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[Senate Report 114-100]
[From the U.S. Government Publishing Office]

                                                      Calendar No. 179
114th Congress    }                                     {       Report
                                 SENATE
 1st Session      }                                     {      114-100

======================================================================

 
                  QUALITY CARE FOR MOMS AND BABIES ACT

                                _______
                                

                 July 30, 2015.--Ordered to be printed

                                _______
                                

               Mr. Hatch, from the Committee on Finance, 
                        submitted the following

                              R E P O R T

                         [To accompany S. 466]

    The Committee on Finance, to which was referred the bill 
(S. 466) 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 
maternity care quality measures and supporting maternity care 
quality collaboratives, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill, as amended, do pass.

                       I. LEGISLATIVE BACKGROUND

    The Committee on Finance, to which was referred the bill 
(S. 466), 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 
maternity care quality measures and supporting maternity care 
quality collaboratives, having considered the same, reports 
favorably thereon with an amendment and recommends the bill, as 
amended, do pass.

Background and need for legislative action

    Obtaining appropriate pre- and post-natal care for mothers 
and infants can improve health outcomes and reduce the risks of 
adverse events and long-term disabilities. The Committee 
recognizes that adding maternity and infant quality measures to 
existing quality measures and encouraging maternity and infant 
quality collaboratives that would develop and carry out plans 
for evaluating maternity and infant care quality improvement 
programs will help facilitate improvements in the quality of 
care and reduce adverse health outcomes. In addition, 
innovations in payment methodologies are now rewarding the 
provision of quality care, and are instrumental in providing 
incentives that improve quality of care but require reliable 
measures in order to be implemented.

                      II. EXPLANATION OF THE BILL

                              PRESENT LAW

    Under the Social Security Act (SSA) section 1139A,\1\ the 
Secretary was required to identify and publish an initial core 
set of pediatric quality measures by no later than January 1, 
2010. The Secretary, not later than January 1, 2011 and every 
three years thereafter, is also required to submit a report to 
Congress on, for example, the quality of children's health care 
under Medicaid and CHIP. A Pediatric Quality Measures Program 
(PQMP) was required to be established by January 1, 2011; this 
program is required to identify pediatric measure gaps and 
development priorities, award grants and contracts to develop 
measures, and revise and strengthen the core measure set, among 
other things. States are required to submit reports to the 
Secretary annually to include, for example, information about 
state-specific child health quality measures applied by the 
state. The Secretary is required to collect, analyze, and make 
publicly available the information reported by states, by not 
later than September 30, 2010, and annually thereafter. The 
Secretary was required, between FY 2009 and FY 2013, to award 
no more than 10 grants to states for demonstration projects to 
evaluate ideas to improve the quality of children's health 
care; in addition, the Secretary, not later than January 1, 
2010, was required to establish a program to encourage the 
development and dissemination of a model electronic health 
record for children. The Institute of Medicine (IOM) was 
required to develop a report on measurement of child health 
status and quality by no later than July 1, 2010. Funding for 
these activities was appropriated in the amount of $45 million 
for each of FY 2009 through FY 2013.
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    \1\42 U.S.C. Sec. 1320b-9a.
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    SSA section 1139B\2\ required the Secretary to publish a 
core set of Medicaid adult health quality measures by January 
1, 2012. Also, no later than January 1, 2013, the Secretary was 
required to develop a standardized format for reporting 
information based on this initial core measurement set. The 
Secretary is required to submit a report to Congress by January 
1, 2014, and every three years thereafter, that describes the 
Secretary's efforts to improve, for example, the quality of 
care of different services for adults under Medicaid. Within 
one year after the release of the recommended core set of adult 
health quality measures, the Secretary is required to establish 
a Medicaid Quality Measurement Program (MQMP). To this end, the 
Secretary is required to award grants and contracts for 
developing, testing, and validating emerging and innovative 
evidence-based measures applicable to Medicaid adults. Not 
later than two years after the establishment of the MQMP, and 
annually thereafter, the Secretary is required to publish 
recommended changes to the initial core set of adult health 
quality measures based on the results of testing, validation, 
and the consensus process for development of these measures. 
States are required to submit reports to the Secretary annually 
to include, for example, information about state-specific adult 
health quality measures applied by the state. The Secretary is 
required to collect, analyze, and make publicly available the 
information reported by states, before September 30, 2014, and 
annually thereafter. Funding for these activities was 
appropriated in the amount of $60 million for each of FY 2010 
through FY 2014.
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    \2\42 U.S.C. Sec. 1320b-9b.
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    Section 210 of the Protecting Access to Medicare Act 
(PAMA)\3\, extended funding only for the PQMP for FY 2014 by 
requiring that $15 million of the $60 million appropriated 
under SSA section 1139B(e) for FY 2014 be used to carry out 
section 1139A(b). The appropriation in section 1139A(i) for 
funding to carry out section 1139A (except for 1139A(e), the 
childhood obesity demonstration project) expired in FY 2013; 
the funding designated to carry out section 1139A(b) expired in 
FY 2014. Similarly, funding for carrying out section 1139B 
expired in FY 2014.
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    \3\Pub. L. No. 113-93.
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    The Medicare Access and CHIP Reauthorization Act of 2015 
(MACRA)\4\, appropriated $20 million for the period of FY 2016 
and FY 2017 for the purposes of carrying out section 1139A. 
This funding is specifically excluded from being used to carry 
out the activities under section 1139A(e) (the childhood 
obesity demonstration project); section 1139A(f) (the 
development of a model electronic health record for children); 
and section 1139A(g) (the IOM study of pediatric health 
quality).
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    \4\Pub. L. No. 114-10.
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                        EXPLANATION OF PROVISION

