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 de-
termined 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 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, 
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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 for 
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 meas-
ures. 
SEC. 2. QUALITY MEASURES FOR MATERNAL AND INFANT 
HEALTH. 
(a) IN GENERAL.—Title XI of the Social Security Act 
(42 U.S.C. 1301 et seq.) is amended by inserting after 
section 1139B the following new section: 
‘‘SEC. 1139C. MATERNAL AND INFANT QUALITY MEASURES. 
‘‘(a) DEVELOPMENT OF CORE SET OF HEALTH CARE 
QUALITY
MEASURES
FOR
MATERNAL
AND
INFANT 
HEALTH.— 
‘‘(1) IN GENERAL.—The Secretary shall iden-
tify and publish a recommended core set of maternal 
and infant health quality measures for women and 
children described in subparagraphs (A) and (B) of 
section 1902(l)(1) in the same manner as the Sec-
retary identifies and publishes a core set of child 
health quality measures under section 1139A, in-
cluding with respect to identifying and publishing 
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‘‘(A) States; 
‘‘(B) physicians, including physicians in 
the fields of general obstetrics, maternal-fetal 
medicine, family medicine, neonatology, and pe-
diatrics; 
‘‘(C) nurse practitioners and nurses; 
‘‘(D) certified nurse-midwives and certified 
midwives; 
‘‘(E) health facilities and health systems; 
‘‘(F) national organizations representing 
mothers and infants; 
‘‘(G) national organizations representing 
consumers and purchasers of health care; 
‘‘(H) national organizations and individ-
uals with expertise in maternal and infant 
health quality measurement; and 
‘‘(I) voluntary consensus standard-setting 
organizations and other organizations involved 
in the advancement of evidence-based measures 
of health care. 
‘‘(b) DEADLINES.— 
‘‘(1) RECOMMENDED
MEASURES.—Not later 
than January 1, 2021, the Secretary shall identify 
and publish for comment a recommended core set of 
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maternal and infant health quality measures that in-
cludes the following: 
‘‘(A) Measures of the process, experience, 
efficiency, and outcomes of maternity care, in-
cluding postpartum outcomes. 
‘‘(B) Measures that apply to childbearing 
women and newborns at healthy, low, and high 
risk, including measures of low-intervention 
birth. 
‘‘(C) Measures that apply to care during 
pregnancy, the intrapartum period, and the 
postpartum period. 
‘‘(D) Measures that apply to a variety of 
settings and provider types, such as clinics, fa-
cilities, health plans, and accountable care orga-
nizations. 
‘‘(E) Measures that address disparities, 
care coordination, and shared decisionmaking. 
‘‘(2) DISSEMINATION.—Not later than January 
1, 2022, the Secretary shall publish an initial core 
set of maternal and infant health quality measures 
that are applicable to Medicaid and CHIP eligible 
mothers and infants. 
‘‘(3) STANDARDIZED
REPORTING.—Not later 
than January 1, 2023, the Secretary, in consultation 
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with States, shall develop a standardized format for 
reporting information based on the initial core set of 
maternal and infant health quality measures and 
create procedures to encourage States to use such 
measures to voluntarily report information regarding 
the quality of health care for Medicaid and CHIP el-
igible mothers and infants. 
‘‘(4) REPORTS TO CONGRESS.—Not later than 
January 1, 2024, and every 3 years thereafter, the 
Secretary shall include in the report to Congress re-
quired under section 1139A(a)(6) information simi-
lar to the information required under that section 
with respect to the measures established under this 
section. 
‘‘(5) ESTABLISHMENT OF MATERNAL AND IN-
FANT QUALITY MEASUREMENT PROGRAM.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the release of the recommended 
core set of maternal and infant health quality 
measures under paragraph (1), the Secretary 
shall establish a Maternal and Infant Quality 
Measurement Program in the same manner as 
the Secretary established the pediatric quality 
measures program under section 1139A(b). 
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‘‘(B) REVISING, STRENGTHENING, AND IM-
PROVING INITIAL CORE MEASURES.—Beginning 
not later than 24 months after the establish-
ment of the Maternal and Infant Quality Meas-
urement Program, and annually thereafter, the 
Secretary shall publish recommended changes 
to the initial core set of maternal and infant 
health quality measures that shall reflect the 
results of the testing, validation, and consensus 
process for the development of maternal and in-
fant health quality measures. 
‘‘(C) EMEASURES.— 
‘‘(i) IN GENERAL.—An entity awarded 
a grant or contract by the Secretary to de-
velop emerging and innovative evidence- 
based measures under the Maternal and 
Infant Quality Measurement Program shall 
work to advance eMeasures that are 
aligned with the measures developed under 
the Pediatric Quality Measures Program 
established under section 1139A(b) and 
the Medicaid Quality Measurement Pro-
gram 
established 
under 
section 
1139B(b)(5). 
