Supporting Best Practices for Healthy Moms Act

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 pro- gram. 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 re- spect to individuals receiving medical assistance under such program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Supporting Best Prac- 4 tices for Healthy Moms Act’’. 5 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 2 •S 408 IS SEC. 2. DEVELOPING GUIDANCE ON MATERNAL MOR- 1 TALITY AND SEVERE MORBIDITY REDUCTION 2 FOR MATERNAL CARE PROVIDERS RECEIV- 3 ING PAYMENT UNDER THE MEDICAID PRO- 4 GRAM. 5 (a) IN GENERAL.—Subject to the availability of ap- 6 propriations, not later than 36 months after the date of 7 enactment of this Act, the Secretary shall publish on a 8 public website of the Centers for Medicare & Medicaid 9 Services guidance for States on resources and strategies 10 for hospitals, freestanding birth centers (as defined in sec- 11 tion 1905(l)(3)(B) of the Social Security Act (42 U.S.C. 12 1396d(l)(3)(B))), and other maternal care providers as de- 13 termined by the Secretary for reducing maternal mortality 14 and severe morbidity in individuals who are eligible for 15 and receiving medical assistance under Medicaid or CHIP. 16 (b) UPDATES.—The Secretary shall update the guid- 17 ance and resources described in subsection (a) at least 18 once every 3 years. 19 (c) CONSULTATION WITH ADVISORY COMMITTEE.— 20 (1) ESTABLISHMENT.—Subject to the avail- 21 ability of appropriations, not later than 18 months 22 after the date of enactment of this Act, the Sec- 23 retary shall establish an advisory committee to be 24 known as the ‘‘National Advisory Committee on Re- 25 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 3 •S 408 IS ducing Maternal Deaths’’ (referred to in this section 1 as the ‘‘Advisory Committee’’). 2 (2) DUTIES.—The Advisory Committee shall 3 provide consensus advice and guidance to the Sec- 4 retary on the development and compilation of the 5 guidance described in subsection (a) (and any up- 6 dates to such guidance). 7 (3) MEMBERSHIP.— 8 (A) IN GENERAL.—The Secretary, in con- 9 sultation with such other heads of agencies, as 10 the Secretary deems appropriate and in accord- 11 ance with this paragraph, shall appoint not 12 more than 35 members to the Advisory Com- 13 mittee. In appointing such members, the Sec- 14 retary shall ensure that— 15 (i) the total number of members of 16 the Advisory Committee is an odd number; 17 and 18 (ii) the total number of voting mem- 19 bers who are not Federal officials does not 20 exceed the total number of voting Federal 21 members who are Federal officials. 22 (B) REQUIRED MEMBERS.— 23 (i) FEDERAL OFFICIALS.—The Advi- 24 sory Committee shall include as voting 25 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 4 •S 408 IS members the following Federal officials, or 1 their designees: 2 (I) The Secretary. 3 (II) The Administrator of the 4 Centers for Medicare & Medicaid 5 Services. 6 (III) The Director of the Centers 7 for Disease Control and Prevention. 8 (IV) The Associate Administrator 9 of the Maternal and Child Health Bu- 10 reau of the Health Resources and 11 Services Administration. 12 (V) The Director of the Agency 13 for Healthcare Research and Quality. 14 (VI) The National Coordinator 15 for Health Information Technology. 16 (VII) The Director of the Na- 17 tional Institutes of Health. 18 (VIII) The Secretary of Veterans 19 Affairs. 20 (IX) The Director of the Indian 21 Health Service. 22 (X) The Deputy Assistant Sec- 23 retary for Minority Health. 24 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 5 •S 408 IS (XI) The Administrator of the 1 Substance Abuse and Mental Health 2 Services Administration. 3 (XII) The Deputy Assistant Sec- 4 retary for Women’s Health. 5 (XIII) Such other Federal offi- 6 cials or their designees as the Sec- 7 retary determines appropriate. 8 (ii) NON-FEDERAL OFFICIALS.— 9 (I) IN GENERAL.—The Advisory 10 Committee shall include the following 11 as voting members: 12 (aa) At least 1 representa- 13 tive from a professional organiza- 14 tion representing hospitals and 15 health systems. 16 (bb) At least 1 representa- 17 tive from a medical professional 18 organization representing pri- 19 mary care providers. 