I 

111TH CONGRESS 

2D SESSION H. R. 6437 

To amend title XIX 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, identifying payment mechanism improvements, and identifying 

essential evidence-based maternity care services. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2010 

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

was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX 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, 

identifying payment mechanism improvements, and identifying essential evidence-based maternity care services. 

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. 

4 This Act may be cited as the ‘‘Partnering to Improve 

5 Maternity Care Quality Act of 2010’’. 


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1 SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER 

2 MEDICAID AND CHIP. 

3 Title XIX of the Social Security Act is amended by 

4 inserting after section 1139B the following new section: 

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

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

7 maternity care quality measurement program for care pro8 vided to childbearing women and newborns for use by— 

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

10 under title XIX or a State Child Health Plan under 

11 title XXI; 

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

13 defined in section 2791 of the Public Health Service 

14 Act (42 U.S.C. 300gg–91)) and managed care enti15 ties that enter into contracts with States for the 

16 purpose of administering such plans; and 

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

18 accountable care organizations) with respect to items 

19 and services provided under such plans. 

20 ‘‘(b) IDENTIFICATION OF AN INITIAL SET OF MATER21 NITY CARE QUALITY MEASURES.— 

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

23 2013, the Secretary shall identify, and publish, from 

24 maternity care quality measures endorsed under sec25 tion 1890(b)(2), an initial core set of maternity care 


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1 quality measures for use in data collection and re2 porting by— 

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

4 under title XIX or a State Child Health Plan 

5 under title XXI; 

6 ‘‘(B) health insurance issuers (as such 

7 term is defined in section 2791 of the Public 

8 Health Service Act (42 U.S.C. 300gg–91)) and 

9 managed care entities that enter into contracts 

10 with States for the purpose of administering 

11 such plans; and 

12 ‘‘(C) providers of items and services (in13 cluding accountable care organizations) with re14 spect to items and services provided under such 

15 plans. 

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

17 Not later than January 1, 2012, 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 ‘‘(c) DEVELOPMENT OF ADDITIONAL QUALITY

25 MEASURES.— 


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

2 Not later than the end of the 6-month period begin3 ning on the date the Secretary publishes the initial 

4 measures under subsection (b)(1), the Secretary, 

5 acting through the Agency for Healthcare Research 

6 and Quality, in consultation with the Centers for 

7 Medicare & Medicaid Services, shall enter into 

8 grants, contracts, or intergovernmental agreements 

9 with qualified measure development entities for the 

10 purpose of developing, testing, and validating mater11 nity care quality measures in areas that are not ade12 quately covered by the measures identified under 

13 subsection (b)(1). 

14 ‘‘(2) QUALIFIED MEASURE DEVELOPMENT EN15 TITY DEFINED.—For purposes of this subsection, 

16 the term ‘qualified measure development entity’ 

17 means an entity that— 

18 ‘‘(A) has demonstrated expertise and ca19 pacity in the development and testing of quality 

20 measures; 

21 ‘‘(B) has adopted procedures for quality 

22 measure development that ensure the inclusion 

23 of— 

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

25 entities who are identified in subsection 


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1 (d)(2)(E) and whose performance will be 

2 assessed by the measures; and 

3 ‘‘(ii) the views of other individuals 

4 and entities (including patients, con5 sumers, and health care purchasers) who 

6 will use the data generated as a result of 

7 the use of the quality measures; 

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

9 quality measures developed under this sub10 section meet the requirements to be considered 

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

12 provided assurances to the Secretary that the 

13 measure development entity will collaborate 

14 with— 

15 ‘‘(i) the Secretary; 

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

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

18 ‘‘(iii) stakeholders (including those 

19 stakeholders identified in subsection 

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

21 ‘‘(D) has transparent policies regarding 

22 governance and conflicts of interest; and 

23 ‘‘(E) submits an application to the Sec24 retary at such time, and in such form and man25 ner, as the Secretary may require. 


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1 ‘‘(3) EMEASURES.— 

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

3 development entity with a grant, contract, or 

4 intergovernmental agreement under paragraph 

5 (1), in developing quality measures, shall use 

6 the measure-authoring tool of the consensus7 based entity with a contract under section 

8 1890(a)(1) to create eMeasures that make use 

9 of and build upon the quality dataset developed 

10 under subsection (g). 