    S. 466, as modified, would add a new SSA section 1139C, 
``Maternal and Infant Quality Measures.'' Under new section 
1139C(a), the Secretary would be required to identify and 
publish a core set of maternal and infant health quality 
measures for women and children, as specified, and would be 
required to do so in the same manner as the Secretary 
identified a pediatric core set of measures under section 
1139A(a) and in consultation with specified stakeholders (e.g., 
states, physicians, and health facilities). In so doing, the 
Secretary would be required to ensure that, to the extent 
possible, the measures align with and do not duplicate the 
pediatric or Medicaid adult core quality measure sets under 
sections 1139A and 1139B.
    Under new section 1139C(b), which specifies deadlines for 
activities under the section, the Secretary would be required 
to publish for comment a recommended core measure set by no 
later than January 1, 2018, and an initial core measure set by 
no later than January 1, 2019. The measures would be required 
to include the following, among others: (1) measures that 
address disparities; (2) measures that apply to a variety of 
care settings and provider types; and (3) measures of process, 
outcome, experience and efficiency of care. The Secretary would 
also be required, not later than January 1, 2020, to develop a 
standardized reporting format for the maternal and infant 
health quality measures, and would be required to, not later 
than January 1, 2021 and every 3 years thereafter, include in 
the report to Congress under section 1139A(a)(6) information 
about the maternal and infant quality measures. The report 
under section 1139A(a)(6) is required to include information 
about efforts to improve the quality of care for Medicaid and 
CHIP eligible women and children; reporting of the core 
measures; and recommended legislative changes to improve 
reporting and quality of care under these programs.
    Finally, new section 1139C(b) would require the Secretary, 
not later than 12 months after enactment, to establish a 
Maternal and Infant Quality Measurement Program, in the same 
manner as the Secretary was required to establish a Pediatric 
Quality Measures Program under section 1139A(b). The Secretary 
would be required to publish recommended changes to strengthen 
and improve the initial core measure set, not later than 24 
months after establishment of the Maternal and Infant Quality 
Measurement Program and annually thereafter, and any entity 
awarded a grant under the Maternal and Infant Quality 
Measurement Program would be required to advance eMeasures that 
are aligned with the core measures under sections 1139A and 
1139B. Amounts awarded as grants under the Maternal and Infant 
Quality Measurement Program would not be allowed to exceed the 
amount awarded as grants under the Pediatric Quality Measures 
Program under section 1139A(b). New section 1139C(c) would 
clarify that nothing in this section would be allowed to be 
construed as supporting the restriction of coverage, under 
Medicaid or CHIP or otherwise, to only evidence based services, 
or in any way limiting available services.
    In addition, under new section 1139C(d), the Agency for 
Healthcare Research and Quality (AHRQ) would be required to 
adapt the Consumer Assessment of Healthcare Providers and 
Systems (CAHPS) survey, as specified, for the purpose of 
measuring the care experiences of childbearing women and 
newborns. The survey would be required to be effective across 
various settings and caregivers, among other things, and would 
be required to be submitted to the National Quality Forum (NQF) 
for consideration for endorsement; adaptation of the survey 
would be required to be carried out in consultation with 
stakeholders, as specified, including professional 
organizations. New section 1139C(e) would require States to 
annually report on state-specific maternal and infant quality 
measures and state-specific information on the quality of 
health care provided to Medicaid and CHIP eligible mothers and 
infants, as specified. The Secretary would be required, not 
later than September 30, 2021, and annually thereafter, to make 
the state-reported information publicly available.
    New section 1139C(f) would authorize to be appropriated $16 
million to carry out the activities under this section. Funds 
would be required to remain available until expended.
    The bill would also authorize the Secretary to award grants 
to eligible entities to support the development of maternity 
and infant care quality collaboratives or to expand activities 
of existing collaboratives. An eligible entity would include 
quality collaboratives, entities seeking to establish a 
maternity and infant care collaborative, state Medicaid 
agencies and departments of health, health insurance issuers, 
and provider organizations. Quality collaboratives receiving 
funding under this section would be required to develop and 
carry out plans for evaluating its maternity and infant care 
quality improvement programs and projects and to publish these 
results, as specified, and would be required to engage in 
regular ongoing consultation, as specified. Quality 
collaboratives would be required to submit a report to the 
Secretary annually, as specified, and would be required to be 
governed by a multi-stakeholder executive committee, as 
specified, including, for example, physicians, nurses, nurse-
midwives, consumers, Medicaid programs, and employers.
    Projects and programs that may be supported by funding 
under this section would include those that have as their goal 
the improvement of the quality of maternity and infant care 
(e.g., improving the appropriate use of cesarean sections); in 
addition, they would be required to meet criteria for use of 
measures, as specified (e.g., include a plan to identify and 
resolve data collection problems). Any reporting requirements 
established by such programs or projects would be required to 
minimize cost and use existing data resources where feasible. 
Activities that may be supported by funding under this section 
would include, for example, facilitating performance data 
collection and feedback reports to providers and developing the 
capability to access data sources, as specified (e.g., a 
mother's medical records, an infant's medical records, and 
birth and death certificates). This section would also require 
the Secretary to establish an online clearinghouse to make 
available resources that may improve the quality of maternity 
and infant care available across the collaboratives and 
individuals working in this area.
    The bill would also amend section 1890(b) of the Social 
Security Act by directing the entity referred to in such 
section to facilitate increased coordination and alignment 
between the public and private sector with respect to quality 
and efficiency measures. The bill would also require such 
entity to make publicly available annual reports on its 
findings, which would be included in the annual report. These 
provisions would be effective upon enactment.
    This section would authorize the appropriation of $15 
million to carry out the activities under this section; funds 
would be required to remain available until expended.

