``(A) Measures of the process, experience, 
                efficiency, and outcomes of maternity care, including 
                postpartum outcomes.
                    ``(B) Measures that apply to--
                            ``(i) women and newborns who are healthy 
                        and at low risk, including measures of 
                        appropriately low-intervention, physiologic 
                        birth in low-risk women; and
                            ``(ii) women and newborns at higher risk.
                    ``(C) Measures that apply to--
                            ``(i) childbearing women; and
                            ``(ii) newborns.
                    ``(D) Measures that apply to care during--
                            ``(i) pregnancy;
                            ``(ii) intrapartum period; and
                            ``(iii) the postpartum period.
                    ``(E) Measures that apply to--
                            ``(i) clinicians and clinician groups;
                            ``(ii) facilities;
                            ``(iii) health plans; and
                            ``(iv) accountable care organizations.
                    ``(F) Measurement of--
                            ``(i) disparities;
                            ``(ii) care coordination; and
                            ``(iii) shared decisionmaking.
            ``(3) Physiologic defined.--For purposes of this 
        subsection, the term `physiologic' means characteristic of or 
        conforming to the normal functioning or state of the body or a 
        tissue or organ, normal, and not pathologic.
            ``(4) Construction.--Nothing in this subsection 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 anyway limiting available services.
    ``(f) Maternity Consumer Assessment of Healthcare Providers and 
Systems Surveys.--
            ``(1) Adaption of surveys.--Not later than January 1, 2016, 
        for the purpose of measuring the care experiences of 
        childbearing women and newborns, the Agency for Healthcare 
        Research and Quality shall adapt the 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 subsection 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 subsection 
        (i)(1).
    ``(g) Annual State Reports Regarding State-Specific Quality of Care 
Measures Applied Under Medicaid.--
            ``(1) Annual state reports.--Each State with a State plan 
        or waiver approved under title XIX shall annually report 
        (separately or as part of an annual report required under 
        section 1139A(c) or section 1139B(d)), to the Secretary on 
        the--
                    ``(A) State-specific maternity health quality 
                measures applied by the State under the such plan; and
                    ``(B) State-specific information on the quality of 
                maternity care furnished to Medicaid eligible 
                individuals under such plan, 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, 2015, and 
        annually thereafter, the Secretary shall collect, analyze, and 
        make publicly available the information reported by States 
        under subparagraph (A).
    ``(h) Conversion of Currently Endorsed Measures and Creation of 
Initial Quality Data Model To Enable Electronic Health Records To 
Measure the Care of Childbearing Women and Newborns.--
            ``(1) In general.--Not later than January 1, 2015, for the 
        purpose of fostering automated patient-centered longitudinal 
        quality measurement of maternal and newborn care using clinical 
        data, the consensus-based entity with a contract under section 
        1890(b)(2) shall coordinate--
                    ``(A) the conversion of endorsed measures for the 
                care of childbearing women and newborns to eMeasures 
                (as such term is defined in subsection (d)(3)(B)); and
                    ``(B) the development of an initial quality data 
                model for use within electronic health records of 
                childbearing women and newborns enrolled in a program 
                administered by a State through State plans under title 
                XIX and State Child Health plans under title XXI for 
                purposes of such eMeasures.
            ``(2) Requirements for emeasure conversion and quality data 
        model creation.--The conversion to eMeasures and the quality 
        data model creation under paragraph (1) shall, for each quality 
        measure of the care of childbearing women or newborns that the 
        consensus-based entity with a contract under section 1890(b)(2) 
        has endorsed, use the entity's measure authoring tool to--
                    ``(A) specify standard data elements, quality data 
                elements, and data flow connectors to electronic 
                information;
                    ``(B) specify quality measure logical statements;
                    ``(C) test quality measure validity with an 
                appropriate electronic health record test database;
                    ``(D) finalize eMeasures for export to electronic 
                health record systems; and
                    ``(E) carry out this work in--
                            ``(i) collaboration with the developer or 
                        sponsor of each endorsed measure, who is 
                        responsible, under an agreement with the entity 
                        that endorsed such measure, for updating such 
                        measure; and
                            ``(ii) consultation with the stakeholders 
                        identified in subsection (i)(1).