20 (cc) At least 1 representa- 21 tive from a medical professional 22 organization representing general 23 obstetrician-gynecologists. 24 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 6 •S 408 IS (dd) At least 1 representa- 1 tive from a medical professional 2 organization representing cer- 3 tified nurse-midwives. 4 (ee) At least 1 representa- 5 tive from a medical professional 6 organization representing other 7 maternal fetal medicine pro- 8 viders. 9 (ff) At least 1 representative 10 from a medical professional orga- 11 nization representing anesthesiol- 12 ogists. 13 (gg) At least 1 representa- 14 tive from a medical professional 15 organization representing emer- 16 gency medicine physicians and 17 urgent care providers. 18 (hh) At least 1 representa- 19 tive from a medical professional 20 organization representing nurses. 21 (ii) At least 1 representative 22 from a professional organization 23 representing community health 24 workers. 25 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 7 •S 408 IS (jj) At least 1 representative 1 from a professional organization 2 representing doulas. 3 (kk) At least 1 representa- 4 tive from a professional organiza- 5 tion representing perinatal psy- 6 chiatrists. 7 (ll) At least 1 representative 8 from State-affiliated programs or 9 existing collaboratives with dem- 10 onstrated expertise or success in 11 improving maternal health. 12 (mm) At least 1 director of 13 a State Medicaid agency that has 14 had demonstrated success in im- 15 proving maternal health. 16 (nn) At least 1 representa- 17 tive from an accrediting organi- 18 zation for maternal health quality 19 and safety standards. 20 (oo) At least 1 representa- 21 tive from a maternal patient ad- 22 vocacy organization with lived ex- 23 perience of severe maternal mor- 24 bidity. 25 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 8 •S 408 IS (II) REQUIREMENTS.—Each in- 1 dividual selected to be a member 2 under this clause shall— 3 (aa) have expertise in mater- 4 nal health; 5 (bb) not be a Federal offi- 6 cial; and 7 (cc) have experience working 8 with populations that are at 9 higher risk for maternal mor- 10 tality or severe morbidity, such 11 as populations that experience 12 racial, ethnic, and geographic 13 health disparities, pregnant and 14 postpartum women experiencing 15 a mental health disorder, or 16 pregnant or postpartum women 17 with other comorbidities such as 18 substance use disorders, hyper- 19 tension, thyroid disorders, and 20 sickle cell disease. 21 (C) ADDITIONAL MEMBERS.— 22 (i) IN GENERAL.—In addition to the 23 members required to be appointed under 24 subparagraph (B), the Secretary may ap- 25 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 9 •S 408 IS point to the Advisory Committee such 1 other individuals with relevant expertise or 2 experience as the Secretary shall determine 3 appropriate, which may include individuals 4 described in clause (ii). 5 (ii) SUGGESTED ADDITIONAL MEM- 6 BERS.—The individuals described in this 7 clause are the following: 8 (I) Representatives from State 9 maternal mortality review committees 10 and perinatal quality collaboratives. 11 (II) Medical providers who care 12 for women and infants during preg- 13 nancy and the postpartum period, 14 such as family practice physicians, 15 cardiologists, pulmonology critical 16 care specialists, endocrinologists, pedi- 17 atricians, and neonatologists. 18 (III) Representatives from State 19 and local public health departments, 20 including State Medicaid Agencies. 21 (IV) Subject matter experts in 22 conducting outreach to women who 23 are African American or belong to an- 24 other minority group. 25 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 10 •S 408 IS (V) Directors of State agencies 1 responsible for administering a State’s 2 maternal and child health services 3 program under title V of the Social 4 Security Act (42 U.S.C. 701 et seq.). 5 (VI) Experts in medical edu- 6 cation or physician training. 7 (VII) Representatives from med- 8 icaid managed care organizations. 9 (4) APPLICABILITY OF FACA.—The Federal Ad- 10 visory Committee Act (5 U.S.C. App.) shall apply to 11 the committee established under this subsection. 12 (d) CONTENTS.