II 

Calendar No. 179 

114TH CONGRESS 

1ST SESSION S. 466 

[Report No. 114–100] 

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 

FEBRUARY 11, 2015 

Ms. STABENOW (for herself, Mr. GRASSLEY, Mrs. BOXER, Mr. CASEY, Mr. 

HEINRICH, Mr. REED, Mr. SCHUMER, Mr. MENENDEZ, and Mr. BROWN) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

JULY 30, 2015 

Reported by Mr. HATCH, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

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. 


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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: 

Sec. 1. Short title; table of contents. 

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

Sec. 3. Quality collaboratives. 

8 SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER 

9 MEDICAID AND CHIP. 

10 (a) IN GENERAL.—Section 1139A of the Social Secu11 rity Act (42 U.S.C. 1320b–9a) is amended by adding at 

12 the end the following new subsection: 

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

14 MEASURES.— 

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

16 quality measures program established under sub17 section (b) and the Medicaid Quality Measurement 

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

19 the Secretary shall— 

20 ‘‘(A) review quality measures endorsed 

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

22 of childbearing women and newborns, particu23 larly with respect to the application of such 

24 measures to the Medicaid and CHIP programs 


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1 under titles XIX and XXI, and identify omis2 sions and deficiencies in the application of those 

3 measures to such programs; 

4 ‘‘(B) develop and publish a set of mater5 nity care quality measures for the Medicaid and 

6 CHIP programs under titles XIX and XXI (in 

7 this subsection referred to as the ‘Mother and 

8 Infant Care (MIC) quality measures’) in ac9 cordance with the requirements of paragraphs 

10 (2) and (3); and 

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

12 quality measures and develop and publish any 

13 modifications of, or additions or deletions to, 

14 such measures that reflect the development, 

15 testing, validation, and consensus process de16 scribed in paragraph (4). 

17 ‘‘(2) PROCESS FOR INITIAL REVIEW AND PUBLI18 CATION.— 

19 ‘‘(A) CONSULTATION AND PUBLIC COM20 MENT.—Not later than January 1, 2018, the 

21 Secretary shall— 

22 ‘‘(i) solicit public comment on the pro23 posed MIC quality measures; and 


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1 ‘‘(ii) consult with the stakeholders 

2 identified in paragraph (6)(A) regarding 

3 such measures. 

4 ‘‘(B) PUBLICATION OF INITIAL SET OF

5 MEASURES.—Not later than January 1, 2019, 

6 the Secretary shall identify and publish the ini7 tial MIC quality measures. 

8 ‘‘(3) REQUIREMENTS.— 

9 ‘‘(A) IN GENERAL.—The MIC quality 

10 measures shall— 

11 ‘‘(i) be evidence-based; 

12 ‘‘(ii) utilize risk adjustment or risk 

13 stratification methodologies, if appropriate; 

14 ‘‘(iii) utilize attribution methods to 

15 specify the clinicians, facilities, and other 

16 entities that the measures are applicable 

17 to; 

18 ‘‘(iv) be pilot-tested with regards to 

19 scientific validity, feasibility, and attribu20 tion method; and 

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

22 types of measures listed in subparagraph 

23 (B). 


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

2 measures listed in this subparagraph are the 

3 following: 

4 ‘‘(i) Measures of the process, experi5 ence, efficiency, and outcomes of maternity 

6 care, including postpartum outcomes. 

7 ‘‘(ii) Measures that apply to— 

8 ‘‘(I) women and newborns who 

9 are healthy and at low risk, including 

10 measures of appropriately low-inter11 vention, physiologic birth in low-risk 

12 women; and 

13 ‘‘(II) women and newborns at 

14 higher risk. 

15 ‘‘(iii) Measures that apply to— 

16 ‘‘(I) childbearing women; and 

17 ‘‘(II) newborns. 

18 ‘‘(iv) Measures that apply to care dur19 ing— 

20 ‘‘(I) pregnancy; 

21 ‘‘(II) the intrapartum period; and 

22 ‘‘(III) the postpartum period. 

23 ‘‘(v) Measures that apply to— 

24 ‘‘(I) clinicians and clinician 

25 groups; 


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1 ‘‘(II) facilities; 

2 ‘‘(III) health plans; and 

3 ‘‘(IV) accountable care organiza4 tions. 

5 ‘‘(vi) Measurement of— 

6 ‘‘(I) disparities; 

7 ‘‘(II) care coordination; and 

8 ‘‘(III) shared decisionmaking. 

9 ‘‘(C) PHYSIOLOGIC DEFINED.—For pur10 poses of this paragraph, the term ‘physiologic’ 

11 means characteristic of or conforming to the 

12 normal functioning or state of the body or a tis13 sue or organ, normal, and not pathologic. 