            ``(3) Coordination with hitech act.--In carrying out 
        activities under this subsection, the consensus-based entity 
        with a contract under section 1890(b)(2) shall take into 
        account, and to the extent practicable, coordinate with, 
        similar activities relating to the implementation of the Health 
        Information Technology for Economic and Clinical Health Act 
        established under title XIII of division A and title IV of 
        division B of Public Law 111-5.
    ``(i) Stakeholders.--
            ``(1) In general.--The stakeholders identified in this 
        paragraph are--
                    ``(A) the various clinical disciplines and 
                specialties involved in providing maternity care;
                    ``(B) State Medicaid administrators;
                    ``(C) maternity care consumers and their advocates;
                    ``(D) technical experts in quality measurement;
                    ``(E) hospital, facility and health system leaders;
                    ``(F) employers and purchasers; and
                    ``(G) other individuals who are involved in the 
                advancement of evidence-based maternity care quality 
                measures.
            ``(2) Professional organizations.--The stakeholders 
        identified under paragraph (1) may include representatives from 
        relevant national medical specialty and professional 
        organizations and specialty societies.
    ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated $28,000,000 to carry out this section. Funds appropriated 
under this subsection shall remain available until expended.''.
    (b) Conforming Amendments.--
            (1) Section 1139A(a)(6) of the Social Security Act (42 
        U.S.C. 1320b-9a(a)(6)) is amended, in the matter preceding 
        subparagraph (A), by inserting ``and the Medicaid and CHIP 
        Payment and Access Commission'' after ``Congress''.
            (2) Section 1139B(b)(4) of such Act (42 U.S.C. 1320b-
        9b(b)(4)) is amended by inserting ``and the Medicaid and CHIP 
        Payment and Access Commission'' after ``Congress''.

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 
        care quality collaboratives;
            (2) expanded activities of existing maternity care quality 
        collaboratives; and
            (3) maternity 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 care initiatives, to the extent that such 
        collaboratives use such grant only for such initiatives.
            (2) Entities seeking to establish a maternity 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 cesarean 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 
                management 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 
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 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 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 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 care quality collaborative or 
        a maternity 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 
        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 
        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. WOMAN- AND FAMILY-CENTERED MATERNITY CARE HOME DEMONSTRATION 
              PROGRAM.

    (a) Definitions.--In this section:
            (1) CHIP.--The term ``CHIP'' means the State Children's 
        Health Insurance Program established under title XXI of the 
        Social Security Act (42 U.S.C. 1397aa et seq.).
            (2) Eligible individuals.--The term ``eligible individual'' 
        means a childbearing woman who is receiving assistance under 
        Medicaid or CHIP.
            (3) Eligible entity.--The term ``eligible entity'' means a 
        State, an entity or organization receiving payments under 
        Medicaid or CHIP, a hospital, a freestanding birth center (as 
        defined in section 1905(l)(3)(B) of the Social Security Act (42 
        U.S.C. 1396d(l)(3)(B)), an entity or organization receiving 
        assistance under section 330 of the Public Health Service Act 
        (42 U.S.C. 254b), a federally qualified health center (as 
        defined in subsection (l)(2)(C) of section 1905 of the Social 
        Security Act (42 U.S.C. 1396d), a rural health clinic (as 
        defined in subsection (l)(1) of such section), or an entity 
        that receives assistance under title X or XX of the Public 
        Health Service Act (42 U.S.C. 300 et seq., 300z et seq.), that 
        submits an approved application to the Secretary to conduct a 
        demonstration project under this section.
            (4) Medicaid.--The term ``Medicaid'' means the Federal and 
        State program for medical assistance established under title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
            (5) Principal maternity care provider.--The term 
        ``principal maternity care provider'' means:
                    (A) A physician (as defined in section 1861(r)(1) 
                of the Social Security Act (42 U.S.C. 1395x(r)(1)) who 
                meets the following requirements:
                            (i) The physician is a board certified 
                        physician who specializes in women's health 
                        issues, such as obstetrics and gynecology, or 
                        family practice, and who provides continuous 
                        and comprehensive care for individuals under 
                        the physician's care.
