I 

115TH CONGRESS 

2D SESSION H. R. 5457 

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 

APRIL 10, 2018 

Mr. ENGEL (for himself, Mr. STIVERS, Mrs. DINGELL, Mr. BEN RAY LUJA ́N

of New Mexico, Mr. GARAMENDI, Ms. LEE, Mr. SCHIFF, Mr. YOUNG of 

Alaska, Ms. MATSUI, Mr. BLUMENAUER, Mr. CA ́RDENAS, Mr. YARMUTH, 

Ms. MICHELLE LUJAN GRISHAM of New Mexico, Ms. ROYBAL-ALLARD, 

and Ms. WASSERMAN SCHULTZ) introduced the following bill; which was 

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

the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XI of the Social Security Act to improve 

the quality, health outcomes, and value of maternity 

care under the Medicaid and CHIP programs by developing maternity care quality measures and supporting 

maternity care quality collaboratives. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Quality Care for Moms and Babies Act’’. 

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

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

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

Sec. 3. Quality collaboratives. 

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

and private sector with respect to quality and efficiency measures. 

6 SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT 

7 HEALTH. 

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

9 (42 U.S.C. 1301 et seq.) is amended by inserting after 

10 section 1139B the following new section: 

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

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

13 QUALITY MEASURES FOR MATERNAL AND INFANT

14 HEALTH.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall iden16 tify and publish a recommended core set of maternal 

17 and infant health quality measures for women and 

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

19 section 1902(l)(1) in the same manner as the Sec20 retary identifies and publishes a core set of child 

21 health quality measures under section 1139A, in22 cluding with respect to identifying and publishing 


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1 existing maternal and infant health quality measures 

2 that are in use under public and privately sponsored 

3 health care coverage arrangements, or that are part 

4 of reporting systems that measure both the presence 

5 and duration of health insurance coverage over time, 

6 that may be applicable to Medicaid and CHIP eligi7 ble mothers and infants. 

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

9 In identifying and publishing the recommended core 

10 set of maternal and infant health quality measures 

11 required under paragraph (1), the Secretary shall 

12 ensure that, to the extent possible, such measures 

13 align with and do not duplicate— 

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

15 measures identified, published, and revised 

16 under section 1139A; or 

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

18 measures identified, published, and revised 

19 under section 1139B. 

20 ‘‘(3) PROCESS FOR MATERNAL AND INFANT

21 QUALITY MEASURES PROGRAM.—In identifying gaps 

22 in existing maternal and infant measures and estab23 lishing priorities for the development and advance24 ment of such measures, the Secretary shall consult 

25 with— 


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1 ‘‘(A) States; 

2 ‘‘(B) physicians, including physicians in 

3 the fields of general obstetrics, maternal-fetal 

4 medicine, family medicine, neonatology, and pe5 diatrics; 

6 ‘‘(C) nurse practitioners and nurses; 

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

8 midwives; 

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

10 ‘‘(F) national organizations representing 

11 mothers and infants; 

12 ‘‘(G) national organizations representing 

13 consumers and purchasers of health care; 

14 ‘‘(H) national organizations and individ15 uals with expertise in maternal and infant 

16 health quality measurement; and 

17 ‘‘(I) voluntary consensus standard-setting 

18 organizations and other organizations involved 

19 in the advancement of evidence-based measures 

20 of health care. 

21 ‘‘(b) DEADLINES.— 

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

23 than January 1, 2021, the Secretary shall identify 

24 and publish for comment a recommended core set of 


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1 maternal and infant health quality measures that in2 cludes the following: 

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

4 efficiency, and outcomes of maternity care, in5 cluding postpartum outcomes. 

6 ‘‘(B) Measures that apply to childbearing 

7 women and newborns at healthy, low, and high 

8 risk, including measures of low-intervention 

9 birth. 

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

11 pregnancy, the intrapartum period, and the 

12 postpartum period. 

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

14 settings and provider types, such as clinics, fa15 cilities, health plans, and accountable care orga16 nizations. 

17 ‘‘(E) Measures that address disparities, 

18 care coordination, and shared decisionmaking. 

