II 

112TH CONGRESS 

1ST SESSION S. 1969 

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 a maternity care quality measurement program, 

evaluating maternity care home models, and supporting maternity care 

quality collaboratives. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 8, 2011 

Ms. STABENOW (for herself and Mr. MENENDEZ) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

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 a maternity care quality measurement program, 

evaluating maternity care home models, and supporting 

maternity care quality collaboratives. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Quality Care for Moms and Babies Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Quality measures for maternity care under Medicaid and CHIP. 

Sec. 3. Quality collaboratives. 

Sec. 4. Woman- and family-centered maternity care home demonstration program. 

3 SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER 

4 MEDICAID AND CHIP. 

5 (a) IN GENERAL.—Title XI of the Social Security Act 

6 is amended by inserting after section 1139B (42 U.S.C. 

7 1320b–9b) the following new section: 

8 ‘‘SEC. 1139C. MATERNITY CARE QUALITY MEASUREMENT. 

9 ‘‘(a) IN GENERAL.—The Secretary shall develop a 

10 maternity care quality measurement program for care pro11 vided to childbearing women and newborns for voluntary 

12 use by— 

13 ‘‘(1) a State in administering a State plan 

14 under title XIX or a State child health plan under 

15 title XXI; 

16 ‘‘(2) health insurance issuers (as such term is 

17 defined in section 2791 of the Public Health Service 

18 Act (42 U.S.C. 300gg–91)) and managed care enti19 ties that enter into contracts with States for the 

20 purpose of administering such plans; and 

21 ‘‘(3) providers of items and services (including 

22 accountable care organizations) with respect to items 

23 and services provided under such plans. 


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1 ‘‘(b) COORDINATION WITH OTHER QUALITY MEAS2 URES.— 

3 ‘‘(1) MEDICAID QUALITY MEASUREMENT PRO4 GRAM.—The maternity care quality measurement 

5 program under subsection (a) shall be developed, ad6 ministered, and evaluated on an ongoing basis as 

7 part of, and in coordination with, the Medicaid 

8 Quality Measurement Program established under 

9 section 1139B(b)(5)(A) and the pediatric quality 

10 measures program established under section 

11 1139A(b). In coordination with the publication re12 quirements under section 1139A(b)(5) and 

13 1139B(b)(5)(B), the Secretary annually shall pub14 lish recommended changes to the core set of mater15 nity care quality measures published under sub16 section (c) that shall reflect the development, test17 ing, validation, and consensus process described in 

18 subsection (d). 

19 ‘‘(2) IDENTIFICATION OF MEASUREMENT

20 GAPS.—The maternity care quality measurement 

21 program under subsection (a) shall include proce22 dures for identifying quality measure gaps and es23 tablishing priorities for the development and ad24 vancement of new or modified quality measures 

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1 gram, the Medicaid Quality Measurement Program 

2 established under section 1139B(b)(5)(A) and the 

3 pediatric quality measures program established 

4 under section 1139A(b). 

5 ‘‘(3) REPORTS TO CONGRESS AND MACPAC.— 

6 Not later than January 1, 2017, and every 3 years 

7 thereafter, the Secretary shall include in the reports 

8 required under sections 1139A(a)(6) and 

9 1139B(b)(4) to Congress and the Medicaid and 

10 CHIP Payment and Access Commission information 

11 similar to the information required under such sec12 tions with respect to the measures established under 

13 this section. 

14 ‘‘(c) IDENTIFICATION OF AN INITIAL SET OF MATER15 NITY CARE QUALITY MEASURES.— 

16 ‘‘(1) CONSULTATION AND PUBLIC COMMENT.— 

17 Not later than January 1, 2014, the Secretary 

18 shall— 

19 ‘‘(A) solicit public comment on a rec20 ommended initial core set of maternity care 

21 quality measures; and 

22 ‘‘(B) consult with stakeholders identified in 

23 subsection (i)(1) regarding such measures. 

24 ‘‘(2) PUBLICATION.—Not later than January 1, 

25 2015, the Secretary shall identify, and publish, from 


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1 maternity care quality measures endorsed under sec2 tion 1890(b)(2), an initial core set of maternity care 

3 quality measures. 

4 ‘‘(3) STANDARDIZED REPORTING.—The Sec5 retary shall develop a standardized format for re6 porting information based on the initial core set of 

7 maternity care quality measure for voluntary use in 

8 data collection and reporting by— 

9 ‘‘(A) a State in administering a State plan 

10 under title XIX or a State Child Health Plan 

11 under title XXI; 

12 ‘‘(B) health insurance issuers and man13 aged care entities that enter into contracts with 

14 States for the purpose of administering such 

15 plans; and 

16 ‘‘(C) providers of items and services (in17 cluding accountable care organizations) with re18 spect to items and services provided under such 

19 plans. 

20 ‘‘(d) DEVELOPMENT OF ADDITIONAL QUALITY

21 MEASURES.— 

22 ‘‘(1) CONTRACTS WITH QUALIFIED ENTITIES.— 

23 Not later than the end of the 6-month period begin24 ning on the date the Secretary publishes the initial 

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1 section (b), the Secretary, acting through the Agen2 cy for Healthcare Research and Quality, in consulta3 tion with the Centers for Medicare & Medicaid Serv4 ices, shall enter into grants, contracts, or intergov5 ernmental agreements with qualified measure devel6 opment entities for the purpose of developing, test7 ing, and validating maternity care quality measures 

8 in areas that are not adequately covered by the 

9 measures so published. 

