Supporting Best Practices for Healthy Moms Act

I 116TH CONGRESS 2D SESSION H. R. 8958 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 HOUSE OF REPRESENTATIVES DECEMBER 14, 2020 Ms. KELLY of Illinois (for herself, Ms. FUDGE, Mr. KELLY of Pennsylvania, and Mr. LATTA) introduced the following bill; which was referred to the Committee on Energy and Commerce 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 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8958 IH 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 of Health and 8 Human Services (referred to in this section as the ‘‘Sec- 9 retary’’) shall publish on a public website of the Centers 10 for Medicare & Medicaid Services guidance for States on 11 resources and strategies for hospitals, freestanding birth 12 centers (as defined in section 1905(l)(3)(B) of the Social 13 Security Act (42 U.S.C. 1396d(l)(3)(B))), and other ma- 14 ternal care providers as determined by the Secretary for 15 reducing maternal mortality and severe morbidity in indi- 16 viduals who are eligible for and receiving medical assist- 17 ance under the Medicaid program under title XIX of such 18 Act (42 U.S.C. 1396 et seq.) or child health assistance 19 under the Children’s Health Insurance Program under 20 title XXI of such Act (42 U.S.C. 1397aa et seq.). 21 (b) UPDATES.—The Secretary shall update the guid- 22 ance and resources described in subsection (a) at least 23 once every 3 years. 24 (c) CONSULTATION WITH ADVISORY COMMITTEE.— 25 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8958 IH (1) ESTABLISHMENT.—Subject to the avail- 1 ability of appropriations, not later than 18 months 2 after the date of enactment of this Act, the Sec- 3 retary shall establish an advisory committee to be 4 known as the ‘‘National Advisory Committee on Re- 5 ducing Maternal Deaths’’ (referred to in this section 6 as the ‘‘Advisory Committee’’). 7 (2) DUTIES.—The Advisory Committee shall 8 provide consensus advice and guidance to the Sec- 9 retary on the development and compilation of the 10 guidance described in subsection (a) (and any up- 11 dates to such guidance). 12 (3) MEMBERSHIP.— 13 (A) IN GENERAL.—The Secretary, in con- 14 sultation with such other heads of agencies, as 15 the Secretary deems appropriate and in accord- 16 ance with this paragraph, shall appoint not 17 more than 41 members to the Advisory Com- 18 mittee. In appointing such members, the Sec- 19 retary shall ensure that— 20 (i) the total number of members of 21 the Advisory Committee is an odd number; 22 and 23 (ii) the total number of voting mem- 24 bers who are not Federal officials does not 25 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8958 IH exceed the total number of voting Federal 1 members who are Federal officials. 2 (B) REQUIRED MEMBERS.— 3 (i) FEDERAL OFFICIALS.—The Advi- 4 sory Committee shall include as voting 5 members the following Federal officials, or 6 their designees: 7 (I) The Secretary of Health and 8 Human Services. 9 (II) The Administrator of the 10 Centers for Medicare & Medicaid 11 Services. 12 (III) The Director of the Centers 13 for Disease Control and Prevention. 14 (IV) The Associate Administrator 15 of the Maternal and Child Health Bu- 16 reau of the Health Resources and 17 Services Administration. 18 (V) The Director of the Agency 19 for Healthcare Research and Quality. 20 (VI) The National Coordinator 21 for Health Information Technology. 22 (VII) The Director of the Na- 23 tional Institutes of Health. 24 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8958 IH (VIII) The Secretary of Veterans 1 Affairs. 2 (IX) The Director of the Indian 3 Health Service. 4 (X) The Deputy Assistant Sec- 5 retary for Minority Health. 6 (XI) The Administrator of the 7 Substance Abuse and Mental Health 8 Services Administration. 9 (XII) The Deputy Assistant Sec- 10 retary for Women’s Health. 11 (XIII) Such other Federal offi- 12 cials or their designees as the Sec- 13 retary determines appropriate. 14 (ii) NON-FEDERAL OFFICIALS.— 15 (I) IN GENERAL.—The Advisory 16 Committee shall include the following 17 as voting members: 18 (aa) At least 1 representa- 19 tive from a professional organiza- 20 tion representing hospitals and 21 health systems. 