[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1318 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 1318
To support States in their work to save and sustain the health of
mothers during pregnancy, childbirth, and in the postpartum period, to
eliminate disparities in maternal health outcomes for pregnancy-related
and pregnancy-associated deaths, to identify solutions to improve
health care quality and health outcomes for mothers, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 2, 2017
Ms. Herrera Beutler (for herself, Mr. Conyers, Mr. Costello of
Pennsylvania, and Ms. DeGette) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To support States in their work to save and sustain the health of
mothers during pregnancy, childbirth, and in the postpartum period, to
eliminate disparities in maternal health outcomes for pregnancy-related
and pregnancy-associated deaths, to identify solutions to improve
health care quality and health outcomes for mothers, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Preventing Maternal Deaths Act of
2017''.
SEC. 2. FINDINGS; PURPOSES.
(a) Findings.--Congress finds the following:
(1) The United States is ranked 50th globally for its
maternal mortality rate, and it is one of eight countries in
which the maternal mortality rate has been on the rise.
(2) In recent studies, the estimated maternal mortality
rate in the United States increased by approximately 26.6
percent from 2000 to 2014, with the rate increasing in nearly
all States. This reported increase, along with no improvement
in previous years, remains a source of great concern for the
Centers for Disease Control and Prevention (CDC), health care
providers, and patient advocates such as the American Congress
of Obstetricians and Gynecologists, the Association of Women's
Health, Obstetric, and Neonatal Nurses, and the Preeclampsia
Foundation.
(3) Maternal deaths in the United States result from
pregnancy-related causes such as hemorrhage, hypertensive
disease and preeclampsia, embolic disease, sepsis, and
substance use disorder and overdose, and violent causes such as
motor vehicle accidents, homicide, and suicide.
(4) Review of pregnancy-related and pregnancy-associated
deaths is essential to determining strategies for developing
prevention efforts and quality improvement and quality control
programs. The United States must identify at-risk populations
and understand how to support them to make pregnancy and the
postpartum period safer.
(5) The most severe complications of pregnancy, generally
referred to as severe maternal morbidity (SMM), affect more
than 65,000 women in the United States every year. The CDC uses
ICD-9-CM codes, which indicate a potentially life-threatening
maternal condition or complication, to define SMM.
(6) Data from the CDC shows Black women are three times
more likely to die from complications of pregnancy or
childbirth than White women: 42.8 Black women per 100,000 live
births, as opposed to 12.5 White women and 17.3 women of other
races.
(7) The CDC recommends that maternal deaths be investigated
through State collaboratives. These State collaboratives would
bring together leaders in obstetric and neonatal health care
from private, academic, and public health care settings to make
recommendations for preventing pregnancy-related and pregnancy-
associated deaths and health complications and identify ways to
improve quality of care for women and infants.
(8) A few States, including California, have worked to
develop and strengthen maternal morbidity and mortality review
systems and utilize data to reduce maternal deaths and injuries
to address leading issues such as maternal hemorrhage,
hypertension and preeclampsia, and health and racial
disparities.
(b) Purposes.--The purposes of this Act are the following:
(1) To establish a shared responsibility between States and
the Federal Government to identify opportunities for
improvement in quality of care and system changes, and to
educate and inform health institutions and professionals,
women, and families about preventing pregnancy-related and
pregnancy-associated deaths and complications and reducing
disparities.
(2) To develop a model for States to operate maternal
mortality reviews and assess the various factors that may have
contributed to maternal mortality, including quality of care,
racial disparities, and systemic problems in the delivery of
health care, and to develop appropriate interventions to reduce
and prevent such deaths.
SEC. 3. STATE MATERNAL MORTALITY REVIEW COMMITTEES ON PREGNANCY-RELATED
AND PREGNANCY-ASSOCIATED DEATHS.
(a) Program Authorized.--
(1) In general.--The Secretary of Health and Human
Services, through the Director of the Centers for Disease
Control and Prevention, shall establish a grant program under
which the Secretary may make grants to States for the purpose
of--
(A) carrying out the activities described in
subsection (b)(1);
(B) establishing and sustaining a State maternal
mortality review committee, in accordance with
subsection (b)(2);
(C) ensuring that the State department of health
carries out the activities described in subsection
(b)(3);
(D) disseminating the case abstraction form
developed under subsection (c); and
(E) providing for the public disclosure of
information, in accordance with subsection (d).
(2) Criteria.--The Secretary shall establish criteria for
determining eligibility for, and the amount of a grant awarded
to, a State under paragraph (1). Such criteria shall provide
that in the case of a State that receives a grant under
paragraph (1) for a fiscal year and is determined by the
Secretary to have not used such grant in accordance with this
section, such State may not be eligible for such a grant for
any subsequent fiscal year.