10 ‘‘(2) QUALIFIED MEASURE DEVELOPMENT EN11 TITY DEFINED.—For purposes of this subsection, 

12 the term ‘qualified measure development entity’ 

13 means an entity that— 

14 ‘‘(A) has demonstrated expertise and ca15 pacity in the development and testing of quality 

16 measures; 

17 ‘‘(B) has adopted procedures for quality 

18 measure development that ensure the inclusion 

19 of— 

20 ‘‘(i) the views of the individuals and 

21 entities referred to in subsection (e)(2)(E) 

22 and whose performance will be assessed by 

23 the measures; and 

24 ‘‘(ii) the views of other individuals 

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1 sumers, and health care purchasers) who 

2 will use the data generated as a result of 

3 the use of the quality measures; 

4 ‘‘(C) for the purpose of ensuring that the 

5 quality measures developed under this sub6 section meet the requirements to be considered 

7 for endorsement under section 1890(b)(2), has 

8 provided assurances to the Secretary that the 

9 measure development entity will collaborate 

10 with— 

11 ‘‘(i) the Secretary; 

12 ‘‘(ii) the consensus-based entity with a 

13 contract under section 1890(a)(1); and 

14 ‘‘(iii) stakeholders (including those 

15 stakeholders identified in subsection 

16 (i)(1)), as practicable; 

17 ‘‘(D) has transparent policies regarding 

18 governance and conflicts of interest; and 

19 ‘‘(E) submits an application to the Sec20 retary at such time, and in such form and man21 ner, as the Secretary may require. 

22 ‘‘(3) eMEASURES.— 

23 ‘‘(A) IN GENERAL.—A qualified measure 

24 development entity with a grant, contract, or 

25 intergovernmental agreement under paragraph 


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1 (1), in developing quality measures, shall con2 sult with the voluntary consensus standards set3 ting organizations and other organizations in4 volved in the advancement of evidence-based 

5 measures of health care as the Secretary 

6 consults with under sections 1139A(b)(3)(H) 

7 and 1139B(b)(5)(A) to create eMeasures that 

8 are aligned with the measures developed under 

9 the Medicaid Quality Measurement Program es10 tablished under section 1139B(b)(5)(A) and the 

11 pediatric quality measures program established 

12 under section 1139A(b). 

13 ‘‘(B) eMEASURE DEFINED.—For purposes 

14 of this section, the term ‘eMeasure’ means a 

15 measure for which measurement data (including 

16 clinical data) will be collected electronically, in17 cluding through the use of electronic health 

18 records and other electronic data sources. 

19 ‘‘(4) ENDORSEMENT.—Any maternity care 

20 quality measures developed under this subsection by 

21 a qualified measure development entity shall be sub22 mitted by the qualified measure development entity 

23 to the consensus-based entity with a contract under 

24 section 1890(a)(1) to be considered for endorsement 

25 under section 1890(b)(2). 


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1 ‘‘(e) TYPES OF MEASURES.— 

2 ‘‘(1) IN GENERAL.—The maternity quality 

3 measures identified under subsection (c) and the 

4 measures developed under subsection (d) shall— 

5 ‘‘(A) be evidence-based; 

6 ‘‘(B) utilize risk adjustment or risk strati7 fication methodologies, if appropriate; 

8 ‘‘(C) utilize attribution methods to specify 

9 the clinicians, facilities, and other entities that 

10 the measures are applicable to; 

11 ‘‘(D) be pilot-tested with regards to sci12 entific validity, feasibility, and attribution meth13 od; and 

14 ‘‘(E) include a balance of each of the types 

15 of measures listed in paragraph (2). 

16 ‘‘(2) LIST OF TYPES OF MEASURES.—The 

17 measures listed in this paragraph are the following: 

18 ‘‘(A) Measures of the process, experience, 

19 efficiency, and outcomes of maternity care, in20 cluding postpartum outcomes. 

21 ‘‘(B) Measures that apply to— 

22 ‘‘(i) women and newborns who are 

23 healthy and at low risk, including meas24 ures of appropriately low-intervention, 

25 physiologic birth in low-risk women; and 


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1 ‘‘(ii) women and newborns at higher 

2 risk. 

3 ‘‘(C) Measures that apply to— 

4 ‘‘(i) childbearing women; and 

5 ‘‘(ii) newborns. 

6 ‘‘(D) Measures that apply to care during— 

7 ‘‘(i) pregnancy; 

8 ‘‘(ii) intrapartum period; and 

9 ‘‘(iii) the postpartum period. 

10 ‘‘(E) Measures that apply to— 

11 ‘‘(i) clinicians and clinician groups; 

12 ‘‘(ii) facilities; 

13 ‘‘(iii) health plans; and 

14 ‘‘(iv) accountable care organizations. 

15 ‘‘(F) Measurement of— 

16 ‘‘(i) disparities; 

17 ‘‘(ii) care coordination; and 

18 ‘‘(iii) shared decisionmaking. 

19 ‘‘(3) PHYSIOLOGIC DEFINED.—For purposes of 

20 this subsection, the term ‘physiologic’ means char21 acteristic of or conforming to the normal functioning 

22 or state of the body or a tissue or organ, normal, 

23 and not pathologic. 

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1 tion of coverage, under title XIX or XXI or other2 wise, to only those services that are evidence-based, 

3 or in anyway limiting available services. 

4 ‘‘(f) MATERNITY CONSUMER ASSESSMENT OF

5 HEALTHCARE PROVIDERS AND SYSTEMS SURVEYS.— 

6 ‘‘(1) ADAPTION OF SURVEYS.—Not later than 

7 January 1, 2016, for the purpose of measuring the 

8 care experiences of childbearing women and 

9 newborns, the Agency for Healthcare Research and 

10 Quality shall adapt the Consumer Assessment of 

11 Healthcare Providers and Systems program surveys 

12 of— 

13 ‘‘(A) providers; 

14 ‘‘(B) facilities; and 

15 ‘‘(C) health plans. 

