II 

115TH CONGRESS 

2D SESSION S. 2637 

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 SENATE OF THE UNITED STATES 

APRIL 10, 2018 

Ms. STABENOW (for herself, Mr. BROWN, Mr. REED, Mr. BLUMENTHAL, Mr. 

HEINRICH, 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 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’’. 

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

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

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

Sec. 3. Quality collaboratives. 

1 SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT 

2 HEALTH. 

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

4 (42 U.S.C. 1301 et seq.) is amended by inserting after 

5 section 1139B the following new section: 

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

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

8 QUALITY MEASURES FOR MATERNAL AND INFANT

9 HEALTH.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall iden11 tify and publish a recommended core set of maternal 

12 and infant health quality measures for women and 

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

14 section 1902(l)(1) in the same manner as the Sec15 retary identifies and publishes a core set of child 

16 health quality measures under section 1139A, in17 cluding with respect to identifying and publishing 

18 existing maternal and infant health quality measures 

19 that are in use under public and privately sponsored 

20 health care coverage arrangements, or that are part 

21 of reporting systems that measure both the presence 

22 and duration of health insurance coverage over time, 

23 that may be applicable to Medicaid and CHIP eligi24 ble mothers and infants. 


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

2 In identifying and publishing the recommended core 

3 set core set of maternal and infant health quality 

4 measures required under paragraph (1), the Sec5 retary shall ensure that, to the extent possible, such 

6 measures align with and do not duplicate— 

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

8 measures identified, published, and revised 

9 under section 1139A; or 

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

11 measures identified, published, and revised 

12 under section 1139B. 

13 ‘‘(3) PROCESS FOR MATERNAL AND INFANT

14 QUALITY MEASURES PROGRAM.—In identifying gaps 

15 in existing maternal and infant measures and estab16 lishing priorities for the development and advance17 ment of such measures, the Secretary shall consult 

18 with— 

19 ‘‘(A) States; 

20 ‘‘(B) physicians, including physicians in 

21 the fields of general obstetrics, maternal-fetal 

22 medicine, family medicine, neonatology, and pe23 diatrics; 

24 ‘‘(C) nurse practitioners and nurses; 


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

2 midwives; 

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

4 ‘‘(F) national organizations representing 

5 mothers and infants; 

6 ‘‘(G) national organizations representing 

7 consumers and purchasers of health care; 

8 ‘‘(H) national organizations and individ9 uals with expertise in maternal and infant 

10 health quality measurement; and 

11 ‘‘(I) voluntary consensus standard-setting 

12 organizations and other organizations involved 

13 in the advancement of evidence-based measures 

14 of health care. 

15 ‘‘(b) DEADLINES.— 

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

17 than January 1, 2021, the Secretary shall identify 

18 and publish for comment a recommended core set of 

19 maternal and infant health quality measures that in20 cludes the following: 

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

22 efficiency, and outcomes of maternity care, in23 cluding postpartum outcomes. 

24 ‘‘(B) Measures that apply to childbearing 

25 women and newborns at healthy, low, and high 


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1 risk, including measures of low-intervention 

2 birth. 

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

4 pregnancy, the intrapartum period, and the 

5 postpartum period. 

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

7 settings and provider types, such as clinics, fa8 cilities, health plans, and accountable care orga9 nizations. 

10 ‘‘(E) Measures that address disparities, 

11 care coordination, and shared decisionmaking. 

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

13 1, 2022, the Secretary shall publish an initial core 

14 set of maternal and infant health quality measures 

15 that are applicable to Medicaid and CHIP eligible 

16 mothers and infants. 

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

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

19 with States, shall develop a standardized format for 

20 reporting information based on the initial core set of 

21 maternal and infant health quality measures and 

22 create procedures to encourage States to use such 

23 measures to voluntarily report information regarding 

24 the quality of health care for Medicaid and CHIP el25 igible mothers and infants. 


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

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

3 Secretary shall include in the report to Congress re4 quired under section 1139A(a)(6) information simi5 lar to the information required under that section 

6 with respect to the measures established under this 

7 section. 

