Sec. 4. Medicaid quality improvement initiatives to reduce rates of cesarean sections; Medicare requirement for hospitals to report on data on cesarean births
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/bill/118/hr/4605/ih/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, 2025, and annually thereafter through January 1, 2035, 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, 2025, 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 payment rates for cesarean births and vaginal births under State Medicaid programs. To the extent feasible and data are available, the study shall include analyses of the following: Payment rates for cesarean births and vaginal births paid by fee-for-service Medicaid programs and by Medicaid programs that contract with Medicaid managed care organizations to furnish medical assistance under such programs. What is known about how Medicaid payment rates have changed over time. What is known about how payment rates for cesarean and vaginal births by Medicaid programs compare with the payment rates for such births by other sources of insurance coverage. Such other factors related to payment rates for cesarean 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 cesarean births. To the extent feasible and data are available, the study shall compare such information on low- and high-risk cesarean births, differences by payer (such as Medicaid and private payers), and hospital characteristics (such as location or hospital type). 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. Section 1866(a)(1) of the Social Security Act ( 42 U.S.C. 1395cc(a)(1) ) is amended— by moving the indentation of subparagraph
(W)2 ems to the left; in subparagraph (X)— by moving the indentation 2 ems to the left; and by striking and at the end; in subparagraph (Y), by striking the period at the end and inserting ; and ; and by inserting after subparagraph
(Y)the following new subparagraph: in the case of a hospital, to submit, in a form and manner, and at a time, specified by the Secretary, data on the Nulliparous, Term, Singleton, Vertex Cesarean section (NTSV C-section) rate with respect to the hospital for the preceding year. . Section 1886(b)(3)(B)(viii) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3)(B)(viii) ) is amended by adding at the end the following new subclause: Effective for payments beginning with fiscal year 2025, in expanding the number of measures under subclause (III), the Secretary shall adopt a measure relating to the Nulliparous, Term, Singleton, Vertex Cesarean section (NTSV C-section) rate for hospitals in inpatient settings. Not later than 2025, the Secretary shall incorporate such measure into the designation of maternity care quality hospitals, as described in the final rule entitled Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-Qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation (87 Fed. Reg. 48780 (August 10, 2022)). .
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- 87 FR 48780
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Sec. 4
Medicaid quality improvement initiatives to reduce rates of cesarean sections; Medicare requirement for hospitals to report on data on cesarean births
Fed. Reg.87 FR 48780
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