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

15 paragraph shall be construed as supporting the 

16 restriction of coverage, under title XIX or XXI 

17 or otherwise, to only those services that are evi18 dence-based, or in any way limiting available 

19 services. 

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

21 eMEASURES.— 

22 ‘‘(A) CONTRACTS WITH QUALIFIED ENTI23 TIES.—Not later than June 30, 2019, the Sec24 retary, acting through the Agency for 

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1 tion with the Centers for Medicare & Medicaid 

2 Services, shall enter into grants, contracts, or 

3 intergovernmental agreements with qualified 

4 measure development entities for the purpose of 

5 identifying quality of care issues that are not 

6 adequately addressed by the MIC quality meas7 ures and developing, testing, and validating 

8 modifications of, or additions or deletions to, 

9 the MIC quality measures, and creating 

10 eMeasures for data collection related to the 

11 MIC quality measures. 

12 ‘‘(B) QUALIFIED MEASURE DEVELOPMENT

13 ENTITY DEFINED.—For purposes of this para14 graph, the term ‘qualified measure development 

15 entity’ means an entity that— 

16 ‘‘(i) has demonstrated expertise and 

17 capacity in the development and testing of 

18 quality measures; 

19 ‘‘(ii) has adopted procedures for qual20 ity measure development that ensure the 

21 inclusion of— 

22 ‘‘(I) the views of the individuals 

23 and entities referred to in paragraph 

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

25 be assessed by the measures; and 


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1 ‘‘(II) the views of other individ2 uals and entities (including patients, 

3 consumers, and health care pur4 chasers) who will use the data gen5 erated as a result of the use of the 

6 quality measures; 

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

8 the MIC quality measures meet the re9 quirements to be considered for endorse10 ment under section 1890(b)(2), has pro11 vided assurances to the Secretary that the 

12 measure development entity will collaborate 

13 with— 

14 ‘‘(I) the Secretary; 

15 ‘‘(II) the consensus-based entity 

16 with a contract under section 

17 1890(a)(1); and 

18 ‘‘(III) stakeholders (including 

19 those stakeholders identified in para20 graph (6)(A)), as practicable; 

21 ‘‘(iv) has transparent policies regard22 ing governance and conflicts of interest; 

23 and 


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1 ‘‘(v) submits an application to the 

2 Secretary at such time, and in such form 

3 and manner, as the Secretary may require. 

4 ‘‘(C) eMEASURES.— 

5 ‘‘(i) IN GENERAL.—A qualified meas6 ure development entity with a grant, con7 tract, or intergovernmental agreement 

8 under subparagraph (A) shall consult with 

9 the voluntary consensus standards setting 

10 organizations and other organizations in11 volved in the advancement of evidence12 based measures of health care that the 

13 Secretary consults with under subsection 

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

15 create, as part of the MIC quality meas16 ures, eMeasures that are aligned with the 

17 measures developed under the pediatric 

18 quality measures program established 

19 under subsection (b) and the Medicaid 

20 Quality Measurement Program established 

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

22 ‘‘(ii) eMEASURE DEFINED.—For pur23 poses of this subparagraph, the term 

24 ‘eMeasure’ means a measure for which 

25 measurement data (including clinical data) 


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1 will be collected electronically, including 

2 through the use of electronic health 

3 records and other electronic data sources. 

4 ‘‘(D) ENDORSEMENT.—Any modifications 

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

6 measures shall be submitted by the qualified 

7 measure development entity to the consensus8 based entity with a contract under section 

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

10 under section 1890(b)(2). 

11 ‘‘(5) MATERNITY CONSUMER ASSESSMENT OF

12 HEALTH CARE PROVIDERS AND SYSTEMS SUR13 VEYS.— 

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

15 than January 1, 2020, for the purpose of meas16 uring the care experiences of childbearing 

17 women and newborns, the Agency for 

18 Healthcare Research and Quality shall adapt 

19 the Consumer Assessment of Healthcare Pro20 viders and Systems program surveys of— 

21 ‘‘(i) providers; 

22 ‘‘(ii) facilities; and 

23 ‘‘(iii) health plans. 

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

25 Agency for Healthcare Research and Quality 


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1 shall ensure that the surveys adapted under 

2 subparagraph (A) are effective in measuring as3 pects of care that childbearing women and 

4 newborns experience, which may include— 

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

6 ‘‘(ii) various types of caregivers; 

7 ‘‘(iii) considerations relating to pain; 

8 ‘‘(iv) shared decisionmaking; 

9 ‘‘(v) supportive care around the time 

10 of birth; and 

11 ‘‘(vi) other topics relevant to the qual12 ity of the experience of childbearing women 

13 and newborns. 