11 ‘‘(B) EMEASURE DEFINED.—For purposes 

12 of this paragraph, the term ‘eMeasure’ means a 

13 measure for which measurement data (including 

14 clinical data) will be collected electronically, in15 cluding through the use of electronic health 

16 records and other electronic data sources. 

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

18 quality measures developed under this subsection by 

19 a qualified measure development entity shall be sub20 mitted by the qualified measure development entity 

21 to the consensus-based entity with a contract under 

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

23 under section 1890(b)(2). 

24 ‘‘(d) TYPES OF MEASURES.— 


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

2 measures identified under subsection (b) and the 

3 measures developed under subsection (c) shall— 

4 ‘‘(A) be evidence-based and, as appro5 priate, risk-adjusted; and 

6 ‘‘(B) include a balance of each of the types 

7 of measures listed in paragraph (2). 

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

9 measures listed in this paragraph are the following: 

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

11 efficiency, and outcomes of maternity care, in12 cluding postpartum outcomes. 

13 ‘‘(B) Measures that apply to— 

14 ‘‘(i) women and newborns who are 

15 healthy and at low risk, including meas16 ures of appropriately low-intervention, 

17 physiologic birth in low-risk women; and 

18 ‘‘(ii) women and newborns at higher 

19 risk. 

20 ‘‘(C) Measures that apply to— 

21 ‘‘(i) childbearing women; and 

22 ‘‘(ii) newborns. 

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

24 ‘‘(i) pregnancy; 

25 ‘‘(ii) intrapartum period; and 


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1 ‘‘(iii) the postpartum period. 

2 ‘‘(E) Measures that apply to— 

3 ‘‘(i) clinicians and clinician groups; 

4 ‘‘(ii) facilities; 

5 ‘‘(iii) health plans; and 

6 ‘‘(iv) accountable care organizations. 

7 ‘‘(F) Measurement of— 

8 ‘‘(i) disparities; 

9 ‘‘(ii) care coordination; and 

10 ‘‘(iii) shared decision making. 

11 ‘‘(e) MATERNITY CONSUMER ASSESSMENT OF

12 HEALTHCARE PROVIDERS AND SYSTEMS SURVEYS.— 

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

14 January 1, 2014, for the purpose of measuring the 

15 care experiences of childbearing women and 

16 newborns, the Agency for Healthcare Research and 

17 Quality shall adapt the Consumer Assessment of 

18 Healthcare Providers and Systems program surveys 

19 of— 

20 ‘‘(A) providers; 

21 ‘‘(B) facilities; and 

22 ‘‘(C) health plans. 

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

24 Agency for Healthcare Research and Quality shall 

25 ensure that the surveys adapted under paragraph 


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

2 childbearing women and newborns experience, in3 cluding aspects related to— 

4 ‘‘(A) various care settings; 

5 ‘‘(B) various types of caregivers; 

6 ‘‘(C) considerations relating to pain; 

7 ‘‘(D) the use of medications; 

8 ‘‘(E) shared decision making— 

9 ‘‘(i) during pregnancy; 

10 ‘‘(ii) in the intrapartum period; and 

11 ‘‘(iii) in the postpartum period; and 

12 ‘‘(F) the provision of information, emo13 tional support, and comfort measures during 

14 the intrapartum period. 

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

16 paragraph (1) shall be available in English and 

17 Spanish. 

18 ‘‘(4) ENDORSEMENT.—The Agency for 

19 Healthcare Research and Quality shall submit any 

20 Consumer Assessment of Healthcare Providers and 

21 Systems surveys adapted under this subsection to 

22 the consensus-based entity with a contract under 

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

24 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 subsection (i)(1). 