16 ‘‘(2) SURVEYS MUST BE EFFECTIVE.—The 

17 Agency for Healthcare Research and Quality shall 

18 ensure that the surveys adapted under paragraph 

19 (1) are effective in measuring aspects of care that 

20 childbearing women and newborns experience, which 

21 may include— 

22 ‘‘(A) various types of care settings; 

23 ‘‘(B) various types of caregivers; 

24 ‘‘(C) considerations relating to pain; 

25 ‘‘(D) shared decisionmaking; 


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1 ‘‘(E) supportive care around the time of 

2 birth; and 

3 ‘‘(F) other topics relevant to the quality of 

4 the experience of childbearing women and 

5 newborns. 

6 ‘‘(3) LANGUAGES.—The surveys adapted under 

7 paragraph (1) shall be available in English and 

8 Spanish. 

9 ‘‘(4) ENDORSEMENT.—The Agency for 

10 Healthcare Research and Quality shall submit any 

11 Consumer Assessment of Healthcare Providers and 

12 Systems surveys adapted under this subsection to 

13 the consensus-based entity with a contract under 

14 section 1890(a)(1) to be considered for endorsement 

15 under section 1890(b)(2). 

16 ‘‘(5) CONSULTATION.—The adaption of (and 

17 process for applying) the surveys under paragraph 

18 (1) shall be conducted in consultation with the 

19 stakeholders identified in subsection (i)(1). 

20 ‘‘(g) ANNUAL STATE REPORTS REGARDING STATE21 SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER

22 MEDICAID.— 

23 ‘‘(1) ANNUAL STATE REPORTS.—Each State 

24 with a State plan or waiver approved under title 

25 XIX shall annually report (separately or as part of 


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1 an annual report required under section 1139A(c) or 

2 section 1139B(d)), to the Secretary on the— 

3 ‘‘(A) State-specific maternity health qual4 ity measures applied by the State under the 

5 such plan; and 

6 ‘‘(B) State-specific information on the 

7 quality of maternity care furnished to Medicaid 

8 eligible individuals under such plan, including 

9 information collected through external quality 

10 reviews of managed care organizations under 

11 section 1932 and benchmark plans under sec12 tion 1937. 

13 ‘‘(2) PUBLICATION.—Not later than September 

14 30, 2015, and annually thereafter, the Secretary 

15 shall collect, analyze, and make publicly available the 

16 information reported by States under subparagraph 

17 (A). 

18 ‘‘(h) CONVERSION OF CURRENTLY ENDORSED MEAS19 URES AND CREATION OF INITIAL QUALITY DATA MODEL

20 TO ENABLE ELECTRONIC HEALTH RECORDS TO MEAS21 URE THE CARE OF CHILDBEARING WOMEN AND

22 NEWBORNS.— 

23 ‘‘(1) IN GENERAL.—Not later than January 1, 

24 2015, for the purpose of fostering automated pa25 tient-centered longitudinal quality measurement of 


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1 maternal and newborn care using clinical data, the 

2 consensus-based entity with a contract under section 

3 1890(b)(2) shall coordinate— 

4 ‘‘(A) the conversion of endorsed measures 

5 for the care of childbearing women and 

6 newborns to eMeasures (as such term is defined 

7 in subsection (d)(3)(B)); and 

8 ‘‘(B) the development of an initial quality 

9 data model for use within electronic health 

10 records of childbearing women and newborns 

11 enrolled in a program administered by a State 

12 through State plans under title XIX and State 

13 Child Health plans under title XXI for pur14 poses of such eMeasures. 

15 ‘‘(2) REQUIREMENTS FOR EMEASURE CONVER16 SION AND QUALITY DATA MODEL CREATION.—The 

17 conversion to eMeasures and the quality data model 

18 creation under paragraph (1) shall, for each quality 

19 measure of the care of childbearing women or 

20 newborns that the consensus-based entity with a 

21 contract under section 1890(b)(2) has endorsed, use 

22 the entity’s measure authoring tool to— 

23 ‘‘(A) specify standard data elements, qual24 ity data elements, and data flow connectors to 

25 electronic information; 


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1 ‘‘(B) specify quality measure logical state2 ments; 

3 ‘‘(C) test quality measure validity with an 

4 appropriate electronic health record test data5 base; 

6 ‘‘(D) finalize eMeasures for export to elec7 tronic health record systems; and 

8 ‘‘(E) carry out this work in— 

9 ‘‘(i) collaboration with the developer 

10 or sponsor of each endorsed measure, who 

11 is responsible, under an agreement with 

12 the entity that endorsed such measure, for 

13 updating such measure; and 

14 ‘‘(ii) consultation with the stake15 holders identified in subsection (i)(1). 

16 ‘‘(3) COORDINATION WITH HITECH ACT.—In 

17 carrying out activities under this subsection, the 

18 consensus-based entity with a contract under section 

19 1890(b)(2) shall take into account, and to the extent 

20 practicable, coordinate with, similar activities relat21 ing to the implementation of the Health Information 

22 Technology for Economic and Clinical Health Act 

23 established under title XIII of division A and title 

24 IV of division B of Public Law 111–5. 

25 ‘‘(i) STAKEHOLDERS.— 


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1 ‘‘(1) IN GENERAL.—The stakeholders identified 

2 in this paragraph are— 

3 ‘‘(A) the various clinical disciplines and 

4 specialties involved in providing maternity care; 

5 ‘‘(B) State Medicaid administrators; 

6 ‘‘(C) maternity care consumers and their 

7 advocates; 

8 ‘‘(D) technical experts in quality measure9 ment; 

10 ‘‘(E) hospital, facility and health system 

11 leaders; 

12 ‘‘(F) employers and purchasers; and 

13 ‘‘(G) other individuals who are involved in 

14 the advancement of evidence-based maternity 

15 care quality measures. 

16 ‘‘(2) PROFESSIONAL ORGANIZATIONS.—The 

17 stakeholders identified under paragraph (1) may in18 clude representatives from relevant national medical 

19 specialty and professional organizations and spe20 cialty societies. 

