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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 466 Reported in Senate (RS)]

                                                       Calendar No. 179
114th CONGRESS
  1st Session
                                 S. 466

                          [Report No. 114-100]

 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.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           February 11, 2015

  Ms. Stabenow (for herself, Mr. Grassley, Mrs. Boxer, Mr. Casey, Mr. 
     Heinrich, Mr. Reed, Mr. Schumer, Mr. Menendez, and Mr. Brown) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

                             July 30, 2015

                Reported by Mr. Hatch, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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 maternity care quality measures 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,

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (a) Short Title.--This Act may be cited as the ``Quality 
Care for Moms and Babies Act''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents of this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
<DELETED>Sec. 2. Quality measures for maternity care under Medicaid and 
                            CHIP.
<DELETED>Sec. 3. Quality collaboratives.

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

<DELETED>    (a) In General.--Section 1139A of the Social Security Act 
(42 U.S.C. 1320b-9a) is amended by adding at the end the following new 
subsection:</DELETED>
<DELETED>    ``(j) Mother and Infant Care (MIC) Quality Measures.--
</DELETED>
        <DELETED>    ``(1) In general.--As part of the pediatric 
        quality measures program established under subsection (b) and 
        the Medicaid Quality Measurement Program established under 
        section 1139B(b)(5)(A), the Secretary shall--</DELETED>
                <DELETED>    ``(A) review quality measures endorsed 
                under section 1890(b)(2) that relate to the care of 
                childbearing women and newborns, particularly with 
                respect to the application of such measures to the 
                Medicaid and CHIP programs under titles XIX and XXI, 
                and identify omissions and deficiencies in the 
                application of those measures to such 
                programs;</DELETED>
                <DELETED>    ``(B) develop and publish a set of 
                maternity care quality measures for the Medicaid and 
                CHIP programs under titles XIX and XXI (in this 
                subsection referred to as the `Mother and Infant Care 
                (MIC) quality measures') in accordance with the 
                requirements of paragraphs (2) and (3); and</DELETED>
                <DELETED>    ``(C) on an ongoing basis, review the MIC 
                quality measures and develop and publish any 
                modifications of, or additions or deletions to, such 
                measures that reflect the development, testing, 
                validation, and consensus process described in 
                paragraph (4).</DELETED>
        <DELETED>    ``(2) Process for initial review and 
        publication.--</DELETED>
                <DELETED>    ``(A) Consultation and public comment.--
                Not later than January 1, 2018, the Secretary shall--
                </DELETED>
                        <DELETED>    ``(i) solicit public comment on 
                        the proposed MIC quality measures; 
                        and</DELETED>
                        <DELETED>    ``(ii) consult with the 
                        stakeholders identified in paragraph (6)(A) 
                        regarding such measures.</DELETED>
                <DELETED>    ``(B) Publication of initial set of 
                measures.--Not later than January 1, 2019, the 
                Secretary shall identify and publish the initial MIC 
                quality measures.</DELETED>
        <DELETED>    ``(3) Requirements.--</DELETED>
                <DELETED>    ``(A) In general.--The MIC quality 
                measures shall--</DELETED>
                        <DELETED>    ``(i) be evidence-based;</DELETED>
                        <DELETED>    ``(ii) utilize risk adjustment or 
                        risk stratification methodologies, if 
                        appropriate;</DELETED>
                        <DELETED>    ``(iii) utilize attribution 
                        methods to specify the clinicians, facilities, 
                        and other entities that the measures are 
                        applicable to;</DELETED>
                        <DELETED>    ``(iv) be pilot-tested with 
                        regards to scientific validity, feasibility, 
                        and attribution method; and</DELETED>
                        <DELETED>    ``(v) include a balance of each of 
                        the types of measures listed in subparagraph 
                        (B).</DELETED>
                <DELETED>    ``(B) List of types of measures.--The 
                measures listed in this subparagraph are the 
                following:</DELETED>
                        <DELETED>    ``(i) Measures of the process, 
                        experience, efficiency, and outcomes of 
                        maternity care, including postpartum 
                        outcomes.</DELETED>
                        <DELETED>    ``(ii) Measures that apply to--
                        </DELETED>
                                <DELETED>    ``(I) women and newborns 
                                who are healthy and at low risk, 
                                including measures of appropriately 
                                low-intervention, physiologic birth in 