5 ‘‘(f) MEASUREMENT REPORTING.— 

6 ‘‘(1) VOLUNTARY REPORTING.—The Secretary 

7 shall encourage voluntary and standardized report8 ing to the Secretary, using the maternity care qual9 ity measures identified under subsection (b) and de10 veloped under subsection (c) and the surveys adapt11 ed under subsection (e), by— 

12 ‘‘(A) clinicians (including physicians, mid13 wives, and clinician groups); 

14 ‘‘(B) facilities (including hospitals and 

15 freestanding birth centers); 

16 ‘‘(C) accountable care organizations; and 

17 ‘‘(D) health plans, 

18 on the performance of such clinicians, facilities, ac19 countable care organizations, or plans. 

20 ‘‘(2) STANDARDIZED FORMAT AND PROCESS.— 

21 Not later than January 1, 2013, the Secretary, in 

22 consultation with the stakeholders identified under 

23 subsection (i)(1), shall— 


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1 ‘‘(A)(i) develop, validate, and test formats 

2 and processes for standardized reporting under 

3 paragraph (1)— 

4 ‘‘(I) to the clinicians, facilities, ac5 countable care organizations, health plans, 

6 and State agencies identified in paragraph 

7 (3); and 

8 ‘‘(II) to the patients, policymakers, 

9 and payers identified in paragraph (4)(A); 

10 and 

11 ‘‘(ii) update such formats and processes to 

12 incorporate any additional quality measures de13 veloped under subsection (c) and any surveys 

14 developed under subsection (e); and 

15 ‘‘(B) reflect best practices for timely, accu16 rate, effective communications for quality meas17 ures, and update such formats and processes as 

18 appropriate. 

19 ‘‘(3) FEEDBACK REPORTS.— 

20 ‘‘(A) CLINICIANS, FACILITIES, ACCOUNT21 ABLE CARE ORGANIZATIONS, AND HEALTH

22 PLANS.—If the Secretary receives a report from 

23 a clinician, facility, accountable care organiza24 tion, or health plan under paragraph (1), the 

25 Secretary shall provide, annually, to such cliniVerDate Mar 15 2010 02:38 Nov 19, 2010 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6437.IH H6437

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1 cian, facility, accountable care organization, or 

2 health plan a confidential feedback report that 

3 contains quality measure data collected through 

4 the report received under paragraph (1), and, if 

5 feasible, risk-adjusted benchmarks. Such feed6 back reports shall be designed and used for the 

7 purpose of quality improvement by such clini8 cian, facility, accountable care organization, or 

9 plan. 

10 ‘‘(B) STATE AGENCIES.—The Secretary 

11 shall provide an annual report to the State 

12 agency administering or supervising the admin13 istration of a State plan under title XIX or a 

14 State Child Health plan under title XXI on the 

15 quality of care provided by clinicians, facilities, 

16 accountable care organizations, and health 

17 plans in such State. 

18 ‘‘(4) PUBLIC AVAILABILITY OF DATA.— 

19 ‘‘(A) IN GENERAL.—Subject to subpara20 graph (B), the data contained in the reports 

21 under paragraph (1) shall be made available 

22 to— 

23 ‘‘(i) patients to use in maternity care 

24 decision making; and 


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1 ‘‘(ii) policymakers and purchasers to 

2 assess the quality of maternity care serv3 ices provided under titles XIX and XXI. 

4 ‘‘(B) ENDORSED AND VALID.—Data re5 ported under this subsection may only be made 

6 available under this paragraph, or otherwise 

7 made public, if— 

8 ‘‘(i) such data are received— 

9 ‘‘(I) from a maternity care qual10 ity measure that is identified under 

11 subsection (b) or developed under sub12 section (c); or 

13 ‘‘(II) through the use of a survey 

14 adapted under subsection (e); 

15 ‘‘(ii) endorsed without time-limited 

16 qualification under section 1890(b)(2); and 

17 ‘‘(iii) the clinician, facility, account18 able care organization, or health plan that 

19 submitted such data has been given an op20 portunity to confirm the quality and accu21 racy of such data. 