22 (bb) At least 1 representa- 23 tive from a medical professional 24 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8958 IH organization representing pri- 1 mary care providers. 2 (cc) At least 1 representa- 3 tive from a medical professional 4 organization representing general 5 obstetrician-gynecologists. 6 (dd) At least 1 representa- 7 tive from a medical professional 8 organization representing cer- 9 tified nurse-midwives. 10 (ee) At least 1 representa- 11 tive from a medical professional 12 organization representing other 13 maternal fetal medicine pro- 14 viders. 15 (ff) At least 1 representative 16 from a medical professional orga- 17 nization representing anesthesiol- 18 ogists. 19 (gg) At least 1 representa- 20 tive from a medical professional 21 organization representing emer- 22 gency medicine physicians and 23 urgent care providers. 24 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8958 IH (hh) At least 1 representa- 1 tive from a medical professional 2 organization representing nurses. 3 (ii) At least 1 representative 4 from a professional organization 5 representing community health 6 workers. 7 (jj) At least 1 representative 8 from a professional organization 9 representing doulas. 10 (kk) At least 1 representa- 11 tive from State-affiliated pro- 12 grams or existing collaboratives 13 with demonstrated expertise or 14 success in improving maternal 15 health. 16 (ll) At least 1 director of a 17 State Medicaid agency that has 18 had demonstrated success in im- 19 proving maternal health. 20 (mm) At least 1 representa- 21 tive from an accrediting organi- 22 zation for maternal health quality 23 and safety standards. 24 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8958 IH (nn) At least 1 representa- 1 tive from a maternal patient ad- 2 vocacy organization with lived ex- 3 perience of severe maternal mor- 4 bidity. 5 (II) REQUIREMENTS.—Each in- 6 dividual selected to be a member 7 under this clause shall— 8 (aa) have expertise in mater- 9 nal health; 10 (bb) not be a Federal offi- 11 cial; and 12 (cc) have experience working 13 with populations that are at 14 higher risk for maternal mor- 15 tality or severe morbidity, such 16 as populations that experience 17 racial, ethnic, and geographic 18 health disparities, pregnant and 19 postpartum women experiencing 20 mental health disorders or other 21 comorbidities such as substance 22 use disorders, hypertension, thy- 23 roid disorders, and sickle cell dis- 24 ease. 25 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8958 IH (C) ADDITIONAL MEMBERS.— 1 (i) IN GENERAL.—In addition to the 2 members required to be appointed under 3 subparagraph (B), the Secretary may ap- 4 point as members to the Advisory Com- 5 mittee such other individuals with relevant 6 expertise or experience as the Secretary 7 shall determine appropriate, which may in- 8 clude individuals described in clause (ii). 9 (ii) SUGGESTED ADDITIONAL MEM- 10 BERS.—The individuals described in this 11 clause are the following: 12 (I) Representatives from State 13 maternal mortality review committees 14 and perinatal quality collaboratives. 15 (II) Medical providers who care 16 for women and infants during preg- 17 nancy and the postpartum period, 18 such as family practice physicians, 19 cardiologists, pulmonology critical 20 care specialists, endocrinologists, pedi- 21 atricians, and neonatologists. 22 (III) Representatives from State 23 and local public health departments. 24 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 8958 IH (IV) Subject matter experts in 1 conducting outreach to women who 2 are African American or belong to an- 3 other minority group. 4 (V) Directors of State agencies 5 responsible for administering a State’s 6 maternal and child health services 7 program under title V of the Social 8 Security Act (42 U.S.C. 701 et seq.). 9 (VI) Experts in medical edu- 10 cation or physician training. 11 (VII) Representatives from Med- 12 icaid managed care organizations. 13 (4) APPLICABILITY OF FACA.—The Federal Ad- 14 visory Committee Act (5 U.S.C. App.) shall apply to 15 the committee established under this subsection. 16 (d) CONTENTS.