                                low-risk women; and</DELETED>
                                <DELETED>    ``(II) women and newborns 
                                at higher risk.</DELETED>
                        <DELETED>    ``(iii) Measures that apply to--
                        </DELETED>
                                <DELETED>    ``(I) childbearing women; 
                                and</DELETED>
                                <DELETED>    ``(II) newborns.</DELETED>
                        <DELETED>    ``(iv) Measures that apply to care 
                        during--</DELETED>
                                <DELETED>    ``(I) pregnancy;</DELETED>
                                <DELETED>    ``(II) the intrapartum 
                                period; and</DELETED>
                                <DELETED>    ``(III) the postpartum 
                                period.</DELETED>
                        <DELETED>    ``(v) Measures that apply to--
                        </DELETED>
                                <DELETED>    ``(I) clinicians and 
                                clinician groups;</DELETED>
                                <DELETED>    ``(II) 
                                facilities;</DELETED>
                                <DELETED>    ``(III) health plans; 
                                and</DELETED>
                                <DELETED>    ``(IV) accountable care 
                                organizations.</DELETED>
                        <DELETED>    ``(vi) Measurement of--</DELETED>
                                <DELETED>    ``(I) 
                                disparities;</DELETED>
                                <DELETED>    ``(II) care coordination; 
                                and</DELETED>
                                <DELETED>    ``(III) shared 
                                decisionmaking.</DELETED>
                <DELETED>    ``(C) Physiologic defined.--For purposes 
                of this paragraph, 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.</DELETED>
                <DELETED>    ``(D) Construction.--Nothing in this 
                paragraph 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 any way limiting available 
                services.</DELETED>
        <DELETED>    ``(4) Ongoing review of the mic measures; 
        eMeasures.--</DELETED>
                <DELETED>    ``(A) Contracts with qualified entities.--
                Not later than June 30, 2019, 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 identifying 
                quality of care issues that are not adequately 
                addressed by the MIC quality measures and developing, 
                testing, and validating modifications of, or additions 
                or deletions to, the MIC quality measures, and creating 
                eMeasures for data collection related to the MIC 
                quality measures.</DELETED>
                <DELETED>    ``(B) Qualified measure development entity 
                defined.--For purposes of this paragraph, the term 
                `qualified measure development entity' means an entity 
                that--</DELETED>
                        <DELETED>    ``(i) has demonstrated expertise 
                        and capacity in the development and testing of 
                        quality measures;</DELETED>
                        <DELETED>    ``(ii) has adopted procedures for 
                        quality measure development that ensure the 
                        inclusion of--</DELETED>
                                <DELETED>    ``(I) the views of the 
                                individuals and entities referred to in 
                                paragraph (3)(B)(v) and whose 
                                performance will be assessed by the 
                                measures; and</DELETED>
                                <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(iii) for the purpose of 
                        ensuring that the MIC quality measures 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--
                        </DELETED>
                                <DELETED>    ``(I) the 
                                Secretary;</DELETED>
                                <DELETED>    ``(II) the consensus-based 
                                entity with a contract under section 
                                1890(a)(1); and</DELETED>
                                <DELETED>    ``(III) stakeholders 
                                (including those stakeholders 
                                identified in paragraph (6)(A)), as 
                                practicable;</DELETED>
                        <DELETED>    ``(iv) has transparent policies 
                        regarding governance and conflicts of interest; 
                        and</DELETED>
                        <DELETED>    ``(v) submits an application to 
                        the Secretary at such time, and in such form 
                        and manner, as the Secretary may 
                        require.</DELETED>
                <DELETED>    ``(C) eMeasures.--</DELETED>
                        <DELETED>    ``(i) In general.--A qualified 
                        measure development entity with a grant, 
                        contract, or intergovernmental agreement under 
                        subparagraph (A) shall consult with the 
                        voluntary consensus standards setting 
                        organizations and other organizations involved 
                        in the advancement of evidence-based measures 
                        of health care that the Secretary consults with 
                        under subsection (b)(3)(H) and section 