22 ‘‘(g) CONVERSION OF CURRENTLY ENDORSED MEAS23 URES AND CREATION OF INITIAL QUALITY DATASET TO

24 ENABLE ELECTRONIC HEALTH RECORDS TO MEASURE


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1 THE CARE OF CHILDBEARING WOMEN AND

2 NEWBORNS.— 

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

4 2012, for the purpose of fostering automated pa5 tient-centered longitudinal quality measurement of 

6 maternity and newborn care using clinical data, the 

7 consensus-based entity with a contract under section 

8 1890(b)(2) shall coordinate— 

9 ‘‘(A) the conversion of endorsed measures 

10 for the care of childbearing women and 

11 newborns to eMeasures (as such term is defined 

12 in subsection (c)(3)(B)); and 

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

14 dataset for use within electronic health records 

15 of childbearing women and newborns enrolled in 

16 a program administered by a State through 

17 State plans under title XIX and State Child 

18 Health plans under title XXI for purposes of 

19 such eMeasures. 

20 ‘‘(2) REQUIREMENTS FOR EMEASURE CONVER21 SION AND DATASET CREATION.—The conversion to 

22 eMeasures and the dataset creation under paragraph 

23 (1) shall, for each quality measure of the care of 

24 childbearing women or newborns that the consensus25 based entity with a contract under section 


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1 1890(b)(2) endorses, use the entity’s measure au2 thoring tool to— 

3 ‘‘(A) specify standard data elements, qual4 ity data elements, and data flow connectors to 

5 electronic information; 

6 ‘‘(B) specify quality measure logical state7 ments; 

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

9 appropriate electronic health record test data10 base; 

11 ‘‘(D) finalize eMeasures for export to elec12 tronic health record systems; and 

13 ‘‘(E) carry out this work in— 

14 ‘‘(i) collaboration with the developer 

15 or sponsor of each endorsed measure, who 

16 is responsible, under an agreement with 

17 the entity that endorsed such measure, for 

18 updating such measure; and 

19 ‘‘(ii) consultation with the stake20 holders identified in subsection (i)(1). 

21 ‘‘(h) MEASUREMENT PROGRAM REPORTING.—Not 

22 later than January 1, 2014, and every 2 years thereafter, 

23 the Secretary shall submit to the Congress and the Med24 icaid and CHIP Payment and Access Commission a report 


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1 on the status of the maternity care quality measurement 

2 program under this section, including— 

3 ‘‘(1) the measured results in maternity care 

4 quality; 

5 ‘‘(2) trends over time in maternity care quality; 

6 ‘‘(3) the adequacy and use of the set of— 

7 ‘‘(A) the quality measures identified under 

8 subsection (b); 

9 ‘‘(B) the quality measures developed under 

10 subsection (c); and 

11 ‘‘(C) the surveys adapted under subsection 

12 (e); 

13 ‘‘(4) the adequacy and use of the reporting for14 mat under subsection (f)(2); 

15 ‘‘(5) the adequacy of the quality dataset under 

16 subsection (g); and 

17 ‘‘(6) any recommendations for programmatic 

18 and legislative changes needed to improve the quality 

19 of care provided to childbearing women and 

20 newborns under this title and title XXI, including 

21 recommendations for quality reporting by the States. 

22 ‘‘(i) STAKEHOLDERS.— 

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

24 in this subsection are— 

25 ‘‘(A) State Medicaid administrators; 


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1 ‘‘(B) maternal-fetal medicine specialists; 

2 ‘‘(C) obstetrician-gynecologists; 

3 ‘‘(D) family physicians; 

4 ‘‘(E) certified nurse-midwives; 

5 ‘‘(F) certified midwives; 

6 ‘‘(G) nurse practitioners; 

7 ‘‘(H) nurses; 

8 ‘‘(I) neonatologists; 

9 ‘‘(J) pediatricians; 

10 ‘‘(K) consumers and their advocates; 

11 ‘‘(L) health quality measurement experts; 

12 ‘‘(M) health quality measure developers; 

13 ‘‘(N) representatives from the consensus14 based entity with a contract under section 

15 1890(a) of the Social Security Act; 

16 ‘‘(O) electronic health record developers 

17 and vendors; 

18 ‘‘(P) employers and purchasers; 

19 ‘‘(Q) health facility and health system 

20 leaders; and 

21 ‘‘(R) other individuals who are involved in 

22 the advancement of evidence-based maternity 

23 care quality measures. 