21 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated $28,000,000 to carry 

23 out this section. Funds appropriated under this subsection 

24 shall remain available until expended.’’. 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) Section 1139A(a)(6) of the Social Security 

2 Act (42 U.S.C. 1320b–9a(a)(6)) is amended, in the 

3 matter preceding subparagraph (A), by inserting 

4 ‘‘and the Medicaid and CHIP Payment and Access 

5 Commission’’ after ‘‘Congress’’. 

6 (2) Section 1139B(b)(4) of such Act (42 U.S.C. 

7 1320b–9b(b)(4)) is amended by inserting ‘‘and the 

8 Medicaid and CHIP Payment and Access Commis9 sion’’ after ‘‘Congress’’. 

10 SEC. 3. QUALITY COLLABORATIVES. 

11 (a) GRANTS.—The Secretary of Health and Human 

12 Services (in this section referred to as the ‘‘Secretary’’) 

13 may make grants to eligible entities to support— 

14 (1) the development of new State and regional 

15 maternity care quality collaboratives; 

16 (2) expanded activities of existing maternity 

17 care quality collaboratives; and 

18 (3) maternity care initiatives within established 

19 State and regional quality collaboratives that are not 

20 focused exclusively on maternity care. 

21 (b) ELIGIBLE ENTITY.—The following entities shall 

22 be eligible for a grant under subsection (a): 

23 (1) Quality collaboratives that focus entirely, or 

24 in part, on maternity care initiatives, to the extent 


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1 that such collaboratives use such grant only for such 

2 initiatives. 

3 (2) Entities seeking to establish a maternity 

4 care quality collaborative. 

5 (3) State Medicaid agencies. 

6 (4) State departments of health. 

7 (5) Health insurance issuers (as such term is 

8 defined in section 2791 of the Public Health Service 

9 Act (42 U.S.C. 300gg–91). 

10 (6) Provider organizations, including associa11 tions representing— 

12 (A) health professionals; and 

13 (B) hospitals. 

14 (c) ELIGIBLE PROJECTS AND PROGRAMS.—In order 

15 for a project or program of an eligible entity to be eligible 

16 for funding under subsection (a), the project or program 

17 must have goals that are designed to improve the quality 

18 of maternity care delivered, such as— 

19 (1) improving the appropriate use of cesarean 

20 section; 

21 (2) reducing maternal and newborn morbidity 

22 rates; 

23 (3) improving breast-feeding rates; 

24 (4) reducing hospital readmission rates; 


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1 (5) identifying improvement priorities through 

2 shared peer review and third-party reviews of quali3 tative and quantitative data, and developing and car4 rying out projects or programs to address such pri5 orities; or 

6 (6) delivering risk-appropriate levels of care. 

7 (d) ACTIVITIES.—Activities that may be supported by 

8 the funding under subsection (a) include the following: 

9 (1) Facilitating performance data collection and 

10 feedback reports to providers with respect to their 

11 performance, relative to peers and benchmarks, if 

12 any. 

13 (2) Developing, implementing, and evaluating 

14 protocols and checklists to foster safe, evidence15 based practice. 

16 (3) Developing, implementing, and evaluating 

17 programs that translate into practice clinical rec18 ommendations supported by high-quality evidence in 

19 national guidelines, systematic reviews, or other well20 conducted clinical studies. 

21 (4) Developing underlying infrastructure needed 

22 to support quality collaborative activities under this 

23 subsection. 

24 (5) Providing technical assistance to providers 

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1 ity and facilitate participation in collaborative activi2 ties. 

3 (6) Developing the capability to access the fol4 lowing data sources: 

5 (A) A mother’s prenatal, intrapartum, and 

6 postpartum records. 

7 (B) A mother’s medical records. 

8 (C) An infant’s medical records since birth. 

9 (D) Birth and death certificates. 

10 (E) Any other relevant State-level gen11 erated data (such as data from the pregnancy 

12 risk assessment management system 

13 (PRAMS)). 

14 (7) Developing access to blinded liability claims 

15 data, analyzing the data, and using the results of 

16 such analysis to improve practice. 

17 (e) SPECIAL RULE FOR BIRTHS.— 

18 (1) IN GENERAL.—Subject to paragraph (2), if 

19 a grant under subsection (a) is for a project or pro20 gram that focuses on births, at least 25 percent of 

21 the births addressed by such project or program 

22 must occur in health facilities that perform fewer 

23 than 1,000 births per year. 

24 (2) EXCEPTION.—In the case of a grant under 

25 subsection (a) for a project or program located in a 


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1 State in which less than 25 percent of the health fa2 cilities in the State perform less than 1,000 births 

3 per year, the percentage of births in such facilities 

4 addressed by such project or program shall be com5 mensurate with the Statewide percentage of births 

6 performed at such facilities. 

7 (f) USE OF QUALITY MEASURES.—Projects and pro8 grams for which such a grant is made shall— 

9 (1) include data collection with rapid analysis 

10 and feedback to participants with a focus on improv11 ing practice and health outcomes; 

12 (2) develop a plan to identify and resolve data 

13 collection problems; 

14 (3) identify and document evidence-based strat15 egies that will be used to improve performance on 

16 quality measures and other metrics; and 

17 (4) exclude from quality measure collection and 

18 reporting physicians and midwives who attend fewer 

19 than 30 births per year. 

20 (g) REPORTING ON QUALITY MEASURES.—Any re21 porting requirements established by a project or program 

22 funded under subsection (a) shall be designed to— 

23 (1) minimize costs and administrative effort; 

24 and 

25 (2) use existing data resources when feasible. 


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1 (h) CLEARINGHOUSE.—The Secretary shall establish 

2 an online, open-access clearinghouse to make protocols, 

3 procedures, reports, tools, and other resources of indi4 vidual collaboratives available to collaboratives and other 

5 entities that are working to improve maternity care qual6 ity. 