                        1139B(b)(5)(A) to create, as part of the MIC 
                        quality measures, eMeasures that are aligned 
                        with the measures developed under the pediatric 
                        quality measures program established under 
                        subsection (b) and the Medicaid Quality 
                        Measurement Program established under section 
                        1139B(b)(5)(A).</DELETED>
                        <DELETED>    ``(ii) eMeasure defined.--For 
                        purposes of this subparagraph, 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.</DELETED>
                <DELETED>    ``(D) Endorsement.--Any modifications of, 
                or additions or deletions to, the MIC quality measures 
                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).</DELETED>
        <DELETED>    ``(5) Maternity consumer assessment of health care 
        providers and systems surveys.--</DELETED>
                <DELETED>    ``(A) Adaption of surveys.--Not later than 
                January 1, 2020, 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--</DELETED>
                        <DELETED>    ``(i) providers;</DELETED>
                        <DELETED>    ``(ii) facilities; and</DELETED>
                        <DELETED>    ``(iii) health plans.</DELETED>
                <DELETED>    ``(B) Surveys must be effective.--The 
                Agency for Healthcare Research and Quality shall ensure 
                that the surveys adapted under subparagraph (A) are 
                effective in measuring aspects of care that 
                childbearing women and newborns experience, which may 
                include--</DELETED>
                        <DELETED>    ``(i) various types of care 
                        settings;</DELETED>
                        <DELETED>    ``(ii) various types of 
                        caregivers;</DELETED>
                        <DELETED>    ``(iii) considerations relating to 
                        pain;</DELETED>
                        <DELETED>    ``(iv) shared 
                        decisionmaking;</DELETED>
                        <DELETED>    ``(v) supportive care around the 
                        time of birth; and</DELETED>
                        <DELETED>    ``(vi) other topics relevant to 
                        the quality of the experience of childbearing 
                        women and newborns.</DELETED>
                <DELETED>    ``(C) Languages.--The surveys adapted 
                under subparagraph (A) shall be available in English 
                and Spanish.</DELETED>
                <DELETED>    ``(D) Endorsement.--The Agency for 
                Healthcare Research and Quality shall submit any 
                Consumer Assessment of Healthcare Providers and Systems 
                surveys adapted under this paragraph to the consensus-
                based entity with a contract under section 1890(a)(1) 
                to be considered for endorsement under section 
                1890(b)(2).</DELETED>
                <DELETED>    ``(E) Consultation.--The adaption of (and 
                process for applying) the surveys under subparagraph 
                (A) shall be conducted in consultation with the 
                stakeholders identified in paragraph (6)(A).</DELETED>
        <DELETED>    ``(6) Stakeholders.--</DELETED>
                <DELETED>    ``(A) In general.--The stakeholders 
                identified in this subparagraph are--</DELETED>
                        <DELETED>    ``(i) the various clinical 
                        disciplines and specialties involved in 
                        providing maternity care;</DELETED>
                        <DELETED>    ``(ii) State Medicaid 
                        administrators;</DELETED>
                        <DELETED>    ``(iii) maternity care consumers 
                        and their advocates;</DELETED>
                        <DELETED>    ``(iv) technical experts in 
                        quality measurement;</DELETED>
                        <DELETED>    ``(v) hospital, facility and 
                        health system leaders;</DELETED>
                        <DELETED>    ``(vi) employers and purchasers; 
                        and</DELETED>
                        <DELETED>    ``(vii) other individuals who are 
                        involved in the advancement of evidence-based 
                        maternity care quality measures.</DELETED>
                <DELETED>    ``(B) Professional organizations.--The 
                stakeholders identified under subparagraph (A) may 
                include representatives from relevant national medical 
                specialty and professional organizations and specialty 
                societies.</DELETED>
        <DELETED>    ``(7) Authorization of appropriations.--There are 
        authorized to be appropriated $16,000,000 to carry out this 
        subsection. Funds appropriated under this paragraph shall 
        remain available until expended.''.</DELETED>
<DELETED>    (b) Conforming Amendments.--</DELETED>
        <DELETED>    (1) Section 1139A of the Social Security Act (42 
        U.S.C. 1320b-9a) is amended--</DELETED>
                <DELETED>    (A) in subsection (a)(6), in the matter 
                preceding subparagraph (A), by inserting ``and the 
                Medicaid and CHIP Payment and Access Commission'' after 
                ``Congress''; and</DELETED>
                <DELETED>    (B) in subsection (i), by striking 
                ``subsection (e)'' and inserting ``subsections (e) and 
                (j)''.</DELETED>
        <DELETED>    (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''.</DELETED>