(b) Use of Funds.--
(1) Review of pregnancy-related and pregnancy-associated
deaths.--With respect to a State that receives a grant under
subsection (a)(1), the following shall apply:
(A) Process for mandatory reporting of pregnancy-
related and pregnancy-associated deaths.--
(i) In general.--The State, through the
State maternal mortality review committee
established under subsection (a)(1), shall
develop a process that provides for mandatory
and confidential case reporting to the State
department of health by individuals and
entities described in clause (ii) with respect
to pregnancy-related and pregnancy-associated
deaths.
(ii) Individuals and entities described.--
Individuals and entities described in this
clause include each of the following:
(I) Health care professionals.
(II) Medical examiners.
(III) Medical coroners.
(IV) Hospitals.
(V) Birth centers.
(VI) Other health care facilities.
(VII) Other individuals responsible
for completing death records.
(VIII) Other appropriate
individuals or entities specified by
the Secretary.
(B) Process for voluntary reporting of pregnancy-
related and pregnancy-associated deaths.--The State,
through the State maternal mortality review committee
established under subsection (a)(1), shall develop a
process that provides for voluntary and confidential
case reporting to the State department of health by
family members of the deceased and other individuals on
possible pregnancy-related and pregnancy-associated
deaths. Such process shall include--
(i) making publicly available on the
website of the State department of health a
telephone number, Internet web link, and email
address for such reporting; and
(ii) publicizing to local professional
organizations, community organizations, and
social services agencies the availability of
the telephone number, Internet web link, and
email address made available under clause (i).
(C) Identification of pregnancy-related and
pregnancy-associated deaths by state vital statistics
unit.--The State, through the vital statistics unit of
the State, shall annually identify pregnancy-related
and pregnancy-associated deaths occurring in such State
in the year involved by--
(i) matching each death record of a woman
in such year to a live birth certificate or an
infant death record for the purpose of
identifying deaths of women that occurred
during pregnancy and within one year after the
end of a pregnancy;
(ii) identifying each death of a woman
reported during such year as having an
underlying or contributing cause of death
related to pregnancy, regardless of the time
that has passed between the end of the
pregnancy and the death;
(iii) collecting data from medical examiner
and coroner reports; and
(iv) using any other method the State may
devise to identify maternal deaths such as
reviewing a random sample of reported deaths of
women to ascertain cases of pregnancy-related
and pregnancy-associated deaths that are not
discernable from a review of death records
alone.
For purposes of effectively collecting and obtaining
data on pregnancy-related and pregnancy-associated
deaths, the State shall adopt the most recent
standardized birth and death records, as issued by the
National Center for Vital Health Statistics, including
the recommended checkbox section for pregnancy on each
death record.
(D) Case investigation and development of case
summaries.--
(i) In general.--Following the receipt of
reports by the State department of health
pursuant to subparagraph (A) or (B) and the
collection of cases of pregnancy-related and
pregnancy-associated deaths by the vital
statistics unit of the State under subparagraph
(C), the State, through the State maternal
mortality review committee established under
subsection (a)(1), shall investigate each case,
using the case abstraction form described in
subsection (c), and prepare a de-identified
case summary for each case, which shall be
reviewed by the committee and included in
applicable reports. The State department of
health or vital statistics unit of the State,
as the case may be, shall provide the State
maternal mortality review committee with access
to the information collected pursuant to
subparagraph (A) or (B), or under subparagraph
(C), as necessary to carry out this
subparagraph.
(ii) Mandatory data and information.--Each
case investigation under this subparagraph
shall, subject to availability, include data
and information obtained through--
(I) medical examiner and autopsy
reports of the woman involved;
(II) medical records of the woman,
including such records related to
health care prior to pregnancy,
prenatal and postnatal care, labor and
delivery care, emergency room care,
hospital discharge records, and any
care delivered up until the time of
death of the woman;
(III) oral and written interviews
of individuals directly involved in the
maternal care of the woman during and
immediately following the pregnancy of
the woman, including health care,
mental health, and social service
providers, as applicable;
(IV) socioeconomic and other
relevant background information about
the woman;
(V) any information collected under
subparagraph (C)(i); and
(VI) any other information on the
cause of death of the woman, such as
social services and child welfare
reports.
(iii) Discretionary data and information.--
Each case investigation under this subparagraph
may include data and information obtained
through oral or written interviews of the
family of the woman.
(2) State maternal mortality review committees.--
(A) Mandatory activities.--A State maternal
mortality review committee established under subsection
(a)(1) shall carry out the following activities:
(i) Develop the processes described in
subparagraphs (A) and (B) of paragraph (1).
(ii) Review the data and information
collected by the vital statistics unit of the
State under paragraph (1)(C) regarding
pregnancy-related and pregnancy-associated
deaths to identify trends, patterns, and
disparities in adverse outcomes and address
medical, non-medical, and system-related
factors that may have contributed to such
pregnancy-related and pregnancy-associated
deaths and disparities.
