,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #hif  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,febru>y #bh1 #bjac   
,mr4 ,engel introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,en]gy &   
,comm]ce  ,a ,,bill  ,to am5d title ,,xi
 ( ! ,social ,security ,act to improve !
 quality1 heal? outcomes1 & value (     
mat]nity c>e "u ! ,m$icaid & ,,*ip      
programs by develop+ mat]nity c>e       
quality measures & support+ mat]nity c>e
 quality collaboratives4  #a4 ,%ort     
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,quality ,c>e 
= ,moms & ,babies ,act4  7b7 ,table (   
cont5ts ,! table ( cont5ts ( ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title2 table
 ( cont5ts4 ,sec4 #b4 ,quality measures 
= mat]nity c>e "u ,m$icaid & ,,*ip4     
,sec4 #c4 ,quality collaboratives4  #b4 
,quality measures = mat]nity c>e "u     
,m$icaid & ,,*ip  7a7 ,9 g5]al ,section 
#aaci;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;b-#i;a7 is am5d$ by    
add+ at ! end ! foll[+ new subsection3  

7j7 ,"m & ,infant c>e 7,,mic7 quality   
measures  7#a7 ,9 g5]al ,z "p ( !       
p$iatric quality measures program       
e/abli%$ "u subsection 7b7 & ! ,m$icaid 
,quality ,measurem5t ,program e/abli%$  
"u section #aaci;,b7b77#e77;,a71 !      
,secret>y %all--  7,a7 review quality   
measures endors$ "u section             
#ahij7;b77#b7 t relate to ! c>e (       
*ildbe>+ wom5 & newborns1 p>ticul>ly )  
respect to ! application ( su* measures 
to ! ,m$icaid & ,,*ip programs "u titles
 ,,xix & ,,xxi1 & id5tify omissions &   
defici5cies 9 ! application ( ^?        
measures to su* programs2  7,b7 develop 
& publi% a set ( mat]nity c>e quality   
measures = ! ,m$icaid & ,,*ip programs  
"u titles ,,xix & ,,xxi 79 ?is          
subsection ref]r$ to z ! ,"m & ,infant  
,c>e 7,,mic7 quality measures7 9        
accordance ) ! requirem5ts ( p>agraphs  
7#b7 & 7#c72 &  7,c7 on an ongo+ basis1 
review ! ,,mic quality measures &       
develop & publi% any modifications (1 or
 additions or deletions to1 su* measures

 t reflect ! developm5t1 te/+1          
validation1 & cons5sus process describ$ 
9 p>agraph 7#d74  7#b7 ,process =       
initial review & publication  7,a7      
,consultation & public comm5t ,n lat]   
?an ,janu>y #a1 #bjaf1 ! ,secret>y      
%all--  7i7 solicit public comm5t on !  
propos$ ,,mic quality measures2 &  7ii7 
consult ) ! /akehold]s id5tifi$ 9       
p>agraph 7#f77;,a7 reg>d+ su* measures4 
7,b7 ,publication ( initial set (       
measures ,n lat] ?an ,janu>y #a1 #bjag1 
! ,secret>y %all id5tify & publi% !     
initial ,,mic quality measures4  7#c7   
,requirem5ts  7,a7 ,9 g5]al ,! ,,mic    
quality measures %all--  7i7 be         
evid5ce-bas$2  7ii7 utilize risk        
adju/m5t or risk /ratification          
me?odologies1 if appropriate2  7iii7    
utilize attribution me?ods to specify ! 
cl9icians1 facilities1 & o!r entities t 
! measures are applicable to2  7iv7 be  
pilot-te/$ ) reg>d to sci5tific         
validity1 feasibility1 & attribution    
me?od2 &  7v7 include a balance ( ea* ( 