8 ‘‘(5) ESTABLISHMENT OF MATERNAL AND IN9 FANT QUALITY MEASUREMENT PROGRAM.— 

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

11 months after the release of the recommended 

12 core set of maternal and infant health quality 

13 measures under paragraph (1), the Secretary 

14 shall establish a Maternal and Infant Quality 

15 Measurement Program in the same manner as 

16 the Secretary established the pediatric quality 

17 measures program under section 1139A(b). 

18 ‘‘(B) REVISING, STRENGTHENING, AND IM19 PROVING INITIAL CORE MEASURES.—Beginning 

20 not later than 24 months after the establish21 ment of the Maternal and Infant Quality Meas22 urement Program, and annually thereafter, the 

23 Secretary shall publish recommended changes 

24 to the initial core set of maternal and infant 

25 health quality measures that shall reflect the 


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1 results of the testing, validation, and consensus 

2 process for the development of maternal and in3 fant health quality measures. 

4 ‘‘(C) EMEASURES.— 

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

6 a grant or contract by the Secretary to de7 velop emerging and innovative evidence8 based measures under the Maternal and 

9 Infant Quality Measurement Program shall 

10 work to advance eMeasures that are 

11 aligned with the measures developed under 

12 the Pediatric Quality Measures Program 

13 established under section 1139A(b) and 

14 the Medicaid Quality Measurement Pro15 gram established under section 

16 1139B(b)(5). 

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

18 this subparagraph, the term eMeasure 

19 means an electronic measure for which 

20 measurement data (including clinical data) 

21 will be collected electronically, including 

22 through the use of electronic health 

23 records and other electronic data sources. 

24 ‘‘(D) AMOUNT AVAILABLE FOR GRANTS

25 AND CONTRACTS.—The aggregate amount of 


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1 funds that may be awarded as grants and con2 tracts under the Maternal and Infant Quality 

3 Measurement Program for the development, 

4 testing, and validation of emerging and innova5 tive evidence-based measures shall not exceed 

6 the aggregate amount of funds awarded as 

7 grants and contracts under section 

8 1139A(b)(4)(A). 

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

10 be construed as supporting the restriction of coverage, 

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

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

13 services. 

14 ‘‘(d) MATERNITY CONSUMER ASSESSMENT OF

15 HEALTH CARE PROVIDERS AND SYSTEMS SURVEYS.— 

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

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

18 care experiences of childbearing women and 

19 newborns, where appropriate, the Agency for 

20 Healthcare Research and Quality shall adapt Con21 sumer Assessment of Healthcare Providers and Sys22 tems program surveys of— 

23 ‘‘(A) providers; 

24 ‘‘(B) facilities; and 

25 ‘‘(C) health plans. 


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

2 Agency for Healthcare Research and Quality shall 

3 ensure that the surveys adapted under paragraph 

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

5 childbearing women and newborns experience, which 

6 may include— 

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

8 ‘‘(B) various types of caregivers; 

9 ‘‘(C) considerations relating to pain; 

10 ‘‘(D) shared decisionmaking; 

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

12 birth; and 

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

14 the experience of childbearing women and 

15 newborns. 

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

17 paragraph (1) shall be available in English and 

18 Spanish. 

19 ‘‘(4) ENDORSEMENT.—The Agency for 

20 Healthcare Research and Quality shall submit any 

21 Consumer Assessment of Healthcare Providers and 

22 Systems surveys adapted under this paragraph to 

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

2 process for applying) the surveys under paragraph 

3 (1) shall be conducted in consultation with the 

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

5 ‘‘(6) STAKEHOLDERS.— 

6 ‘‘(A) IN GENERAL.—The stakeholders 

7 identified in this subparagraph are— 

8 ‘‘(i) the various clinical disciplines and 

9 specialties involved in providing maternity 

10 care; 

11 ‘‘(ii) State Medicaid administrators; 

12 ‘‘(iii) maternity care consumers and 

13 their advocates; 

14 ‘‘(iv) technical experts in quality 

15 measurement; 

16 ‘‘(v) hospital, facility and health sys17 tem leaders; 

18 ‘‘(vi) employers and purchasers; and 

19 ‘‘(vii) other individuals who are in20 volved in the advancement of evidence21 based maternity care quality measures. 

