Sec. 4. Medicaid quality improvement initiatives to reduce rates of caesarean sections
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/bill/117/s/5015/is/section-4·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended— in paragraph (86), by striking and after the semicolon; in paragraph (87), by striking the period at the end and inserting ; and ; and by inserting after paragraph
(87)the following: provide that, not later than January 1, 2024, and annually thereafter through January 1, 2034, the State shall submit a report to the Secretary, that shall be made publicly available, which contains with respect to the preceding calendar year— the rate of low-risk cesarean delivery, as defined by the Secretary in consultation with relevant stakeholders, for pregnant women eligible for medical assistance under the State plan or a waiver of such plan in the State, as compared to the overall rate of cesarean delivery in the State; a description of the State’s quality improvement activities to safely reduce the rate of low-risk cesarean delivery (as so defined) for pregnant women eligible for medical assistance under the State plan or a waiver of such plan in the State reported under subparagraph (A), including initiatives aimed at reducing racial and ethnic health disparities, hospital-level quality improvement initiatives, taking into account hospital type and the patient population served, and, if applicable, partnerships with State or regional perinatal quality collaboratives; for each report submitted after January 1, 2024, the percentage change (if any) in the rate of low-risk cesarean delivery (as so defined) for pregnant women eligible for medical assistance under the State plan or a waiver of such plan in the State reported under subparagraph
(A)from the rate reported for the most recent previous report; and such other relevant data and information as determined by the Secretary, and in consultation with relevant stakeholders, such as State initiatives and evaluations of quality improvement activities, cesarean delivery rates, and health outcomes. . The Comptroller General shall conduct a study regarding caesarean births under State Medicaid programs. The study shall include analyses of the following: Changes in Medicaid payment rates for caesarean births and vaginal births over time, disaggregated by rates paid by fee-for-service Medicaid programs and by Medicaid programs that contract with medicaid managed care organizations and other specified entities to furnish medical assistance under such programs. The frequency of primary and repeat caesarean births, as well as vaginal births after a caesarean, under Medicaid programs and a comparison of such frequency with the frequency of such births when paid for under a group health plan or by a health insurance issuer offering group or individual health insurance coverage. To the extent feasible, this information should be disaggregated according to race and ethnicity. Comparisons of payment rates for caesarean and vaginal births under Medicaid programs with the payment rates for such births under a group health plan or by a health insurance issuer offering group or individual health insurance coverage. Such other factors related to payment rates for caesarean and vaginal births under Medicaid as the Comptroller General determines appropriate. Not later than 18 months after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate. The Comptroller General shall conduct a study on racial disparities in the frequency of low- and high-risk caesarean births across hospitals of different settings (rural, urban, and suburban), volumes, and types (such as teaching, private, public, and not-for-profit) in a selection of 10 States. The study shall compare such information with respect to Medicaid and private payers and compare total charges, if feasible. The study shall also investigate, to the extent practicable, the day of the week and time of day that such births occur at a subset of hospitals in the selected States. Such study may consider other factors related to racial disparities in maternal health as the Comptroller General deems appropriate. Not later than 2 years after the date of enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.
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Sec. 4
Medicaid quality improvement initiatives to reduce rates of caesarean sections
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