I 
113TH CONGRESS 
1ST SESSION 
H. R. 896 
To amend title XI of the Social Security Act to improve the quality, health 
outcomes, and value of maternity care under the Medicaid and CHIP 
programs by developing maternity care quality measures and supporting 
maternity care quality collaboratives. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 28, 2013 
Mr. ENGEL introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To amend title XI of the Social Security Act to improve 
the quality, health outcomes, and value of maternity 
care under the Medicaid and CHIP programs by devel-
oping maternity care quality measures and supporting 
maternity care quality collaboratives. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Quality Care for Moms and Babies Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
Sec. 1. Short title; table of contents. 
Sec. 2. Quality measures for maternity care under Medicaid and CHIP. 
Sec. 3. Quality collaboratives. 
SEC. 2. QUALITY MEASURES FOR MATERNITY CARE UNDER 
MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 1139A of the Social Secu-
rity Act (42 U.S.C. 1320b–9a) is amended by adding at 
the end the following new subsection: 
‘‘(j) MOTHER AND INFANT CARE (MIC) QUALITY 
MEASURES.— 
‘‘(1) IN GENERAL.—As part of the pediatric 
quality measures program established under sub-
section (b) and the Medicaid Quality Measurement 
Program established under section 1139B(b)(5)(A), 
the Secretary shall— 
‘‘(A) review quality measures endorsed 
under section 1890(b)(2) that relate to the care 
of childbearing women and newborns, particu-
larly with respect to the application of such 
measures to the Medicaid and CHIP programs 
under titles XIX and XXI, and identify omis-
sions and deficiencies in the application of those 
measures to such programs; 
‘‘(B) develop and publish a set of mater-
nity care quality measures for the Medicaid and 
CHIP programs under titles XIX and XXI (in 
this subsection referred to as the ‘Mother and 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
Infant Care (MIC) quality measures’) in ac-
cordance with the requirements of paragraphs 
(2) and (3); and 
‘‘(C) on an ongoing basis, review the MIC 
quality measures and develop and publish any 
modifications of, or additions or deletions to, 
such measures that reflect the development, 
testing, validation, and consensus process de-
scribed in paragraph (4). 
‘‘(2) PROCESS FOR INITIAL REVIEW AND PUBLI-
CATION.— 
‘‘(A) CONSULTATION
AND
PUBLIC
COM-
MENT.—Not later than January 1, 2016, the 
Secretary shall— 
‘‘(i) solicit public comment on the pro-
posed MIC quality measures; and 
‘‘(ii) consult with the stakeholders 
identified in paragraph (6)(A) regarding 
such measures. 
‘‘(B) PUBLICATION
OF
INITIAL
SET
OF 
MEASURES.—Not later than January 1, 2017, 
the Secretary shall identify and publish the ini-
tial MIC quality measures. 
‘‘(3) REQUIREMENTS.— 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
‘‘(A) IN
GENERAL.—The MIC quality 
measures shall— 
‘‘(i) be evidence-based; 
‘‘(ii) utilize risk adjustment or risk 
stratification methodologies, if appropriate; 
‘‘(iii) utilize attribution methods to 
specify the clinicians, facilities, and other 
entities that the measures are applicable 
to; 
‘‘(iv) be pilot-tested with regard to 
scientific validity, feasibility, and attribu-
tion method; and 
‘‘(v) include a balance of each of the 
types of measures listed in subparagraph 
(B). 
‘‘(B) LIST OF TYPES OF MEASURES.—The 
measures listed in this subparagraph are the 
following: 
‘‘(i) Measures of the process, experi-
ence, efficiency, and outcomes of maternity 
care, including postpartum outcomes. 
‘‘(ii) Measures that apply to— 
‘‘(I) women and newborns who 
are healthy and at low risk, including 
measures of appropriately low-inter-
VerDate Mar 15 2010 
18:04 Mar 04, 2013
Jkt 029200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
vention, physiologic birth in low-risk 
women; and 
‘‘(II) women and newborns at 
higher risk. 