22 ‘‘(B) PROFESSIONAL ORGANIZATIONS.— 

23 The stakeholders identified under subparagraph 

24 (A) may include representatives from relevant 


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1 national medical specialty and professional or2 ganizations and specialty societies. 

3 ‘‘(e) ANNUAL STATE REPORTS REGARDING STATE4 SPECIFIC MATERNAL AND INFANT QUALITY OF CARE

5 MEASURES APPLIED UNDER MEDICAID OR CHIP.— 

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

7 waiver approved under title XIX or XXI shall annu8 ally report (separately or as part of the annual re9 port required under section 1139A(c)) to the Sec10 retary on— 

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

12 health quality measures applied by the State 

13 under such plan or waiver, including measures 

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

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

16 quality of health care furnished to Medicaid and 

17 CHIP eligible mothers and infants under such 

18 plan or waiver, including information collected 

19 through external quality reviews of managed 

20 care organizations under section 1932 and 

21 benchmark plans under section 1937. 

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

23 30, 2024, and annually thereafter, the Secretary 

24 shall collect, analyze, and make publicly available the 

25 information reported by States under paragraph (1). 


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

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

3 out this section. Funds appropriated under this subsection 

4 shall remain available until expended.’’. 

5 (b) TECHNICAL AMENDMENT.—Section 

6 1139B(d)(1)(A) of the Social Security Act (42 U.S.C. 

7 1320b–9b(d)(1)(A)) is amended by striking ‘‘subsection 

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

9 SEC. 3. QUALITY COLLABORATIVES. 

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

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

12 make grants to eligible entities to support— 

13 (1) the development of new State and regional 

14 maternity and infant care quality collaboratives; 

15 (2) expanded activities of existing maternity 

16 and infant care quality collaboratives; and 

17 (3) maternity and infant care initiatives within 

18 established State and regional quality collaboratives 

19 that are not focused exclusively on maternity care. 

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

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

22 (1) Quality collaboratives that focus entirely, or 

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

24 the extent that such collaboratives use such grant 

25 only for such initiatives. 


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1 (2) Entities seeking to establish a maternity 

2 and infant care quality collaborative. 

3 (3) State Medicaid agencies. 

4 (4) State departments of health. 

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

6 defined in section 2791 of the Public Health Service 

7 Act (42 U.S.C. 300gg–91)). 

8 (6) Provider organizations, including associa9 tions representing— 

10 (A) health professionals; and 

11 (B) hospitals. 

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

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

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

15 must have goals that are designed to improve the quality 

16 of maternity care delivered, such as— 

17 (1) improving the appropriate use of cesarean 

18 section; 

19 (2) reducing maternal and newborn morbidity 

20 rates; 

21 (3) improving breast-feeding rates; 

22 (4) reducing hospital readmission rates; 

23 (5) identifying improvement priorities through 

24 shared peer review and third-party reviews of quali25 tative and quantitative data, and developing and carVerDate Sep 11 2014 23:51 Apr 10, 2018 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2637.IS S2637

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1 rying out projects or programs to address such pri2 orities; or 

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

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

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

6 (1) Facilitating performance data collection and 

7 feedback reports to providers with respect to their 

8 performance, relative to peers and benchmarks, if 

9 any. 

10 (2) Developing, implementing, and evaluating 

11 protocols and checklists to foster safe, evidence12 based practice. 

13 (3) Developing, implementing, and evaluating 

14 programs that translate into practice clinical rec15 ommendations supported by high-quality evidence in 

16 national guidelines, systematic reviews, or other well17 conducted clinical studies. 

18 (4) Developing underlying infrastructure needed 

19 to support quality collaborative activities under this 

20 subsection. 

21 (5) Providing technical assistance to providers 

22 and institutions to build quality improvement capac23 ity and facilitate participation in collaborative activi24 ties. 