                            (ii) The physician has the staff and 
                        resources to manage the comprehensive and 
                        coordinated health care of each such 
                        individual.
                            (iii) The physician practices in a 
                        practice, health or birth center, clinic, or 
                        hospital recognized to be a maternity care 
                        home.
                            (iv) Such other requirements as are defined 
                        by the Secretary.
                    (B) An advanced practice nurse, a certified nurse-
                midwife (CNM) or certified midwife (CM) certified by 
                the American Midwifery Certification Board, or 
                physician assistant, who meets the following 
                requirements:
                            (i) The advanced practice nurse, midwife, 
                        or physician assistant specializes in women's 
                        health issues, such as obstetrics and 
                        gynecology, and provides continuous and 
                        comprehensive care for patients.
                            (ii) The advanced practice nurse, midwife, 
                        or physician assistant has the staff and 
                        resources to manage the comprehensive and 
                        coordinated health care of each such 
                        individual.
                            (iii) The advanced practice nurse, midwife, 
                        or physician assistant practices in a practice 
                        or health or birth center recognized to be a 
                        maternity care home.
                            (iv) Such other requirements as are defined 
                        by the Secretary.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) Maternity care home.--The term ``maternity care home'' 
        means a physician-led practice, or advanced practice nurse-, 
        certified nurse-midwife-, certified midwife, or physician 
        assistant-led practice in those States in which State law does 
        not require direct supervision of licensed advanced practice 
        nurses, certified nurse-midwives, certified midwives, or 
        physician assistants providing services in a hospital, 
        practice, health or birth center, or clinic participating as 
        maternity care home under the program that uses practice 
        innovations and coordination agreements with other providers to 
        improve the management and coordination of maternity care that 
        meets the following standards:
                    (A) The practice, health or birth center, clinic, 
                or hospital is able to provide or coordinate maternity 
                care for women, including preconception care, prenatal 
                care, family planning, medical care, mental and 
                behavioral health care, and screening, that, at a 
                minimum, includes at least 3 of the following, and may 
                include all of the following:
                            (i) An initial health assessment and 
                        development of a maternity care plan.
                            (ii) Pregnancy care to foster access of all 
                        women to preventive services and support, 
                        including guidance about nutrition, weight 
                        gain, exercise, stress management, rest, and 
                        environmental exposures.
                            (iii) Pregnancy care to foster access of 
                        women with special needs to such services as 
                        help with smoking cessation; use of alcohol and 
                        other harmful substances; mood disorders; and 
                        domestic violence.
                            (iv) Evaluation and development of a plan 
                        for appropriate use of any continuing and new 
                        prescription and over-the-counter medications.
                            (v) Appropriate care for women who are 
                        deemed at risk for premature birth.
                            (vi) Appropriate care for women who are 
                        members of a minority population that 
                        experiences pregnancy-related health 
                        disparities.
                            (vii) Coordination with providers of 
                        services for any ongoing or new medical 
                        conditions.
                            (viii) Care to foster initiation and 
                        establishment of breast feeding through 
                        effective prenatal, intrapartum, and postpartum 
                        services and practices.
                            (ix) Plan for childbirth that supports 
                        utilization of evidence-based intrapartum 
                        practices.
                            (x) Care of the newborn from birth until 
                        transition to the baby's primary care provider, 
                        including preventive practices promoting 
                        optimal feeding and attachment.
                            (xi) Postpartum health services for the 
                        first two months after birth, including family 
                        planning, weight control, exercise, nutrition, 
                        and other preventive services; assessment and 
                        treatment for postpartum depression and other 
                        mood disorders; assessment and treatment of 
                        other new-onset conditions that may include 
                        infection, pain, and heavy bleeding; and any 
                        continuing needs for help with smoking 
                        cessation, substance abuse, and other health 
                        risks.
                            (xii) At the conclusion of maternity 
                        services and as needed in the course of 
                        maternity services, communication with the 
                        primary care providers of the woman and newborn 
                        about care processes, outcomes of maternal and 
                        newborn care, and any continuing health care 
                        needs.
                            (xiii) Any other services specified by the 
                        Secretary.
