II 

116TH CONGRESS 

1ST SESSION S. 1960 

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 

JUNE 25, 2019 

Ms. STABENOW (for herself and Ms. COLLINS) 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. 

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

and private sector with respect to quality and efficiency measures. 

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, 


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1 that may be applicable to Medicaid and CHIP eligi2 ble mothers and infants. 

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

4 In identifying and publishing the recommended core 

5 set of maternal and infant health quality measures 

6 required under paragraph (1), the Secretary shall 

7 ensure that, to the extent possible, such measures 

8 align with and do not duplicate— 

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

10 measures identified, published, and revised 

11 under section 1139A; or 

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

13 measures identified, published, and revised 

14 under section 1139B. 

15 ‘‘(3) PROCESS FOR MATERNAL AND INFANT

16 QUALITY MEASURES PROGRAM.—In identifying gaps 

17 in existing maternal and infant measures and estab18 lishing priorities for the development and advance19 ment of such measures, the Secretary shall consult 

20 with— 

21 ‘‘(A) States; 

22 ‘‘(B) physicians, including physicians in 

23 the fields of general obstetrics, maternal-fetal 

24 medicine, family medicine, neonatology, and pe25 diatrics; 


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1 ‘‘(C) nurse practitioners and nurses; 

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

3 midwives; 

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

5 ‘‘(F) national organizations representing 

6 mothers and infants; 

7 ‘‘(G) national organizations representing 

8 consumers and purchasers of health care; 

9 ‘‘(H) national organizations and individ10 uals with expertise in maternal and infant 

11 health quality measurement; and 

12 ‘‘(I) voluntary consensus standard-setting 

13 organizations and other organizations involved 

14 in the advancement of evidence-based measures 

15 of health care. 

16 ‘‘(b) DEADLINES.— 

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

18 than January 1, 2021, the Secretary shall identify 

19 and publish for comment a recommended core set of 

20 maternal and infant health quality measures that in21 cludes the following: 

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

23 efficiency, and outcomes of maternity care, in24 cluding postpartum outcomes. 


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1 ‘‘(B) Measures that apply to childbearing 

2 women and newborns at healthy, low, and high 

3 risk, including measures of low-intervention 

4 birth. 

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

6 pregnancy, the intrapartum period, and the 

7 postpartum period. 

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

9 settings and provider types, such as clinics, fa10 cilities, health plans, and accountable care orga11 nizations. 

12 ‘‘(E) Measures that address disparities, 

13 care coordination, and shared decisionmaking. 

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

15 1, 2022, the Secretary shall publish an initial core 

16 set of maternal and infant health quality measures 

17 that are applicable to Medicaid and CHIP eligible 

18 mothers and infants. 

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

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

21 with States, shall develop a standardized format for 

22 reporting information based on the initial core set of 

23 maternal and infant health quality measures and 

24 create procedures to encourage States to use such 

25 measures to voluntarily report information regarding 


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1 the quality of health care for Medicaid and CHIP el2 igible mothers and infants. 

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

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

5 Secretary shall include in the report to Congress re6 quired under section 1139A(a)(6) information simi7 lar to the information required under that section 

8 with respect to the measures established under this 

9 section. 

10 ‘‘(5) ESTABLISHMENT OF MATERNAL AND IN11 FANT QUALITY MEASUREMENT PROGRAM.— 

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

13 months after the release of the recommended 

14 core set of maternal and infant health quality 

15 measures under paragraph (1), the Secretary 

16 shall establish a Maternal and Infant Quality 

17 Measurement Program in the same manner as 

18 the Secretary established the pediatric quality 

19 measures program under section 1139A(b). 

20 ‘‘(B) REVISING, STRENGTHENING, AND IM21 PROVING INITIAL CORE MEASURES.—Beginning 

22 not later than 24 months after the establish23 ment of the Maternal and Infant Quality Meas24 urement Program, and annually thereafter, the 

25 Secretary shall publish recommended changes 


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1 to the initial core set of maternal and infant 

2 health quality measures that shall reflect the 

3 results of the testing, validation, and consensus 

4 process for the development of maternal and in5 fant health quality measures. 

6 ‘‘(C) EMEASURES.— 

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

8 a grant or contract by the Secretary to de9 velop emerging and innovative evidence10 based measures under the Maternal and 

11 Infant Quality Measurement Program shall 

12 work to advance eMeasures that are 

13 aligned with the measures developed under 

14 the Pediatric Quality Measures Program 

15 established under section 1139A(b) and 

16 the Medicaid Quality Measurement Pro17 gram established under section 

18 1139B(b)(5). 