<DELETED>SEC. 3. QUALITY COLLABORATIVES.</DELETED>

<DELETED>    (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--</DELETED>
        <DELETED>    (1) the development of new State and regional 
        maternity care quality collaboratives;</DELETED>
        <DELETED>    (2) expanded activities of existing maternity care 
        quality collaboratives; and</DELETED>
        <DELETED>    (3) maternity care initiatives within established 
        State and regional quality collaboratives that are not focused 
        exclusively on maternity care.</DELETED>
<DELETED>    (b) Eligible Entity.--The following entities shall be 
eligible for a grant under subsection (a):</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (2) Entities seeking to establish a maternity care 
        quality collaborative.</DELETED>
        <DELETED>    (3) State Medicaid agencies.</DELETED>
        <DELETED>    (4) State departments of health.</DELETED>
        <DELETED>    (5) Health insurance issuers (as such term is 
        defined in section 2791 of the Public Health Service Act (42 
        U.S.C. 300gg-91)).</DELETED>
        <DELETED>    (6) Provider organizations, including associations 
        representing--</DELETED>
                <DELETED>    (A) health professionals; and</DELETED>
                <DELETED>    (B) hospitals.</DELETED>
<DELETED>    (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--
</DELETED>
        <DELETED>    (1) improving the appropriate use of cesarean 
        section;</DELETED>
        <DELETED>    (2) reducing maternal and newborn morbidity 
        rates;</DELETED>
        <DELETED>    (3) improving breast-feeding rates;</DELETED>
        <DELETED>    (4) reducing hospital readmission rates;</DELETED>
        <DELETED>    (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</DELETED>
        <DELETED>    (6) delivering risk-appropriate levels of 
        care.</DELETED>
<DELETED>    (d) Activities.--Activities that may be supported by the 
funding under subsection (a) include the following:</DELETED>
        <DELETED>    (1) Facilitating performance data collection and 
        feedback reports to providers with respect to their 
        performance, relative to peers and benchmarks, if 
        any.</DELETED>
        <DELETED>    (2) Developing, implementing, and evaluating 
        protocols and checklists to foster safe, evidence-based 
        practice.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (4) Developing underlying infrastructure needed to 
        support quality collaborative activities under this 
        subsection.</DELETED>
        <DELETED>    (5) Providing technical assistance to providers 
        and institutions to build quality improvement capacity and 
        facilitate participation in collaborative activities.</DELETED>
        <DELETED>    (6) Developing the capability to access the 
        following data sources:</DELETED>
                <DELETED>    (A) A mother's prenatal, intrapartum, and 
                postpartum records.</DELETED>
                <DELETED>    (B) A mother's medical records.</DELETED>
                <DELETED>    (C) An infant's medical records since 
                birth.</DELETED>
                <DELETED>    (D) Birth and death 
                certificates.</DELETED>
                <DELETED>    (E) Any other relevant State-level 
                generated data (such as data from the pregnancy risk 
                assessment management system (PRAMS)).</DELETED>
        <DELETED>    (7) Developing access to blinded liability claims 
        data, analyzing the data, and using the results of such 
        analysis to improve practice.</DELETED>
<DELETED>    (e) Special Rule for Births.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (f) Use of Quality Measures.--Projects and programs for 
which such a grant is made shall--</DELETED>
        <DELETED>    (1) include data collection with rapid analysis 
        and feedback to participants with a focus on improving practice 
        and health outcomes;</DELETED>
        <DELETED>    (2) develop a plan to identify and resolve data 
        collection problems;</DELETED>
        <DELETED>    (3) identify and document evidence-based 
        strategies that will be used to improve performance on quality 
        measures and other metrics; and</DELETED>
        <DELETED>    (4) exclude from quality measure collection and 
        reporting physicians and midwives who attend fewer than 30 
        births per year.</DELETED>
<DELETED>    (g) Reporting on Quality Measures.--Any reporting 
requirements established by a project or program funded under 
subsection (a) shall be designed to--</DELETED>
        <DELETED>    (1) minimize costs and administrative effort; 
        and</DELETED>
        <DELETED>    (2) use existing data resources when 
        feasible.</DELETED>
<DELETED>    (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.</DELETED>
<DELETED>    (i) Evaluation.--A quality collaborative (or other entity 
receiving a grant under subsection (a)) shall--</DELETED>
        <DELETED>    (1) develop and carry out plans for evaluating its 
        maternity care quality improvement programs and projects; 
        and</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (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:</DELETED>
        <DELETED>    (1) A description of the activities carried out 
        using the funding from such grant.</DELETED>
        <DELETED>    (2) A description of any barriers that limited the 
        ability of the collaborative or entity to achieve its 
        goals.</DELETED>
        <DELETED>    (3) The achievements of the collaborative or 
        entity under the grant with respect to the quality, health 
        outcomes, and value of maternity care.</DELETED>
        <DELETED>    (4) A list of lessons learned from the 
        grant.</DELETED>
<DELETED>Such reports shall be made available to the public.</DELETED>
<DELETED>    (k) Governance.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (2) Composition.--Such executive committee shall 
        include individuals who represent--</DELETED>
                <DELETED>    (A) physicians, including physicians in 
                the fields of general obstetrics, maternal-fetal 
                medicine, family medicine, neonatology, and 
                pediatrics;</DELETED>
                <DELETED>    (B) nurse-practitioners and 
                nurses;</DELETED>
                <DELETED>    (C) certified nurse-midwives and certified 
                midwives;</DELETED>
                <DELETED>    (D) health facilities and health 
                systems;</DELETED>
                <DELETED>    (E) consumers;</DELETED>
                <DELETED>    (F) employers and other private 
                purchasers;</DELETED>
                <DELETED>    (G) Medicaid programs; and</DELETED>
                <DELETED>    (H) other public health agencies and 
                organizations, as appropriate.</DELETED>
        <DELETED>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.</DELETED>
<DELETED>    (l) Consultation.--A quality collaborative or other 
eligible entity that receives a grant under subsection (a) shall engage 
in regular ongoing consultation with--</DELETED>
        <DELETED>    (1) regional and State public health agencies and 
        organizations;</DELETED>
        <DELETED>    (2) public and private health insurers; 
        and</DELETED>
        <DELETED>    (3) regional and State organizations representing 
        physicians, midwives, and nurses who provide maternity 
        services.</DELETED>
<DELETED>    (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.</DELETED>