! types ( measures li/$ 9 subp>agraph   
7,b74  7,b7 ,li/ ( types ( measures ,!  
measures li/$ 9 ?is subp>agraph are !   
foll[+3  7i7 ,measures ( ! process1     
exp]i5ce1 effici5cy1 & outcomes (       
mat]nity c>e1 includ+ po/p>tum outcomes4
  7ii7 ,measures t apply to--  7,i7 wom5
 & newborns :o are heal?y & at l[ risk1 
includ+ measures ( appropriately        
l[-int]v5tion1 physiologic bir? 9       
l[-risk wom52 &  7,,ii7 wom5 & newborns 
at high] risk4  7iii7 ,measures t apply 
to--  7,i7 *ildbe>+ wom52 &  7,,ii7     
newborns4  7iv7 ,measures t apply to c>e
 dur+--  7,i7 pregnancy2  7,,ii7        
intrap>tum p]iod2 &  7,,iii7 ! po/p>tum 
p]iod4  7v7 ,measures t apply to--  7,i7
 cl9icians & cl9ician gr\ps2  7,,ii7    
facilities2  7,,iii7 heal? plans2 &     
7,,iv7 acc\ntable c>e organizations4    
7vi7 ,measurem5t (--  7,i7 disp>ities2  
7,,ii7 c>e coord9ation2 &  7,,iii7 %>$  
decisionmak+4  7,c7 ,physiologic def9$  
,= purposes ( ?is p>agraph1 ! t]m       
physiologic means *>act]i/ic ( or con=m+

 to ! normal function+ or /ate ( ! body 
or a tissue or organ1 normal1 & n       
pa?ologic4  7,d7 ,con/ruction ,no?+ 9   
?is p>agraph %all be con/ru$ z support+ 
! re/riction ( cov]age1 "u title ,,xix  
or ,,xxi or o!rwise1 to only ^? s]vices 
t are evid5ce-bas$1 or 9 any way limit+ 
available s]vices4  7#d7 ,ongo+ review (
 ! ,,mic measures2 e,measures  7,a7     
,contracts ) qualifi$ entities ,n lat]  
?an ,june #cj1 #bjag1 ! ,secret>y1 act+ 
?r\gh ! ,ag5cy = ,heal?c>e ,rese>* &    
,quality1 9 consultation ) ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices1 %all ent]   
into grants1 contracts1 or              
int]gov]nm5tal agreem5ts ) qualifi$     
measure developm5t entities = ! purpose 
( id5tify+ quality ( c>e issues t are n 
adequately address$ by ! ,,mic quality  
measures & develop+1 te/+1 & validat+   
modifications (1 or additions or        
deletions to1 ! ,,mic quality measures1 
& creat+ e,measures = data collection   
relat$ to ! ,,mic quality measures4     
7,b7 ,qualifi$ measure developm5t entity

 def9$ ,= purposes ( ?is p>agraph1 ! t]m
 qualifi$ measure developm5t entity     
means an entity t--  7i7 has demon/rat$ 
exp]tise & capacity 9 ! developm5t &    
te/+ ( quality measures2  7ii7 has      
adopt$ proc$ures = quality measure      
developm5t t ensure ! inclusion (--     
7,i7 ! views ( ! individuals & entities 
ref]r$ to 9 p>agraph 7#c77;,b77v7 & ^:  
p]=mance w be assess$ by ! measures2 &  
7,,ii7 ! views ( o!r individuals &      
entities 7includ+ pati5ts1 consum]s1 &  
heal? c>e pur*as]s7 :o w use ! data     
g5]at$ z a result ( ! use ( ! quality   
measures2  7iii7 = ! purpose ( ensur+ t 
! ,,mic quality measures meet !         
requirem5ts to be consid]$ = endorsem5t 
"u section #ahij7;b77#b71 has provid$   
assurances to ! ,secret>y t ! measure   
developm5t entity w collaborate )--     
7,i7 ! ,secret>y2  7,,ii7 !             
cons5sus-bas$ entity ) a contract "u    
section #ahij7;a77#a72 &  7,,iii7       
/akehold]s 7includ+ ^? /akehold]s       
id5tifi$ 9 p>agraph 7#f77;,a771 z       