‘‘(iii) Measures that apply to— 
‘‘(I) childbearing women; and 
‘‘(II) newborns. 
‘‘(iv) Measures that apply to care dur-
ing— 
‘‘(I) pregnancy; 
‘‘(II) intrapartum period; and 
‘‘(III) the postpartum period. 
‘‘(v) Measures that apply to— 
‘‘(I) 
clinicians 
and 
clinician 
groups; 
‘‘(II) facilities; 
‘‘(III) health plans; and 
‘‘(IV) accountable care organiza-
tions. 
‘‘(vi) Measurement of— 
‘‘(I) disparities; 
‘‘(II) care coordination; and 
‘‘(III) shared decisionmaking. 
‘‘(C) PHYSIOLOGIC
DEFINED.—For pur-
poses of this paragraph, the term ‘physiologic’ 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
means characteristic of or conforming to the 
normal functioning or state of the body or a tis-
sue or organ, normal, and not pathologic. 
‘‘(D) CONSTRUCTION.—Nothing in this 
paragraph shall be construed as supporting the 
restriction of coverage, under title XIX or XXI 
or otherwise, to only those services that are evi-
dence-based, or in any way limiting available 
services. 
‘‘(4) ONGOING REVIEW OF THE MIC MEASURES; 
eMEASURES.— 
‘‘(A) CONTRACTS WITH QUALIFIED ENTI-
TIES.—Not later than June 30, 2017, the Sec-
retary, 
acting 
through 
the 
Agency 
for 
Healthcare Research and Quality, in consulta-
tion with the Centers for Medicare & Medicaid 
Services, shall enter into grants, contracts, or 
intergovernmental agreements with qualified 
measure development entities for the purpose of 
identifying quality of care issues that are not 
adequately addressed by the MIC quality meas-
ures and developing, testing, and validating 
modifications of, or additions or deletions to, 
the MIC quality measures, and creating 
VerDate Mar 15 2010 
18:04 Mar 04, 2013
Jkt 029200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
eMeasures for data collection related to the 
MIC quality measures. 
‘‘(B) QUALIFIED MEASURE DEVELOPMENT 
ENTITY DEFINED.—For purposes of this para-
graph, the term ‘qualified measure development 
entity’ means an entity that— 
‘‘(i) has demonstrated expertise and 
capacity in the development and testing of 
quality measures; 
‘‘(ii) has adopted procedures for qual-
ity measure development that ensure the 
inclusion of— 
‘‘(I) the views of the individuals 
and entities referred to in paragraph 
(3)(B)(v) and whose performance will 
be assessed by the measures; and 
‘‘(II) the views of other individ-
uals and entities (including patients, 
consumers, and health care pur-
chasers) who will use the data gen-
erated as a result of the use of the 
quality measures; 
‘‘(iii) for the purpose of ensuring that 
the MIC quality measures meet the re-
quirements to be considered for endorse-
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
ment under section 1890(b)(2), has pro-
vided assurances to the Secretary that the 
measure development entity will collaborate 
with— 
‘‘(I) the Secretary; 
‘‘(II) the consensus-based entity 
with 
a 
contract 
under 
section 
1890(a)(1); and 
‘‘(III) 
stakeholders 
(including 
those stakeholders identified in para-
graph (6)(A)), as practicable; 
‘‘(iv) has transparent policies regard-
ing governance and conflicts of interest; 
and 
‘‘(v) submits an application to the 
Secretary at such time, and in such form 
and manner, as the Secretary may require. 
‘‘(C) eMEASURES.— 
‘‘(i) IN GENERAL.—A qualified meas-
ure development entity with a grant, con-
tract, 
or 
intergovernmental 
agreement 
under subparagraph (A) shall consult with 
the voluntary consensus standards setting 
organizations and other organizations in-
volved in the advancement of evidence- 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
based measures of health care that the 
Secretary consults with under subsection 
(b)(3)(H) and section 1139B(b)(5)(A) to 
create, as part of the MIC quality meas-
ures, eMeasures that are aligned with the 
measures developed under the pediatric 
quality 
measures 
program 
established 
under subsection (b) and the Medicaid 
Quality Measurement Program established 
under section 1139B(b)(5)(A). 
