49–010 

Calendar No. 179 

114TH CONGRESS REPORT " ! SENATE 1st Session 114–100 

QUALITY CARE FOR MOMS AND BABIES ACT 

JULY 30, 2015.—Ordered to be printed 

Mr. HATCH, from the Committee on Finance, 

submitted the following 

R E P O R T 

[To accompany S. 466] 

The Committee on Finance, to which was referred the bill (S. 

466) 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, 

having considered the same, reports favorably thereon with an 

amendment and recommends that the bill, as amended, do pass. 

I. LEGISLATIVE BACKGROUND 

The Committee on Finance, to which was referred the bill (S. 

466), 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, 

having considered the same, reports favorably thereon with an 

amendment and recommends the bill, as amended, do pass. 

Background and need for legislative action 

Obtaining appropriate pre- and post-natal care for mothers and 

infants can improve health outcomes and reduce the risks of adverse events and long-term disabilities. The Committee recognizes 

that adding maternity and infant quality measures to existing 

quality measures and encouraging maternity and infant quality 

collaboratives that would develop and carry out plans for evaluating maternity and infant care quality improvement programs will 


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1 42 U.S.C. § 1320b–9a. 

2 42 U.S.C. § 1320b–9b. 

help facilitate improvements in the quality of care and reduce adverse health outcomes. In addition, innovations in payment methodologies are now rewarding the provision of quality care, and are 

instrumental in providing incentives that improve quality of care 

but require reliable measures in order to be implemented. 

II. EXPLANATION OF THE BILL 

PRESENT LAW

Under the Social Security Act (SSA) section 1139A,1 the Secretary was required to identify and publish an initial core set of pediatric quality measures by no later than January 1, 2010. The 

Secretary, not later than January 1, 2011 and every three years 

thereafter, is also required to submit a report to Congress on, for 

example, the quality of children’s health care under Medicaid and 

CHIP. A Pediatric Quality Measures Program (PQMP) was required to be established by January 1, 2011; this program is required to identify pediatric measure gaps and development priorities, award grants and contracts to develop measures, and revise 

and strengthen the core measure set, among other things. States 

are required to submit reports to the Secretary annually to include, 

for example, information about state-specific child health quality 

measures applied by the state. The Secretary is required to collect, 

analyze, and make publicly available the information reported by 

states, by not later than September 30, 2010, and annually thereafter. The Secretary was required, between FY 2009 and FY 2013, 

to award no more than 10 grants to states for demonstration 

projects to evaluate ideas to improve the quality of children’s 

health care; in addition, the Secretary, not later than January 1, 

2010, was required to establish a program to encourage the development and dissemination of a model electronic health record for 

children. The Institute of Medicine (IOM) was required to develop 

a report on measurement of child health status and quality by no 

later than July 1, 2010. Funding for these activities was appropriated in the amount of $45 million for each of FY 2009 through 

FY 2013. 

SSA section 1139B 2 required the Secretary to publish a core set 

of Medicaid adult health quality measures by January 1, 2012. 

Also, no later than January 1, 2013, the Secretary was required to 

develop a standardized format for reporting information based on 

this initial core measurement set. The Secretary is required to submit a report to Congress by January 1, 2014, and every three years 

thereafter, that describes the Secretary’s efforts to improve, for example, the quality of care of different services for adults under 

Medicaid. Within one year after the release of the recommended 

core set of adult health quality measures, the Secretary is required 

to establish a Medicaid Quality Measurement Program (MQMP). 

To this end, the Secretary is required to award grants and contracts for developing, testing, and validating emerging and innovative evidence-based measures applicable to Medicaid adults. Not 

later than two years after the establishment of the MQMP, and annually thereafter, the Secretary is required to publish recVerDate Sep 11 2014 02:00 Aug 04, 2015 Jkt 049010 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\SR100.XXX SR100

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3Pub. L. No. 113–93. 

4Pub. L. No. 114–10. 

ommended changes to the initial core set of adult health quality 

measures based on the results of testing, validation, and the consensus process for development of these measures. States are required to submit reports to the Secretary annually to include, for 

example, information about state-specific adult health quality 

measures applied by the state. The Secretary is required to collect, 

analyze, and make publicly available the information reported by 

states, before September 30, 2014, and annually thereafter. Funding for these activities was appropriated in the amount of $60 million for each of FY 2010 through FY 2014. 

Section 210 of the Protecting Access to Medicare Act (PAMA) 3, extended funding only for the PQMP for FY 2014 by requiring that 

$15 million of the $60 million appropriated under SSA section 

1139B(e) for FY 2014 be used to carry out section 1139A(b). The 

appropriation in section 1139A(i) for funding to carry out section 

1139A (except for 1139A(e), the childhood obesity demonstration 

project) expired in FY 2013; the funding designated to carry out 

section 1139A(b) expired in FY 2014. Similarly, funding for carrying out section 1139B expired in FY 2014. 