24 ‘‘(2) PROFESSIONAL ORGANIZATIONS.—The 

25 stakeholders identified under paragraph (1) may inVerDate Mar 15 2010 02:38 Nov 19, 2010 Jkt 099200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H6437.IH H6437

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1 clude representatives from professional organizations 

2 and specialty societies (such as the American College 

3 of Obstetricians and Gynecologists, the American 

4 Academy of Family Physicians, the American Col5 lege of Nurse-Midwives, the Society for Maternal 

6 Fetal Medicine, and the Association of Women’s 

7 Health, Obstetric, and Neonatal Nurses). 

8 ‘‘(j) APPROPRIATION.—Out of any funds in the 

9 Treasury not otherwise appropriated, there are appro10 priated for each of fiscal years 2011 through 2015, such 

11 sums as may be necessary for the purpose of carrying out 

12 this section. Funds appropriated under this subsection 

13 shall remain available until expended.’’. 

14 SEC. 3. DEMONSTRATION PROJECT TO EVALUATE PAY15 MENT REFORM IN MATERNITY CARE. 

16 (a) IN GENERAL.—The Secretary of Health and 

17 Human Services shall establish a demonstration project 

18 to evaluate the use of alternative payment methods under 

19 the Medicaid program under title XIX of the Social Secu20 rity Act, for the purpose of— 

21 (1) improving the quality, value, and outcomes 

22 of maternity care by reliably delivering effective care 

23 that contributes to improved outcomes; and 

24 (2) reducing the costs of maternity care for 

25 beneficiaries under such program by— 


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1 (A) delivering effective care; 

2 (B) avoiding overuse of care that may 

3 cause harm to the beneficiary or a waste of re4 sources, without providing a benefit to the ben5 eficiary; and 

6 (C) discouraging the provision of care that 

7 lacks an evidence base and is contrary to strong 

8 recommendations supported by high quality evi9 dence in clinical practice guidelines from na10 tionally recognized specialty societies and pro11 fessional organizations. 

12 (b) PAYMENTS.— 

13 (1) REQUIREMENTS.—Payments made under 

14 the demonstration project under subsection (a) for 

15 the provision of medical services shall be adjusted 

16 for the health conditions and other characteristics of 

17 Medicaid beneficiaries, as determined by the Sec18 retary. 

19 (2) ALLOWABLE PAYMENT STRUCTURES.— 

20 Under the demonstration project under subsection 

21 (a), the Secretary may evaluate alternative payment 

22 methods, including the following: 

23 (A) Payments that are defined to cover 

24 services for a single episode of care for an indi25 vidual woman and her newborn, including— 


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1 (i) all care from the prenatal through 

2 the postpartum period; or 

3 (ii) all care received during the 

4 intrapartum period. 

5 (B) Payments based on a condition-ad6 justed capitated rate for a population of women 

7 and newborns. 

8 (C) Payments that cover multiple providers 

9 (such as hospitals, birth centers, physicians, 

10 midwives, and nurse practitioners) that would 

11 otherwise be paid separately. 

12 (D) Payments in the form of ‘‘virtual bun13 dling’’, in which providers are paid separately, 

14 but the amount of such payments are adjusted 

15 so that the total of the individual payments to 

16 each provider remains under a total payment 

17 budget for the episode of care. 

18 (E) Payments to providers (including 

19 doulas, and other providers of continuous labor 

20 support) and for services (such as shared deci21 sion making, breast-feeding support programs, 

22 and doula services) that may not currently be 

23 eligible for direct reimbursement under title 

24 XIX of the Social Security Act. 


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1 (F) Payments that cover multiple services 

2 that would otherwise be paid for separately, or 

3 that allow greater flexibility as to the type of 

4 provider, location of service, or approach to care 

5 than would otherwise be permitted, to enable 

6 providers to improve outcomes or value. 

7 (G) Other payment innovations that are 

8 likely to result in improved maternity care qual9 ity, outcomes, and value (such as payment of 

10 bonuses for improved outcomes or payments for 

11 care coordination). 