‘‘(ii) eMEASURE DEFINED.—For pur-
poses of this subparagraph, the term 
‘eMeasure’ means a measure for which 
measurement data (including clinical data) 
will be collected electronically, including 
through the use of electronic health 
records and other electronic data sources. 
‘‘(D) ENDORSEMENT.—Any modifications 
of, or additions or deletions to, the MIC quality 
measures shall be submitted by the qualified 
measure development entity to the consensus- 
based entity with a contract under section 
1890(a)(1) to be considered for endorsement 
under section 1890(b)(2). 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
‘‘(5) MATERNITY CONSUMER ASSESSMENT OF 
HEALTH
CARE
PROVIDERS
AND
SYSTEMS
SUR-
VEYS.— 
‘‘(A) ADAPTION OF SURVEYS.—Not later 
than January 1, 2018, for the purpose of meas-
uring the care experiences of childbearing 
women 
and 
newborns, 
the 
Agency 
for 
Healthcare Research and Quality shall adapt 
the Consumer Assessment of Healthcare Pro-
viders and Systems program surveys of— 
‘‘(i) providers; 
‘‘(ii) facilities; and 
‘‘(iii) health plans. 
‘‘(B) SURVEYS MUST BE EFFECTIVE.—The 
Agency for Healthcare Research and Quality 
shall ensure that the surveys adapted under 
subparagraph (A) are effective in measuring as-
pects of care that childbearing women and 
newborns experience, which may include— 
‘‘(i) various types of care settings; 
‘‘(ii) various types of caregivers; 
‘‘(iii) considerations relating to pain; 
‘‘(iv) shared decisionmaking; 
‘‘(v) supportive care around the time 
of birth; and 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
‘‘(vi) other topics relevant to the qual-
ity of the experience of childbearing women 
and newborns. 
‘‘(C) LANGUAGES.—The surveys adapted 
under subparagraph (A) shall be available in 
English and Spanish. 
‘‘(D) ENDORSEMENT.—The Agency for 
Healthcare Research and Quality shall submit 
any Consumer Assessment of Healthcare Pro-
viders and Systems surveys adapted under this 
paragraph to the consensus-based entity with a 
contract under section 1890(a)(1) to be consid-
ered for endorsement under section 1890(b)(2). 
‘‘(E) CONSULTATION.—The adaption of 
(and process for applying) the surveys under 
subparagraph (A) shall be conducted in con-
sultation with the stakeholders identified in 
paragraph (6)(A). 
‘‘(6) STAKEHOLDERS.— 
‘‘(A) 
IN
GENERAL.—The 
stakeholders 
identified in this subparagraph are— 
‘‘(i) the various clinical disciplines and 
specialties involved in providing maternity 
care; 
‘‘(ii) State Medicaid administrators; 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
‘‘(iii) maternity care consumers and 
their advocates; 
‘‘(iv) technical experts in quality 
measurement; 
‘‘(v) hospital, facility and health sys-
tem leaders; 
‘‘(vi) employers and purchasers; and 
‘‘(vii) other individuals who are in-
volved in the advancement of evidence- 
based maternity care quality measures. 
‘‘(B) PROFESSIONAL
ORGANIZATIONS.— 
The stakeholders identified under subparagraph 
(A) may include representatives from relevant 
national medical specialty and professional or-
ganizations and specialty societies. 