(iii) Carry out the activities described in
paragraph (1)(D).
(iv) Develop recommendations, based on the
case summaries prepared under paragraph (1)(D)
and the data and information collected under
paragraph (1)(C), to improve maternal care,
social and health services, and public health
policy and institutions, including improving
access to maternal care and social and health
services and identifying disparities in
maternal care and outcomes.
(B) Discretionary activities.--
(i) In general.--A State maternal mortality
review committee established under subsection
(a)(1) may, while subject to confidentiality
requirements, present findings and
recommendations based on the case summaries
prepared under paragraph (1)(D) directly to a
health care facility or its local or State
professional organization for the purpose of--
(I) instituting policy changes,
educational activities, and
improvements in the quality of care
provided by the facility; and
(II) exploring and forming regional
collaborations.
(ii) Investigation of cases of severe
maternal morbidity.--A State maternal mortality
review committee may investigate cases of
severe maternal morbidity and any such
investigation may include data and information
obtained through--
(I) identified patient registries;
or
(II) oral or written interviews of
the woman concerned and the family of
such woman.
(C) Composition of state maternal mortality review
committees.--
(i) In general.--A State maternal mortality
review committee established under subsection
(a)(1) shall be multidisciplinary and diverse.
Membership on the State maternal mortality
review committee shall be reviewed annually by
the State department of health to ensure that
membership representation requirements are
being fulfilled in accordance with this
subparagraph.
(ii) Required membership.--Each State
maternal mortality review committee shall
include--
(I) representatives from medical
specialties providing care to pregnant
and postpartum patients, including
obstetricians (including generalists
and maternal fetal medicine
specialists) and family practice
physicians;
(II) certified nurse midwives,
certified midwives, and advanced
practice nurses;
(III) hospital-based registered
nurses;
(IV) representatives of the
maternal and child health department of
the State department of health;
(V) social service providers or
social workers, including those with
experience working with communities
diverse with respect to race,
ethnicity, and limited English
proficiency;
(VI) chief medical examiners or
designees;
(VII) facility representatives,
such as from hospitals or birth
centers;
(VIII) patient advocates, community
maternal health organizations, and
minority advocacy groups that represent
those diverse racial and ethnic
communities within the State that are
the most affected by pregnancy-related
or pregnancy-associated deaths and by a
lack of access to maternal health care
services; and
(IX) representatives of the
departments of health or public health
of major cities in the State.
(iii) Discretionary membership.--Each State
maternal mortality review committee may also
include representatives from other relevant
academic, health, social service, or policy
professions or community organizations on an
ongoing basis, or as needed, as determined
beneficial by the committee, including--
(I) anesthesiologists;
(II) emergency physicians;
(III) pathologists;
(IV) epidemiologists;
(V) intensivists;
(VI) nutritionists;
(VII) mental health professionals;
(VIII) substance use disorder
treatment specialists;
(IX) representatives of relevant
patient and provider advocacy groups;
(X) academics;
(XI) paramedics; and
(XII) risk management specialists.
(iv) Staff.--Staff of each State maternal
mortality review committee shall include--
(I) vital health statisticians,
maternal child health statisticians, or
epidemiologists;
(II) a coordinator of the State
maternal mortality review committee, to
be designated by the State; and
(III) administrative staff.
(D) Option for states to establish regional
maternal mortality review committees.--States may
choose to partner with one or more neighboring States
to carry out the activities required of a State
maternal mortality review committee under this section.
In such a case, with respect to the States in such a
partnership, any requirement under this section
relating to the reporting of information related to
such activities shall be deemed to be fulfilled by each
such State if a single such report is submitted for the
partnership.
(E) Treatment as public health authority for
purposes of hipaa.--For purposes of applying HIPAA
privacy and security law (as defined in section
3009(a)(2) of the Public Health Service Act (42 U.S.C.
300jj-19)), each State maternal mortality review
committee and regional maternal mortality review
committee established under subsection (a)(1) or
subsection (b)(2)(D), as the case may be, shall be
deemed to be a public health authority described in
section 164.501 (and referenced in section
164.512(b)(1)(i)) of title 45, Code of Federal
Regulations (or any successor regulation), carrying out
public health activities and purposes described in such
section 164.512(b)(1)(i) (or any such successor
regulation).
(3) State department of health activities.--With respect to
a State that receives a grant under subsection (a)(1), the
State department of health shall--
(A) in consultation with the State maternal
mortality review committee and in conjunction with
relevant professional organizations and patient
advocacy organizations, develop a plan for ongoing
health care provider education, based on the findings
and recommendations of the committee, in order to
improve the quality of maternal care; and
(B) take steps to widely disseminate the findings
and recommendations of the State maternal mortality
review committee and implement the recommendations of
the committee.
