II 

117TH CONGRESS 

1ST SESSION S. 408 

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 

FEBRUARY 24, 2021 

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 shall publish on a 

9 public website of the Centers for Medicare & Medicaid 

10 Services guidance for States on resources and strategies 

11 for hospitals, freestanding birth centers (as defined in sec12 tion 1905(l)(3)(B) of the Social Security Act (42 U.S.C. 

13 1396d(l)(3)(B))), and other maternal care providers as de14 termined by the Secretary for reducing maternal mortality 

15 and severe morbidity in individuals who are eligible for 

16 and receiving medical assistance under Medicaid or CHIP. 

17 (b) UPDATES.—The Secretary shall update the guid18 ance and resources described in subsection (a) at least 

19 once every 3 years. 

20 (c) CONSULTATION WITH ADVISORY COMMITTEE.— 

21 (1) ESTABLISHMENT.—Subject to the avail22 ability of appropriations, not later than 18 months 

23 after the date of enactment of this Act, the Sec24 retary shall establish an advisory committee to be 

25 known as the ‘‘National Advisory Committee on ReVerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408

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1 ducing Maternal Deaths’’ (referred to in this section 

2 as the ‘‘Advisory Committee’’). 

3 (2) DUTIES.—The Advisory Committee shall 

4 provide consensus advice and guidance to the Sec5 retary on the development and compilation of the 

6 guidance described in subsection (a) (and any up7 dates to such guidance). 

8 (3) MEMBERSHIP.— 

9 (A) IN GENERAL.—The Secretary, in con10 sultation with such other heads of agencies, as 

11 the Secretary deems appropriate and in accord12 ance with this paragraph, shall appoint not 

13 more than 35 members to the Advisory Com14 mittee. In appointing such members, the Sec15 retary shall ensure that— 

16 (i) the total number of members of 

17 the Advisory Committee is an odd number; 

18 and 

19 (ii) the total number of voting mem20 bers who are not Federal officials does not 

21 exceed the total number of voting Federal 

22 members who are Federal officials. 

23 (B) REQUIRED MEMBERS.— 

24 (i) FEDERAL OFFICIALS.—The Advi25 sory Committee shall include as voting 


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1 members the following Federal officials, or 

2 their designees: 

3 (I) The Secretary. 

4 (II) The Administrator of the 

5 Centers for Medicare & Medicaid 

6 Services. 

7 (III) The Director of the Centers 

8 for Disease Control and Prevention. 

9 (IV) The Associate Administrator 

10 of the Maternal and Child Health Bu11 reau of the Health Resources and 

12 Services Administration. 

13 (V) The Director of the Agency 

14 for Healthcare Research and Quality. 

15 (VI) The National Coordinator 

16 for Health Information Technology. 

17 (VII) The Director of the Na18 tional Institutes of Health. 

19 (VIII) The Secretary of Veterans 

20 Affairs. 

21 (IX) The Director of the Indian 

22 Health Service. 

23 (X) The Deputy Assistant Sec24 retary for Minority Health. 


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1 (XI) The Administrator of the 

2 Substance Abuse and Mental Health 

3 Services Administration. 

4 (XII) The Deputy Assistant Sec5 retary for Women’s Health. 

6 (XIII) Such other Federal offi7 cials or their designees as the Sec8 retary determines appropriate. 

9 (ii) NON-FEDERAL OFFICIALS.— 

10 (I) IN GENERAL.—The Advisory 

11 Committee shall include the following 

12 as voting members: 

13 (aa) At least 1 representa14 tive from a professional organiza15 tion representing hospitals and 

16 health systems. 

17 (bb) At least 1 representa18 tive from a medical professional 

19 organization representing pri20 mary care providers. 

21 (cc) At least 1 representa22 tive from a medical professional 

23 organization representing general 

24 obstetrician-gynecologists. 


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

3 organization representing cer4 tified nurse-midwives. 

5 (ee) At least 1 representa6 tive from a medical professional 

7 organization representing other 

8 maternal fetal medicine pro9 viders. 

10 (ff) At least 1 representative 

11 from a medical professional orga12 nization representing anesthesiol13 ogists. 

14 (gg) At least 1 representa15 tive from a medical professional 

16 organization representing emer17 gency medicine physicians and 

18 urgent care providers. 

19 (hh) At least 1 representa20 tive from a medical professional 

21 organization representing nurses. 

22 (ii) At least 1 representative 

23 from a professional organization 

24 representing community health 

25 workers. 


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1 (jj) At least 1 representative 

2 from a professional organization 

3 representing doulas. 

4 (kk) At least 1 representa5 tive from a professional organiza6 tion representing perinatal psy7 chiatrists. 

8 (ll) At least 1 representative 

9 from State-affiliated programs or 

10 existing collaboratives with dem11 onstrated expertise or success in 

12 improving maternal health. 

13 (mm) At least 1 director of 

14 a State Medicaid agency that has 

15 had demonstrated success in im16 proving maternal health. 

