I 

116TH CONGRESS 

1ST SESSION H. R. 1551 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 6, 2019 

Mr. ENGEL (for himself and Mr. STIVERS) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Ways and Means, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

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 maternity care quality measures 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 for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Quality measures for maternal and infant health. 

Sec. 3. Quality collaboratives. 

Sec. 4. Facilitation of increased coordination and alignment between the public 

and private sector with respect to quality and efficiency measures. 

3 SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT 

4 HEALTH. 

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

6 (42 U.S.C. 1301 et seq.) is amended by inserting after 

7 section 1139B the following new section: 

8 ‘‘SEC. 1139C. MATERNAL AND INFANT QUALITY MEASURES. 

9 ‘‘(a) DEVELOPMENT OF CORE SET OF HEALTH CARE

10 QUALITY MEASURES FOR MATERNAL AND INFANT

11 HEALTH.— 

12 ‘‘(1) IN GENERAL.—The Secretary shall iden13 tify and publish a recommended core set of maternal 

14 and infant health quality measures for women and 

15 children described in subparagraphs (A) and (B) of 

16 section 1902(l)(1) in the same manner as the Sec17 retary identifies and publishes a core set of child 

18 health quality measures under section 1139A, in19 cluding with respect to identifying and publishing 

20 existing maternal and infant health quality measures 

21 that are in use under public and privately sponsored 

22 health care coverage arrangements, or that are part 


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1 of reporting systems that measure both the presence 

2 and duration of health insurance coverage over time, 

3 that may be applicable to Medicaid and CHIP eligi4 ble mothers and infants. 

5 ‘‘(2) ALIGNMENT WITH EXISTING CORE SETS.— 

6 In identifying and publishing the recommended core 

7 set of maternal and infant health quality measures 

8 required under paragraph (1), the Secretary shall 

9 ensure that, to the extent possible, such measures 

10 align with and do not duplicate— 

11 ‘‘(A) the core set of child health quality 

12 measures identified, published, and revised 

13 under section 1139A; or 

14 ‘‘(B) the core set of adult health quality 

15 measures identified, published, and revised 

16 under section 1139B. 

17 ‘‘(3) PROCESS FOR MATERNAL AND INFANT

18 QUALITY MEASURES PROGRAM.—In identifying gaps 

19 in existing maternal and infant measures and estab20 lishing priorities for the development and advance21 ment of such measures, the Secretary shall consult 

22 with— 

23 ‘‘(A) States; 

24 ‘‘(B) physicians, including physicians in 

25 the fields of general obstetrics, maternal-fetal 


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1 medicine, family medicine, neonatology, and pe2 diatrics; 

3 ‘‘(C) nurse practitioners and nurses; 

4 ‘‘(D) certified nurse-midwives and certified 

5 midwives; 

6 ‘‘(E) health facilities and health systems; 

7 ‘‘(F) national organizations representing 

8 mothers and infants; 

9 ‘‘(G) national organizations representing 

10 consumers and purchasers of health care; 

11 ‘‘(H) national organizations and individ12 uals with expertise in maternal and infant 

13 health quality measurement; and 

14 ‘‘(I) voluntary consensus standard-setting 

15 organizations and other organizations involved 

16 in the advancement of evidence-based measures 

17 of health care. 

18 ‘‘(b) DEADLINES.— 

19 ‘‘(1) RECOMMENDED MEASURES.—Not later 

20 than January 1, 2021, the Secretary shall identify 

21 and publish for comment a recommended core set of 

22 maternal and infant health quality measures that in23 cludes the following: 


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

2 efficiency, and outcomes of maternity care, in3 cluding postpartum outcomes. 

4 ‘‘(B) Measures that apply to childbearing 

5 women and newborns at healthy, low, and high 

6 risk, including measures of low-intervention 

7 birth. 

8 ‘‘(C) Measures that apply to care during 

9 pregnancy, the intrapartum period, and the 

10 postpartum period. 