The Medicare Access and CHIP Reauthorization Act of 2015 

(MACRA) 4, appropriated $20 million for the period of FY 2016 and 

FY 2017 for the purposes of carrying out section 1139A. This funding is specifically excluded from being used to carry out the activities under section 1139A(e) (the childhood obesity demonstration 

project); section 1139A(f) (the development of a model electronic 

health record for children); and section 1139A(g) (the IOM study of 

pediatric health quality). 

EXPLANATION OF PROVISION

S. 466, as modified, would add a new SSA section 1139C, ‘‘Maternal and Infant Quality Measures.’’ Under new section 1139C(a), the 

Secretary would be required to identify and publish a core set of 

maternal and infant health quality measures for women and children, as specified, and would be required to do so in the same manner as the Secretary identified a pediatric core set of measures 

under section 1139A(a) and in consultation with specified stakeholders (e.g., states, physicians, and health facilities). In so doing, 

the Secretary would be required to ensure that, to the extent possible, the measures align with and do not duplicate the pediatric 

or Medicaid adult core quality measure sets under sections 1139A 

and 1139B. 

Under new section 1139C(b), which specifies deadlines for activities under the section, the Secretary would be required to publish 

for comment a recommended core measure set by no later than 

January 1, 2018, and an initial core measure set by no later than 

January 1, 2019. The measures would be required to include the 

following, among others: (1) measures that address disparities; (2) 

measures that apply to a variety of care settings and provider 

types; and (3) measures of process, outcome, experience and efficiency of care. The Secretary would also be required, not later than 

January 1, 2020, to develop a standardized reporting format for the 

maternal and infant health quality measures, and would be reVerDate Sep 11 2014 02:00 Aug 04, 2015 Jkt 049010 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\SR100.XXX SR100

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quired to, not later than January 1, 2021 and every 3 years thereafter, include in the report to Congress under section 1139A(a)(6) 

information about the maternal and infant quality measures. The 

report under section 1139A(a)(6) is required to include information 

about efforts to improve the quality of care for Medicaid and CHIP 

eligible women and children; reporting of the core measures; and 

recommended legislative changes to improve reporting and quality 

of care under these programs. 

Finally, new section 1139C(b) would require the Secretary, not 

later than 12 months after enactment, to establish a Maternal and 

Infant Quality Measurement Program, in the same manner as the 

Secretary was required to establish a Pediatric Quality Measures 

Program under section 1139A(b). The Secretary would be required 

to publish recommended changes to strengthen and improve the 

initial core measure set, not later than 24 months after establishment of the Maternal and Infant Quality Measurement Program 

and annually thereafter, and any entity awarded a grant under the 

Maternal and Infant Quality Measurement Program would be required to advance eMeasures that are aligned with the core measures under sections 1139A and 1139B. Amounts awarded as grants 

under the Maternal and Infant Quality Measurement Program 

would not be allowed to exceed the amount awarded as grants 

under the Pediatric Quality Measures Program under section 

1139A(b). New section 1139C(c) would clarify that nothing in this 

section would be allowed to be construed as supporting the restriction of coverage, under Medicaid or CHIP or otherwise, to only evidence based services, or in any way limiting available services. 

In addition, under new section 1139C(d), the Agency for 

Healthcare Research and Quality (AHRQ) would be required to 

adapt the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, as specified, for the purpose of measuring 

the care experiences of childbearing women and newborns. The survey would be required to be effective across various settings and 

caregivers, among other things, and would be required to be submitted to the National Quality Forum (NQF) for consideration for 

endorsement; adaptation of the survey would be required to be carried out in consultation with stakeholders, as specified, including 

professional organizations. New section 1139C(e) would require 

States to annually report on state-specific maternal and infant 

quality measures and state-specific information on the quality of 

health care provided to Medicaid and CHIP eligible mothers and 

infants, as specified. The Secretary would be required, not later 

than September 30, 2021, and annually thereafter, to make the 

state-reported information publicly available. 

New section 1139C(f) would authorize to be appropriated $16 

million to carry out the activities under this section. Funds would 

be required to remain available until expended. 