17 (nn) At least 1 representa18 tive from an accrediting organi19 zation for maternal health quality 

20 and safety standards. 

21 (oo) At least 1 representa22 tive from a maternal patient ad23 vocacy organization with lived ex24 perience of severe maternal mor25 bidity. 


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1 (II) REQUIREMENTS.—Each in2 dividual selected to be a member 

3 under this clause shall— 

4 (aa) have expertise in mater5 nal health; 

6 (bb) not be a Federal offi7 cial; and 

8 (cc) have experience working 

9 with populations that are at 

10 higher risk for maternal mor11 tality or severe morbidity, such 

12 as populations that experience 

13 racial, ethnic, and geographic 

14 health disparities, pregnant and 

15 postpartum women experiencing 

16 a mental health disorder, or 

17 pregnant or postpartum women 

18 with other comorbidities such as 

19 substance use disorders, hyper20 tension, thyroid disorders, and 

21 sickle cell disease. 

22 (C) ADDITIONAL MEMBERS.— 

23 (i) IN GENERAL.—In addition to the 

24 members required to be appointed under 

25 subparagraph (B), the Secretary may apVerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408

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1 point to the Advisory Committee such 

2 other individuals with relevant expertise or 

3 experience as the Secretary shall determine 

4 appropriate, which may include individuals 

5 described in clause (ii). 

6 (ii) SUGGESTED ADDITIONAL MEM7 BERS.—The individuals described in this 

8 clause are the following: 

9 (I) Representatives from State 

10 maternal mortality review committees 

11 and perinatal quality collaboratives. 

12 (II) Medical providers who care 

13 for women and infants during preg14 nancy and the postpartum period, 

15 such as family practice physicians, 

16 cardiologists, pulmonology critical 

17 care specialists, endocrinologists, pedi18 atricians, and neonatologists. 

19 (III) Representatives from State 

20 and local public health departments, 

21 including State Medicaid Agencies. 

22 (IV) Subject matter experts in 

23 conducting outreach to women who 

24 are African American or belong to an25 other minority group. 


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1 (V) Directors of State agencies 

2 responsible for administering a State’s 

3 maternal and child health services 

4 program under title V of the Social 

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

6 (VI) Experts in medical edu7 cation or physician training. 

8 (VII) Representatives from med9 icaid managed care organizations. 

10 (4) APPLICABILITY OF FACA.—The Federal Ad11 visory Committee Act (5 U.S.C. App.) shall apply to 

12 the committee established under this subsection. 

13 (d) CONTENTS.—The guidance described in sub14 section (a) shall include, with respect to hospitals, free15 standing birth centers, and other maternal care providers, 

16 the following: 

17 (1) Best practices regarding evidence-based 

18 screening and clinician education initiatives relating 

19 to screening and treatment protocols for individuals 

20 who are at risk of experiencing complications related 

21 to pregnancy, with an emphasis on individuals with 

22 preconditions directly linked to pregnancy complica23 tions and maternal mortality and severe morbidity, 

24 including— 


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1 (A) methods to identify individuals who are 

2 at risk of maternal mortality or severe mor3 bidity, including risk stratification; 

4 (B) evidence-based risk factors associated 

5 with maternal mortality or severe morbidity and 

6 racial, ethnic, and geographic health disparities; 

7 (C) evidence-based strategies to reduce risk 

8 factors associated with maternal mortality or 

9 severe morbidity through services which may be 

10 covered under Medicaid or CHIP, including, 

11 but not limited to, activities by community 

12 health workers (as such term is defined in sec13 tion 2113(f)(4) of the Social Security Act (42 

14 U.S.C. 1397mm(f)(4))) that are funded by a 

15 grant awarded under such section; 

16 (D) resources available to such individuals, 

17 such as nutrition assistance and education, 

18 home visitation, mental health and substance 

19 use disorder services, smoking cessation pro20 grams, prenatal care, and other evidence-based 

21 maternal mortality or severe morbidity reduc22 tion programs; 

23 (E) examples of educational materials used 

24 by providers of obstetrics services; 


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1 (F) methods for improving community cen2 tralized care, including providing telehealth 

3 services or home visits to increase and facilitate 

4 access to and engagement in prenatal and 

5 postpartum care and collaboration with home 

6 health agencies, community health centers, local 

7 public health departments, or clinics; 

8 (G) guidance on medical record diagnosis 

9 codes linked to maternal mortality and severe 

10 morbidity, including, if applicable, codes related 

11 to social risk factors, and methods for edu12 cating clinicians on the proper use of such 

13 codes; 

14 (H) risk appropriate transfer protocols 

15 during pregnancy, childbirth, and the postpar16 tum period; and 

17 (I) any other information related to pre18 vention and treatment of at-risk individuals de19 termined appropriate by the Secretary. 

20 (2) Guidance on monitoring programs for indi21 viduals who have been identified as at risk of com22 plications related to pregnancy. 