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

20 this subparagraph, the term ‘eMeasure’ 

21 means an electronic measure for which 

22 measurement data (including clinical data) 

23 will be collected electronically, including 

24 through the use of electronic health 

25 records and other electronic data sources. 


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1 ‘‘(D) AMOUNT AVAILABLE FOR GRANTS

2 AND CONTRACTS.—The aggregate amount of 

3 funds that may be awarded as grants and con4 tracts under the Maternal and Infant Quality 

5 Measurement Program for the development, 

6 testing, and validation of emerging and innova7 tive evidence-based measures shall not exceed 

8 the aggregate amount of funds awarded as 

9 grants and contracts under section 

10 1139A(b)(4)(A). 

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

12 be construed as supporting the restriction of coverage, 

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

14 that are evidence-based, or in any way limiting available 

15 services. 

16 ‘‘(d) MATERNITY CONSUMER ASSESSMENT OF

17 HEALTH CARE PROVIDERS AND SYSTEMS SURVEYS.— 

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

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

20 care experiences of childbearing women and 

21 newborns, where appropriate, the Agency for 

22 Healthcare Research and Quality shall adapt Con23 sumer Assessment of Healthcare Providers and Sys24 tems program surveys of— 

25 ‘‘(A) providers; 


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1 ‘‘(B) facilities; and 

2 ‘‘(C) health plans. 

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

4 Agency for Healthcare Research and Quality shall 

5 ensure that the surveys adapted under paragraph 

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

7 childbearing women and newborns experience, which 

8 may include— 

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

10 ‘‘(B) various types of caregivers; 

11 ‘‘(C) considerations relating to pain; 

12 ‘‘(D) shared decisionmaking; 

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

14 birth; and 

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

16 the experience of childbearing women and 

17 newborns. 

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

19 paragraph (1) shall be available in English and 

20 Spanish. 

21 ‘‘(4) ENDORSEMENT.—The Agency for Health22 care Research and Quality shall submit any Con23 sumer Assessment of Healthcare Providers and Sys24 tems surveys adapted under this paragraph to the 

25 consensus-based entity with a contract under section 


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

2 section 1890(b)(2). 

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

4 process for applying) the surveys under paragraph 

5 (1) shall be conducted in consultation with the 

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

7 ‘‘(6) STAKEHOLDERS.— 

8 ‘‘(A) IN GENERAL.—The stakeholders 

9 identified in this subparagraph are— 

10 ‘‘(i) the various clinical disciplines and 

11 specialties involved in providing maternity 

12 care; 

13 ‘‘(ii) State Medicaid administrators; 

14 ‘‘(iii) maternity care consumers and 

15 their advocates; 

16 ‘‘(iv) technical experts in quality 

17 measurement; 

18 ‘‘(v) hospital, facility, and health sys19 tem leaders; 

20 ‘‘(vi) employers and purchasers; and 

21 ‘‘(vii) other individuals who are in22 volved in the advancement of evidence23 based maternity care quality measures. 

24 ‘‘(B) PROFESSIONAL ORGANIZATIONS.— 

25 The stakeholders identified under subparagraph 


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1 (A) may include representatives from relevant 

2 national medical specialty and professional or3 ganizations and specialty societies. 

4 ‘‘(e) ANNUAL STATE REPORTS REGARDING STATE5 SPECIFIC MATERNAL AND INFANT QUALITY OF CARE

6 MEASURES APPLIED UNDER MEDICAID OR CHIP.— 

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

8 waiver approved under title XIX or XXI shall annu9 ally report (separately or as part of the annual re10 port required under section 1139A(c)) to the Sec11 retary on— 

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

13 health quality measures applied by the State 

14 under such plan or waiver, including measures 

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

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

17 quality of health care furnished to Medicaid and 

18 CHIP eligible mothers and infants under such 

19 plan or waiver, including information collected 

20 through external quality reviews of managed 

21 care organizations under section 1932 and 

22 benchmark plans under section 1937. 

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

24 30, 2024, and annually thereafter, the Secretary 


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1 shall collect, analyze, and make publicly available the 

2 information reported by States under paragraph (1). 

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

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

5 out this section. Funds appropriated under this subsection 

6 shall remain available until expended.’’. 

7 (b) TECHNICAL AMENDMENT.—Section 

8 1139B(d)(1)(A) of the Social Security Act (42 U.S.C. 

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

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

11 SEC. 3. QUALITY COLLABORATIVES. 

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

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

14 make grants to eligible entities to support— 

15 (1) the development of new State and regional 

16 maternity and infant care quality collaboratives; 

17 (2) expanded activities of existing maternity 

18 and infant care quality collaboratives; and 

19 (3) maternity and infant care initiatives within 

20 established State and regional quality collaboratives 

21 that are not focused exclusively on maternity care. 