12 (3) EVALUATION AND MONITORING.—The Sec13 retary shall also make payments for the purpose of 

14 collecting data necessary for the evaluation and 

15 monitoring of the demonstration project under this 

16 section. 

17 (c) SCOPE AND SELECTION OF STATES.—The dem18 onstration project under subsection (a) shall be conducted 

19 in no more than 8 States, which shall be selected by the 

20 Secretary based on— 

21 (1) an application that— 

22 (A) is submitted by a entity or consortium 

23 that— 

24 (i) includes the single State agency 

25 under section 1902(a)(5); and 


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1 (ii) may include managed care organi2 zations, integrated health systems, and ac3 countable care organizations providing ma4 ternity care to Medicaid and CHIP bene5 ficiaries; and 

6 (B) specifies the regions and populations 

7 in the State that will be served by the entity or 

8 consortium under the demonstration project; 

9 (2) criteria designed to ensure that, as a whole, 

10 the demonstration project is, to the greatest extent 

11 possible, representative of the demographic and geo12 graphic composition of Medicaid beneficiaries nation13 ally; and 

14 (3) criteria designed to ensure that multiple 

15 payment models are tested through the demonstra16 tion project. 

17 (d) PROTECTIONS FOR BENEFICIARIES.— 

18 (1) NO ADDITIONAL COST SHARING.—Under 

19 the demonstration project under subsection (a), a 

20 Medicaid beneficiary shall not be liable for any cost 

21 sharing in excess of the amount of cost sharing that 

22 such beneficiary would otherwise be liable for under 

23 title XIX of the Social Security Act. 

24 (2) NO REDUCTION IN QUALITY.—A provider 

25 who provides services to a Medicaid beneficiary 


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1 under the demonstration project under subsection 

2 (a) shall provide services that the provider expects 

3 will result in a similar or improved health outcome 

4 for such beneficiary, compared with the services such 

5 beneficiary would receive under title XIX of the So6 cial Security Act if the beneficiary was not receiving 

7 services under the demonstration project. 

8 (3) NO DENIAL OF COVERED SERVICES.—In no 

9 case may a Medicaid beneficiary be denied maternity 

10 and nonmaternity items and services under the dem11 onstration project under subsection (a) than such 

12 beneficiary would otherwise receive under title XIX 

13 of the Social Security Act. 

14 (e) PERIOD.—The demonstration project under sub15 section (a) shall begin on January 1, 2012, and shall end 

16 on December 31, 2016. 

17 (f) REPORTS.— 

18 (1) STATE REPORTS.—Each entity or consor19 tium with an application that is approved under sub20 section (c) that participates in the demonstration 

21 project under subsection (a) shall report to the Sec22 retary, in a time, form, and manner specified by the 

23 Secretary, the data necessary to— 

24 (A) monitor the— 


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1 (i) health outcomes of participating 

2 beneficiaries; 

3 (ii) the costs of the project; and 

4 (iii) the quality of maternity care pro5 vided under the project; and 

6 (B) evaluate the rationale for the selection 

7 of the items and services included in any bun8 dled payment made by the entity or consortium 

9 under the project. 

10 (2) FINAL REPORT.—Not later than December 

11 31, 2017, the Secretary shall submit to Congress a 

12 report containing— 

13 (A) the results of the demonstration 

14 project under subsection (a); 

15 (B) an assessment of the influence of med16 ical liability on the results of such project; and 

17 (C) recommendations for changes in Med18 icaid payment policies to enhance the quality, 

19 health outcomes, and value of maternity care 

20 provided through the Medicaid program. 

21 SEC. 4. ESSENTIAL SERVICES FOR CHILDBEARING WOMEN 

22 AND NEWBORNS. 

23 (a) REPORT ON EVIDENCE-BASED MATERNITY CARE

24 SERVICES.—The Secretary of Health and Human Services 

25 is authorized to, and shall seek to, enter an agreement 


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1 with the Institute of Medicine of the National Academies 

2 to develop and, not later than January 1, 2013, publish 

3 a report that, on the basis of the best available evidence, 

4 identifies the following: 

5 (1) ESSENTIAL SERVICES.—The following es6 sential maternity care services: 

7 (A) A package of evidence-based maternity 

8 care services that the Institute of Medicine 

9 identifies as essential for the majority of child10 bearing women and newborns who are healthy 

11 and at low risk for complications during preg12 nancy, birth, the postpartum period, and the 

13 newborn period (the 28-day period beginning on 

14 the date of birth). 