7 (i) EVALUATION.—A quality collaborative (or other 

8 entity receiving a grant under subsection (a)) shall— 

9 (1) develop and carry out plans for evaluating 

10 its maternity care quality improvement programs 

11 and projects; and 

12 (2) publish its experiences and results in arti13 cles, technical reports, or other formats for the ben14 efit of others working on maternity care quality im15 provement activities. 

16 (j) ANNUAL REPORTS TO SECRETARY.—A quality 

17 collaborative or other eligible entity that receives a grant 

18 under subsection (a) shall submit an annual report to the 

19 Secretary containing the following: 

20 (1) A description of the activities carried out 

21 using the funding from such grant. 

22 (2) A description of any barriers that limited 

23 the ability of the collaborative or entity to achieve its 

24 goals. 


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1 (3) The achievements of the collaborative or en2 tity under the grant with respect to the quality, 

3 health outcomes, and value of maternity care. 

4 (4) A list of lessons learned from the grant. 

5 Such reports shall be made available to the public. 

6 (k) GOVERNANCE.— 

7 (1) IN GENERAL.—A maternity care quality col8 laborative or a maternity care program within a 

9 broader quality collaborative that is supported under 

10 subsection (a) shall be governed by a multi-stake11 holder executive committee. 

12 (2) COMPOSITION.—Such executive committee 

13 shall include individuals who represent— 

14 (A) physicians, including physicians in the 

15 fields of general obstetrics, maternal-fetal medi16 cine, family medicine, neonatology, and pediat17 rics; 

18 (B) nurse-practitioners and nurses; 

19 (C) certified nurse-midwives and certified 

20 midwives; 

21 (D) health facilities and health systems; 

22 (E) consumers; 

23 (F) employers and other private pur24 chasers; 

25 (G) Medicaid programs; and 


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1 (H) other public health agencies and orga2 nizations, as appropriate. 

3 Such committee also may include other individuals, 

4 such as individuals with expertise in health quality 

5 measurement and other types of expertise as rec6 ommended by the Secretary. Such committee also 

7 may be composed of a combination of general col8 laborative executive committee members and mater9 nity specific project executive committee members. 

10 (l) CONSULTATION.—A quality collaborative or other 

11 eligible entity that receives a grant under subsection (a) 

12 shall engage in regular ongoing consultation with— 

13 (1) regional and State public health agencies 

14 and organizations; 

15 (2) public and private health insurers; and 

16 (3) regional and State organizations rep17 resenting physicians, midwives, and nurses who pro18 vide maternity services. 

19 (m) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated $15,000,000 to carry 

21 out this section. Funds appropriated under this subsection 

22 shall remain available until expended. 

23 SEC. 4. WOMAN- AND FAMILY-CENTERED MATERNITY CARE 

24 HOME DEMONSTRATION PROGRAM. 

25 (a) DEFINITIONS.—In this section: 


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1 (1) CHIP.—The term ‘‘CHIP’’ means the 

2 State Children’s Health Insurance Program estab3 lished under title XXI of the Social Security Act (42 

4 U.S.C. 1397aa et seq.). 

5 (2) ELIGIBLE INDIVIDUALS.—The term ‘‘eligi6 ble individual’’ means a childbearing woman who is 

7 receiving assistance under Medicaid or CHIP. 

8 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti9 ty’’ means a State, an entity or organization receiv10 ing payments under Medicaid or CHIP, a hospital, 

11 a freestanding birth center (as defined in section 

12 1905(l)(3)(B) of the Social Security Act (42 U.S.C. 

13 1396d(l)(3)(B)), an entity or organization receiving 

14 assistance under section 330 of the Public Health 

15 Service Act (42 U.S.C. 254b), a Federally qualified 

16 health center (as defined in subsection (l)(2)(C) of 

17 section 1905 of the Social Security Act (42 U.S.C. 

18 1396d), a rural health clinic (as defined in sub19 section (l)(1) of such section), or an entity that re20 ceives assistance under title X or XX of the Public 

21 Health Service Act (42 U.S.C. 300 et seq., 300z et 

22 seq.), that submits an approved application to the 

23 Secretary to conduct a demonstration project under 

24 this section. 


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1 (4) MEDICAID.—The term ‘‘Medicaid’’ means 

2 the Federal and State program for medical assist3 ance established under title XIX of the Social Secu4 rity Act (42 U.S.C. 1396 et seq.). 

5 (5) PRINCIPAL MATERNITY CARE PROVIDER.— 

6 The term ‘‘principal maternity care provider’’ 

7 means: 

8 (A) A physician (as defined in section 

9 1861(r)(1) of the Social Security Act (42 

10 U.S.C. 1395x(r)(1)) who meets the following re11 quirements: 

12 (i) The physician is a board certified 

13 physician who specializes in women’s 

14 health issues, such as obstetrics and gyne15 cology, or family practice, and who pro16 vides continuous and comprehensive care 

17 for individuals under the physician’s care. 

18 (ii) The physician has the staff and 

19 resources to manage the comprehensive 

20 and coordinated health care of each such 

21 individual. 

22 (iii) The physician practices in a prac23 tice, health or birth center, clinic, or hos24 pital recognized to be a maternity care 

25 home. 


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1 (iv) Such other requirements as are 

2 defined by the Secretary. 

3 (B) An advanced practice nurse, a certified 

4 nurse-midwife (CNM) or certified midwife (CM) 

5 certified by the American Midwifery Certifi6 cation Board, or physician assistant, who meets 

7 the following requirements: 

8 (i) The advanced practice nurse, mid9 wife, or physician assistant specializes in 

10 women’s health issues, such as obstetrics 

11 and gynecology, and provides continuous 

12 and comprehensive care for patients. 

13 (ii) The advanced practice nurse, mid14 wife, or physician assistant has the staff 

15 and resources to manage the comprehen16 sive and coordinated health care of each 

17 such individual. 

18 (iii) The advanced practice nurse, 

19 midwife, or physician assistant practices in 

20 a practice or health or birth center recog21 nized to be a maternity care home. 

