II 

116TH CONGRESS 

2D SESSION S. 4949 

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 program. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 2, 2020 

Mr. TOOMEY (for himself and Mr. BROWN) introduced the following bill; 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 program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Supporting Best Prac5 tices for Healthy Moms Act’’. 


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1 SEC. 2. DEVELOPING GUIDANCE ON MATERNAL MOR2 TALITY AND SEVERE MORBIDITY REDUCTION 

3 FOR MATERNAL CARE PROVIDERS RECEIV4 ING PAYMENT UNDER THE MEDICAID PRO5 GRAM. 

6 (a) IN GENERAL.—Subject to the availability of ap7 propriations, not later than 36 months after the date of 

8 enactment of this Act, the Secretary of Health and 

9 Human Services (referred to in this section as the ‘‘Sec10 retary’’) shall publish on a public website of the Centers 

11 for Medicare & Medicaid Services guidance for States on 

12 resources and strategies for hospitals, freestanding birth 

13 centers (as defined in section 1905(l)(3)(B) of the Social 

14 Security Act (42 U.S.C. 1396d(l)(3)(B))), and other ma15 ternal care providers as determined by the Secretary for 

16 reducing maternal mortality and severe morbidity in indi17 viduals who are eligible for and receiving medical assist18 ance under the Medicaid program under title XIX of such 

19 Act (42 U.S.C. 1396 et seq.) or child health assistance 

20 under the Children’s Health Insurance Program under 

21 title XXI of such Act (42 U.S.C. 1397aa et seq.). 

22 (b) UPDATES.—The Secretary shall update the guid23 ance and resources described in subsection (a) at least 

24 once every 3 years. 

25 (c) CONSULTATION WITH ADVISORY COMMITTEE.— 


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1 (1) ESTABLISHMENT.—Subject to the avail2 ability of appropriations, not later than 18 months 

3 after the date of enactment of this Act, the Sec4 retary shall establish an advisory committee to be 

5 known as the ‘‘National Advisory Committee on Re6 ducing Maternal Deaths’’ (referred to in this section 

7 as the ‘‘Advisory Committee’’). 

8 (2) DUTIES.—The Advisory Committee shall 

9 provide consensus advice and guidance to the Sec10 retary on the development and compilation of the 

11 guidance described in subsection (a) (and any up12 dates to such guidance). 

13 (3) MEMBERSHIP.— 

14 (A) IN GENERAL.—The Secretary, in con15 sultation with such other heads of agencies, as 

16 the Secretary deems appropriate and in accord17 ance with this paragraph, shall appoint not 

18 more than 41 members to the Advisory Com19 mittee. In appointing such members, the Sec20 retary shall ensure that— 

21 (i) the total number of members of 

22 the Advisory Committee is an odd number; 

23 and 

24 (ii) the total number of voting mem25 bers who are not Federal officials does not 


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1 exceed the total number of voting Federal 

2 members who are Federal officials. 

3 (B) REQUIRED MEMBERS.— 

4 (i) FEDERAL OFFICIALS.—The Advi5 sory Committee shall include as voting 

6 members the following Federal officials, or 

7 their designees: 

8 (I) The Secretary of Health and 

9 Human Services. 

10 (II) The Administrator of the 

11 Centers for Medicare & Medicaid 

12 Services. 

13 (III) The Director of the Centers 

14 for Disease Control and Prevention. 

15 (IV) The Associate Administrator 

16 of the Maternal and Child Health Bu17 reau of the Health Resources and 

18 Services Administration. 

19 (V) The Director of the Agency 

20 for Healthcare Research and Quality. 

21 (VI) The National Coordinator 

22 for Health Information Technology. 

23 (VII) The Director of the Na24 tional Institutes of Health. 


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1 (VIII) The Secretary of Veterans 

2 Affairs. 

3 (IX) The Director of the Indian 

4 Health Service. 

5 (X) The Deputy Assistant Sec6 retary for Minority Health. 

7 (XI) The Administrator of the 

8 Substance Abuse and Mental Health 

9 Services Administration. 

10 (XII) The Deputy Assistant Sec11 retary for Women’s Health. 