11 ‘‘(D) Measures that apply to a variety of 

12 settings and provider types, such as clinics, fa13 cilities, health plans, and accountable care orga14 nizations. 

15 ‘‘(E) Measures that address disparities, 

16 care coordination, and shared decisionmaking. 

17 ‘‘(2) DISSEMINATION.—Not later than January 

18 1, 2022, the Secretary shall publish an initial core 

19 set of maternal and infant health quality measures 

20 that are applicable to Medicaid and CHIP eligible 

21 mothers and infants. 

22 ‘‘(3) STANDARDIZED REPORTING.—Not later 

23 than January 1, 2023, the Secretary, in consultation 

24 with States, shall develop a standardized format for 

25 reporting information based on the initial core set of 


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1 maternal and infant health quality measures and 

2 create procedures to encourage States to use such 

3 measures to voluntarily report information regarding 

4 the quality of health care for Medicaid and CHIP el5 igible mothers and infants. 

6 ‘‘(4) REPORTS TO CONGRESS.—Not later than 

7 January 1, 2024, and every 3 years thereafter, the 

8 Secretary shall include in the report to Congress re9 quired under section 1139A(a)(6) information simi10 lar to the information required under that section 

11 with respect to the measures established under this 

12 section. 

13 ‘‘(5) ESTABLISHMENT OF MATERNAL AND IN14 FANT QUALITY MEASUREMENT PROGRAM.— 

15 ‘‘(A) IN GENERAL.—Not later than 12 

16 months after the release of the recommended 

17 core set of maternal and infant health quality 

18 measures under paragraph (1), the Secretary 

19 shall establish a Maternal and Infant Quality 

20 Measurement Program in the same manner as 

21 the Secretary established the pediatric quality 

22 measures program under section 1139A(b). 

23 ‘‘(B) REVISING, STRENGTHENING, AND IM24 PROVING INITIAL CORE MEASURES.—Beginning 

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1 ment of the Maternal and Infant Quality Meas2 urement Program, and annually thereafter, the 

3 Secretary shall publish recommended changes 

4 to the initial core set of maternal and infant 

5 health quality measures that shall reflect the 

6 results of the testing, validation, and consensus 

7 process for the development of maternal and in8 fant health quality measures. 

9 ‘‘(C) EMEASURES.— 

10 ‘‘(i) IN GENERAL.—An entity awarded 

11 a grant or contract by the Secretary to de12 velop emerging and innovative evidence13 based measures under the Maternal and 

14 Infant Quality Measurement Program shall 

15 work to advance eMeasures that are 

16 aligned with the measures developed under 

17 the Pediatric Quality Measures Program 

18 established under section 1139A(b) and 

19 the Medicaid Quality Measurement Pro20 gram established under section 

21 1139B(b)(5). 

22 ‘‘(ii) DEFINITION.—For purposes of 

23 this subparagraph, the term ‘eMeasure’ 

24 means an electronic measure for which 

25 measurement data (including clinical data) 


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1 will be collected electronically, including 

2 through the use of electronic health 

3 records and other electronic data sources. 

4 ‘‘(D) AMOUNT AVAILABLE FOR GRANTS

5 AND CONTRACTS.—The aggregate amount of 

6 funds that may be awarded as grants and con7 tracts under the Maternal and Infant Quality 

8 Measurement Program for the development, 

9 testing, and validation of emerging and innova10 tive evidence-based measures shall not exceed 

11 the aggregate amount of funds awarded as 

12 grants and contracts under section 

13 1139A(b)(4)(A). 

14 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

15 be construed as supporting the restriction of coverage, 

16 under title XIX or XXI or otherwise, to only those services 

17 that are evidence based, or in any way limiting available 

18 services. 

