I 

113TH CONGRESS 

1ST SESSION H. R. 896 

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 

FEBRUARY 28, 2013 

Mr. ENGEL introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

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 of 

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

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

Sec. 3. Quality collaboratives. 

1 SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER 

2 MEDICAID AND CHIP. 

3 (a) IN GENERAL.—Section 1139A of the Social Secu4 rity Act (42 U.S.C. 1320b–9a) is amended by adding at 

5 the end the following new subsection: 

6 ‘‘(j) MOTHER AND INFANT CARE (MIC) QUALITY

7 MEASURES.— 

8 ‘‘(1) IN GENERAL.—As part of the pediatric 

9 quality measures program established under sub10 section (b) and the Medicaid Quality Measurement 

11 Program established under section 1139B(b)(5)(A), 

12 the Secretary shall— 

13 ‘‘(A) review quality measures endorsed 

14 under section 1890(b)(2) that relate to the care 

15 of childbearing women and newborns, particu16 larly with respect to the application of such 

17 measures to the Medicaid and CHIP programs 

18 under titles XIX and XXI, and identify omis19 sions and deficiencies in the application of those 

20 measures to such programs; 

21 ‘‘(B) develop and publish a set of mater22 nity care quality measures for the Medicaid and 

23 CHIP programs under titles XIX and XXI (in 

24 this subsection referred to as the ‘Mother and 


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1 Infant Care (MIC) quality measures’) in ac2 cordance with the requirements of paragraphs 

3 (2) and (3); and 

4 ‘‘(C) on an ongoing basis, review the MIC 

5 quality measures and develop and publish any 

6 modifications of, or additions or deletions to, 

7 such measures that reflect the development, 

8 testing, validation, and consensus process de9 scribed in paragraph (4). 

10 ‘‘(2) PROCESS FOR INITIAL REVIEW AND PUBLI11 CATION.— 

12 ‘‘(A) CONSULTATION AND PUBLIC COM13 MENT.—Not later than January 1, 2016, the 

14 Secretary shall— 

15 ‘‘(i) solicit public comment on the pro16 posed MIC quality measures; and 

17 ‘‘(ii) consult with the stakeholders 

18 identified in paragraph (6)(A) regarding 

19 such measures. 

20 ‘‘(B) PUBLICATION OF INITIAL SET OF

21 MEASURES.—Not later than January 1, 2017, 

22 the Secretary shall identify and publish the ini23 tial MIC quality measures. 

24 ‘‘(3) REQUIREMENTS.— 


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1 ‘‘(A) IN GENERAL.—The MIC quality 

2 measures shall— 

3 ‘‘(i) be evidence-based; 

4 ‘‘(ii) utilize risk adjustment or risk 

5 stratification methodologies, if appropriate; 

6 ‘‘(iii) utilize attribution methods to 

7 specify the clinicians, facilities, and other 

8 entities that the measures are applicable 

9 to; 

10 ‘‘(iv) be pilot-tested with regard to 

11 scientific validity, feasibility, and attribu12 tion method; and 

13 ‘‘(v) include a balance of each of the 

14 types of measures listed in subparagraph 

15 (B). 

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

17 measures listed in this subparagraph are the 

18 following: 

19 ‘‘(i) Measures of the process, experi20 ence, efficiency, and outcomes of maternity 

21 care, including postpartum outcomes. 

22 ‘‘(ii) Measures that apply to— 

23 ‘‘(I) women and newborns who 

24 are healthy and at low risk, including 

25 measures of appropriately low-interVerDate Mar 15 2010 18:04 Mar 04, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H896.IH H896

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1 vention, physiologic birth in low-risk 

2 women; and 

3 ‘‘(II) women and newborns at 

4 higher risk. 

5 ‘‘(iii) Measures that apply to— 

6 ‘‘(I) childbearing women; and 

7 ‘‘(II) newborns. 

8 ‘‘(iv) Measures that apply to care dur9 ing— 

10 ‘‘(I) pregnancy; 

11 ‘‘(II) intrapartum period; and 

12 ‘‘(III) the postpartum period. 