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

15 under subparagraph (A) shall be available in 

16 English and Spanish. 

17 ‘‘(D) ENDORSEMENT.—The Agency for 

18 Healthcare Research and Quality shall submit 

19 any Consumer Assessment of Healthcare Pro20 viders and Systems surveys adapted under this 

21 paragraph to the consensus-based entity with a 

22 contract under section 1890(a)(1) to be consid23 ered for endorsement under section 1890(b)(2). 

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

25 (and process for applying) the surveys under 


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1 subparagraph (A) shall be conducted in con2 sultation with the stakeholders identified in 

3 paragraph (6)(A). 

4 ‘‘(6) STAKEHOLDERS.— 

5 ‘‘(A) IN GENERAL.—The stakeholders 

6 identified in this subparagraph are— 

7 ‘‘(i) the various clinical disciplines and 

8 specialties involved in providing maternity 

9 care; 

10 ‘‘(ii) State Medicaid administrators; 

11 ‘‘(iii) maternity care consumers and 

12 their advocates; 

13 ‘‘(iv) technical experts in quality 

14 measurement; 

15 ‘‘(v) hospital, facility and health sys16 tem leaders; 

17 ‘‘(vi) employers and purchasers; and 

18 ‘‘(vii) other individuals who are in19 volved in the advancement of evidence20 based maternity care quality measures. 

21 ‘‘(B) PROFESSIONAL ORGANIZATIONS.— 

22 The stakeholders identified under subparagraph 

23 (A) may include representatives from relevant 

24 national medical specialty and professional or25 ganizations and specialty societies. 


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1 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated 

3 $16,000,000 to carry out this subsection. Funds ap4 propriated under this paragraph shall remain avail5 able until expended.’’. 

6 (b) CONFORMING AMENDMENTS.— 

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

8 (42 U.S.C. 1320b–9a) is amended— 

9 (A) in subsection (a)(6), in the matter pre10 ceding subparagraph (A), by inserting ‘‘and the 

11 Medicaid and CHIP Payment and Access Com12 mission’’ after ‘‘Congress’’; and 

13 (B) in subsection (i), by striking ‘‘sub14 section (e)’’ and inserting ‘‘subsections (e) and 

15 (j)’’. 

16 (2) Section 1139B(b)(4) of such Act (42 U.S.C. 

17 1320b–9b(b)(4)) is amended by inserting ‘‘and the 

18 Medicaid and CHIP Payment and Access Commis19 sion’’ after ‘‘Congress’’. 

20 SEC. 3. QUALITY COLLABORATIVES. 

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

22 Services (in this section referred to as the ‘‘Secretary’’) 

23 may make grants to eligible entities to support— 

24 (1) the development of new State and regional 

25 maternity care quality collaboratives; 


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1 (2) expanded activities of existing maternity 

2 care quality collaboratives; and 

3 (3) maternity care initiatives within established 

4 State and regional quality collaboratives that are not 

5 focused exclusively on maternity care. 

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

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

8 (1) Quality collaboratives that focus entirely, or 

9 in part, on maternity care initiatives, to the extent 

10 that such collaboratives use such grant only for such 

11 initiatives. 

12 (2) Entities seeking to establish a maternity 

13 care quality collaborative. 

14 (3) State Medicaid agencies. 

15 (4) State departments of health. 

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

17 defined in section 2791 of the Public Health Service 

18 Act (42 U.S.C. 300gg–91)). 

19 (6) Provider organizations, including associa20 tions representing— 

21 (A) health professionals; and 

22 (B) hospitals. 

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

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

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


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1 must have goals that are designed to improve the quality 

2 of maternity care delivered, such as— 

3 (1) improving the appropriate use of cesarean 

4 section; 

5 (2) reducing maternal and newborn morbidity 

6 rates; 

7 (3) improving breast-feeding rates; 

8 (4) reducing hospital readmission rates; 

9 (5) identifying improvement priorities through 

10 shared peer review and third-party reviews of quali11 tative and quantitative data, and developing and car12 rying out projects or programs to address such pri13 orities; or 

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

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

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

17 (1) Facilitating performance data collection and 

18 feedback reports to providers with respect to their 

19 performance, relative to peers and benchmarks, if 

20 any. 

21 (2) Developing, implementing, and evaluating 

22 protocols and checklists to foster safe, evidence23 based practice. 

24 (3) Developing, implementing, and evaluating 

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1 ommendations supported by high-quality evidence in 

2 national guidelines, systematic reviews, or other well3 conducted clinical studies. 