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

20 1, 2022, the Secretary shall publish an initial core 

21 set of maternal and infant health quality measures 

22 that are applicable to Medicaid and CHIP eligible 

23 mothers and infants. 

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

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


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1 with States, shall develop a standardized format for 

2 reporting information based on the initial core set of 

3 maternal and infant health quality measures and 

4 create procedures to encourage States to use such 

5 measures to voluntarily report information regarding 

6 the quality of health care for Medicaid and CHIP el7 igible mothers and infants. 

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

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

10 Secretary shall include in the report to Congress re11 quired under section 1139A(a)(6) information simi12 lar to the information required under that section 

13 with respect to the measures established under this 

14 section. 

15 ‘‘(5) ESTABLISHMENT OF MATERNAL AND IN16 FANT QUALITY MEASUREMENT PROGRAM.— 

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

18 months after the release of the recommended 

19 core set of maternal and infant health quality 

20 measures under paragraph (1), the Secretary 

21 shall establish a Maternal and Infant Quality 

22 Measurement Program in the same manner as 

23 the Secretary established the pediatric quality 

24 measures program under section 1139A(b). 


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1 ‘‘(B) REVISING, STRENGTHENING, AND IM2 PROVING INITIAL CORE MEASURES.—Beginning 

3 not later than 24 months after the establish4 ment of the Maternal and Infant Quality Meas5 urement Program, and annually thereafter, the 

6 Secretary shall publish recommended changes 

7 to the initial core set of maternal and infant 

8 health quality measures that shall reflect the 

9 results of the testing, validation, and consensus 

10 process for the development of maternal and in11 fant health quality measures. 

12 ‘‘(C) EMEASURES.— 

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

14 a grant or contract by the Secretary to de15 velop emerging and innovative evidence16 based measures under the Maternal and 

17 Infant Quality Measurement Program shall 

18 work to advance eMeasures that are 

19 aligned with the measures developed under 

20 the Pediatric Quality Measures Program 

21 established under section 1139A(b) and 

22 the Medicaid Quality Measurement Pro23 gram established under section 

24 1139B(b)(5). 


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1 ‘‘(ii) DEFINITION.—For purposes of 

2 this subparagraph, the term eMeasure 

3 means an electronic measure for which 

4 measurement data (including clinical data) 

5 will be collected electronically, including 

6 through the use of electronic health 

7 records and other electronic data sources. 

8 ‘‘(D) AMOUNT AVAILABLE FOR GRANTS

9 AND CONTRACTS.—The aggregate amount of 

10 funds that may be awarded as grants and con11 tracts under the Maternal and Infant Quality 

12 Measurement Program for the development, 

13 testing, and validation of emerging and innova14 tive evidence-based measures shall not exceed 

15 the aggregate amount of funds awarded as 

16 grants and contracts under section 

17 1139A(b)(4)(A). 

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

19 be construed as supporting the restriction of coverage, 

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

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

22 services. 

23 ‘‘(d) MATERNITY CONSUMER ASSESSMENT OF

24 HEALTH CARE PROVIDERS AND SYSTEMS SURVEYS.— 


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

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

3 care experiences of childbearing women and 

4 newborns, where appropriate, the Agency for 

5 Healthcare Research and Quality shall adapt Con6 sumer Assessment of Healthcare Providers and Sys7 tems program surveys of— 

8 ‘‘(A) providers; 

9 ‘‘(B) facilities; and 

10 ‘‘(C) health plans. 

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

12 Agency for Healthcare Research and Quality shall 

13 ensure that the surveys adapted under paragraph 

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

15 childbearing women and newborns experience, which 

16 may include— 

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

18 ‘‘(B) various types of caregivers; 

19 ‘‘(C) considerations relating to pain; 

20 ‘‘(D) shared decisionmaking; 

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

22 birth; and 

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

24 the experience of childbearing women and 

25 newborns. 


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

2 paragraph (1) shall be available in English and 

3 Spanish. 

4 ‘‘(4) ENDORSEMENT.—The Agency for Health5 care Research and Quality shall submit any Con6 sumer Assessment of Healthcare Providers and Sys7 tems surveys adapted under this paragraph to the 

8 consensus-based entity with a contract under section 

9 1890(a)(1) to be considered for endorsement under 

10 section 1890(b)(2). 