‘‘(7) AUTHORIZATION
OF
APPROPRIATIONS.— 
There 
are 
authorized 
to 
be 
appropriated 
$16,000,000 to carry out this subsection. Funds ap-
propriated under this paragraph shall remain avail-
able until expended.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1139A of the Social Security Act 
(42 U.S.C. 1320b–9a) is amended— 
(A) in subsection (a)(6), in the matter pre-
ceding subparagraph (A), by inserting ‘‘and the 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
Medicaid and CHIP Payment and Access Com-
mission’’ after ‘‘Congress’’; and 
(B) in subsection (i), by striking ‘‘sub-
section (e)’’ and inserting ‘‘subsections (e) and 
(j)’’. 
(2) Section 1139B(b)(4) of such Act (42 U.S.C. 
1320b–9b(b)(4)) is amended by inserting ‘‘and the 
Medicaid and CHIP Payment and Access Commis-
sion’’ after ‘‘Congress’’. 
SEC. 3. QUALITY COLLABORATIVES. 
(a) GRANTS.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
may make grants to eligible entities to support— 
(1) the development of new State and regional 
maternity care quality collaboratives; 
(2) expanded activities of existing maternity 
care quality collaboratives; and 
(3) maternity care initiatives within established 
State and regional quality collaboratives that are not 
focused exclusively on maternity care. 
(b) ELIGIBLE ENTITY.—The following entities shall 
be eligible for a grant under subsection (a): 
(1) Quality collaboratives that focus entirely, or 
in part, on maternity care initiatives, to the extent 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
that such collaboratives use such grant only for such 
initiatives. 
(2) Entities seeking to establish a maternity 
care quality collaborative. 
(3) State Medicaid agencies. 
(4) State departments of health. 
(5) Health insurance issuers (as such term is 
defined in section 2791 of the Public Health Service 
Act (42 U.S.C. 300gg–91). 
(6) Provider organizations, including associa-
tions representing— 
(A) health professionals; and 
(B) hospitals. 
(c) ELIGIBLE PROJECTS AND PROGRAMS.—In order 
for a project or program of an eligible entity to be eligible 
for funding under subsection (a), the project or program 
must have goals that are designed to improve the quality 
of maternity care delivered, such as— 
(1) improving the appropriate use of cesarean 
section; 
(2) reducing maternal and newborn morbidity 
rates; 
(3) improving breast-feeding rates; 
(4) reducing hospital readmission rates; 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
(5) identifying improvement priorities through 
shared peer review and third-party reviews of quali-
tative and quantitative data, and developing and car-
rying out projects or programs to address such pri-
orities; or 
(6) delivering risk-appropriate levels of care. 
(d) ACTIVITIES.—Activities that may be supported by 
the funding under subsection (a) include the following: 
(1) Facilitating performance data collection and 
feedback reports to providers with respect to their 
performance, relative to peers and benchmarks, if 
any. 
(2) Developing, implementing, and evaluating 
protocols and checklists to foster safe, evidence- 
based practice. 
(3) Developing, implementing, and evaluating 
programs that translate into practice clinical rec-
ommendations supported by high-quality evidence in 
national guidelines, systematic reviews, or other well- 
conducted clinical studies. 
(4) Developing underlying infrastructure needed 
to support quality collaborative activities under this 
subsection. 
(5) Providing technical assistance to providers 
and institutions to build quality improvement capac-
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
ity and facilitate participation in collaborative activi-
ties. 
(6) Developing the capability to access the fol-
lowing data sources: 
(A) A mother’s prenatal, intrapartum, and 
postpartum records. 
(B) A mother’s medical records. 
(C) An infant’s medical records since birth. 
(D) Birth and death certificates. 
(E) Any other relevant State-level gen-
erated data (such as data from the pregnancy 
risk 
assessment 
management 
system 
(PRAMS)). 
(7) Developing access to blinded liability claims 
data, analyzing the data, and using the results of 
such analysis to improve practice. 
(e) SPECIAL RULE FOR BIRTHS.— 
(1) IN GENERAL.—Subject to paragraph (2), if 
a grant under subsection (a) is for a project or pro-
gram that focuses on births, at least 25 percent of 
the births addressed by such project or program 
must occur in health facilities that perform fewer 
than 1,000 births per year. 