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 Maternal and Infant Health.
Sec. 3. Quality collaboratives.
Sec. 4. Facilitation of increased coordination and alignment between 
                            the public and private sector with respect 
                            to quality and efficiency measures.

SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT HEALTH.

    (a) In General.--Title XI of the Social Security Act (42 U.S.C. 
1301 et seq.) is amended by inserting after section 1139B the following 
new section:

``SEC. 1139C. MATERNAL AND INFANT QUALITY MEASURES.

    ``(a) Development of Core Set of Health Care Quality Measures for 
Maternal and Infant Health.--
            ``(1) In general.--The Secretary shall identify and publish 
        a recommended core set of maternal and infant health quality 
        measures for women and children described in subparagraphs (A) 
        and (B) of section 1902(l)(1) in the same manner as the 
        Secretary identifies and publishes a core set of child health 
        quality measures under section 1139A, including with respect to 
        identifying and publishing existing maternal and infant health 
        quality measures that are in use under public and privately 
        sponsored health care coverage arrangements, or that are part 
        of reporting systems that measure both the presence and 
        duration of health insurance coverage over time, that may be 
        applicable to Medicaid and CHIP eligible mothers and infants.
            ``(2) Alignment with existing core sets.--In identifying 
        and publishing the recommended core set core set of maternal 
        and infant health quality measures required under paragraph 
        (1), the Secretary shall ensure that, to the extent possible, 
        such measures align with and do not duplicate--
                    ``(A) the core set of child health quality measures 
                identified, published, and revised under section 1139A; 
                or
                    ``(B) the core set of adult health quality measures 
                identified, published, and revised under section 1139B.
            ``(3) Process for maternal and infant quality measures 
        program.--In identifying gaps in existing maternal and infant 
        measures and establishing priorities for the development and 
        advancement of such measures, the Secretary shall consult 
        with--
                    ``(A) States;
                    ``(B) physicians, including physicians in the 
                fields of general obstetrics, maternal-fetal medicine, 
                family medicine, neonatology, and pediatrics;
                    ``(C) nurse practitioners and nurses;
                    ``(D) certified nurse-midwives and certified 
                midwives;
                    ``(E) health facilities and health systems;
                    ``(F) national organizations representing mothers 
                and infants;
                    ``(G) national organizations representing consumers 
                and purchasers of health care;
                    ``(H) national organizations and individuals with 
                expertise in maternal and infant health quality 
                measurement; and
                    ``(I) voluntary consensus standard-setting 
                organizations and other organizations involved in the 
                advancement of evidence-based measures of health care.
    ``(b) Deadlines.--
            ``(1) Recommended measures.--Not later than January 1, 
        2018, the Secretary shall identify and publish for comment a 
        recommended core set of maternal and infant health quality 
        measures that includes the following:
                    ``(A) Measures of the process, experience, 
                efficiency, and outcomes of maternity care, including 
                postpartum outcomes.
                    ``(B) Measures that apply to childbearing women and 
                newborns at healthy, low, and high risk, including 
                measures of low-intervention birth.
                    ``(C) Measures that apply to care during pregnancy, 
                the intrapartum period, and the postpartum period.
                    ``(D) Measures that apply to a variety of settings 
                and provider types, such as clinics, facilities, health 
                plans, and accountable care organizations.
                    ``(E) Measures that address disparities, care 
                coordination, and shared decisionmaking.
            ``(2) Dissemination.--Not later than January 1, 2019, the 
        Secretary shall publish an initial core set of maternal and 
        infant health quality measures that are applicable to Medicaid 
        and CHIP eligible mothers and infants.
            ``(3) Standardized reporting.--Not later than January 1, 
        2020, the Secretary, in consultation with States, shall develop 
        a standardized format for reporting information based on the 
        initial core set of maternal and infant health quality measures 
        and create procedures to encourage States to use such measures 
        to voluntarily report information regarding the quality of 
        health care for Medicaid and CHIP eligible mothers and infants.
            ``(4) Reports to congress.--Not later than January 1, 2021, 
        and every 3 years thereafter, the Secretary shall include in 
        the report to Congress required under section 1139A(a)(6) 
        information similar to the information required under that 
        section with respect to the measures established under this 
        section.
            ``(5) Establishment of maternal and infant quality 
        measurement program.--
                    ``(A) In general.--Not later than 12 months after 