—The guidance described in sub- 13 section (a) shall include, with respect to hospitals, free- 14 standing birth centers, and other maternal care providers, 15 the following: 16 (1) Best practices regarding evidence-based 17 screening and clinician education initiatives relating 18 to screening and treatment protocols for individuals 19 who are at risk of experiencing complications related 20 to pregnancy, with an emphasis on individuals with 21 preconditions directly linked to pregnancy complica- 22 tions and maternal mortality and severe morbidity, 23 including— 24 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 11 •S 408 IS (A) methods to identify individuals who are 1 at risk of maternal mortality or severe mor- 2 bidity, including risk stratification; 3 (B) evidence-based risk factors associated 4 with maternal mortality or severe morbidity and 5 racial, ethnic, and geographic health disparities; 6 (C) evidence-based strategies to reduce risk 7 factors associated with maternal mortality or 8 severe morbidity through services which may be 9 covered under Medicaid or CHIP, including, 10 but not limited to, activities by community 11 health workers (as such term is defined in sec- 12 tion 2113(f)(4) of the Social Security Act (42 13 U.S.C. 1397mm(f)(4))) that are funded by a 14 grant awarded under such section; 15 (D) resources available to such individuals, 16 such as nutrition assistance and education, 17 home visitation, mental health and substance 18 use disorder services, smoking cessation pro- 19 grams, prenatal care, and other evidence-based 20 maternal mortality or severe morbidity reduc- 21 tion programs; 22 (E) examples of educational materials used 23 by providers of obstetrics services; 24 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 12 •S 408 IS (F) methods for improving community cen- 1 tralized care, including providing telehealth 2 services or home visits to increase and facilitate 3 access to and engagement in prenatal and 4 postpartum care and collaboration with home 5 health agencies, community health centers, local 6 public health departments, or clinics; 7 (G) guidance on medical record diagnosis 8 codes linked to maternal mortality and severe 9 morbidity, including, if applicable, codes related 10 to social risk factors, and methods for edu- 11 cating clinicians on the proper use of such 12 codes; 13 (H) risk appropriate transfer protocols 14 during pregnancy, childbirth, and the postpar- 15 tum period; and 16 (I) any other information related to pre- 17 vention and treatment of at-risk individuals de- 18 termined appropriate by the Secretary. 19 (2) Guidance on monitoring programs for indi- 20 viduals who have been identified as at risk of com- 21 plications related to pregnancy. 22 (3) Best practices for such hospitals, free- 23 standing birth centers, and providers to make preg- 24 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 13 •S 408 IS nant women aware of the complications related to 1 pregnancy. 2 (4) A fact sheet for providing pregnant women 3 who are receiving care on an outpatient basis with 4 a notice during the prenatal stage of pregnancy 5 that— 6 (A) explains the risks associated with preg- 7 nancy, birth, and the postpartum period (in- 8 cluding the risks of hemorrhage, preterm birth, 9 sepsis, eclampsia, obstructed labor), chronic 10 conditions (including high blood pressure, dia- 11 betes, heart disease, depression, and obesity) 12 correlated with adverse pregnancy outcomes, 13 risks associated with advanced maternal age, 14 and the importance of adhering to a personal- 15 ized plan of care; 16 (B) highlights multimodal and evidence- 17 based prevention and treatment techniques; 18 (C) provides for a method (through signa- 19 ture or otherwise) for such an individual, or a 20 person acting on such individual’s behalf, to ac- 21 knowledge receipt of such fact sheet; 22 (D) is worded in an easily understandable 23 manner and made available in multiple lan- 24 VerDate Sep 11 2014 00:01 Mar 21, 2021 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S408.IS S408 kjohnson on DSK79L0C42PROD with BILLS 14 •S 408 IS guages and accessible formats determined ap- 1 propriate by the Secretary; and 2 (E) includes any other information deter- 3 mined appropriate by the Secretary. 4 (5) A template for a voluntary clinician check- 5 list that outlines [Text truncated for display. Full text available on Congress.gov.]