12 (XIII) Such other Federal offi13 cials or their designees as the Sec14 retary determines appropriate. 

15 (ii) NON-FEDERAL OFFICIALS.— 

16 (I) IN GENERAL.—The Advisory 

17 Committee shall include the following 

18 as voting members: 

19 (aa) At least 1 representa20 tive from a professional organiza21 tion representing hospitals and 

22 health systems. 

23 (bb) At least 1 representa24 tive from a medical professional 


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1 organization representing pri2 mary care providers. 

3 (cc) At least 1 representa4 tive from a medical professional 

5 organization representing general 

6 obstetrician-gynecologists. 

7 (dd) At least 1 representa8 tive from a medical professional 

9 organization representing cer10 tified nurse-midwives. 

11 (ee) At least 1 representa12 tive from a medical professional 

13 organization representing other 

14 maternal fetal medicine pro15 viders. 

16 (ff) At least 1 representative 

17 from a medical professional orga18 nization representing anesthesiol19 ogists. 

20 (gg) At least 1 representa21 tive from a medical professional 

22 organization representing emer23 gency medicine physicians and 

24 urgent care providers. 


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1 (hh) At least 1 representa2 tive from a medical professional 

3 organization representing nurses. 

4 (ii) At least 1 representative 

5 from a professional organization 

6 representing community health 

7 workers. 

8 (jj) At least 1 representative 

9 from a professional organization 

10 representing doulas. 

11 (kk) At least 1 representa12 tive from State-affiliated pro13 grams or existing collaboratives 

14 with demonstrated expertise or 

15 success in improving maternal 

16 health. 

17 (ll) At least 1 director of a 

18 State Medicaid agency that has 

19 had demonstrated success in im20 proving maternal health. 

21 (mm) At least 1 representa22 tive from an accrediting organi23 zation for maternal health quality 

24 and safety standards. 


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1 (nn) At least 1 representa2 tive from a maternal patient ad3 vocacy organization with lived ex4 perience of severe maternal mor5 bidity. 

6 (II) REQUIREMENTS.—Each in7 dividual selected to be a member 

8 under this clause shall— 

9 (aa) have expertise in mater10 nal health; 

11 (bb) not be a Federal offi12 cial; and 

13 (cc) have experience working 

14 with populations that are at 

15 higher risk for maternal mor16 tality or severe morbidity, such 

17 as populations that experience 

18 racial, ethnic, and geographic 

19 health disparities, pregnant and 

20 postpartum women experiencing 

21 mental health disorders or other 

22 comorbidities such as substance 

23 use disorders, hypertension, thy24 roid disorders, and sickle cell dis25 ease. 


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1 (C) ADDITIONAL MEMBERS.— 

2 (i) IN GENERAL.—In addition to the 

3 members required to be appointed under 

4 subparagraph (B), the Secretary may ap5 point as members to the Advisory Com6 mittee such other individuals with relevant 

7 expertise or experience as the Secretary 

8 shall determine appropriate, which may in9 clude individuals described in clause (ii). 

10 (ii) SUGGESTED ADDITIONAL MEM11 BERS.—The individuals described in this 

12 clause are the following: 

13 (I) Representatives from State 

14 maternal mortality review committees 

15 and perinatal quality collaboratives. 

16 (II) Medical providers who care 

17 for women and infants during preg18 nancy and the postpartum period, 

19 such as family practice physicians, 

20 cardiologists, pulmonology critical 

21 care specialists, endocrinologists, pedi22 atricians, and neonatologists. 

23 (III) Representatives from State 

24 and local public health departments. 


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1 (IV) Subject matter experts in 

2 conducting outreach to women who 

3 are African American or belong to an4 other minority group. 

5 (V) Directors of State agencies 

6 responsible for administering a State’s 

7 maternal and child health services 

8 program under title V of the Social 

9 Security Act (42 U.S.C. 701 et seq.). 

10 (VI) Experts in medical edu11 cation or physician training. 

12 (VII) Representatives from Med13 icaid managed care organizations. 

14 (4) APPLICABILITY OF FACA.—The Federal Ad15 visory Committee Act (5 U.S.C. App.) shall apply to 

16 the committee established under this subsection. 