                the release of the recommended core set of maternal and 
                infant health quality measures under paragraph (1), the 
                Secretary shall establish a Maternal and Infant Quality 
                Measurement Program in the same manner as the Secretary 
                established the pediatric quality measures program 
                under section 1139A(b).
                    ``(B) Revising, strengthening, and improving 
                initial core measures.--Beginning not later than 24 
                months after the establishment of the Maternal and 
                Infant Quality Measurement Program, and annually 
                thereafter, the Secretary shall publish recommended 
                changes to the initial core set of maternal and infant 
                health quality measures that shall reflect the results 
                of the testing, validation, and consensus process for 
                the development of maternal and infant health quality 
                measures.
                    ``(C) Emeasures.--
                            ``(i) In general.--An entity awarded a 
                        grant or contract by the Secretary to develop 
                        emerging and innovative evidence-based measures 
                        under the Maternal and Infant Quality 
                        Measurement Program shall work to advance 
                        eMeasures that are aligned with the measures 
                        developed under the Pediatric Quality Measures 
                        Program established under section 1139A(b) and 
                        the Medicaid Quality Measurement Program 
                        established under section 1139B(b)(5).
                            ``(ii) Definition.--For purposes of this 
                        subparagraph, the term `eMeasure' means an 
                        electronic 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.
                    ``(D) Amount available for grants and contracts.--
                The aggregate amount of funds that may be awarded as 
                grants and contracts under the Maternal and Infant 
                Quality Measurement Program for the development, 
                testing, and validation of emerging and innovative 
                evidence-based measures shall not exceed the aggregate 
                amount of funds awarded as grants and contracts under 
                section 1139A(b)(4)(A).
    ``(c) Construction.--Nothing in this section 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 any 
way limiting available services.
    ``(d) Maternity Consumer Assessment of Health Care Providers and 
Systems Surveys.--
            ``(1) Adaption of surveys.--Not later than January 1, 2020, 
        for the purpose of measuring the care experiences of 
        childbearing women and newborns, where appropriate, the Agency 
        for Healthcare Research and Quality shall adapt 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 paragraph 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 paragraph 
        (6)(A).
            ``(6) Stakeholders.--
                    ``(A) In general.--The stakeholders identified in 
                this subparagraph are--
                            ``(i) the various clinical disciplines and 
                        specialties involved in providing maternity 
                        care;
                            ``(ii) State Medicaid administrators;
                            ``(iii) maternity care consumers and their 
                        advocates;
                            ``(iv) technical experts in quality 
                        measurement;
                            ``(v) hospital, facility and health system 
                        leaders;
                            ``(vi) employers and purchasers; and
                            ``(vii) other individuals who are involved 
                        in the advancement of evidence-based maternity 
                        care quality measures.
                    ``(B) Professional organizations.--The stakeholders 
                identified under subparagraph (A) may include 
                representatives from relevant national medical 
                specialty and professional organizations and specialty 
                societies.
    ``(e) Annual State Reports Regarding State-specific Maternal and 
Infant Quality of Care Measures Applied Under Medicaid or CHIP.--
            ``(1) In general.--Each State with a plan or waiver 
        approved under title XIX or XXI shall annually report 
        (separately or as part of the annual report required under 
        section 1139A(c)) to the Secretary on the--
                    ``(A) State-specific maternal and infant health 
                quality measures applied by the State under such plan 
                or waiver, including measures described in subsection 
                (b)(5)(B);
                    ``(B) State-specific information on the quality of 
                health care furnished to Medicaid and CHIP eligible 
                mothers and infants under such plan or waiver, 
                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, 2021, and 
        annually thereafter, the Secretary shall collect, analyze, and 
        make publicly available the information reported by States 
        under paragraph (1).
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated $16,000,000 to carry out this section. Funds appropriated 
under this subsection shall remain available until expended.''.
    (b) Technical Amendment.--Section 1139B(d)(1)(A) of the Social 
Security Act (42 U.S.C. 1320b-9b(d)(1)(A)) is amended by striking 
``subsection (a)(5)'' and inserting ``subsection (b)(5)''.