                             EFFECTIVE DATE

    The provision is effective upon enactment.

                    III. BUDGET EFFECTS OF THE BILL

                         A. Committee Estimates

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the following statement is made 
concerning the estimated budget effects of the revenue 
provisions of the of the ``Quality Care for Moms and Babies 
Act'' as reported.
    The bill is estimated to have the following effects on 
Federal budget receipts for fiscal years 2016-2025:

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                              --------------------------------------------------
                                                                2016    2017    2018    2019    2020   2016-2020
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION
 
Maternal and Infant Health Quality Measures:
    Authorization Level......................................      16       0       0       0       0        16
    Estimated Outlays........................................       3       4       4       3       2        16
Grants for Quality Collaboratives:
    Authorization Level......................................      15       0       0       0       0        15
    Estimated Outlays........................................       3       8       4       0       0        15
    Total Changes:
        Authorization Level..................................      31       0       0       0       0        31
        Estimated Outlays....................................       6      12       8       3       2        31
----------------------------------------------------------------------------------------------------------------
Source: Estimate provided by the staff of the Congressional Budget Office.

Summary

    S. 466 would authorize the appropriation of $31 million for 
the Department of Health and Human Services (HHS) to identify 
and publish quality measures for maternal and infant health and 
to award grants to develop or expand collaborative activities 
related to maternity and infant care quality. Implementing S. 
466 would cost $31 million over the 2016-2020 period, assuming 
appropriation of the specified amounts. For this estimate, CBO 
assumes that the legislation will be enacted near the beginning 
of fiscal year 2016 and that the amounts specified will be 
appropriate in that year. Enacting S. 466 would not affect 
direct spending or revenues; therefore, pay-as-you-go 
procedures do not apply. The bill would not impose 
intergovernmental or private sector mandates as defined in the 
Unfunded Mandates Reform Act and would impose no costs on 
state, local, or tribal governments. The annual estimated 
budgetary impact of S. 466 is shown in the following table.

                          B. Budget Authority

Budget authority

    In compliance with section 308(a)(1) of the Congressional 
Budget and Impoundment Control Act of 1974 (``Budget Act''),\5\ 
the Committee states that the bill as reported involves 
increased budget authority (see table in Part A, above).
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    \5\Pub. L. No. 93-344.
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Tax expenditures

    In compliance with section 308(a)(1) of the Budget Act, the 
Committee states that the bill does not involve increased tax 
expenditures.