22 (iv) Such other requirements as are 

23 defined by the Secretary. 

24 (6) SECRETARY.—The term ‘‘Secretary’’ means 

25 the Secretary of Health and Human Services. 


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1 (7) MATERNITY CARE HOME.—The term ‘‘ma2 ternity care home’’ means a physician-led practice, 

3 or an advanced practice nurse-led, certified nurse4 midwife-led, certified midwife-led, or physician as5 sistant-led practice in those States in which State 

6 law does not require direct supervision of licensed 

7 advanced practice nurses, certified nurse-midwives, 

8 certified midwives, or physician assistants providing 

9 services in a hospital, practice, health or birth cen10 ter, or clinic participating as maternity care home 

11 under the program that uses practice innovations 

12 and coordination agreements with other providers to 

13 improve the management and coordination of mater14 nity care that meets the following standards: 

15 (A) The practice, health or birth center, 

16 clinic, or hospital is able to provide or coordi17 nate maternity care for women, including pre18 conception care, prenatal care, family planning, 

19 medical care, mental and behavioral health 

20 care, and screening, that, at a minimum, in21 cludes at least 3 of the following, and may in22 clude all of the following: 

23 (i) An initial health assessment and 

24 development of a maternity care plan. 


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1 (ii) Pregnancy care to foster access of 

2 all women to preventive services and sup3 port, including guidance about nutrition, 

4 weight gain, exercise, stress management, 

5 rest, and environmental exposures. 

6 (iii) Pregnancy care to foster access of 

7 women with special needs to such services 

8 as help with smoking cessation; use of al9 cohol and other harmful substances; mood 

10 disorders; and domestic violence. 

11 (iv) Evaluation and development of a 

12 plan for appropriate use of any continuing 

13 and new prescription and over-the-counter 

14 medications. 

15 (v) Appropriate care for women who 

16 are deemed at risk for premature birth. 

17 (vi) Appropriate care for women who 

18 are members of a minority population that 

19 experiences pregnancy-related health dis20 parities. 

21 (vii) Coordination with providers of 

22 services for any ongoing or new medical 

23 conditions. 

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1 fective prenatal, intrapartum, and 

2 postpartum services and practices. 

3 (ix) Plan for childbirth that supports 

4 utilization of evidence-based intrapartum 

5 practices. 

6 (x) Care of the newborn from birth 

7 until transition to the baby’s primary care 

8 provider, including preventive practices 

9 promoting optimal feeding and attachment. 

10 (xi) Postpartum health services for 

11 the first two months after birth, including 

12 family planning, weight control, exercise, 

13 nutrition, and other preventive services; as14 sessment and treatment for postpartum 

15 depression and other mood disorders; as16 sessment and treatment of other new-onset 

17 conditions that may include infection, pain, 

18 and heavy bleeding; and any continuing 

19 needs for help with smoking cessation, sub20 stance abuse, and other health risks. 

21 (xii) At the conclusion of maternity 

22 services and as needed in the course of ma23 ternity services, communication with the 

24 primary care providers of the woman and 

25 newborn about care processes, outcomes of 


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1 maternal and newborn care, and any con2 tinuing health care needs. 

3 (xiii) Any other services specified by 

4 the Secretary. 

5 (B) The practice, health or birth center, 

6 clinic, or hospital applies standards for access 

7 to care and communication with eligible individ8 uals participating in the demonstration program 

9 established under this section, including direct 

10 and ongoing access to the principal maternity 

11 care provider who accepts responsibility for pro12 viding continuous care, including coordination 

13 for comprehensive maternity care to the whole 

14 person, in collaboration with a team of other 

15 health professionals, including other nurses, pri16 mary care and specialist physicians, and mental 

17 health professionals, as needed and appropriate. 

18 Care is patient and family centered, culturally 

19 and linguistically appropriate, structured to en20 sure women receive complete and accurate 

21 health information for shared decisionmaking, 

22 and structured to assure confidentiality so that 

23 teens and women may seek needed care in a 

24 timely way. 


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1 (C) The practice, health or birth center, 

2 clinic, or hospital has readily accessible, clini3 cally useful records on eligible individuals par4 ticipating in the demonstration program estab5 lished under this section, when feasible through 

6 electronic health records available in ambula7 tory and inpatient settings, that enable the 

8 practice to treat such individuals comprehen9 sively and systematically. 

10 (D) The practice, health or birth center, 

11 clinic or hospital maintains continuous relation12 ships with eligible individuals participating in 

13 the demonstration program established under 

14 this section by implementing clinical rec15 ommendations supported by high-quality evi16 dence in national guidelines, systematic reviews, 

17 or other well-conducted clinical studies and ap18 plying them to the identified needs of such indi19 viduals over time and with the intensity needed 

20 by such individuals. 

21 (E) The practice, health or birth center, 

22 clinic, or hospital supports eligible individuals in 

23 self-care to pursue their goals and achieve opti24 mal health. 


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1 (F) The practice, health or birth center, 

2 clinic, or hospital assesses and addresses bar3 riers to communication between health profes4 sions and eligible individuals. 

5 (G) The practice, health or birth center, 

6 clinic, or hospital has in place the resources and 

7 processes necessary to achieve improvements in 

8 the management and coordination of care for 

9 eligible individuals participating in the dem10 onstration program established under this sec11 tion, including— 

12 (i) providing training programs for 

13 personnel involved in the coordination of 

14 care; 

15 (ii) utilizing information technology to 

16 support optimal patient care, performance 

17 measurement and use of the results to im18 prove practice, patient education, and en19 hanced communication; and 

20 (iii) implementation of programs to 

21 improve the quality of care. 