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 and 
        infant care quality collaboratives;
            (2) expanded activities of existing maternity and infant 
        care quality collaboratives; and
            (3) maternity and infant 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 and infant care initiatives, to the extent that 
        such collaboratives use such grant only for such initiatives.
            (2) Entities seeking to establish a maternity and infant 
        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 
and infant 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 and infant 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 and infant 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 and infant 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 and infant care quality 
        collaborative or a maternity and infant 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 and 
        infant 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 and 
        infant 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. FACILITATION OF INCREASED COORDINATION AND ALIGNMENT BETWEEN 
              THE PUBLIC AND PRIVATE SECTOR WITH RESPECT TO QUALITY AND 
              EFFICIENCY MEASURES.

    (a) In General.--Section 1890(b) of the Social Security Act (42 
U.S.C. 1395aaa(b)) is amended by inserting after paragraph (3) the 
following new paragraph:
            ``(4) Facilitation of increased coordination and alignment 
        between the public and private sector with respect to quality 
        and efficiency measures.--
                    ``(A) In general.--The entity shall facilitate 
                increased coordination and alignment between the public 
                and private sector with respect to quality and 
                efficiency measures.
                    ``(B) Annual reports.--The entity shall prepare and 
                make available to the public its findings under this 
                paragraph in its annual report. Such public 
                availability shall include posting each report on the 
                Internet website of the entity.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act.
                                                       Calendar No. 179

114th CONGRESS

  1st Session

                                 S. 466

                          [Report No. 114-100]

_______________________________________________________________________

                                 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 maternity care quality measures and 
           supporting maternity care quality collaboratives.

_______________________________________________________________________

                             July 30, 2015

                       Reported with an amendment
```