            C. Consultation With Congressional Budget Office

    In accordance with section 403 of the Budget Act, the 
Committee advises that the Congressional Budget Office has 
submitted a statement on the bill.

S. 466--Quality Care for Moms and Babies Act

    Summary: S. 466 would authorize the appropriation of $31 
million for the Department of Health and Human Services (HHS) 
to identify and publish quality measures for maternal and 
infant health and to award grants to develop or expand 
collaborative activities related to maternity and infant care 
quality. CBO estimates that implementing S. 466 would cost $31 
million over the 2016-2020 period, assuming appropriation of 
the specified amounts. Enacting S. 466 would not affect direct 
spending or revenues; therefore, pay-as-you-go procedures do 
not apply.
    S. 466 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 466 is shown in the following table. The 
costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                              --------------------------------------------------
                                                                2016    2017    2018    2019    2020   2016-2020
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION
 
Maternal and Infant Health Quality Measures:
    Authorization Level......................................      16       0       0       0       0         16
    Estimated Outlays........................................       3       4       4       3       2         16
Grants for Quality Collaboratives:
    Authorization Level......................................      15       0       0       0       0         15
    Estimated Outlays........................................       3       8       4       0       0         15
    Total Changes:
        Authorization Level..................................      31       0       0       0       0         31
        Estimated Outlays....................................       6      12       8       3       2         31
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that the 
legislation will be enacted near the beginning of fiscal year 
2016 and that the amounts specified will be appropriated in 
that year.
    S. 466 would authorize the appropriation of $16 million for 
the Secretary of HHS to identify and publish quality measures 
for maternal and infant health. The legislation would require 
HHS to:
           Make initial measures available for public 
        comment no later than January 2018;
           Publish final measures applicable to mothers 
        and infants eligible for Medicaid or the Children's 
        Health Insurance Program by January 2019; and
           Establish a Maternal and Infant Quality 
        Measurement Program to improve and expand those 
        measures, including providing grants to develop and 
        test evidence-based measures.
    Based on historical spending for similar programs--the 
Child Health Quality Measures established by the Children's 
Health Insurance Program Reauthorization Act of 2009 and the 
Adult Health Quality Measures established by the Patient 
Protection and Affordable Care Act--CBO estimates that 
implementing similar measures for mothers and infants would 
cost $16 million over the 2016-2020 period.
    The bill also would authorize the appropriation of $15 
million for HHS to award grants to develop and expand quality 
collaboratives for maternity and infant care. A quality 
collaborative is a group of people or organizations--for 
example, universities, state and local agencies, health 
systems, and professional associations--working together to 
improve health care. Funding also would be used to make 
reports, tools, and other resources of individual 
collaboratives available to others. Based on historical 
spending by similar programs, CBO estimates that implementing 
these grants would cost $15 million over the 2016-2018 period.
    Pay-As-You-Go considerations: None.
    Intergovernmental and private-sector impact: S. 466 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments.
    Estimate prepared by: Federal Costs: Daniel Hoople; Impact 
on State, Local, and Tribal Governments: J'nell Blanco Suchy; 
Impact on the Private Sector: Amy Petz.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       IV. VOTES OF THE COMMITTEE

    In compliance with paragraph 7(b) of rule XXVI of the 
standing rules of the Senate, the Committee states that, with a 
majority present, the ``Quality Care for Moms and Babies Act,'' 
as modified was ordered favorably reported on June 24, 2015 as 
follows:
    Final Passage of the Quality Care for Moms and Babies Act--
approved, as modified, by voice vote.

                 V. REGULATORY IMPACT AND OTHER MATTERS

                          A. Regulatory Impact

    Pursuant to paragraph 11(b) of rule XXVI of the Standing 
Rules of the Senate, the Committee makes the following 
statement concerning the regulatory impact that might be 
incurred in carrying out the provisions of the bill.

Impact on individuals and businesses, personal privacy and paperwork

    The bill is not expected to impose additional 
administrative requirements or regulatory burdens on 
individuals. The bill is expected to reduce administrative 
requirements and regulatory burdens on some businesses.
    The provisions of the bill do not impact personal privacy.

                     B. Unfunded Mandates Statement

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
any private sector mandates. The Committee has determined that 
the bill contains no intergovernmental mandate.

       VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    In the opinion of the Committee, it is necessary in order 
to expedite the business of the Senate, to dispense with the 
requirements of paragraph 12 of rule XXVI of the Standing Rules 
of the Senate (relating to the showing of changes in existing 
law made by the bill as reported by the Committee).

                                  [all]
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