17 (d) CONTENTS.—The guidance described in sub18 section (a) shall include, with respect to hospitals, free19 standing birth centers, and other maternal care providers, 

20 the following: 

21 (1) Best practices regarding evidence-based 

22 screening and clinician education initiatives relating 

23 to screening and treatment protocols for individuals 

24 who are at risk of experiencing complications related 

25 to pregnancy, with an emphasis on individuals with 


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1 preconditions directly linked to pregnancy complica2 tions and maternal mortality and severe morbidity, 

3 including— 

4 (A) methods to identify individuals who are 

5 at risk of maternal mortality or severe mor6 bidity, including risk stratification; 

7 (B) evidence-based risk factors associated 

8 with maternal mortality or severe morbidity and 

9 racial, ethnic, and geographic health disparities; 

10 (C) evidence-based strategies to reduce risk 

11 factors associated with maternal mortality or 

12 severe morbidity through services which may be 

13 covered under the Medicaid program under title 

14 XIX of the Social Security Act (42 U.S.C. 1396 

15 et seq.) or the Children’s Health Insurance Pro16 gram under title XXI of such Act (42 U.S.C. 

17 1397aa et seq.), including activities by commu18 nity health workers (as such term is defined in 

19 section 2113 of such Act (42 U.S.C. 1397mm)) 

20 that are funded by a grant awarded under such 

21 section; 

22 (D) resources available to such individuals, 

23 such as nutrition assistance and education, 

24 home visitation, mental health and substance 

25 use disorder services, smoking cessation proVerDate Sep 11 2014 06:21 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4949.IS S4949

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1 grams, pre-natal care, and other evidence-based 

2 maternal mortality or severe morbidity reduc3 tion programs; 

4 (E) examples of educational materials used 

5 by providers of obstetrics services; 

6 (F) methods for improving community cen7 tralized care, including providing telehealth 

8 services or home visits to increase and facilitate 

9 access to and engagement in prenatal and 

10 postpartum care and collaboration with home 

11 health agencies, community health centers, local 

12 public health departments, or clinics; 

13 (G) guidance on medical record diagnosis 

14 codes linked to maternal mortality and severe 

15 morbidity, including, if applicable, codes related 

16 to social risk factors, and methods for edu17 cating clinicians on the proper use of such 

18 codes; 

19 (H) risk appropriate transfer protocols 

20 during pregnancy, childbirth, and the postpar21 tum period; and 

22 (I) any other information related to pre23 vention and treatment of at-risk individuals de24 termined appropriate by the Secretary. 


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1 (2) Guidance on monitoring programs for indi2 viduals who have been identified as at risk of com3 plications related to pregnancy. 

4 (3) Best practices for such hospitals, free5 standing birth centers, and providers to make preg6 nant women aware of the complications related to 

7 pregnancy. 

8 (4) A fact sheet for providing pregnant women 

9 who are receiving care on an outpatient basis with 

10 a notice during the prenatal stage of pregnancy 

11 that— 

12 (A) explains the risks associated with preg13 nancy, birth, and the postpartum period (in14 cluding the risks of hemorrhage, preterm birth, 

15 sepsis, eclampsia, obstructed labor), chronic 

16 conditions (including high blood pressure, dia17 betes, heart disease, depression, and obesity) 

18 correlated with adverse pregnancy outcomes, 

19 risks associated with advanced maternal age, 

20 and the importance of adhering to a personal21 ized plan of care; 

22 (B) highlights multimodal and evidence23 based prevention and treatment techniques; 

24 (C) provides for a method (through signa25 ture or otherwise) for such an individual, or a 


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1 person acting on such individual’s behalf, to ac2 knowledge receipt of such fact sheet; 

3 (D) is worded in an easily understandable 

4 manner and made available in multiple lan5 guages and accessible formats determined ap6 propriate by the Secretary; and 

7 (E) includes any other information deter8 mined appropriate by the Secretary. 