The bill would also authorize the Secretary to award grants to 

eligible entities to support the development of maternity and infant 

care quality collaboratives or to expand activities of existing 

collaboratives. An eligible entity would include quality collaboratives, entities seeking to establish a maternity and infant care collaborative, state Medicaid agencies and departments of health, 

health insurance issuers, and provider organizations. Quality 

collaboratives receiving funding under this section would be reVerDate Sep 11 2014 02:00 Aug 04, 2015 Jkt 049010 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\SR100.XXX SR100

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quired to develop and carry out plans for evaluating its maternity 

and infant care quality improvement programs and projects and to 

publish these results, as specified, and would be required to engage 

in regular ongoing consultation, as specified. Quality collaboratives 

would be required to submit a report to the Secretary annually, as 

specified, and would be required to be governed by a multi-stakeholder executive committee, as specified, including, for example, 

physicians, nurses, nurse-midwives, consumers, Medicaid programs, and employers. 

Projects and programs that may be supported by funding under 

this section would include those that have as their goal the improvement of the quality of maternity and infant care (e.g., improving the appropriate use of cesarean sections); in addition, they 

would be required to meet criteria for use of measures, as specified 

(e.g., include a plan to identify and resolve data collection problems). Any reporting requirements established by such programs or 

projects would be required to minimize cost and use existing data 

resources where feasible. Activities that may be supported by funding under this section would include, for example, facilitating performance data collection and feedback reports to providers and developing the capability to access data sources, as specified (e.g., a 

mother’s medical records, an infant’s medical records, and birth 

and death certificates). This section would also require the Secretary to establish an online clearinghouse to make available resources that may improve the quality of maternity and infant care 

available across the collaboratives and individuals working in this 

area. 

The bill would also amend section 1890(b) of the Social Security 

Act by directing the entity referred to in such section to facilitate 

increased coordination and alignment between the public and private sector with respect to quality and efficiency measures. The bill 

would also require such entity to make publicly available annual 

reports on its findings, which would be included in the annual report. These provisions would be effective upon enactment. 

This section would authorize the appropriation of $15 million to 

carry out the activities under this section; funds would be required 

to remain available until expended. 

EFFECTIVE DATE

The provision is effective upon enactment. 

III. BUDGET EFFECTS OF THE BILL 

A. COMMITTEE ESTIMATES

In compliance with paragraph 11(a) of rule XXVI of the Standing 

Rules of the Senate, the following statement is made concerning 

the estimated budget effects of the revenue provisions of the of the 

‘‘Quality Care for Moms and Babies Act’’ as reported. 

The bill is estimated to have the following effects on Federal 

budget receipts for fiscal years 2016–2025: 


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5Pub. L. No. 93–344. 

By fiscal year, in millions of dollars— 

2016 2017 2018 2019 2020 2016– 

2020 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Maternal and Infant Health Quality Measures: 

Authorization Level ........................................................................ 16 0 0 0 0 16 

Estimated Outlays ......................................................................... 3 4 4 3 2 16 

Grants for Quality Collaboratives: 

Authorization Level ........................................................................ 15 0 0 0 0 15 

Estimated Outlays ......................................................................... 3 8 4 0 0 15 

Total Changes: 

Authorization Level ............................................................... 31 0 0 0 0 31 

Estimated Outlays ................................................................ 6 12 8 3 2 31 

Source: Estimate provided by the staff of the Congressional Budget Office. 

Summary 

S. 466 would authorize the appropriation of $31 million for the 

Department of Health and Human Services (HHS) to identify and 

publish quality measures for maternal and infant health and to 

award grants to develop or expand collaborative activities related 

to maternity and infant care quality. Implementing S. 466 would 

cost $31 million over the 2016–2020 period, assuming appropriation of the specified amounts. For this estimate, CBO assumes that 

the legislation will be enacted near the beginning of fiscal year 

2016 and that the amounts specified will be appropriate in that 

year. Enacting S. 466 would not affect direct spending or revenues; 

therefore, pay-as-you-go procedures do not apply. The bill would 

not impose intergovernmental or private sector mandates as defined in the Unfunded Mandates Reform Act and would impose no 

costs on state, local, or tribal governments. The annual estimated 

budgetary impact of S. 466 is shown in the following table. 

B. BUDGET AUTHORITY

Budget authority 

In compliance with section 308(a)(1) of the Congressional Budget 

and Impoundment Control Act of 1974 (‘‘Budget Act’’), 5 the Committee states that the bill as reported involves increased budget authority (see table in Part A, above). 

Tax expenditures 

In compliance with section 308(a)(1) of the Budget Act, the Committee states that the bill does not involve increased tax expenditures. 

C. CONSULTATION WITH CONGRESSIONAL BUDGET OFFICE

In accordance with section 403 of the Budget Act, the Committee 

advises that the Congressional Budget Office has submitted a 

statement on the bill. 