(2) EXCEPTION.—In the case of a grant under 
subsection (a) for a project or program located in a 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
State in which less than 25 percent of the health fa-
cilities in the State perform less than 1,000 births 
per year, the percentage of births in such facilities 
addressed by such project or program shall be com-
mensurate with the Statewide percentage of births 
performed at such facilities. 
(f) USE OF QUALITY MEASURES.—Projects and pro-
grams for which such a grant is made shall— 
(1) include data collection with rapid analysis 
and feedback to participants with a focus on improv-
ing practice and health outcomes; 
(2) develop a plan to identify and resolve data 
collection problems; 
(3) identify and document evidence-based strat-
egies that will be used to improve performance on 
quality measures and other metrics; and 
(4) exclude from quality measure collection and 
reporting physicians and midwives who attend fewer 
than 30 births per year. 
(g) REPORTING ON QUALITY MEASURES.—Any re-
porting requirements established by a project or program 
funded under subsection (a) shall be designed to— 
(1) minimize costs and administrative effort; 
and 
(2) use existing data resources when feasible. 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
(h) CLEARINGHOUSE.—The Secretary shall establish 
an online, open-access clearinghouse to make protocols, 
procedures, reports, tools, and other resources of indi-
vidual collaboratives available to collaboratives and other 
entities that are working to improve maternity care qual-
ity. 
(i) EVALUATION.—A quality collaborative (or other 
entity receiving a grant under subsection (a)) shall— 
(1) develop and carry out plans for evaluating 
its maternity care quality improvement programs 
and projects; and 
(2) publish its experiences and results in arti-
cles, technical reports, or other formats for the ben-
efit of others working on maternity care quality im-
provement activities. 
(j) ANNUAL REPORTS TO SECRETARY.—A quality 
collaborative or other eligible entity that receives a grant 
under subsection (a) shall submit an annual report to the 
Secretary containing the following: 
(1) A description of the activities carried out 
using the funding from such grant. 
(2) A description of any barriers that limited 
the ability of the collaborative or entity to achieve its 
goals. 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
(3) The achievements of the collaborative or en-
tity under the grant with respect to the quality, 
health outcomes, and value of maternity care. 
(4) A list of lessons learned from the grant. 
Such reports shall be made available to the public. 
(k) GOVERNANCE.— 
(1) IN GENERAL.—A maternity care quality col-
laborative or a maternity care program within a 
broader quality collaborative that is supported under 
subsection (a) shall be governed by a multi-stake-
holder executive committee. 
(2) COMPOSITION.—Such executive committee 
shall include individuals who represent— 
(A) physicians, including physicians in the 
fields of general obstetrics, maternal-fetal medi-
cine, family medicine, neonatology, and pediat-
rics; 
(B) nurse-practitioners and nurses; 
(C) certified nurse-midwives and certified 
midwives; 
(D) health facilities and health systems; 
(E) consumers; 
(F) employers and other private pur-
chasers; 
(G) Medicaid programs; and 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS
(H) other public health agencies and orga-
nizations, as appropriate. 
Such committee also may include other individuals, 
such as individuals with expertise in health quality 
measurement and other types of expertise as rec-
ommended by the Secretary. Such committee also 
may be composed of a combination of general col-
laborative executive committee members and mater-
nity specific project executive committee members. 
(l) CONSULTATION.—A quality collaborative or other 
eligible entity that receives a grant under subsection (a) 
shall engage in regular ongoing consultation with— 
(1) regional and State public health agencies 
and organizations; 
(2) public and private health insurers; and 
(3) regional and State organizations rep-
resenting physicians, midwives, and nurses who pro-
vide maternity services. 
(m) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $15,000,000 to carry 
out this section. Funds appropriated under this subsection 
shall remain available until expended. 
Æ 
VerDate Mar 15 2010 
03:06 Mar 02, 2013
Jkt 029200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6301
E:\BILLS\H896.IH
H896
tjames on DSK6SPTVN1PROD with BILLS