22 (H) The practice, health or birth center, 

23 clinic, or hospital meets the requirements im24 posed on a covered entity for purposes of apply25 ing part C of title XI of the Public Health 


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•S 1969 IS

1 Service Act (42 U.S.C. 300b–1 et seq.) and all 

2 regulatory provisions promulgated there under, 

3 including regulations (relating to privacy) 

4 adopted pursuant to the authority of the Sec5 retary under section 264(c) of the Health In6 surance Portability and Accountability Act of 

7 1996 (42 U.S.C. 1320d–2 note). 

8 (b) ESTABLISHMENT.— 

9 (1) IN GENERAL.—Not later than 1 year after 

10 the date of enactment of this Act, the Secretary 

11 shall establish a maternity care home demonstration 

12 program (in this section referred to as the ‘‘pro13 gram’’). 

14 (2) DURATION; SCOPE.—The program shall be 

15 conducted for a 3-year period (except that an eligible 

16 individual participating in the program shall remain 

17 eligible for items and services provided under the 

18 program through 2 months postpartum regardless of 

19 the termination of the program period) and shall in20 clude a nationally representative sample of physi21 cians, advanced practice nurses, certified nurse mid22 wives, certified midwives, and physician assistants 

23 who specialize in women’s health issues, such as ob24 stetrics and gynecology, or family practice, and who 


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•S 1969 IS

1 serve urban, rural, and underserved areas in a total 

2 of no more than 8 States. 

3 (3) COMPREHENSIVENESS.—The Secretary 

4 shall give priority under the program to demonstra5 tion projects that reflect a comprehensive inclusion 

6 of the care components identified under subsection 

7 (a)(7)(A). 

8 (4) ENCOURAGING PARTICIPATION OF SMALL

9 PHYSICIAN PRACTICES.—The program shall be de10 signed to include the participation of maternity care 

11 providers in practices with fewer than 4 full-time 

12 equivalent clinicians, as well as maternity care pro13 viders in larger practices, particularly in rural and 

14 underserved areas. 

15 (5) PROGRAM GOALS.—The program shall be 

16 designed in order to determine whether and to what 

17 extent maternity care homes accomplish the fol18 lowing: 

19 (A) Increase— 

20 (i) cost efficiencies of maternity care 

21 delivery; 

22 (ii) the reliable provision of care sup23 ported by high-quality evidence in national 

24 guidelines, systematic reviews, or other 

25 well-conducted clinical studies; 


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•S 1969 IS

1 (iii) communication among maternity 

2 care providers, other health professionals, 

3 facilities, and eligible individuals; and 

4 (iv) the quality of maternity care serv5 ices provided, as based on nationally en6 dorsed quality measures. 

7 (B) Decrease— 

8 (i) inappropriate emergency room uti9 lization; 

10 (ii) avoidable maternal and newborn 

11 hospitalizations and admissions to inten12 sive care units; 

13 (iii) duplication of health care services 

14 provided; and 

15 (iv) health disparities. 

16 (C) Improve— 

17 (i) the woman’s experience of care and 

18 the maternity care provider’s experience of 

19 providing care; and 

20 (ii) health outcomes of women and 

21 newborns, such as— 

22 (I) decreased preterm and early 

23 term birth, postpartum morbidities, 

24 and untreated postpartum depression; 

25 and 


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•S 1969 IS

1 (II) increased vaginal birth and 

2 initiation and duration of exclusive 

3 breast feeding. 

4 (6) ELIGIBLE INDIVIDUAL AND ELIGIBLE ENTI5 TY PARTICIPATION.— 

6 (A) ELIGIBLE INDIVIDUALS.—The Sec7 retary shall establish a process under which— 

8 (i) an eligible individual may elect to 

9 participate in a maternity care home under 

10 the program; and 

11 (ii) no cost sharing shall be imposed 

12 with respect to any service required under 

13 to be provided to the individual under the 

14 program. 

15 (B) ASSURANCE OF PARTICIPATION OF EL16 IGIBLE ENTITIES THAT ARE NOT PARTICI17 PATING PROVIDERS OR ARE IN STATES WITH

18 MANAGED CARE.—The Secretary shall establish 

19 a process to ensure that eligible entities that 

20 are not participating providers under Medicaid 

21 or CHIP in the State, or, in the case of a State 

22 that contracts with a private entity to manage 

23 parts of the Medicaid or CHIP in the State, do 

24 not participate with that entity, are able to par25 ticipate in the program. 


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1 (7) STANDARD SETTING PROCESS.—In con2 sultation with the stakeholders specified in sub3 section (d), the Secretary shall— 

4 (A) develop a maternity care home reim5 bursement methodology that takes into consid6 eration, to the maximum extent practicable— 

7 (i) recognition of the value of mater8 nity care provider and clinical staff work 

9 associated with patient care that falls out10 side the face-to-face visit, such as the time 

11 and effort spent on educating family mem12 bers and arranging appropriate followup 

13 services with other health care profes14 sionals; 

15 (ii) reimbursement of services associ16 ated with coordination of care both within 

17 a given practice and between consultants, 

18 ancillary providers, and community re19 sources; 

20 (iii) recognition of expenses that the 

21 maternity care home practices will incur to 

22 acquire and utilize health information tech23 nology, such as clinical decision support 

24 tools, patient registries, or electronic med25 ical records; 


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•S 1969 IS

1 (iv) reimbursement for separately 

2 identifiable e-mail and telephonic consulta3 tions, either as separately billable services 

4 or as part of a global management fee; 

5 (v) recognition of the value of provider 

6 work associated with remote monitoring of 

7 clinical data using technology; 

8 (vi) reimbursement for provision of 

9 preventive services, health education, and 

10 participation in shared decisionmaking; 

11 (vii) recognition and sharing of sav12 ings with respect to reduction of proce13 dures and practices that are contrary to 

14 high-quality evidence in national guide15 lines, systematic reviews, or other well-con16 ducted clinical studies and to reductions in 

17 the occurrence of health and pregnancy 

18 complications, hospitalization rates, med19 ical errors, adverse drug reactions, and 

20 other occurrences; 