practicable2  7iv7 has transp>5t        
policies reg>d+ gov]nance & conflicts ( 
int]e/2 &  7v7 submits an application to
 ! ,secret>y at su* "t1 & 9 su* =m &    
mann]1 z ! ,secret>y may require4  7,c7 
e,measures  7i7 ,9 g5]al ,a qualifi$    
measure developm5t entity ) a grant1    
contract1 or int]gov]nm5tal agreem5t "u 
subp>agraph 7,a7 %all consult ) !       
volunt>y cons5sus /&>ds sett+           
organizations & o!r organizations       
involv$ 9 ! advancem5t ( evid5ce-bas$   
measures ( heal? c>e t ! ,secret>y      
consults ) "u subsection 7b77#c77;,h7 & 
section #aaci;,b7b77#e77;,a7 to create1 
z "p ( ! ,,mic quality measures1        
e,measures t are align$ ) ! measures    
develop$ "u ! p$iatric quality measures 
program e/abli%$ "u subsection 7b7 & !  
,m$icaid ,quality ,measurem5t ,program  
e/abli%$ "u section                     
#aaci;,b7b77#e77;,a74  7ii7 e,measure   
def9$ ,= purposes ( ?is subp>agraph1 !  
t]m e,measure means a measure = :i*     
measurem5t data 7includ+ cl9ical data7 w

 be collect$ electronically1 includ+    
?r\gh ! use ( electronic heal? records &
 o!r electronic data s\rces4  7,d7      
,endorsem5t ,any modifications (1 or    
additions or deletions to1 ! ,,mic      
quality measures %all be submitt$ by !  
qualifi$ measure developm5t entity to ! 
cons5sus-bas$ entity ) a contract "u    
section #ahij7;a77#a7 to be consid]$ =  
endorsem5t "u section #ahij7;b77#b74    
7#e7 ,mat]nity consum] assessm5t ( heal?
 c>e provid]s & sy/ems surveys  7,a7    
,adaption ( surveys ,n lat] ?an ,janu>y 
#a1 #bjah1 = ! purpose ( measur+ ! c>e  
exp]i5ces ( *ildbe>+ wom5 & newborns1 ! 
,ag5cy = ,heal?c>e ,rese>* & ,quality   
%all adapt ! ,consum] ,assessm5t (      
,heal?c>e ,provid]s & ,sy/ems program   
surveys (--  7i7 provid]s2  7ii7        
facilities2 &  7iii7 heal? plans4  7,b7 
,surveys mu/ be effective ,! ,ag5cy =   
,heal?c>e ,rese>* & ,quality %all ensure
 t ! surveys adapt$ "u subp>agraph 7,a7 
are effective 9 measur+ aspects ( c>e t 
*ildbe>+ wom5 & newborns exp]i5ce1 :i*  

may include--  7i7 v>i\s types ( c>e    
sett+s2  7ii7 v>i\s types ( c>egiv]s2   
7iii7 consid]ations relat+ to pa92  7iv7
 %>$ decisionmak+2  7v7 supportive c>e  
ar\nd ! "t ( bir?2 &  7vi7 o!r topics   
relevant to ! quality ( ! exp]i5ce (    
*ildbe>+ wom5 & newborns4  7,c7         
,languages ,! surveys adapt$ "u         
subp>agraph 7,a7 %all be available 9    
,engli% & ,spani%4  7,d7 ,endorsem5t ,! 
,ag5cy = ,heal?c>e ,rese>* & ,quality   
%all submit any ,consum] ,assessm5t (   
,heal?c>e ,provid]s & ,sy/ems surveys   
adapt$ "u ?is p>agraph to !             
cons5sus-bas$ entity ) a contract "u    
section #ahij7;a77#a7 to be consid]$ =  
endorsem5t "u section #ahij7;b77#b74    
7,e7 ,consultation ,! adaption ( 7&     
process = apply+7 ! surveys "u          
subp>agraph 7,a7 %all be conduct$ 9     
consultation ) ! /akehold]s id5tifi$ 9  
p>agraph 7#f77;,a74  7#f7 ,/akehold]s   
7,a7 ,9 g5]al ,! /akehold]s id5tifi$ 9  
?is subp>agraph are--  7i7 ! v>i\s      
cl9ical discipl9es & specialties involv$