4 (4) Developing underlying infrastructure needed 

5 to support quality collaborative activities under this 

6 subsection. 

7 (5) Providing technical assistance to providers 

8 and institutions to build quality improvement capac9 ity and facilitate participation in collaborative activi10 ties. 

11 (6) Developing the capability to access the fol12 lowing data sources: 

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

14 postpartum records. 

15 (B) A mother’s medical records. 

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

17 (D) Birth and death certificates. 

18 (E) Any other relevant State-level gen19 erated data (such as data from the pregnancy 

20 risk assessment management system 

21 (PRAMS)). 

22 (7) Developing access to blinded liability claims 

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

24 such analysis to improve practice. 

25 (e) SPECIAL RULE FOR BIRTHS.— 


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

2 a grant under subsection (a) is for a project or pro3 gram that focuses on births, at least 25 percent of 

4 the births addressed by such project or program 

5 must occur in health facilities that perform fewer 

6 than 1,000 births per year. 

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

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

9 State in which less than 25 percent of the health fa10 cilities in the State perform less than 1,000 births 

11 per year, the percentage of births in such facilities 

12 addressed by such project or program shall be com13 mensurate with the Statewide percentage of births 

14 performed at such facilities. 

15 (f) USE OF QUALITY MEASURES.—Projects and pro16 grams for which such a grant is made shall— 

17 (1) include data collection with rapid analysis 

18 and feedback to participants with a focus on improv19 ing practice and health outcomes; 

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

21 collection problems; 

22 (3) identify and document evidence-based strat23 egies that will be used to improve performance on 

24 quality measures and other metrics; and 


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1 (4) exclude from quality measure collection and 

2 reporting physicians and midwives who attend fewer 

3 than 30 births per year. 

4 (g) REPORTING ON QUALITY MEASURES.—Any re5 porting requirements established by a project or program 

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

7 (1) minimize costs and administrative effort; 

8 and 

9 (2) use existing data resources when feasible. 

10 (h) CLEARINGHOUSE.—The Secretary shall establish 

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

12 procedures, reports, tools, and other resources of indi13 vidual collaboratives available to collaboratives and other 

14 entities that are working to improve maternity care qual15 ity. 

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

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

18 (1) develop and carry out plans for evaluating 

19 its maternity care quality improvement programs 

20 and projects; and 

21 (2) publish its experiences and results in arti22 cles, technical reports, or other formats for the ben23 efit of others working on maternity care quality im24 provement activities. 


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

2 collaborative or other eligible entity that receives a grant 

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

4 Secretary containing the following: 

5 (1) A description of the activities carried out 

6 using the funding from such grant. 

7 (2) A description of any barriers that limited 

8 the ability of the collaborative or entity to achieve its 

9 goals. 

10 (3) The achievements of the collaborative or en11 tity under the grant with respect to the quality, 

12 health outcomes, and value of maternity care. 

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

14 Such reports shall be made available to the public. 

15 (k) GOVERNANCE.— 

16 (1) IN GENERAL.—A maternity care quality col17 laborative or a maternity care program within a 

18 broader quality collaborative that is supported under 

19 subsection (a) shall be governed by a multi-stake20 holder executive committee. 

21 (2) COMPOSITION.—Such executive committee 

22 shall include individuals who represent— 

23 (A) physicians, including physicians in the 

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1 cine, family medicine, neonatology, and pediat2 rics; 

3 (B) nurse-practitioners and nurses; 

4 (C) certified nurse-midwives and certified 

5 midwives; 

6 (D) health facilities and health systems; 

7 (E) consumers; 

8 (F) employers and other private pur9 chasers; 

10 (G) Medicaid programs; and 

11 (H) other public health agencies and orga12 nizations, as appropriate. 

13 Such committee also may include other individuals, 

14 such as individuals with expertise in health quality 

15 measurement and other types of expertise as rec16 ommended by the Secretary. Such committee also 

17 may be composed of a combination of general col18 laborative executive committee members and mater19 nity specific project executive committee members. 

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

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

22 shall engage in regular ongoing consultation with— 

23 (1) regional and State public health agencies 

24 and organizations; 

25 (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 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 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

11 (b) TABLE OF CONTENTS.—The table of contents of this 

12 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. 

13 SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT 

14 HEALTH. 

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

16 (42 U.S.C. 1301 et seq.) is amended by inserting after sec17 tion 1139B the following new section: 

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

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

20 QUALITY MEASURES FOR MATERNAL AND INFANT

21 HEALTH.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall identify 

2 and publish a recommended core set of maternal and 

3 infant health quality measures for women and chil4 dren described in subparagraphs (A) and (B) of sec5 tion 1902(l)(1) in the same manner as the Secretary 

6 identifies and publishes a core set of child health 

7 quality measures under section 1139A, including with 

8 respect to identifying and publishing existing mater9 nal and infant health quality measures that are in 

10 use under public and privately sponsored health care 

11 coverage arrangements, or that are part of reporting 

12 systems that measure both the presence and duration 

13 of health insurance coverage over time, that may be 

14 applicable to Medicaid and CHIP eligible mothers 

15 and infants. 