19 ‘‘(d) MATERNITY CONSUMER ASSESSMENT OF

20 HEALTH CARE PROVIDERS AND SYSTEMS SURVEYS.— 

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

22 January 1, 2022, for the purpose of measuring the 

23 care experiences of childbearing women and 

24 newborns, where appropriate, the Agency for 

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1 sumer Assessment of Healthcare Providers and Sys2 tems program surveys of— 

3 ‘‘(A) providers; 

4 ‘‘(B) facilities; and 

5 ‘‘(C) health plans. 

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

7 Agency for Healthcare Research and Quality shall 

8 ensure that the surveys adapted under paragraph 

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

10 childbearing women and newborns experience, which 

11 may include— 

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

13 ‘‘(B) various types of caregivers; 

14 ‘‘(C) considerations relating to pain; 

15 ‘‘(D) shared decisionmaking; 

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

17 birth; and 

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

19 the experience of childbearing women and 

20 newborns. 

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

22 paragraph (1) shall be available in English and 

23 Spanish. 

24 ‘‘(4) ENDORSEMENT.—The Agency for Health25 care Research and Quality shall submit any ConVerDate Sep 11 2014 22:29 Mar 20, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1551.IH H1551

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1 sumer Assessment of Healthcare Providers and Sys2 tems surveys adapted under this paragraph to the 

3 consensus-based entity with a contract under section 

4 1890(a)(1) to be considered for endorsement under 

5 section 1890(b)(2). 

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

7 process for applying) the surveys under paragraph 

8 (1) shall be conducted in consultation with the 

9 stakeholders identified in paragraph (6)(A). 

10 ‘‘(6) STAKEHOLDERS.— 

11 ‘‘(A) IN GENERAL.—The stakeholders 

12 identified in this subparagraph are— 

13 ‘‘(i) the various clinical disciplines and 

14 specialties involved in providing maternity 

15 care; 

16 ‘‘(ii) State Medicaid administrators; 

17 ‘‘(iii) maternity care consumers and 

18 their advocates; 

19 ‘‘(iv) technical experts in quality 

20 measurement; 

21 ‘‘(v) hospital, facility and health sys22 tem leaders; 

23 ‘‘(vi) employers and purchasers; and 


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1 ‘‘(vii) other individuals who are in2 volved in the advancement of evidence3 based maternity care quality measures. 

4 ‘‘(B) PROFESSIONAL ORGANIZATIONS.— 

5 The stakeholders identified under subparagraph 

6 (A) may include representatives from relevant 

7 national medical specialty and professional or8 ganizations and specialty societies. 

9 ‘‘(e) ANNUAL STATE REPORTS REGARDING STATE10 SPECIFIC MATERNAL AND INFANT QUALITY OF CARE

11 MEASURES APPLIED UNDER MEDICAID OR CHIP.— 

12 ‘‘(1) IN GENERAL.—Each State with a plan or 

13 waiver approved under title XIX or XXI shall annu14 ally report (separately or as part of the annual re15 port required under section 1139A(c)) to the Sec16 retary on— 

17 ‘‘(A) the State-specific maternal and infant 

18 health quality measures applied by the State 

19 under such plan or waiver, including measures 

20 described in subsection (b)(5)(B); and 

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

22 quality of health care furnished to Medicaid and 

23 CHIP eligible mothers and infants under such 

24 plan or waiver, including information collected 

25 through external quality reviews of managed 


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1 care organizations under section 1932 and 

2 benchmark plans under section 1937. 

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

4 30, 2024, and annually thereafter, the Secretary 

5 shall collect, analyze, and make publicly available the 

6 information reported by States under paragraph (1). 

7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated $16,000,000 to carry 

9 out this section. Funds appropriated under this subsection 

10 shall remain available until expended.’’. 

11 (b) TECHNICAL AMENDMENT.—Section 

12 1139B(d)(1)(A) of the Social Security Act (42 U.S.C. 

13 1320b–9b(d)(1)(A)) is amended by striking ‘‘subsection 

14 (a)(5)’’ and inserting ‘‘subsection (b)(5)’’. 