S. 466—Quality Care for Moms and Babies Act 

Summary: S. 466 would authorize the appropriation of $31 million for the Department of Health and Human Services (HHS) to 

identify and publish quality measures for maternal and infant 


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health and to award grants to develop or expand collaborative activities related to maternity and infant care quality. CBO estimates 

that implementing S. 466 would cost $31 million over the 2016– 

2020 period, assuming appropriation of the specified amounts. Enacting S. 466 would not affect direct spending or revenues; therefore, pay-as-you-go procedures do not apply. 

S. 466 contains no intergovernmental or private-sector mandates 

as defined in the Unfunded Mandates Reform Act (UMRA). 

Estimated cost to the Federal Government: The estimated budgetary impact of S. 466 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 

By fiscal year, in millions of dollars— 

2016 2017 2018 2019 2020 2016–2020 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Maternal and Infant Health Quality Measures: 

Authorization Level .................................................................... 16 0 0 0 0 16 

Estimated Outlays ..................................................................... 3 4 4 3 2 16 

Grants for Quality Collaboratives: 

Authorization Level .................................................................... 15 0 0 0 0 15 

Estimated Outlays ..................................................................... 3 8 4 0 0 15 

Total Changes: 

Authorization Level ........................................................... 31 0 0 0 0 31 

Estimated Outlays ............................................................ 6 12 8 3 2 31 

Basis of estimate: For this estimate, CBO assumes that the legislation will be enacted near the beginning of fiscal year 2016 and 

that the amounts specified will be appropriated in that year. S. 466 would authorize the appropriation of $16 million for the 

Secretary of HHS to identify and publish quality measures for maternal and infant health. The legislation would require HHS to: • Make initial measures available for public comment no 

later than January 2018; • Publish final measures applicable to mothers and infants 

eligible for Medicaid or the Children’s Health Insurance Program by January 2019; and • Establish a Maternal and Infant Quality Measurement 

Program to improve and expand those measures, including providing grants to develop and test evidence-based measures. 

Based on historical spending for similar programs—the Child 

Health Quality Measures established by the Children’s Health Insurance Program Reauthorization Act of 2009 and the Adult Health 

Quality Measures established by the Patient Protection and Affordable Care Act—CBO estimates that implementing similar measures for mothers and infants would cost $16 million over the 2016– 

2020 period. 

The bill also would authorize the appropriation of $15 million for 

HHS to award grants to develop and expand quality collaboratives 

for maternity and infant care. A quality collaborative is a group of 

people or organizations—for example, universities, state and local 

agencies, health systems, and professional associations—working 

together to improve health care. Funding also would be used to 

make reports, tools, and other resources of individual collaboratives 

available to others. Based on historical spending by similar programs, CBO estimates that implementing these grants would cost 

$15 million over the 2016–2018 period. 

Pay-As-You-Go considerations: None. 


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Intergovernmental and private-sector impact: S. 466 contains no 

intergovernmental or private-sector mandates as defined in UMRA 

and would impose no costs on state, local, or tribal governments. 

Estimate prepared by: Federal Costs: Daniel Hoople; Impact on 

State, Local, and Tribal Governments: J’nell Blanco Suchy; Impact 

on the Private Sector: Amy Petz. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 

IV. VOTES OF THE COMMITTEE 

In compliance with paragraph 7(b) of rule XXVI of the standing 

rules of the Senate, the Committee states that, with a majority 

present, the ‘‘Quality Care for Moms and Babies Act,’’ as modified 

was ordered favorably reported on June 24, 2015 as follows: 

Final Passage of the Quality Care for Moms and Babies Act—approved, as modified, by voice vote. 

V. REGULATORY IMPACT AND OTHER MATTERS 

A. REGULATORY IMPACT

Pursuant to paragraph 11(b) of rule XXVI of the Standing Rules 

of the Senate, the Committee makes the following statement concerning the regulatory impact that might be incurred in carrying 

out the provisions of the bill. 

Impact on individuals and businesses, personal privacy and paperwork 

The bill is not expected to impose additional administrative requirements or regulatory burdens on individuals. The bill is expected to reduce administrative requirements and regulatory burdens on some businesses. 

The provisions of the bill do not impact personal privacy. 

B. UNFUNDED MANDATES STATEMENT

This information is provided in accordance with section 423 of 

the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104–4). 

The Committee has determined that the bill does not contain any 

private sector mandates. The Committee has determined that the 

bill contains no intergovernmental mandate. 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS 

REPORTED 

In the opinion of the Committee, it is necessary in order to expedite the business of the Senate, to dispense with the requirements 

of paragraph 12 of rule XXVI of the Standing Rules of the Senate 

(relating to the showing of changes in existing law made by the bill 

as reported by the Committee). 

Æ 


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