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1 nant women aware of the complications related to 

2 pregnancy. 

3 (4) A fact sheet for providing pregnant women 

4 who are receiving care on an outpatient basis with 

5 a notice during the prenatal stage of pregnancy 

6 that— 

7 (A) explains the risks associated with preg8 nancy, birth, and the postpartum period (in9 cluding the risks of hemorrhage, preterm birth, 

10 sepsis, eclampsia, obstructed labor), chronic 

11 conditions (including high blood pressure, dia12 betes, heart disease, depression, and obesity) 

13 correlated with adverse pregnancy outcomes, 

14 risks associated with advanced maternal age, 

15 and the importance of adhering to a personal16 ized plan of care; 

17 (B) highlights multimodal and evidence18 based prevention and treatment techniques; 

19 (C) provides for a method (through signa20 ture or otherwise) for such an individual, or a 

21 person acting on such individual’s behalf, to ac22 knowledge receipt of such fact sheet; 

23 (D) is worded in an easily understandable 

24 manner and made available in multiple lanVerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408

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1 guages and accessible formats determined ap2 propriate by the Secretary; and 

3 (E) includes any other information deter4 mined appropriate by the Secretary. 

5 (5) A template for a voluntary clinician check6 list that outlines the minimum responsibilities that 

7 clinicians, such as physicians, certified nurse-mid8 wives, emergency room and urgent care providers, 

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

10 promote quality and safety in the provision of ob11 stetric services. 

12 (6) A template for a voluntary checklist that 

13 outlines the minimum responsibilities that hospital 

14 leadership responsible for direct patient care, such 

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

16 chief nursing officer, or other hospital leadership 

17 that directly report to the president or chief execu18 tive officer of the institution, should meet to pro19 mote hospital-wide initiatives that improve quality 

20 and safety in the provision of obstetric services. 

21 (7) Information on multi-stakeholder quality 

22 improvement initiatives, such as the Alliance for In23 novation on Maternal Health, State perinatal quality 

24 improvement initiatives, and other similar initiatives 


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1 determined appropriate by the Secretary, includ2 ing— 

3 (A) information about such improvement 

4 initiatives and how to join; 

5 (B) information about public maternal 

6 data collection centers; 

7 (C) information about quality metrics used 

8 and outcomes achieved by such improvement 

9 initiatives; 

10 (D) information about data sharing tech11 niques used by such improvement initiatives; 

12 (E) information about data sources used 

13 by such improvement initiatives to identify ma14 ternal mortality and severe morbidity risks; 

15 (F) information about interventions used 

16 by such improvement initiatives to mitigate 

17 risks of maternal mortality and severe mor18 bidity; 

19 (G) information about data collection tech20 niques on race, ethnicity, geography, age, in21 come, and other demographic information used 

22 by such improvement initiatives; and 

23 (H) any other information determined ap24 propriate by the Secretary. 


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

2 18 months after the date of the publication of the guid3 ance required under subsection (a), the Secretary shall up4 date such guidance to include best practices identified by 

5 the Secretary for such hospitals, freestanding birth cen6 ters, and providers to track maternal mortality and severe 

7 morbidity trends by clinicians at such hospitals, free8 standing birth centers, and providers including— 

9 (1) ways to establish scoring systems, which 

10 may include quality triggers and safety and quality 

11 metrics to score case and patient outcome metrics, 

12 for such clinicians; 

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

14 such clinicians who may have higher rates of mater15 nal mortality or severe morbidity compared to their 

16 regional or State peers (taking into account dif17 ferences in patient risk for adverse outcomes, which 

18 may include social risk factors); 

19 (3) methods for using such data and tracking 

20 to enhance research efforts focused on maternal 

21 health, while also improving patient outcomes, clini22 cian education and training, and coordination of 

23 care; and 

24 (4) any other information determined appro25 priate by the Secretary. 


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1 (f) CULTURAL AND LINGUISTIC APPROPRIATE2 NESS.—To the extent practicable, the Secretary should de3 velop the guidance, best practices, fact sheets, templates, 

4 and other materials that are required under this section 

5 in a trauma-informed, culturally and linguistically appro6 priate manner. 

7 SEC. 3. REPORT ON PAYMENT METHODOLOGIES FOR 

8 TRANSFERRING PREGNANT WOMEN BE9 TWEEN FACILITIES BEFORE, DURING, AND 

10 AFTER CHILDBIRTH. 

11 (a) IN GENERAL.—Subject to the availability of ap12 propriations, not later than 36 months after the date of 

13 enactment of this Act, the Secretary shall submit to Con14 gress a report on the payment methodologies under Med15 icaid for the antepartum, intrapartum, and postpartum 

16 transfer of pregnant women from one health care facility 

17 to another, including any potential disincentives or regu18 latory barriers to such transfers. 

19 (b) CONSULTATION.—In developing the report re20 quired under subsection (a), the Secretary shall consult 

21 with the advisory committee established under section 

22 2(c). 

Æ 


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