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

17 In identifying and publishing the recommended core 

18 set core set of maternal and infant health quality 

19 measures required under paragraph (1), the Secretary 

20 shall ensure that, to the extent possible, such measures 

21 align with and do not duplicate— 

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

23 measures identified, published, and revised under 

24 section 1139A; or 


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

2 measures identified, published, and revised under 

3 section 1139B. 

4 ‘‘(3) PROCESS FOR MATERNAL AND INFANT

5 QUALITY MEASURES PROGRAM.—In identifying gaps 

6 in existing maternal and infant measures and estab7 lishing priorities for the development and advance8 ment of such measures, the Secretary shall consult 

9 with— 

10 ‘‘(A) States; 

11 ‘‘(B) physicians, including physicians in 

12 the fields of general obstetrics, maternal-fetal 

13 medicine, family medicine, neonatology, and pe14 diatrics; 

15 ‘‘(C) nurse practitioners and nurses; 

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

17 midwives; 

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

19 ‘‘(F) national organizations representing 

20 mothers and infants; 

21 ‘‘(G) national organizations representing 

22 consumers and purchasers of health care; 

23 ‘‘(H) national organizations and individ24 uals with expertise in maternal and infant 

25 health quality measurement; and 


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1 ‘‘(I) voluntary consensus standard-setting 

2 organizations and other organizations involved 

3 in the advancement of evidence-based measures of 

4 health care. 

5 ‘‘(b) DEADLINES.— 

6 ‘‘(1) RECOMMENDED MEASURES.—Not later than 

7 January 1, 2018, the Secretary shall identify and 

8 publish for comment a recommended core set of ma9 ternal and infant health quality measures that in10 cludes the following: 

11 ‘‘(A) Measures of the process, experience, ef12 ficiency, and outcomes of maternity care, includ13 ing postpartum outcomes. 

14 ‘‘(B) Measures that apply to childbearing 

15 women and newborns at healthy, low, and high 

16 risk, including measures of low-intervention 

17 birth. 

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

19 pregnancy, the intrapartum period, and the 

20 postpartum period. 

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

22 settings and provider types, such as clinics, fa23 cilities, health plans, and accountable care orga24 nizations. 


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1 ‘‘(E) Measures that address disparities, care 

2 coordination, and shared decisionmaking. 

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

4 1, 2019, the Secretary shall publish an initial core set 

5 of maternal and infant health quality measures that 

6 are applicable to Medicaid and CHIP eligible mothers 

7 and infants. 

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

9 than January 1, 2020, the Secretary, in consultation 

10 with States, shall develop a standardized format for 

11 reporting information based on the initial core set of 

12 maternal and infant health quality measures and cre13 ate procedures to encourage States to use such meas14 ures to voluntarily report information regarding the 

15 quality of health care for Medicaid and CHIP eligible 

16 mothers and infants. 

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

18 January 1, 2021, and every 3 years thereafter, the 

19 Secretary shall include in the report to Congress re20 quired under section 1139A(a)(6) information similar 

21 to the information required under that section with 

22 respect to the measures established under this section. 

23 ‘‘(5) ESTABLISHMENT OF MATERNAL AND INFANT

24 QUALITY MEASUREMENT PROGRAM.— 


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

2 months after the release of the recommended core 

3 set of maternal and infant health quality meas4 ures under paragraph (1), the Secretary shall es5 tablish a Maternal and Infant Quality Measure6 ment Program in the same manner as the Sec7 retary established the pediatric quality measures 

8 program under section 1139A(b). 

9 ‘‘(B) REVISING, STRENGTHENING, AND IM10 PROVING INITIAL CORE MEASURES.—Beginning 

11 not later than 24 months after the establishment 

12 of the Maternal and Infant Quality Measurement 

13 Program, and annually thereafter, the Secretary 

14 shall publish recommended changes to the initial 

15 core set of maternal and infant health quality 

16 measures that shall reflect the results of the test17 ing, validation, and consensus process for the de18 velopment of maternal and infant health quality 

19 measures. 