15 SEC. 3. QUALITY COLLABORATIVES. 

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

17 Services (in this section referred to as the Secretary) may 

18 make grants to eligible entities to support— 

19 (1) the development of new State and regional 

20 maternity and infant care quality collaboratives; 

21 (2) expanded activities of existing maternity 

22 and infant care quality collaboratives; and 

23 (3) maternity and infant care initiatives within 

24 established State and regional quality collaboratives 

25 that are not focused exclusively on maternity care. 


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

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

3 (1) Quality collaboratives that focus entirely, or 

4 in part, on maternity and infant care initiatives, to 

5 the extent that such collaboratives use such grant 

6 only for such initiatives. 

7 (2) Entities seeking to establish a maternity 

8 and infant care quality collaborative. 

9 (3) State Medicaid agencies. 

10 (4) State departments of health. 

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

12 defined in section 2791 of the Public Health Service 

13 Act (42 U.S.C. 300gg–91)). 

14 (6) Provider organizations, including associa15 tions representing— 

16 (A) health professionals; and 

17 (B) hospitals. 

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

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

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

21 must have goals that are designed to improve the quality 

22 of maternity care delivered, such as— 

23 (1) improving the appropriate use of caesarean 

24 section; 


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1 (2) reducing maternal and newborn morbidity 

2 rates; 

3 (3) improving breast-feeding rates; 

4 (4) reducing hospital readmission rates; 

5 (5) identifying improvement priorities through 

6 shared peer review and third-party reviews of quali7 tative and quantitative data, and developing and car8 rying out projects or programs to address such pri9 orities; or 

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

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

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

13 (1) Facilitating performance data collection and 

14 feedback reports to providers with respect to their 

15 performance, relative to peers and benchmarks, if 

16 any. 

17 (2) Developing, implementing, and evaluating 

18 protocols and checklists to foster safe, evidence19 based practice. 

20 (3) Developing, implementing, and evaluating 

21 programs that translate into practice clinical rec22 ommendations supported by high-quality evidence in 

23 national guidelines, systematic reviews, or other well24 conducted clinical studies. 


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1 (4) Developing underlying infrastructure needed 

2 to support quality collaborative activities under this 

3 subsection. 

4 (5) Providing technical assistance to providers 

5 and institutions to build quality improvement capac6 ity and facilitate participation in collaborative activi7 ties. 

8 (6) Developing the capability to access the fol9 lowing data sources: 

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

11 postpartum records. 

12 (B) A mother’s medical records. 

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

14 (D) Birth and death certificates. 

15 (E) Any other relevant State-level gen16 erated data (such as data from the Pregnancy 

17 Risk Assessment Monitoring System (PRAMS)). 

18 (7) Developing access to blinded liability claims 

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

20 such analysis to improve practice. 

21 (e) SPECIAL RULE FOR BIRTHS.— 

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

23 a grant under subsection (a) is for a project or pro24 gram that focuses on births, at least 25 percent of 

25 the births addressed by such project or program 


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1 must occur in health facilities that perform fewer 

2 than 1,000 births per year. 

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

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

5 State in which less than 25 percent of the health fa6 cilities in the State perform less than 1,000 births 

7 per year, the percentage of births in such facilities 

8 addressed by such project or program shall be com9 mensurate with the Statewide percentage of births 

10 performed at such facilities. 

11 (f) USE OF QUALITY MEASURES.—Projects and pro12 grams for which such a grant is made shall— 

13 (1) include data collection with rapid analysis 

14 and feedback to participants with a focus on improv15 ing practice and health outcomes; 

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

17 collection problems; 

18 (3) identify and document evidence-based strat19 egies that will be used to improve performance on 

20 quality measures and other metrics; and 

21 (4) exclude from quality measure collection and 

22 reporting physicians and midwives who attend fewer 

23 than 30 births per year. 


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1 (g) REPORTING ON QUALITY MEASURES.—Any re2 porting requirements established by a project or program 

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

4 (1) minimize costs and administrative effort; 

5 and 

6 (2) use existing data resources when feasible. 