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

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

24 (1) Quality collaboratives that focus entirely, or 

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


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1 the extent that such collaboratives use such grant 

2 only for such initiatives. 

3 (2) Entities seeking to establish a maternity 

4 and infant 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 caesarean 

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 Monitoring System (PRAMS)). 

13 (7) Developing access to blinded liability claims 

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

15 such analysis to improve practice. 

16 (e) SPECIAL RULE FOR BIRTHS.— 

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

18 a grant under subsection (a) is for a project or pro19 gram that focuses on births, at least 25 percent of 

20 the births addressed by such project or program 

21 must occur in health facilities that perform fewer 

22 than 1,000 births per year. 

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

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

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1 cilities in the State perform less than 1,000 births 

2 per year, the percentage of births in such facilities 

3 addressed by such project or program shall be com4 mensurate with the Statewide percentage of births 

5 performed at such facilities. 

6 (f) USE OF QUALITY MEASURES.—Projects and pro7 grams for which such a grant is made shall— 

8 (1) include data collection with rapid analysis 

9 and feedback to participants with a focus on improv10 ing practice and health outcomes; 

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

12 collection problems; 

13 (3) identify and document evidence-based strat14 egies that will be used to improve performance on 

15 quality measures and other metrics; and 

16 (4) exclude from quality measure collection and 

17 reporting physicians and midwives who attend fewer 

18 than 30 births per year. 

19 (g) REPORTING ON QUALITY MEASURES.—Any re20 porting requirements established by a project or program 

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

22 (1) minimize costs and administrative effort; 

23 and 

24 (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 and infant 

6 care quality. 

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 and infant care quality improvement 

11 programs 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 and infant care 

15 quality improvement 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 and infant 

4 care. 

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

6 Such reports shall be made available to the public. 

7 (k) GOVERNANCE.— 

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

9 quality collaborative or a maternity and infant care 

10 program within a broader quality collaborative that 

11 is supported under subsection (a) shall be governed 

12 by a multi-stakeholder executive committee. 

13 (2) COMPOSITION.—Such executive committee 

14 shall include individuals who represent— 

15 (A) physicians, including physicians in the 

16 fields of general obstetrics, maternal-fetal medi17 cine, family medicine, neonatology, and pediat18 rics; 

19 (B) nurse-practitioners and nurses; 

20 (C) certified nurse-midwives and certified 

21 midwives; 

22 (D) health facilities and health systems; 

23 (E) consumers; 

24 (F) employers and other private pur25 chasers; 


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1 (G) Medicaid programs; and 

2 (H) other public health agencies and orga3 nizations, as appropriate. 

4 Such committee also may include other individuals, 

5 such as individuals with expertise in health quality 

6 measurement and other types of expertise as rec7 ommended by the Secretary. Such committee also 

8 may be composed of a combination of general col9 laborative executive committee members and mater10 nity and infant specific project executive committee 

11 members. 

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

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

14 shall engage in regular ongoing consultation with— 

15 (1) regional and State public health agencies 

16 and organizations; 

17 (2) public and private health insurers; and 

18 (3) regional and State organizations rep19 resenting physicians, midwives, and nurses who pro20 vide maternity and infant services. 

21 (m) AUTHORIZATION OF APPROPRIATIONS.—There 

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

23 out this section. Funds appropriated under this subsection 

24 shall remain available until expended. 


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1 SEC. 4. FACILITATION OF INCREASED COORDINATION AND 

2 ALIGNMENT BETWEEN THE PUBLIC AND PRI3 VATE SECTOR WITH RESPECT TO QUALITY 

4 AND EFFICIENCY MEASURES. 

5 (a) IN GENERAL.—Section 1890(b) of the Social Se6 curity Act (42 U.S.C. 1395aaa(b)) is amended by insert7 ing after paragraph (3) the following new paragraph: 

8 ‘‘(4) FACILITATION OF INCREASED COORDINA9 TION AND ALIGNMENT BETWEEN THE PUBLIC AND

10 PRIVATE SECTOR WITH RESPECT TO QUALITY AND

11 EFFICIENCY MEASURES.— 

12 ‘‘(A) IN GENERAL.—The entity shall facili13 tate increased coordination and alignment be14 tween the public and private sector with respect 

15 to quality and efficiency measures. 

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

17 prepare and make available to the public its 

18 findings under this paragraph in its annual re19 port. Such public availability shall include post20 ing each report on the Internet website of the 

21 entity.’’. 

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

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

24 of this Act. 

Æ 


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