20 ‘‘(C) EMEASURES.— 

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

22 a grant or contract by the Secretary to de23 velop emerging and innovative evidence24 based measures under the Maternal and In25 fant Quality Measurement Program shall 


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1 work to advance eMeasures that are aligned 

2 with the measures developed under the Pedi3 atric Quality Measures Program established 

4 under section 1139A(b) and the Medicaid 

5 Quality Measurement Program established 

6 under section 1139B(b)(5). 

7 ‘‘(ii) DEFINITION.—For purposes of 

8 this subparagraph, the term ‘eMeasure’ 

9 means an electronic measure for which 

10 measurement data (including clinical data) 

11 will be collected electronically, including 

12 through the use of electronic health records 

13 and other electronic data sources. 

14 ‘‘(D) AMOUNT AVAILABLE FOR GRANTS AND

15 CONTRACTS.—The aggregate amount of funds 

16 that may be awarded as grants and contracts 

17 under the Maternal and Infant Quality Measure18 ment Program for the development, testing, and 

19 validation of emerging and innovative evidence20 based measures shall not exceed the aggregate 

21 amount of funds awarded as grants and con22 tracts under section 1139A(b)(4)(A). 

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

24 construed as supporting the restriction of coverage, under 

25 title XIX or XXI or otherwise, to only those services that 


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1 are evidence based, or in any way limiting available serv2 ices. 

3 ‘‘(d) MATERNITY CONSUMER ASSESSMENT OF HEALTH

4 CARE PROVIDERS AND SYSTEMS SURVEYS.— 

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

6 January 1, 2020, for the purpose of measuring the 

7 care experiences of childbearing women and newborns, 

8 where appropriate, the Agency for Healthcare Re9 search and Quality shall adapt Consumer Assessment 

10 of Healthcare Providers and Systems program sur11 veys of— 

12 ‘‘(A) providers; 

13 ‘‘(B) facilities; and 

14 ‘‘(C) health plans. 

15 ‘‘(2) SURVEYS MUST BE EFFECTIVE.—The Agen16 cy for Healthcare Research and Quality shall ensure 

17 that the surveys adapted under paragraph (1) are ef18 fective in measuring aspects of care that childbearing 

19 women and newborns experience, which may in20 clude— 

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

22 ‘‘(B) various types of caregivers; 

23 ‘‘(C) considerations relating to pain; 

24 ‘‘(D) shared decisionmaking; 


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

2 birth; and 

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

4 the experience of childbearing women and 

5 newborns. 

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

7 paragraph (1) shall be available in English and 

8 Spanish. 

9 ‘‘(4) ENDORSEMENT.—The Agency for 

10 Healthcare Research and Quality shall submit any 

11 Consumer Assessment of Healthcare Providers and 

12 Systems surveys adapted under this paragraph to the 

13 consensus-based entity with a contract under section 

14 1890(a)(1) to be considered for endorsement under 

15 section 1890(b)(2). 

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

17 process for applying) the surveys under paragraph 

18 (1) shall be conducted in consultation with the stake19 holders identified in paragraph (6)(A). 

20 ‘‘(6) STAKEHOLDERS.— 

21 ‘‘(A) IN GENERAL.—The stakeholders identi22 fied in this subparagraph are— 

23 ‘‘(i) the various clinical disciplines 

24 and specialties involved in providing mater25 nity care; 


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1 ‘‘(ii) State Medicaid administrators; 

2 ‘‘(iii) maternity care consumers and 

3 their advocates; 

4 ‘‘(iv) technical experts in quality meas5 urement; 

6 ‘‘(v) hospital, facility and health sys7 tem leaders; 

8 ‘‘(vi) employers and purchasers; and 

9 ‘‘(vii) other individuals who are in10 volved in the advancement of evidence-based 

11 maternity care quality measures. 

12 ‘‘(B) PROFESSIONAL ORGANIZATIONS.—The 

13 stakeholders identified under subparagraph (A) 

14 may include representatives from relevant na15 tional medical specialty and professional organi16 zations and specialty societies. 

17 ‘‘(e) ANNUAL STATE REPORTS REGARDING STATE18 SPECIFIC MATERNAL AND INFANT QUALITY OF CARE MEAS19 URES APPLIED UNDER MEDICAID OR CHIP.— 

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

21 waiver approved under title XIX or XXI shall annu22 ally report (separately or as part of the annual report 

23 required under section 1139A(c)) to the Secretary on 

24 the— 


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1 ‘‘(A) State-specific maternal and infant 

2 health quality measures applied by the State 

3 under such plan or waiver, including measures 

4 described in subsection (b)(5)(B); 

5 ‘‘(B) State-specific information on the qual6 ity of health care furnished to Medicaid and 

7 CHIP eligible mothers and infants under such 

8 plan or waiver, including information collected 

9 through external quality reviews of managed care 

10 organizations under section 1932 and benchmark 

11 plans under section 1937. 