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‘‘(ii) DEFINITION.—For purposes of 
this subparagraph, the term eMeasure 
means an electronic 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) AMOUNT
AVAILABLE
FOR
GRANTS 
AND
CONTRACTS.—The aggregate amount of 
funds that may be awarded as grants and con-
tracts under the Maternal and Infant Quality 
Measurement Program for the development, 
testing, and validation of emerging and innova-
tive evidence-based measures shall not exceed 
the aggregate amount of funds awarded as 
grants 
and 
contracts 
under 
section 
1139A(b)(4)(A). 
‘‘(c) CONSTRUCTION.—Nothing in this section shall 
be construed as supporting the restriction of coverage, 
under title XIX or XXI or otherwise, to only those services 
that are evidence based, or in any way limiting available 
services. 
‘‘(d) MATERNITY
CONSUMER
ASSESSMENT
OF 
HEALTH CARE PROVIDERS AND SYSTEMS SURVEYS.— 
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‘‘(1) ADAPTION OF SURVEYS.—Not later than 
January 1, 2022, for the purpose of measuring the 
care 
experiences 
of 
childbearing 
women 
and 
newborns, where appropriate, the Agency for 
Healthcare Research and Quality shall adapt Con-
sumer Assessment of Healthcare Providers and Sys-
tems program surveys of— 
‘‘(A) providers; 
‘‘(B) facilities; and 
‘‘(C) health plans. 
‘‘(2) SURVEYS
MUST
BE
EFFECTIVE.—The 
Agency for Healthcare Research and Quality shall 
ensure that the surveys adapted under paragraph 
(1) are effective in measuring aspects of care that 
childbearing women and newborns experience, which 
may include— 
‘‘(A) various types of care settings; 
‘‘(B) various types of caregivers; 
‘‘(C) considerations relating to pain; 
‘‘(D) shared decisionmaking; 
‘‘(E) supportive care around the time of 
birth; and 
‘‘(F) other topics relevant to the quality of 
the experience of childbearing women and 
newborns. 
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‘‘(3) LANGUAGES.—The surveys adapted under 
paragraph (1) shall be available in English and 
Spanish. 
‘‘(4) ENDORSEMENT.—The Agency for Health-
care Research and Quality shall submit any Con-
sumer Assessment of Healthcare Providers and Sys-
tems surveys adapted under this paragraph to the 
consensus-based entity with a contract under section 
1890(a)(1) to be considered for endorsement under 
section 1890(b)(2). 
‘‘(5) CONSULTATION.—The adaption of (and 
process for applying) the surveys under paragraph 
(1) shall be conducted in consultation 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; 
‘‘(iii) maternity care consumers and 
their advocates; 
‘‘(iv) technical experts in quality 
measurement; 
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‘‘(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. 
‘‘(e) ANNUAL STATE REPORTS REGARDING STATE- 
SPECIFIC MATERNAL AND INFANT QUALITY OF CARE 
MEASURES APPLIED UNDER MEDICAID OR CHIP.— 
‘‘(1) IN GENERAL.—Each State with a plan or 
waiver approved under title XIX or XXI shall annu-
ally report (separately or as part of the annual re-
port required under section 1139A(c)) to the Sec-
retary on— 
‘‘(A) the State-specific maternal and infant 
health quality measures applied by the State 
under such plan or waiver, including measures 
described in subsection (b)(5)(B); and 
‘‘(B) the State-specific information on the 
quality of health care furnished to Medicaid and 
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CHIP eligible mothers and infants under such 
plan or waiver, including information collected 
through external quality reviews of managed 
care organizations under section 1932 and 
benchmark plans under section 1937. 
‘‘(2) PUBLICATION.—Not later than September 
30, 2024, and annually thereafter, the Secretary 
shall collect, analyze, and make publicly available the 
information reported by States under paragraph (1). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $16,000,000 to carry 
out this section. Funds appropriated under this subsection 
shall remain available until expended.’’. 
(b) 
TECHNICAL
AMENDMENT.—Section 
1139B(d)(1)(A) of the Social Security Act (42 U.S.C. 
1320b–9b(d)(1)(A)) is amended by striking ‘‘subsection 
(a)(5)’’ and inserting ‘‘subsection (b)(5)’’. 
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 and infant care quality collaboratives; 
(2) expanded activities of existing maternity 
and infant care quality collaboratives; and 
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(3) maternity and infant 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 and infant care initiatives, to 
the extent that such collaboratives use such grant 
only for such initiatives. 
(2) Entities seeking to establish a maternity 
and infant 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— 
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(1) improving the appropriate use of caesarean 
section; 
(2) reducing maternal and newborn morbidity 
rates; 
(3) improving breast-feeding rates; 
(4) reducing hospital readmission rates; 
(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 
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