                    (B) The practice, health or birth center, clinic, 
                or hospital applies standards for access to care and 
                communication with eligible individuals participating 
                in the demonstration program established under this 
                section, including direct and ongoing access to the 
                principal maternity care provider who accepts 
                responsibility for providing continuous care, including 
                coordination for comprehensive maternity care to the 
                whole person, in collaboration with a team of other 
                health professionals, including other nurses, primary 
                care and specialist physicians, and mental health 
                professionals, as needed and appropriate. Care is 
                patient and family centered, culturally and 
                linguistically appropriate, structured to ensure women 
                receive complete and accurate health information for 
                shared decisionmaking, and structured to assure 
                confidentiality so that teens and women may seek needed 
                care in a timely way.
                    (C) The practice, health or birth center, clinic, 
                or hospital has readily accessible, clinically useful 
                records on eligible individuals participating in the 
                demonstration program established under this section, 
                when feasible through electronic health records 
                available in ambulatory and inpatient settings, that 
                enable the practice to treat such individuals 
                comprehensively and systematically.
                    (D) The practice, health or birth center, clinic or 
                hospital maintains continuous relationships with 
                eligible individuals participating in the demonstration 
                program established under this section by implementing 
                clinical recommendations supported by high-quality 
                evidence in national guidelines, systematic reviews, or 
                other well-conducted clinical studies and applying them 
                to the identified needs of such individuals over time 
                and with the intensity needed by such individuals.
                    (E) The practice, health or birth center, clinic, 
                or hospital supports eligible individuals in self-care 
                to pursue their goals and achieve optimal health.
                    (F) The practice, health or birth center, clinic, 
                or hospital assesses and addresses barriers to 
                communication between health professions and eligible 
                individuals.
                    (G) The practice, health or birth center, clinic, 
                or hospital has in place the resources and processes 
                necessary to achieve improvements in the management and 
                coordination of care for eligible individuals 
                participating in the demonstration program established 
                under this section, including--
                            (i) providing training programs for 
                        personnel involved in the coordination of care;
                            (ii) utilizing information technology to 
                        support optimal patient care, performance 
                        measurement and use of the results to improve 
                        practice, patient education, and enhanced 
                        communication; and
                            (iii) implementation of programs to improve 
                        the quality of care.
                    (H) The practice, health or birth center, clinic, 
                or hospital meets the requirements imposed on a covered 
                entity for purposes of applying part C of title XI of 
                the Public Health Service Act (42 U.S.C. 300b-1 et 
                seq.) and all regulatory provisions promulgated there 
                under, including regulations (relating to privacy) 
                adopted pursuant to the authority of the Secretary 
                under section 264(c) of the Health Insurance 
                Portability and Accountability Act of 1996 (42 U.S.C. 
                1320d-2 note).
    (b) Establishment.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall establish a 
        maternity care home demonstration program (in this section 
        referred to as the ``program'').
            (2) Duration; scope.--The program shall be conducted for a 
        3-year period (except that an eligible individual participating 
        in the program shall remain eligible for items and services 
        provided under the program through 2 months postpartum 
        regardless of the termination of the program period) and shall 
        include a nationally representative sample of physicians, 
        advanced practice nurses, certified nurse midwives, certified 
        midwives, and physician assistants who specialize in women's 
        health issues, such as obstetrics and gynecology, or family 
        practice, and who serve urban, rural, and underserved areas in 
        a total of no more than 8 States.
            (3) Comprehensiveness.--The Secretary shall give priority 
        under the program to demonstration projects that reflect a 
        comprehensive inclusion of the care components identified under 
        subsection (a)(7)(A).
            (4) Encouraging participation of small physician 
        practices.--The program shall be designed to include the 
        participation of maternity care providers in practices with 
        fewer than 4 full-time equivalent clinicians, as well as 
        maternity care providers in larger practices, particularly in 
        rural and underserved areas.
            (5) Program goals.--The program shall be designed in order 
        to determine whether and to what extent maternity care homes 
        accomplish the following:
                    (A) Increase--
                            (i) cost efficiencies of maternity care 
                        delivery;
                            (ii) the reliable provision of care 
                        supported by high-quality evidence in national 
                        guidelines, systematic reviews, or other well-
                        conducted clinical studies;
                            (iii) communication among maternity care 
                        providers, other health professionals, 
                        facilities, and eligible individuals; and
                            (iv) the quality of maternity care services 
                        provided, as based on nationally endorsed 
                        quality measures.