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

13 30, 2021, and annually thereafter, the Secretary shall 

14 collect, analyze, and make publicly available the in15 formation reported by States under paragraph (1). 

16 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There are 

17 authorized to be appropriated $16,000,000 to carry out this 

18 section. Funds appropriated under this subsection shall re19 main available until expended.’’. 

20 (b) TECHNICAL AMENDMENT.—Section 

21 1139B(d)(1)(A) of the Social Security Act (42 U.S.C. 

22 1320b–9b(d)(1)(A)) is amended by striking ‘‘subsection 

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


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1 SEC. 3. QUALITY COLLABORATIVES. 

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

3 Services (in this section referred to as the ‘‘Secretary’’) may 

4 make grants to eligible entities to support— 

5 (1) the development of new State and regional 

6 maternity and infant care quality collaboratives; 

7 (2) expanded activities of existing maternity and 

8 infant care quality collaboratives; and 

9 (3) maternity and infant care initiatives within 

10 established State and regional quality collaboratives 

11 that are not focused exclusively on maternity care. 

12 (b) ELIGIBLE ENTITY.—The following entities shall be 

13 eligible for a grant under subsection (a): 

14 (1) Quality collaboratives that focus entirely, or 

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

16 the extent that such collaboratives use such grant only 

17 for such initiatives. 

18 (2) Entities seeking to establish a maternity and 

19 infant care quality collaborative. 

20 (3) State Medicaid agencies. 

21 (4) State departments of health. 

22 (5) Health insurance issuers (as such term is de23 fined in section 2791 of the Public Health Service Act 

24 (42 U.S.C. 300gg–91)). 

25 (6) Provider organizations, including associa26 tions representing— 


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1 (A) health professionals; and 

2 (B) hospitals. 

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

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

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

6 must have goals that are designed to improve the quality 

7 of maternity care delivered, such as— 

8 (1) improving the appropriate use of cesarean 

9 section; 

10 (2) reducing maternal and newborn morbidity 

11 rates; 

12 (3) improving breast-feeding rates; 

13 (4) reducing hospital readmission rates; 

14 (5) identifying improvement priorities through 

15 shared peer review and third-party reviews of quali16 tative and quantitative data, and developing and car17 rying out projects or programs to address such prior18 ities; or 

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

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

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

22 (1) Facilitating performance data collection and 

23 feedback reports to providers with respect to their per24 formance, relative to peers and benchmarks, if any. 


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1 (2) Developing, implementing, and evaluating 

2 protocols and checklists to foster safe, evidence-based 

3 practice. 

4 (3) Developing, implementing, and evaluating 

5 programs that translate into practice clinical rec6 ommendations supported by high-quality evidence in 

7 national guidelines, systematic reviews, or other well8 conducted clinical studies. 

9 (4) Developing underlying infrastructure needed 

10 to support quality collaborative activities under this 

11 subsection. 

12 (5) Providing technical assistance to providers 

13 and institutions to build quality improvement capac14 ity and facilitate participation in collaborative ac15 tivities. 

16 (6) Developing the capability to access the fol17 lowing data sources: 

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

19 postpartum records. 

20 (B) A mother’s medical records. 

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

22 (D) Birth and death certificates. 

23 (E) Any other relevant State-level generated 

24 data (such as data from the pregnancy risk as25 sessment management system (PRAMS)). 


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1 (7) Developing access to blinded liability claims 

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

3 such analysis to improve practice. 

4 (e) SPECIAL RULE FOR BIRTHS.— 

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

6 grant under subsection (a) is for a project or program 

7 that focuses on births, at least 25 percent of the births 

8 addressed by such project or program must occur in 

9 health facilities that perform fewer than 1,000 births 

10 per year. 

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

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

13 State in which less than 25 percent of the health fa14 cilities in the State perform less than 1,000 births per 

15 year, the percentage of births in such facilities ad16 dressed by such project or program shall be commen17 surate with the Statewide percentage of births per18 formed at such facilities. 

19 (f) USE OF QUALITY MEASURES.—Projects and pro20 grams for which such a grant is made shall— 

21 (1) include data collection with rapid analysis 

22 and feedback to participants with a focus on improv23 ing practice and health outcomes; 

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

25 collection problems; 


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1 (3) identify and document evidence-based strate2 gies that will be used to improve performance on 

3 quality measures and other metrics; and 

4 (4) exclude from quality measure collection and 

5 reporting physicians and midwives who attend fewer 

6 than 30 births per year. 

7 (g) REPORTING ON QUALITY MEASURES.—Any report8 ing requirements established by a project or program funded 

9 under subsection (a) shall be designed to— 

10 (1) minimize costs and administrative effort; 

11 and 

12 (2) use existing data resources when feasible. 