13 ‘‘(v) Measures that apply to— 

14 ‘‘(I) clinicians and clinician 

15 groups; 

16 ‘‘(II) facilities; 

17 ‘‘(III) health plans; and 

18 ‘‘(IV) accountable care organiza19 tions. 

20 ‘‘(vi) Measurement of— 

21 ‘‘(I) disparities; 

22 ‘‘(II) care coordination; and 

23 ‘‘(III) shared decisionmaking. 

24 ‘‘(C) PHYSIOLOGIC DEFINED.—For pur25 poses of this paragraph, the term ‘physiologic’ 


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1 means characteristic of or conforming to the 

2 normal functioning or state of the body or a tis3 sue or organ, normal, and not pathologic. 

4 ‘‘(D) CONSTRUCTION.—Nothing in this 

5 paragraph shall be construed as supporting the 

6 restriction of coverage, under title XIX or XXI 

7 or otherwise, to only those services that are evi8 dence-based, or in any way limiting available 

9 services. 

10 ‘‘(4) ONGOING REVIEW OF THE MIC MEASURES; 

11 eMEASURES.— 

12 ‘‘(A) CONTRACTS WITH QUALIFIED ENTI13 TIES.—Not later than June 30, 2017, the Sec14 retary, acting through the Agency for 

15 Healthcare Research and Quality, in consulta16 tion with the Centers for Medicare & Medicaid 

17 Services, shall enter into grants, contracts, or 

18 intergovernmental agreements with qualified 

19 measure development entities for the purpose of 

20 identifying quality of care issues that are not 

21 adequately addressed by the MIC quality meas22 ures and developing, testing, and validating 

23 modifications of, or additions or deletions to, 

24 the MIC quality measures, and creating 


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1 eMeasures for data collection related to the 

2 MIC quality measures. 

3 ‘‘(B) QUALIFIED MEASURE DEVELOPMENT

4 ENTITY DEFINED.—For purposes of this para5 graph, the term ‘qualified measure development 

6 entity’ means an entity that— 

7 ‘‘(i) has demonstrated expertise and 

8 capacity in the development and testing of 

9 quality measures; 

10 ‘‘(ii) has adopted procedures for qual11 ity measure development that ensure the 

12 inclusion of— 

13 ‘‘(I) the views of the individuals 

14 and entities referred to in paragraph 

15 (3)(B)(v) and whose performance will 

16 be assessed by the measures; and 

17 ‘‘(II) the views of other individ18 uals and entities (including patients, 

19 consumers, and health care pur20 chasers) who will use the data gen21 erated as a result of the use of the 

22 quality measures; 

23 ‘‘(iii) for the purpose of ensuring that 

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1 ment under section 1890(b)(2), has pro2 vided assurances to the Secretary that the 

3 measure development entity will collaborate 

4 with— 

5 ‘‘(I) the Secretary; 

6 ‘‘(II) the consensus-based entity 

7 with a contract under section 

8 1890(a)(1); and 

9 ‘‘(III) stakeholders (including 

10 those stakeholders identified in para11 graph (6)(A)), as practicable; 

12 ‘‘(iv) has transparent policies regard13 ing governance and conflicts of interest; 

14 and 

15 ‘‘(v) submits an application to the 

16 Secretary at such time, and in such form 

17 and manner, as the Secretary may require. 

18 ‘‘(C) eMEASURES.— 

19 ‘‘(i) IN GENERAL.—A qualified meas20 ure development entity with a grant, con21 tract, or intergovernmental agreement 

22 under subparagraph (A) shall consult with 

23 the voluntary consensus standards setting 

24 organizations and other organizations in25 volved in the advancement of evidenceVerDate Mar 15 2010 03:06 Mar 02, 2013 Jkt 029200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H896.IH H896

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1 based measures of health care that the 

2 Secretary consults with under subsection 

3 (b)(3)(H) and section 1139B(b)(5)(A) to 

4 create, as part of the MIC quality meas5 ures, eMeasures that are aligned with the 

6 measures developed under the pediatric 

7 quality measures program established 

8 under subsection (b) and the Medicaid 

9 Quality Measurement Program established 

10 under section 1139B(b)(5)(A). 

11 ‘‘(ii) eMEASURE DEFINED.—For pur12 poses of this subparagraph, the term 

13 ‘eMeasure’ means a measure for which 

14 measurement data (including clinical data) 

15 will be collected electronically, including 

16 through the use of electronic health 

17 records and other electronic data sources. 