                    (B) Decrease--
                            (i) inappropriate emergency room 
                        utilization;
                            (ii) avoidable maternal and newborn 
                        hospitalizations and admissions to intensive 
                        care units;
                            (iii) duplication of health care services 
                        provided; and
                            (iv) health disparities.
                    (C) Improve--
                            (i) the woman's experience of care and the 
                        maternity care provider's experience of 
                        providing care; and
                            (ii) health outcomes of women and newborns, 
                        such as--
                                    (I) decreased preterm and early 
                                term birth, postpartum morbidities, and 
                                untreated postpartum depression; and
                                    (II) increased vaginal birth and 
                                initiation and duration of exclusive 
                                breast feeding.
            (6) Eligible individual and eligible entity 
        participation.--
                    (A) Eligible individuals.--The Secretary shall 
                establish a process under which--
                            (i) an eligible individual may elect to 
                        participate in a maternity care home under the 
                        program; and
                            (ii) no cost sharing shall be imposed with 
                        respect to any service required under to be 
                        provided to the individual under the program.
                    (B) Assurance of participation of eligible entities 
                that are not participating providers or are in states 
                with managed care.--The Secretary shall establish a 
                process to ensure that eligible entities that are not 
                participating providers under Medicaid or CHIP in the 
                State, or, in the case of a State that contracts with a 
                private entity to manage parts of the Medicaid or CHIP 
                in the State, do not participate with that entity, are 
                able to participate in the program.
            (7) Standard setting process.--In consultation with the 
        stakeholders specified in subsection (d), the Secretary shall--
                    (A) develop a maternity care home reimbursement 
                methodology that takes into consideration, to the 
                maximum extent practicable--
                            (i) recognition of the value of maternity 
                        care provider and clinical staff work 
                        associated with patient care that falls outside 
                        the face-to-face visit, such as the time and 
                        effort spent on educating family members and 
                        arranging appropriate followup services with 
                        other health care professionals;
                            (ii) reimbursement of services associated 
                        with coordination of care both within a given 
                        practice and between consultants, ancillary 
                        providers, and community resources;
                            (iii) recognition of expenses that the 
                        maternity care home practices will incur to 
                        acquire and utilize health information 
                        technology, such as clinical decision support 
                        tools, patient registries, or electronic 
                        medical records;
                            (iv) reimbursement for separately 
                        identifiable e-mail and telephonic 
                        consultations, either as separately billable 
                        services or as part of a global management fee;
                            (v) recognition of the value of provider 
                        work associated with remote monitoring of 
                        clinical data using technology;
                            (vi) reimbursement for provision of 
                        preventive services, health education, and 
                        participation in shared decisionmaking;
                            (vii) recognition and sharing of savings 
                        with respect to reduction of procedures and 
                        practices that are contrary to high-quality 
                        evidence in national guidelines, systematic 
                        reviews, or other well-conducted clinical 
                        studies and to reductions in the occurrence of 
                        health and pregnancy complications, 
                        hospitalization rates, medical errors, adverse 
                        drug reactions, and other occurrences;
                            (viii) allowance for additional payments 
                        for achieving measurable and continuous quality 
                        improvements, including under a process 
                        established by the Secretary for paying a 
                        performance-based bonus to maternity care homes 
                        which meet or achieve substantial improvements 
                        in performance (as specified under clinical, 
                        patient experience of care, and efficiency 
                        benchmarks established by the Secretary);
                            (ix) recognition of the existing payment 
                        methodology for federally qualified health 
                        centers when determining the most appropriate 
                        mechanism for providing bonus payments for 
                        maternity care home services delivered at such 
                        centers; and
                            (x) such other innovative methods as the 
                        Secretary finds appropriate;
                    (B) develop appropriate risk-adjustment mechanisms 
                to account for varying costs of maternity care homes 
                based upon characteristics of the eligible individuals 
                participating in the program;
                    (C) make allowance for additional payments for 
                achieving measurable and continuous quality 
                improvements, including under a process established by 
                the Secretary for paying a performance-based bonus to 
                maternity care homes which meet or achieve substantial 
                improvements in performance (as specified under 
                clinical, patient experience, and efficiency benchmarks 
                established by the Secretary in consultation with the 
                stakeholders specified in subsection (d));
                    (D) recognize the existing payment methodology for 
                federally qualified health centers when determining the 
                most appropriate mechanism for providing bonus payments 
                for maternity care home services delivered at such 
                centers; and
                    (E) establish such other methods as the Secretary, 
                in consultation with the stakeholders specified in 
                subsection (d), finds appropriate.