 9 provid+ mat]nity c>e2  7ii7 ,/ate    
,m$icaid adm9i/rators2  7iii7 mat]nity  
c>e consum]s & _! advocates2  7iv7      
te*nical exp]ts 9 quality measurem5t2   
7v7 hospital1 facility & heal? sy/em    
lead]s2  7vi7 employ]s & pur*as]s2 &    
7vii7 o!r individuals :o are involv$ 9 !
 advancem5t ( evid5ce-bas$ mat]nity c>e 
quality measures4  7,b7 ,pr(essional    
organizations ,! /akehold]s id5tifi$ "u 
subp>agraph 7,a7 may include            
repres5tatives f relevant national      
m$ical specialty & pr(essional          
organizations & specialty societies4    
7#g7 ,au?orization ( appropriations ,!re
 are au?oriz$ to be appropriat$         
#af1jjj1jjj to c>ry out ?is subsection4 
,funds appropriat$ "u ?is p>agraph %all 
rema9 available until exp5d$4  4  7b7   
,con=m+ am5dm5ts  7#a7 ,section #aaci;,a
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acbj;b-#i;a7 is am5d$--  7,a7
 9 subsection 7a77#f71 9 ! matt] prec$+ 
subp>agraph 7,a71 by ins]t+ & ! ,m$icaid
 & ,,*ip ,paym5t & ,access ,commission  

aft] ,congress2 &  7,b7 9 subsection    
7i71 by /rik+ subsection 7e7 & ins]t+   
subsections 7e7 & 7j74  7#b7 ,section   
#aaci;,b7b77#d7 ( su* ,act 7#db         
,u4,s4,c4 #acbj;b-#i;b7b77#d77 is am5d$ 
by ins]t+ & ! ,m$icaid & ,,*ip ,paym5t &
 ,access ,commission aft] ,congress4    
#c4 ,quality collaboratives  7a7 ,grants
 ,! ,secret>y ( ,heal? & ,human ,s]vices
 79 ?is section ref]r$ to z ! ,secret>y7
 may make grants to eligible entities to
 support--  7#a7 ! developm5t ( new     
,/ate & regional mat]nity c>e quality   
collaboratives2  7#b7 exp&$ activities (
 exi/+ mat]nity c>e quality             
collaboratives2 &  7#c7 mat]nity c>e    
initiatives )9 e/abli%$ ,/ate & regional
 quality collaboratives t are n focus$  
exclusively on mat]nity c>e4  7b7       
,eligible entity ,! foll[+ entities %all
 be eligible = a grant "u subsection    
7a73  7#a7 ,quality collaboratives t    
focus entirely1 or 9 "p1 on mat]nity c>e
 initiatives1 to ! ext5t t su*          
collaboratives use su* grant only = su* 

initiatives4  7#b7 ,entities seek+ to   
e/abli% a mat]nity c>e quality          
collaborative4  7#c7 ,/ate ,m$icaid     
ag5cies4  7#d7 ,/ate dep>tm5ts ( heal?4 
7#e7 ,heal? insurance issu]s 7z su* t]m 
is def9$ 9 section #bgia ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#ia74  7#f7 ,provid]            
organizations1 includ+ associations     
repres5t+--  7,a7 heal? pr(essionals2 & 
7,b7 hospitals4  7c7 ,eligible projects 
& programs ,9 ord] = a project or       
program ( an eligible entity to be      
eligible = fund+ "u subsection 7a71 !   
project or program mu/ h goals t are    
design$ to improve ! quality ( mat]nity 
c>e deliv]$1 su* z--  7#a7 improv+ !    
appropriate use ( ces>ean section2  7#b7
 r$uc+ mat]nal & newborn morbidity      
rates2  7#c7 improv+ brea/-fe$+ rates2  
7#d7 r$uc+ hospital readmission rates2  
7#e7 id5tify+ improvem5t priorities     
?r\gh %>$ pe] review & ?ird-p>ty reviews
 ( qualitative & quantitative data1 &   
develop+ & c>ry+ out projects or        