18 ‘‘(D) ENDORSEMENT.—Any modifications 

19 of, or additions or deletions to, the MIC quality 

20 measures shall be submitted by the qualified 

21 measure development entity to the consensus22 based entity with a contract under section 

23 1890(a)(1) to be considered for endorsement 

24 under section 1890(b)(2). 


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1 ‘‘(5) MATERNITY CONSUMER ASSESSMENT OF

2 HEALTH CARE PROVIDERS AND SYSTEMS SUR3 VEYS.— 

4 ‘‘(A) ADAPTION OF SURVEYS.—Not later 

5 than January 1, 2018, for the purpose of meas6 uring the care experiences of childbearing 

7 women and newborns, the Agency for 

8 Healthcare Research and Quality shall adapt 

9 the Consumer Assessment of Healthcare Pro10 viders and Systems program surveys of— 

11 ‘‘(i) providers; 

12 ‘‘(ii) facilities; and 

13 ‘‘(iii) health plans. 

14 ‘‘(B) SURVEYS MUST BE EFFECTIVE.—The 

15 Agency for Healthcare Research and Quality 

16 shall ensure that the surveys adapted under 

17 subparagraph (A) are effective in measuring as18 pects of care that childbearing women and 

19 newborns experience, which may include— 

20 ‘‘(i) various types of care settings; 

21 ‘‘(ii) various types of caregivers; 

22 ‘‘(iii) considerations relating to pain; 

23 ‘‘(iv) shared decisionmaking; 

24 ‘‘(v) supportive care around the time 

25 of birth; and 


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1 ‘‘(vi) other topics relevant to the qual2 ity of the experience of childbearing women 

3 and newborns. 

4 ‘‘(C) LANGUAGES.—The surveys adapted 

5 under subparagraph (A) shall be available in 

6 English and Spanish. 

7 ‘‘(D) ENDORSEMENT.—The Agency for 

8 Healthcare Research and Quality shall submit 

9 any Consumer Assessment of Healthcare Pro10 viders and Systems surveys adapted under this 

11 paragraph to the consensus-based entity with a 

12 contract under section 1890(a)(1) to be consid13 ered for endorsement under section 1890(b)(2). 

14 ‘‘(E) CONSULTATION.—The adaption of 

15 (and process for applying) the surveys under 

16 subparagraph (A) shall be conducted in con17 sultation with the stakeholders identified in 

18 paragraph (6)(A). 

19 ‘‘(6) STAKEHOLDERS.— 

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

21 identified in this subparagraph are— 

22 ‘‘(i) the various clinical disciplines and 

23 specialties involved in providing maternity 

24 care; 

25 ‘‘(ii) State Medicaid administrators; 


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1 ‘‘(iii) maternity care consumers and 

2 their advocates; 

3 ‘‘(iv) technical experts in quality 

4 measurement; 

5 ‘‘(v) hospital, facility and health sys6 tem leaders; 

7 ‘‘(vi) employers and purchasers; and 

8 ‘‘(vii) other individuals who are in9 volved in the advancement of evidence10 based maternity care quality measures. 

11 ‘‘(B) PROFESSIONAL ORGANIZATIONS.— 

12 The stakeholders identified under subparagraph 

13 (A) may include representatives from relevant 

14 national medical specialty and professional or15 ganizations and specialty societies. 

16 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

17 There are authorized to be appropriated 

18 $16,000,000 to carry out this subsection. Funds ap19 propriated under this paragraph shall remain avail20 able until expended.’’. 

21 (b) CONFORMING AMENDMENTS.— 

22 (1) Section 1139A of the Social Security Act 

23 (42 U.S.C. 1320b–9a) is amended— 

24 (A) in subsection (a)(6), in the matter pre25 ceding subparagraph (A), by inserting ‘‘and the 


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1 Medicaid and CHIP Payment and Access Com2 mission’’ after ‘‘Congress’’; and 

3 (B) in subsection (i), by striking ‘‘sub4 section (e)’’ and inserting ‘‘subsections (e) and 

5 (j)’’. 

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. 

Æ 


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