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1 (6) Developing the capability to access the fol2 lowing data sources: 

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

4 postpartum records. 

5 (B) A mother’s medical records. 

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

7 (D) Birth and death certificates. 

8 (E) Any other relevant State-level gen9 erated data (such as data from the pregnancy 

10 risk assessment management system 

11 (PRAMS)). 

12 (7) Developing access to blinded liability claims 

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

14 such analysis to improve practice. 

15 (e) SPECIAL RULE FOR BIRTHS.— 

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

17 a grant under subsection (a) is for a project or pro18 gram that focuses on births, at least 25 percent of 

19 the births addressed by such project or program 

20 must occur in health facilities that perform fewer 

21 than 1,000 births per year. 

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

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

24 State in which less than 25 percent of the health fa25 cilities in the State perform less than 1,000 births 


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1 per year, the percentage of births in such facilities 

2 addressed by such project or program shall be com3 mensurate with the Statewide percentage of births 

4 performed at such facilities. 

5 (f) USE OF QUALITY MEASURES.—Projects and pro6 grams for which such a grant is made shall— 

7 (1) include data collection with rapid analysis 

8 and feedback to participants with a focus on improv9 ing practice and health outcomes; 

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

11 collection problems; 

12 (3) identify and document evidence-based strat13 egies that will be used to improve performance on 

14 quality measures and other metrics; and 

15 (4) exclude from quality measure collection and 

16 reporting physicians and midwives who attend fewer 

17 than 30 births per year. 

18 (g) REPORTING ON QUALITY MEASURES.—Any re19 porting requirements established by a project or program 

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

21 (1) minimize costs and administrative effort; 

22 and 

23 (2) use existing data resources when feasible. 

24 (h) CLEARINGHOUSE.—The Secretary shall establish 

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


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1 procedures, reports, tools, and other resources of indi2 vidual collaboratives available to collaboratives and other 

3 entities that are working to improve maternity and infant 

4 care quality. 

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

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

7 (1) develop and carry out plans for evaluating 

8 its maternity and infant care quality improvement 

9 programs and projects; and 

10 (2) publish its experiences and results in arti11 cles, technical reports, or other formats for the ben12 efit of others working on maternity and infant care 

13 quality improvement activities. 

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

15 collaborative or other eligible entity that receives a grant 

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

17 Secretary containing the following: 

18 (1) A description of the activities carried out 

19 using the funding from such grant. 

20 (2) A description of any barriers that limited 

21 the ability of the collaborative or entity to achieve its 

22 goals. 

23 (3) The achievements of the collaborative or en24 tity under the grant with respect to the quality, 


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1 health outcomes, and value of maternity and infant 

2 care. 

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

4 Such reports shall be made available to the public. 

5 (k) GOVERNANCE.— 

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

7 quality collaborative or a maternity and infant care 

8 program within a broader quality collaborative that 

9 is supported under subsection (a) shall be governed 

10 by a multi-stakeholder executive committee. 

11 (2) COMPOSITION.—Such executive committee 

12 shall include individuals who represent— 

13 (A) physicians, including physicians in the 

14 fields of general obstetrics, maternal-fetal medi15 cine, family medicine, neonatology, and pediat16 rics; 

17 (B) nurse-practitioners and nurses; 

18 (C) certified nurse-midwives and certified 

19 midwives; 

20 (D) health facilities and health systems; 

21 (E) consumers; 

22 (F) employers and other private pur23 chasers; 

24 (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 and infant specific project executive committee 

10 members. 

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

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

13 shall engage in regular ongoing consultation with— 

14 (1) regional and State public health agencies 

15 and organizations; 

16 (2) public and private health insurers; and 

17 (3) regional and State organizations rep18 resenting physicians, midwives, and nurses who pro19 vide maternity and infant services. 

20 (m) AUTHORIZATION OF APPROPRIATIONS.—There 

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

22 out this section. Funds appropriated under this subsection 

23 shall remain available until expended. 

Æ 


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