programs to address su* priorities2 or  
7#f7 deliv]+ risk-appropriate levels (  
c>e4  7d7 ,activities ,activities t may 
be support$ by ! fund+ "u subsection 7a7
 include ! foll[+3  7#a7 ,facilitat+    
p]=mance data collection & fe$back      
reports to provid]s ) respect to _!     
p]=mance1 relative to pe]s & b5*m>ks1 if
 any4  7#b7 ,develop+1 implem5t+1 &     
evaluat+ protocols & *eckli/s to fo/]   
safe1 evid5ce-bas$ practice4  7#c7      
,develop+1 implem5t+1 & evaluat+        
programs t translate into practice      
cl9ical recomm5dations support$ by      
high-quality evid5ce 9 national         
guidel9es1 sy/ematic reviews1 or o!r    
well-conduct$ cl9ical /udies4  7#d7     
,develop+ und]ly+ infra/ructure ne$$ to 
support quality collaborative activities
 "u ?is subsection4  7#e7 ,provid+      
te*nical assi/ance to provid]s &        
in/itutions to build quality improvem5t 
capacity & facilitate p>ticipation 9    
collaborative activities4  7#f7         
,develop+ ! capability to access !      

foll[+ data s\rces3  7,a7 ,a "m's       
pr5atal1 intrap>tum1 & po/p>tum records4
  7,b7 ,a "m's m$ical records4  7,c7 ,an
 infant's m$ical records s9ce bir?4     
7,d7 ,bir? & dea? c]tificates4  7,e7    
,any o!r relevant ,/ate-level g5]at$    
data 7su* z data f ! pregnancy risk     
assessm5t managem5t sy/em 7,,prams774   
7#g7 ,develop+ access to bl9d$ liability
 claims data1 analyz+ ! data1 & us+ !   
results ( su* analysis to improve       
practice4  7e7 ,special rule = bir?s    
7#a7 ,9 g5]al ,subject to p>agraph 7#b71
 if a grant "u subsection 7a7 is = a    
project or program t focuses on bir?s1  
at lea/ #be p]c5t ( ! bir?s address$ by 
su* project or program mu/ occur 9 heal?
 facilities t p]=m few] ?an #a1jjj bir?s
 p] ye>4  7#b7 ,exception ,9 ! case ( a 
grant "u subsection 7a7 = a project or  
program locat$ 9 a ,/ate 9 :i* less ?an 
#be p]c5t ( ! heal? facilities 9 ! ,/ate
 p]=m less ?an #a1jjj bir?s p] ye>1 !   
p]c5tage ( bir?s 9 su* facilities       
address$ by su* project or program %all 

be comm5surate ) ! ,/atewide p]c5tage ( 
bir?s p]=m$ at su* facilities4  7f7 ,use
 ( quality measures ,projects & programs
 = :i* su* a grant is made %all--  7#a7 
include data collection ) rapid analysis
 & fe$back to p>ticipants ) a focus on  
improv+ practice & heal? outcomes2  7#b7
 develop a plan to id5tify & resolve    
data collection problems2  7#c7 id5tify 
& docum5t evid5ce-bas$ /rategies t w be 
us$ to improve p]=mance on quality      
measures & o!r metrics2 &  7#d7 exclude 
f quality measure collection & report+  
physicians & midwives :o att5d few] ?an 
#cj bir?s p] ye>4  7g7 ,report+ on      
quality measures ,any report+           
requirem5ts e/abli%$ by a project or    
program fund$ "u subsection 7a7 %all be 
design$ to--  7#a7 m9imize co/s &       
adm9i/rative ef=t2 &  7#b7 use exi/+    
data res\rces :5 feasible4  7h7         
,cle>+h\se ,! ,secret>y %all e/abli% an 
onl9e1 op5-access cle>+h\se to make     
protocols1 proc$ures1 reports1 tools1 & 
o!r res\rces ( individual collaboratives