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

12 process for applying) the surveys under paragraph 

13 (1) shall be conducted in consultation with the 

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

15 ‘‘(6) STAKEHOLDERS.— 

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

17 identified in this subparagraph are— 

18 ‘‘(i) the various clinical disciplines and 

19 specialties involved in providing maternity 

20 care; 

21 ‘‘(ii) State Medicaid administrators; 

22 ‘‘(iii) maternity care consumers and 

23 their advocates; 

24 ‘‘(iv) technical experts in quality 

25 measurement; 


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1 ‘‘(v) hospital, facility and health sys2 tem leaders; 

3 ‘‘(vi) employers and purchasers; and 

4 ‘‘(vii) other individuals who are in5 volved in the advancement of evidence6 based maternity care quality measures. 

7 ‘‘(B) PROFESSIONAL ORGANIZATIONS.— 

8 The stakeholders identified under subparagraph 

9 (A) may include representatives from relevant 

10 national medical specialty and professional or11 ganizations and specialty societies. 

12 ‘‘(e) ANNUAL STATE REPORTS REGARDING STATE13 SPECIFIC MATERNAL AND INFANT QUALITY OF CARE

14 MEASURES APPLIED UNDER MEDICAID OR CHIP.— 

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

16 waiver approved under title XIX or XXI shall annu17 ally report (separately or as part of the annual re18 port required under section 1139A(c)) to the Sec19 retary on— 

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

21 health quality measures applied by the State 

22 under such plan or waiver, including measures 

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

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

25 quality of health care furnished to Medicaid and 


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1 CHIP eligible mothers and infants under such 

2 plan or waiver, including information collected 

3 through external quality reviews of managed 

4 care organizations under section 1932 and 

5 benchmark plans under section 1937. 

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

7 30, 2024, and annually thereafter, the Secretary 

8 shall collect, analyze, and make publicly available the 

9 information reported by States under paragraph (1). 

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

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

12 out this section. Funds appropriated under this subsection 

13 shall remain available until expended.’’. 

14 (b) TECHNICAL AMENDMENT.—Section 

15 1139B(d)(1)(A) of the Social Security Act (42 U.S.C. 

16 1320b–9b(d)(1)(A)) is amended by striking ‘‘subsection 

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

18 SEC. 3. QUALITY COLLABORATIVES. 

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

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

21 make grants to eligible entities to support— 

22 (1) the development of new State and regional 

23 maternity and infant care quality collaboratives; 

24 (2) expanded activities of existing maternity 

25 and infant care quality collaboratives; and 


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1 (3) maternity and infant care initiatives within 

2 established State and regional quality collaboratives 

3 that are not focused exclusively on maternity care. 

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

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

6 (1) Quality collaboratives that focus entirely, or 

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

8 the extent that such collaboratives use such grant 

9 only for such initiatives. 

10 (2) Entities seeking to establish a maternity 

11 and infant care quality collaborative. 

12 (3) State Medicaid agencies. 

13 (4) State departments of health. 

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

15 defined in section 2791 of the Public Health Service 

16 Act (42 U.S.C. 300gg–91)). 

17 (6) Provider organizations, including associa18 tions representing— 

19 (A) health professionals; and 

20 (B) hospitals. 

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

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

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

24 must have goals that are designed to improve the quality 

25 of maternity care delivered, such as— 


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1 (1) improving the appropriate use of caesarean 

2 section; 

3 (2) reducing maternal and newborn morbidity 

4 rates; 

5 (3) improving breast-feeding rates; 

6 (4) reducing hospital readmission rates; 

7 (5) identifying improvement priorities through 

8 shared peer review and third-party reviews of quali9 tative and quantitative data, and developing and car10 rying out projects or programs to address such pri11 orities; or 

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

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

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

15 (1) Facilitating performance data collection and 

16 feedback reports to providers with respect to their 

17 performance, relative to peers and benchmarks, if 

18 any. 

19 (2) Developing, implementing, and evaluating 

20 protocols and checklists to foster safe, evidence21 based practice. 