13 (h) CLEARINGHOUSE.—The Secretary shall establish 

14 an online, open-access clearinghouse to make protocols, pro15 cedures, reports, tools, and other resources of individual 

16 collaboratives available to collaboratives and other entities 

17 that are working to improve maternity and infant care 

18 quality. 

19 (i) EVALUATION.—A quality collaborative (or other en20 tity receiving a grant under subsection (a)) shall— 

21 (1) develop and carry out plans for evaluating 

22 its maternity and infant care quality improvement 

23 programs and projects; and 

24 (2) publish its experiences and results in articles, 

25 technical reports, or other formats for the benefit of 


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1 others working on maternity and infant care quality 

2 improvement activities. 

3 (j) ANNUAL REPORTS TO SECRETARY.—A quality col4 laborative or other eligible entity that receives a grant 

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

6 Secretary containing the following: 

7 (1) A description of the activities carried out 

8 using the funding from such grant. 

9 (2) A description of any barriers that limited the 

10 ability of the collaborative or entity to achieve its 

11 goals. 

12 (3) The achievements of the collaborative or enti13 ty under the grant with respect to the quality, health 

14 outcomes, and value of maternity and infant care. 

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

16 Such reports shall be made available to the public. 

17 (k) GOVERNANCE.— 

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

19 quality collaborative or a maternity and infant care 

20 program within a broader quality collaborative that 

21 is supported under subsection (a) shall be governed by 

22 a multi-stakeholder executive committee. 

23 (2) COMPOSITION.—Such executive committee 

24 shall include individuals who represent— 


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1 (A) physicians, including physicians in the 

2 fields of general obstetrics, maternal-fetal medi3 cine, family medicine, neonatology, and pediat4 rics; 

5 (B) nurse-practitioners and nurses; 

6 (C) certified nurse-midwives and certified 

7 midwives; 

8 (D) health facilities and health systems; 

9 (E) consumers; 

10 (F) employers and other private purchasers; 

11 (G) Medicaid programs; and 

12 (H) other public health agencies and orga13 nizations, as appropriate. 

14 Such committee also may include other individuals, 

15 such as individuals with expertise in health quality 

16 measurement and other types of expertise as rec17 ommended by the Secretary. Such committee also 

18 may be composed of a combination of general collabo19 rative executive committee members and maternity 

20 and infant specific project executive committee mem21 bers. 

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

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

24 shall engage in regular ongoing consultation with— 


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1 (1) regional and State public health agencies 

2 and organizations; 

3 (2) public and private health insurers; and 

4 (3) regional and State organizations rep5 resenting physicians, midwives, and nurses who pro6 vide maternity and infant services. 

7 (m) AUTHORIZATION OF APPROPRIATIONS.—There are 

8 authorized to be appropriated $15,000,000 to carry out this 

9 section. Funds appropriated under this subsection shall re10 main available until expended. 

11 SEC. 4. FACILITATION OF INCREASED COORDINATION AND 

12 ALIGNMENT BETWEEN THE PUBLIC AND PRI13 VATE SECTOR WITH RESPECT TO QUALITY 

14 AND EFFICIENCY MEASURES. 

15 (a) IN GENERAL.—Section 1890(b) of the Social Secu16 rity Act (42 U.S.C. 1395aaa(b)) is amended by inserting 

17 after paragraph (3) the following new paragraph: 

18 ‘‘(4) FACILITATION OF INCREASED COORDINA19 TION AND ALIGNMENT BETWEEN THE PUBLIC AND

20 PRIVATE SECTOR WITH RESPECT TO QUALITY AND EF21 FICIENCY MEASURES.— 

22 ‘‘(A) IN GENERAL.—The entity shall facili23 tate increased coordination and alignment be24 tween the public and private sector with respect 

25 to quality and efficiency measures. 


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

2 prepare and make available to the public its 

3 findings under this paragraph in its annual re4 port. Such public availability shall include post5 ing each report on the Internet website of the en6 tity.’’. 

7 (b) EFFECTIVE DATE.—The amendment made by sub8 section (a) shall take effect on the date of the enactment 

9 of this Act. 


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tkelley on DSK3SPTVN1PROD with BILLS
Calendar No. 179 

114TH CONGRESS 

1ST SESSION S. 466 

[Report No. 114–100] 

A BILL 

To amend title XI of the Social Security Act to imcollaboratives. measures and supporting maternity care quality programs by developing maternity care quality maternity care under the Medicaid and CHIP prove the quality, health outcomes, and value of 

JULY 30, 2015 

Reported with an amendment 


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