 available to collaboratives & o!r      
entities t are work+ to improve mat]nity
 c>e quality4  7i7 ,evaluation ,a       
quality collaborative 7or o!r entity    
receiv+ a grant "u subsection 7a77      
%all--  7#a7 develop & c>ry out plans = 
evaluat+ its mat]nity c>e quality       
improvem5t programs & projects2 &  7#b7 
publi% its exp]i5ces & results 9        
articles1 te*nical reports1 or o!r =mats
 = ! b5efit ( o!rs work+ on mat]nity c>e
 quality improvem5t activities4  7j7    
,annual reports to ,secret>y ,a quality 
collaborative or o!r eligible entity t  
receives a grant "u subsection 7a7 %all 
submit an annual report to ! ,secret>y  
conta9+ ! foll[+3  7#a7 ,a description (
 ! activities c>ri$ out us+ ! fund+ f   
su* grant4  7#b7 ,a description ( any   
b>ri]s t limit$ ! ability ( !           
collaborative or entity to a*ieve its   
goals4  7#c7 ,! a*ievem5ts ( !          
collaborative or entity "u ! grant )    
respect to ! quality1 heal? outcomes1 & 
value ( mat]nity c>e4  7#d7 ,a li/ (    

lessons le>n$ f ! grant4  ,su* reports  
%all be made available to ! public4  7k7
 ,gov]nance  7#a7 ,9 g5]al ,a mat]nity  
c>e quality collaborative or a mat]nity 
c>e program )9 a broad] quality         
collaborative t is support$ "u          
subsection 7a7 %all be gov]n$ by a      
multi-/akehold] executive committee4    
7#b7 ,composition ,su* executive        
committee %all include individuals :o   
repres5t--  7,a7 physicians1 includ+    
physicians 9 ! fields ( g5]al ob/etrics1
 mat]nal-fetal m$ic9e1 family m$ic9e1   
neonatology1 & p$iatrics2  7,b7         
nurse-practition]s & nurses2  7,c7      
c]tifi$ nurse-midwives & c]tifi$        
midwives2  7,d7 heal? facilities & heal?
 sy/ems2  7,e7 consum]s2  7,f7 employ]s 
& o!r private pur*as]s2  7,g7 ,m$icaid  
programs2 &  7,h7 o!r public heal?      
ag5cies & organizations1 z appropriate4 
,su* committee also may include o!r     
individuals1 su* z individuals )        
exp]tise 9 heal? quality measurem5t &   
o!r types ( exp]tise z recomm5d$ by !   

,secret>y4 ,su* committee also may be   
compos$ ( a comb9ation ( g5]al          
collaborative executive committee memb]s
 & mat]nity specific project executive  
committee memb]s4  7l7 ,consultation ,a 
quality collaborative or o!r eligible   
entity t receives a grant "u subsection 
7a7 %all engage 9 regul> ongo+          
consultation )--  7#a7 regional & ,/ate 
public heal? ag5cies & organizations2   
7#b7 public & private heal? insur]s2 &  
7#c7 regional & ,/ate organizations     
repres5t+ physicians1 midwives1 & nurses
 :o provide mat]nity s]vices4  7m7      
,au?orization ( appropriations ,!re are 
au?oriz$ to be appropriat$ #ae1jjj1jjj  
to c>ry out ?is section4 ,funds         
appropriat$ "u ?is subsection %all rema9
 available until exp5d$4