22 (3) Developing, implementing, and evaluating 

23 programs that translate into practice clinical rec24 ommendations supported by high-quality evidence in 


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1 national guidelines, systematic reviews, or other well2 conducted clinical studies. 

3 (4) Developing underlying infrastructure needed 

4 to support quality collaborative activities under this 

5 subsection. 

6 (5) Providing technical assistance to providers 

7 and institutions to build quality improvement capac8 ity and facilitate participation in collaborative activi9 ties. 

10 (6) Developing the capability to access the fol11 lowing data sources: 

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

13 postpartum records. 

14 (B) A mother’s medical records. 

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

16 (D) Birth and death certificates. 

17 (E) Any other relevant State-level gen18 erated data (such as data from the pregnancy 

19 risk assessment monitoring system (PRAMS)). 

20 (7) Developing access to blinded liability claims 

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

22 such analysis to improve practice. 

23 (e) SPECIAL RULE FOR BIRTHS.— 

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

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1 gram that focuses on births, at least 25 percent of 

2 the births addressed by such project or program 

3 must occur in health facilities that perform fewer 

4 than 1,000 births per year. 

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

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

7 State in which less than 25 percent of the health fa8 cilities in the State perform less than 1,000 births 

9 per year, the percentage of births in such facilities 

10 addressed by such project or program shall be com11 mensurate with the Statewide percentage of births 

12 performed at such facilities. 

13 (f) USE OF QUALITY MEASURES.—Projects and pro14 grams for which such a grant is made shall— 

15 (1) include data collection with rapid analysis 

16 and feedback to participants with a focus on improv17 ing practice and health outcomes; 

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

19 collection problems; 

20 (3) identify and document evidence-based strat21 egies that will be used to improve performance on 

22 quality measures and other metrics; and 

23 (4) exclude from quality measure collection and 

24 reporting physicians and midwives who attend fewer 

25 than 30 births per year. 


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

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

4 (1) minimize costs and administrative effort; 

5 and 

6 (2) use existing data resources when feasible. 

7 (h) CLEARINGHOUSE.—The Secretary shall establish 

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

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

11 entities that are working to improve maternity and infant 

12 care quality. 

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

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

15 (1) develop and carry out plans for evaluating 

16 its maternity and infant care quality improvement 

17 programs and projects; and 

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

21 quality improvement activities. 

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

23 collaborative or other eligible entity that receives a grant 

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

25 Secretary containing the following: 


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1 (1) A description of the activities carried out 

2 using the funding from such grant. 

3 (2) A description of any barriers that limited 

4 the ability of the collaborative or entity to achieve its 

5 goals. 

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

8 health outcomes, and value of maternity and infant 

9 care. 

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

11 Such reports shall be made available to the public. 

12 (k) GOVERNANCE.— 

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

14 quality collaborative or a maternity and infant care 

15 program within a broader quality collaborative that 

16 is supported under subsection (a) shall be governed 

17 by a multi-stakeholder executive committee. 

18 (2) COMPOSITION.—Such executive committee 

19 shall include individuals who represent— 

20 (A) physicians, including physicians in the 

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

24 (B) nurse-practitioners and nurses; 


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1 (C) certified nurse-midwives and certified 

2 midwives; 

3 (D) health facilities and health systems; 

4 (E) consumers; 

5 (F) employers and other private pur6 chasers; 

7 (G) Medicaid programs; and 

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

10 Such committee also may include other individuals, 

11 such as individuals with expertise in health quality 

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

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

17 members. 

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

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

20 shall engage in regular ongoing consultation with— 

21 (1) regional and State public health agencies 

22 and organizations; 

23 (2) public and private health insurers; and 


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

4 (m) AUTHORIZATION OF APPROPRIATIONS.—There 

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

6 out this section. Funds appropriated under this subsection 

7 shall remain available until expended. 

8 SEC. 4. FACILITATION OF INCREASED COORDINATION AND 

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

11 AND EFFICIENCY MEASURES. 

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

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

17 PRIVATE SECTOR WITH RESPECT TO QUALITY AND

18 EFFICIENCY MEASURES.— 

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

22 to quality and efficiency measures. 

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

24 prepare and make available to the public its 

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

3 entity.’’. 

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

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

6 of this Act. 

Æ 


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