            (8) Planning or implementation grants.--The Secretary may 
        award planning or implementation grants to eligible entities 
        desiring or selected to participate in the program.
            (9) Ongoing oversight and performance assessment.--The 
        Secretary shall establish procedures to ensure that hospitals, 
        practices, health or birth centers, and clinics participating 
        as maternity care homes under the program, and the physicians, 
        advanced practice nurses, certified nurse-midwives, certified 
        midwives, and physician assistants providing services at such 
        hospitals, practices, centers, and clinics, have access to 
        confidential feedback and benchmarking reports as a function of 
        the hospital's, practice's, health or birth center's, or 
        clinic's monitoring of its clinical process and performance 
        (including process and outcome measures).
            (10) Technical assistance.--The Secretary shall establish 
        mechanisms to provide technical assistance to hospitals, 
        practices, health or birth centers, and clinics participating 
        as maternity care homes under the program.
            (11) Payments to states.--The Secretary shall pay each 
        State participating in the program an amount equal to 100 
        percent of the amounts expended by the State for services 
        provided to an eligible individual under the program, including 
        administrative expenses.
            (12) Authorization of appropriations.--There are authorized 
        to be appropriated $50,000,000 to carry out this section. Funds 
        appropriated under this paragraph shall remain available until 
        expended.
    (c) Evaluations and Program Reports.--
            (1) Annual interim evaluations and reports.--For each year 
        of the program, the Secretary shall provide for an interim 
        evaluation of the program and shall submit to Congress and the 
        Medicaid and CHIP Payment and Access Commission established 
        under section 1900 of the Social Security Act (42 U.S.C. 1396) 
        (in this subsection referred to as ``MACPAC'') reports on the 
        results of such evaluations.
            (2) Final evaluation and report.--The Secretary shall 
        provide for a final evaluation of the program and shall submit 
        to Congress and MACPAC, not later than 1 year after completion 
        of the program, a final report on the program based on the 
        results of such evaluation. Such final report shall include--
                    (A) an assessment of improvements in quality and 
                outcomes of childbearing women and newborns identified 
                under the program goals specified in subsection (b)(4);
                    (B) an assessment of the women's experience of care 
                and the maternity care providers' satisfaction;
                    (C) an assessment of which women, based on 
                demographic factors, such as age, race, sexual 
                orientation, disability, ethnicity, and socioeconomic 
                status, benefit the most from participating in a 
                maternity care home;
                    (D) estimates of cost savings to Medicaid, CHIP, 
                and other Federal programs resulting from the program; 
                and
                    (E) recommendations for such legislation and 
                administrative action as the Secretary determines to be 
                appropriate.
    (d) Consultation With Relevant Stakeholders.--In carrying out the 
activities under this section, the Secretary shall consult with the 
following stakeholders on selection and evaluation of the program, 
setting of payment and incentives criteria, and other activities 
determined by the Secretary (in addition to the issues for which 
consultation with such stakeholders is required in other subsections of 
this section):
            (1) States.
            (2) National organizations and individuals representing 
        obstetrician-gynecologists, family physicians, certified nurse-
        midwives and certified midwives, advanced practice nurses, 
        registered nurses, and physician assistants.
            (3) National organizations representing consumers.
            (4) Health care providers that furnish care to women who 
        live in urban and rural medically underserved communities and 
        are at heightened risk for poor health outcomes.
            (5) National organizations and individuals with expertise 
        in maternity health quality measurement and coding and 
        reimbursement related issues.
            (6) National organizations and individuals that provide 
        social and medical services to pregnant women, such as mental 
        health professionals and social workers.
                                 <all>
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