15 (B) Any additional and differing maternity 

16 care services that the Institute of Medicine 

17 identifies as essential to women and newborns 

18 who are at higher risk than the individuals de19 scribed under paragraph (1) for complications 

20 during pregnancy, birth, the postpartum period, 

21 and the newborn period. 

22 (C) Any pre- and interconception care 

23 services that have been demonstrated to con24 tribute to improved maternal and newborn out25 comes. 


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1 (2) LIMITED VALUE AND UNDERSTUDIED SERV2 ICES.—Maternity care services that are identified by 

3 the Institute of Medicine as— 

4 (A) being of limited value (including use of 

5 a specific service for indications that are not 

6 supported); or 

7 (B) requiring comparative effectiveness re8 search to clarify the safety and effectiveness of 

9 such services. 

10 (b) STRENGTH OF EVIDENCE.—In identifying the es11 sential services under subsection (a)(1), the Institute of 

12 Medicine shall— 

13 (1) give priority to maternal care services that 

14 are supported for use for specific indications or pop15 ulations by systematic reviews with high- or mod16 erate-quality evidence and strong recommendations, 

17 as determined by a valid assessment system, such as 

18 GRADE (Grading of Recommendations Assessment, 

19 Development and Evaluation); and 

20 (2) clearly indicate if a service that is rec21 ommended as essential is based on lower quality evi22 dence or weaker recommendations than the levels de23 scribed under paragraph (1). 

24 (c) CONSULTATIVE PROCESS.— 


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•HR 6437 IH

1 (1) IN GENERAL.—The Institute of Medicine 

2 shall develop the report under subsection (a) in con3 sultation with a multistakeholder panel that includes 

4 representatives of— 

5 (A) clinicians with expertise in— 

6 (i) obstetrics; 

7 (ii) family medicine; 

8 (iii) pediatrics; 

9 (iv) midwifery; 

10 (v) nursing; 

11 (vi) maternal fetal medicine; 

12 (vii) genetics; 

13 (viii) anesthesia; 

14 (ix) substance abuse; 

15 (x) reproductive endocrinology; 

16 (xi) mental health; 

17 (xii) infectious disease; and 

18 (xiii) interconception care; 

19 (B) consumers and their advocates; 

20 (C) payers and purchasers; and 

21 (D) research methodology experts. 

22 (2) PROFESSIONAL ORGANIZATIONS.—The rep23 resentatives under paragraph (1) may include rep24 resentatives from professional organizations and spe25 cialty societies (such as the American College of ObVerDate Mar 15 2010 02:38 Nov 19, 2010 Jkt 099200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H6437.IH H6437

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•HR 6437 IH

1 stetricians and Gynecologists, the American Acad2 emy of Family Physicians, the American College of 

3 Nurse-Midwives, the Society for Maternal Fetal 

4 Medicine, and the Association of Women’s Health, 

5 Obstetric, and Neonatal Nurses). 

6 (d) DEFINITION OF MATERNAL CARE SERVICES.— 

7 For purposes of the report under subsection (a), the term 

8 ‘‘maternity care services’’ shall include— 

9 (1) services related to the confirmation of preg10 nancy and preconception, prenatal, intrapartum, 

11 postpartum, newborn, and interconception care; 

12 (2) newborn care services that are incidental to 

13 interconception care; 

14 (3) mental health and substance abuse services; 

15 and 

16 (4) support services (such as language trans17 lation and care coordination). 

18 (e) SENSE OF CONGRESS.—It is the sense of Con19 gress that the Administrator of the Centers for Medicare 

20 & Medicaid Services and the directors of State Medicaid 

21 agencies should ensure that the services available to child22 bearing women and newborns under the Medicaid program 

23 in each State are well-aligned with the essential maternity 

24 care services identified in subsection (a)(1). 

Æ 


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