21 (viii) allowance for additional pay22 ments for achieving measurable and con23 tinuous quality improvements, including 

24 under a process established by the Sec25 retary for paying a performance-based 


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1 bonus to maternity care homes which meet 

2 or achieve substantial improvements in 

3 performance (as specified under clinical, 

4 patient experience of care, and efficiency 

5 benchmarks established by the Secretary); 

6 (ix) recognition of the existing pay7 ment methodology for Federally qualified 

8 health centers when determining the most 

9 appropriate mechanism for providing 

10 bonus payments for maternity care home 

11 services delivered at such centers; and 

12 (x) such other innovative methods as 

13 the Secretary finds appropriate; 

14 (B) develop appropriate risk-adjustment 

15 mechanisms to account for varying costs of ma16 ternity care homes based upon characteristics of 

17 the eligible individuals participating in the pro18 gram; 

19 (C) make allowance for additional pay20 ments for achieving measurable and continuous 

21 quality improvements, including under a process 

22 established by the Secretary for paying a per23 formance-based bonus to maternity care homes 

24 which meet or achieve substantial improvements 

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•S 1969 IS

1 tient experience, and efficiency benchmarks es2 tablished by the Secretary in consultation with 

3 the stakeholders specified in subsection (d)); 

4 (D) recognize the existing payment meth5 odology for Federally qualified health centers 

6 when determining the most appropriate mecha7 nism for providing bonus payments for mater8 nity care home services delivered at such cen9 ters; and 

10 (E) establish such other methods as the 

11 Secretary, in consultation with the stakeholders 

12 specified in subsection (d), finds appropriate. 

13 (8) PLANNING OR IMPLEMENTATION GRANTS.— 

14 The Secretary may award planning or implementa15 tion grants to eligible entities desiring or selected to 

16 participate in the program. 

17 (9) ONGOING OVERSIGHT AND PERFORMANCE

18 ASSESSMENT.—The Secretary shall establish proce19 dures to ensure that hospitals, practices, health or 

20 birth centers, and clinics participating as maternity 

21 care homes under the program, and the physicians, 

22 advanced practice nurses, certified nurse-midwives, 

23 certified midwives, and physician assistants pro24 viding services at such hospitals, practices, centers, 

25 and clinics, have access to confidential feedback and 


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•S 1969 IS

1 benchmarking reports as a function of the hospital’s, 

2 practice’s, health or birth center’s, or clinic’s moni3 toring of its clinical process and performance (in4 cluding process and outcome measures). 

5 (10) TECHNICAL ASSISTANCE.—The Secretary 

6 shall establish mechanisms to provide technical as7 sistance to hospitals, practices, health or birth cen8 ters, and clinics participating as maternity care 

9 homes under the program. 

10 (11) PAYMENTS TO STATES.—The Secretary 

11 shall pay each State participating in the program an 

12 amount equal to 100 percent of the amounts ex13 pended by the State for services provided to an eligi14 ble individual under the program, including adminis15 trative expenses. 

16 (12) AUTHORIZATION OF APPROPRIATIONS.— 

17 There are authorized to be appropriated 

18 $50,000,000 to carry out this section. Funds appro19 priated under this paragraph shall remain available 

20 until expended. 

21 (c) EVALUATIONS AND PROGRAM REPORTS.— 

22 (1) ANNUAL INTERIM EVALUATIONS AND RE23 PORTS.—For each year of the program, the Sec24 retary shall provide for an interim evaluation of the 

25 program and shall submit to Congress and the MedVerDate Mar 15 2010 01:48 Dec 10, 2011 Jkt 019200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1969.IS S1969

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1 icaid and CHIP Payment and Access Commission 

2 established under section 1900 of the Social Security 

3 Act (42 U.S.C. 1396) (in this subsection referred to 

4 as ‘‘MACPAC’’) reports on the results of such eval5 uations. 

6 (2) FINAL EVALUATION AND REPORT.—The 

7 Secretary shall provide for a final evaluation of the 

8 program and shall submit to Congress and 

9 MACPAC, not later than 1 year after completion of 

10 the program, a final report on the program based on 

11 the results of such evaluation. Such final report shall 

12 include— 

13 (A) an assessment of improvements in 

14 quality and outcomes of childbearing women 

15 and newborns identified under the program 

16 goals specified in subsection (b)(4); 

17 (B) an assessment of the women’s experi18 ence of care and the maternity care providers’ 

19 satisfaction; 

20 (C) an assessment of which women, based 

21 on demographic factors, such as age, race, sex22 ual orientation, disability, ethnicity, and socio23 economic status, benefit the most from partici24 pating in a maternity care home; 


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1 (D) estimates of cost savings to Medicaid, 

2 CHIP, and other Federal programs resulting 

3 from the program; and 

4 (E) recommendations for such legislation 

5 and administrative action as the Secretary de6 termines to be appropriate. 

7 (d) CONSULTATION WITH RELEVANT STAKE8 HOLDERS.—In carrying out the activities under this sec9 tion, the Secretary shall consult with the following stake10 holders on selection and evaluation of the program, setting 

11 of payment and incentives criteria, and other activities de12 termined by the Secretary (in addition to the issues for 

13 which consultation with such stakeholders is required in 

14 other subsections of this section): 

15 (1) States. 

16 (2) National organizations and individuals rep17 resenting obstetrician-gynecologists, family physi18 cians, certified nurse-midwives and certified mid19 wives, registered nurses, advanced practice nurses, 

20 and physician assistants. 

21 (3) National organizations representing con22 sumers. 

23 (4) Health care providers that furnish care to 

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1 served communities and are at heightened risk for 

2 poor health outcomes. 

3 (5) National organizations and individuals with 

4 expertise in maternity health quality measurement 

5 and coding and reimbursement related issues. 

6 (6) National organizations and individuals that 

7 provide social and medical services to pregnant 

8 women, such as mental health professionals and so9 cial workers. 

Æ 


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