7 (h) CLEARINGHOUSE.—The Secretary shall establish 

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

9 procedures, reports, tools, and other resources of indi10 vidual collaboratives available to collaboratives and other 

11 entities that are working to improve maternity and infant 

12 care quality. 

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

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

15 (1) develop and carry out plans for evaluating 

16 its maternity and infant care quality improvement 

17 programs and projects; and 

18 (2) publish its experiences and results in arti19 cles, technical reports, or other formats for the ben20 efit of others working on maternity and infant care 

21 quality improvement activities. 

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

23 collaborative or other eligible entity that receives a grant 

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

25 Secretary containing the following: 


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1 (1) A description of the activities carried out 

2 using the funding from such grant. 

3 (2) A description of any barriers that limited 

4 the ability of the collaborative or entity to achieve its 

5 goals. 

6 (3) The achievements of the collaborative or en7 tity under the grant with respect to the quality, 

8 health outcomes, and value of maternity and infant 

9 care. 

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

11 Such reports shall be made available to the public. 

12 (k) GOVERNANCE.— 

13 (1) IN GENERAL.—A maternity and infant care 

14 quality collaborative or a maternity and infant care 

15 program within a broader quality collaborative that 

16 is supported under subsection (a) shall be governed 

17 by a multi-stakeholder executive committee. 

18 (2) COMPOSITION.—Such executive committee 

19 shall include individuals who represent— 

20 (A) physicians, including physicians in the 

21 fields of general obstetrics, maternal-fetal medi22 cine, family medicine, neonatology, and pediat23 rics; 

24 (B) nurse-practitioners and nurses; 


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1 (C) certified nurse-midwives and certified 

2 midwives; 

3 (D) health facilities and health systems; 

4 (E) consumers; 

5 (F) employers and other private pur6 chasers; 

7 (G) Medicaid programs; and 

8 (H) other public health agencies and orga9 nizations, as appropriate. 

10 Such committee also may include other individuals, 

11 such as individuals with expertise in health quality 

12 measurement and other types of expertise as rec13 ommended by the Secretary. Such committee also 

14 may be composed of a combination of general col15 laborative executive committee members and mater16 nity and infant specific project executive committee 

17 members. 

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

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

20 shall engage in regular ongoing consultation with— 

21 (1) regional and State public health agencies 

22 and organizations; 

23 (2) public and private health insurers; and 


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1 (3) regional and State organizations rep2 resenting physicians, midwives, and nurses who pro3 vide maternity and infant services. 

4 (m) AUTHORIZATION OF APPROPRIATIONS.—There 

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

6 out this section. Funds appropriated under this subsection 

7 shall remain available until expended. 

8 SEC. 4. FACILITATION OF INCREASED COORDINATION AND 

9 ALIGNMENT BETWEEN THE PUBLIC AND PRI10 VATE SECTOR WITH RESPECT TO QUALITY 

11 AND EFFICIENCY MEASURES. 

12 (a) IN GENERAL.—Section 1890(b) of the Social Se13 curity Act (42 U.S.C. 1395aaa(b)) is amended by insert14 ing after paragraph (3) the following new paragraph: 

15 ‘‘(4) FACILITATION OF INCREASED COORDINA16 TION AND ALIGNMENT BETWEEN THE PUBLIC AND

17 PRIVATE SECTOR WITH RESPECT TO QUALITY AND

18 EFFICIENCY MEASURES.— 

19 ‘‘(A) IN GENERAL.—The entity shall facili20 tate increased coordination and alignment be21 tween the public and private sector with respect 

22 to quality and efficiency measures. 

23 ‘‘(B) ANNUAL REPORTS.—The entity shall 

24 prepare and make available to the public its 

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1 port. Such public availability shall include post2 ing each report on the Internet website of the 

3 entity.’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 subsection (a) shall take effect on the date of enactment 

6 of this Act. 

Æ 


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