9 (5) A template for a voluntary clinician check10 list that outlines the minimum responsibilities that 

11 clinicians, such as physicians, certified nurse-mid12 wives, emergency room and urgent care providers, 

13 nurses and others, are expected to meet in order to 

14 promote quality and safety in the provision of ob15 stetric services. 

16 (6) A template for a voluntary checklist that 

17 outlines the minimum responsibilities that hospital 

18 leadership responsible for direct patient care, such 

19 as the institution’s president, chief medical officer, 

20 chief nursing officer, or other hospital leadership 

21 that directly report to the president or chief execu22 tive officer of the institution, should meet to pro23 mote hospital-wide initiatives that improve quality 

24 and safety in the provision of obstetric services. 


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1 (7) Information on multi-stakeholder quality 

2 improvement initiatives, such as the Alliance for In3 novation on Maternal Health, State perinatal quality 

4 improvement initiatives, and other similar initiatives 

5 determined appropriate by the Secretary, includ6 ing— 

7 (A) information about such improvement 

8 initiatives and how to join; 

9 (B) information about public maternal 

10 data collection centers; 

11 (C) information about quality metrics used 

12 and outcomes achieved by such improvement 

13 initiatives; 

14 (D) information about data sharing tech15 niques used by such improvement initiatives; 

16 (E) information about data sources used 

17 by such improvement initiatives to identify ma18 ternal mortality and severe morbidity risks; 

19 (F) information about interventions used 

20 by such improvement initiatives to mitigate 

21 risks of maternal mortality and severe mor22 bidity; 

23 (G) information about data collection tech24 niques on race, ethnicity, geography, age, inVerDate Sep 11 2014 06:21 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S4949.IS S4949

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1 come, and other demographic information used 

2 by such improvement initiatives; and 

3 (H) any other information determined ap4 propriate by the Secretary. 

5 (e) INCLUSION OF BEST PRACTICES.—Not later than 

6 18 months after the date of the publication of the guid7 ance required under subsection (a), the Secretary shall up8 date such guidance to include best practices identified by 

9 the Secretary for such hospitals, freestanding birth cen10 ters, and providers to track maternal mortality and severe 

11 morbidity trends by clinicians at such hospitals, free12 standing birth centers, and providers including— 

13 (1) ways to establish scoring systems, which 

14 may include quality triggers and safety and quality 

15 metrics to score case and patient outcome metrics, 

16 for such clinicians; 

17 (2) methods to identify, educate, and improve 

18 such clinicians who may have higher rates of mater19 nal mortality or severe morbidity compared to their 

20 regional or State peers (taking into account dif21 ferences in patient risk for adverse outcomes, which 

22 may include social risk factors); 

23 (3) methods for using such data and tracking 

24 to enhance research efforts focused on maternal 

25 health, while also improving patient outcomes, cliniVerDate Sep 11 2014 06:21 Dec 09, 2020 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4949.IS S4949

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1 cian education and training, and coordination of 

2 care; and 

3 (4) any other information determined appro4 priate by the Secretary. 

5 (f) CULTURAL APPROPRIATENESS.—To the extent 

6 practicable, the Secretary should develop the guidance, 

7 best practices, fact sheets, templates, and other materials 

8 that are required under this section in a trauma-informed, 

9 culturally and linguistically appropriate manner. 

10 SEC. 3. REPORT ON PAYMENT METHODOLOGIES FOR 

11 TRANSFERRING PREGNANT WOMEN BE12 TWEEN FACILITIES BEFORE, DURING, AND 

13 AFTER CHILDBIRTH. 

14 (a) IN GENERAL.—Subject to the availability of ap15 propriations, not later than 36 months after the date of 

16 enactment of this Act, the Secretary of Health and 

17 Human Services (referred to in this section as the ‘‘Sec18 retary’’) shall submit to Congress a report on the payment 

19 methodologies under the Medicaid program under title 

20 XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 

21 for the antepartum, intrapartum, and postpartum transfer 

22 of pregnant women from one health care facility to an23 other, including any potential disincentives or regulatory 

24 barriers to such transfers. 


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1 (b) CONSULTATION.—In developing the report re2 quired under subsection (a), the Secretary shall consult 

3 with the advisory committee established under section 

4 2(c). 

Æ 


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