—The guidance described in sub- 17 section (a) shall include, with respect to hospitals, free- 18 standing birth centers, and other maternal care providers, 19 the following: 20 (1) Best practices regarding evidence-based 21 screening and clinician education initiatives relating 22 to screening and treatment protocols for individuals 23 who are at risk of experiencing complications related 24 to pregnancy, with an emphasis on individuals with 25 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 8958 IH preconditions directly linked to pregnancy complica- 1 tions and maternal mortality and severe morbidity, 2 including— 3 (A) methods to identify individuals who are 4 at risk of maternal mortality or severe mor- 5 bidity, including risk stratification; 6 (B) evidence-based risk factors associated 7 with maternal mortality or severe morbidity and 8 racial, ethnic, and geographic health disparities; 9 (C) evidence-based strategies to reduce risk 10 factors associated with maternal mortality or 11 severe morbidity through services which may be 12 covered under the Medicaid program under title 13 XIX of the Social Security Act (42 U.S.C. 1396 14 et seq.) or the Children’s Health Insurance Pro- 15 gram under title XXI of such Act (42 U.S.C. 16 1397aa et seq.), including activities by commu- 17 nity health workers (as such term is defined in 18 section 2113 of such Act (42 U.S.C. 1397mm)) 19 that are funded by a grant awarded under such 20 section; 21 (D) resources available to such individuals, 22 such as nutrition assistance and education, 23 home visitation, mental health and substance 24 use disorder services, smoking cessation pro- 25 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 8958 IH grams, pre-natal care, and other evidence-based 1 maternal mortality or severe morbidity reduc- 2 tion programs; 3 (E) examples of educational materials used 4 by providers of obstetrics services; 5 (F) methods for improving community cen- 6 tralized care, including providing telehealth 7 services or home visits to increase and facilitate 8 access to and engagement in prenatal and 9 postpartum care and collaboration with home 10 health agencies, community health centers, local 11 public health departments, or clinics; 12 (G) guidance on medical record diagnosis 13 codes linked to maternal mortality and severe 14 morbidity, including, if applicable, codes related 15 to social risk factors, and methods for edu- 16 cating clinicians on the proper use of such 17 codes; 18 (H) risk appropriate transfer protocols 19 during pregnancy, childbirth, and the 20 postpartum period; and 21 (I) any other information related to pre- 22 vention and treatment of at-risk individuals de- 23 termined appropriate by the Secretary. 24 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 13 •HR 8958 IH (2) Guidance on monitoring programs for indi- 1 viduals who have been identified as at risk of com- 2 plications related to pregnancy. 3 (3) Best practices for such hospitals, free- 4 standing birth centers, and providers to make preg- 5 nant women aware of the complications related to 6 pregnancy. 7 (4) A fact sheet for providing pregnant women 8 who are receiving care on an outpatient basis with 9 a notice during the prenatal stage of pregnancy 10 that— 11 (A) explains the risks associated with preg- 12 nancy, birth, and the postpartum period (in- 13 cluding the risks of hemorrhage, preterm birth, 14 sepsis, eclampsia, obstructed labor), chronic 15 conditions (including high blood pressure, dia- 16 betes, heart disease, depression, and obesity) 17 correlated with adverse pregnancy outcomes, 18 risks associated with advanced maternal age, 19 and the importance of adhering to a personal- 20 ized plan of care; 21 (B) highlights multimodal and evidence- 22 based prevention and treatment techniques; 23 (C) provides for a method (through signa- 24 ture or otherwise) for such an individual, or a 25 VerDate Sep 11 2014 00:26 Dec 28, 2020 Jkt 019200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H8958.IH H8958 pbinns on DSKJLVW7X2PROD with BILLS 14 •HR 8958 IH person acting on such individual’s behalf, to ac- 1 knowledge receipt [Text truncated for display. 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