(c) Case Abstraction Form.--
(1) Dissemination.--The Director of the Centers for Disease
Control and Prevention shall disseminate a uniform case
abstraction form to States and State maternal mortality review
committees for the purpose of--
(A) ensuring that the data and information
collected and reviewed by such committees can be pooled
for review by the Department of Health and Human
Services and its agencies; and
(B) preserving the uniformity of the information
collected for Federal public health purposes.
(2) Permissible state modification.--Each State may modify
the form developed under paragraph (1) for implementation and
use by such State or by the State maternal mortality review
committee of such State by including on such form additional
information to be collected, but may not alter the standard
questions on such form, in order to ensure that the information
can be collected and reviewed centrally at the Federal level.
(d) Public Disclosure of Information.--
(1) In general.--For fiscal year 2018, or a subsequent
fiscal year, each State receiving a grant under this section
for such year shall, subject to paragraph (3), provide for the
public disclosure, and submission to the information
clearinghouse established under paragraph (2), of the
information included in the report of the State under
subsection (f)(1) for such year.
(2) Information clearinghouse.--The Secretary shall
establish an information clearinghouse, to be administered by
the Director of the Centers for Disease Control and Prevention,
that will maintain findings and recommendations submitted
pursuant to paragraph (1) and provide such findings and
recommendations for public review and research purposes by
State departments of health, State maternal mortality review
committees, health providers and institutions, and national
patient and provider advocacy groups.
(3) Confidentiality of information.--In no case may any
individually identifiable health information be provided to the
public, or submitted to the information clearinghouse, under
this subsection.
(e) Confidentiality of Proceedings of State Maternal Mortality
Review Committees.--
(1) In general.--All proceedings and activities of a State
maternal mortality review committee established under
subsection (a)(1), opinions of members of such a committee
formed as a result of such proceedings and activities, and
records obtained, created, or maintained pursuant to this
section, including records of interviews, written reports, and
statements procured by the Department of Health and Human
Services or by any other person, agency, or organization acting
jointly with the Department, in connection with morbidity and
mortality reviews under this section, shall be confidential and
may not be subject to discovery, subpoena, or introduction into
evidence in any civil, criminal, legislative, or other
proceeding. Such records shall not be open to public
inspection.
(2) Testimony of members of committee.--
(A) In general.--Members of a State maternal
mortality review committee established under subsection
(a)(1) may not be questioned in any civil, criminal,
legislative, or other proceeding regarding information
presented in, or opinions formed as a result of, a
meeting or communication of the committee.
(B) Clarification.--Nothing in this subsection may
be construed to prevent a member of a State maternal
mortality review committee established under subsection
(a)(1) from testifying regarding information that was
obtained independent of such member's participation on
the committee, or public information.
(3) Availability of information for research purposes.--
Nothing in this subsection may prohibit a State maternal
mortality review committee established under subsection (a)(1)
or the Department of Health and Human Services from publishing
statistical compilations and research reports that--
(A) are based on confidential information, relating
to morbidity and mortality reviews under this section;
and
(B) do not contain identifying information or any
other information that could be used to ultimately
identify the individuals concerned.
(f) Reports.--
(1) State reports.--Not later than one year after the end
of fiscal year 2018, and each subsequent fiscal year, each
State maternal mortality review committee established under
subsection (a)(1) and receiving a grant under this section for
such year, shall submit to the Director of the Centers for
Disease Control and Prevention a report on the findings and
recommendations of such committee and information on the
implementation of such recommendations during such year.
(2) Annual reports to congress.--Not later than 60 days
after the deadline for State reports under paragraph (1) for
fiscal year 2018, and each subsequent fiscal year, the
Secretary of Health and Human Services shall submit to Congress
a report on--
(A) the findings, recommendations, and
implementation information submitted by any State
pursuant to paragraph (1); and
(B) the status of pregnancy-related and pregnancy-
associated deaths in the United States, including
recommendations on methods to prevent such deaths in
the United States.
(g) Definitions.--In this section:
(1) The term ``pregnancy-associated death'' means the death
of a woman while pregnant or during the one-year period
following the date of the end of pregnancy, irrespective of the
cause of such death.
(2) The term ``pregnancy-related death'' means the death of
a woman while pregnant or during the one-year period following
the date of the end of pregnancy, irrespective of the duration
of the pregnancy, from any cause related to, or aggravated by,
the pregnancy or its management, excluding any accidental or
incidental cause.
(3) The term ``severe maternal morbidity'' means the
physical and psychological conditions that result from, or are
aggravated by, pregnancy and have an adverse effect on the
health of a woman.
(4) The term ``State'' means each of the 50 States, the
District of Columbia, and each of the territories.
(5) The term ``vital statistics unit'' means the entity
that is responsible for maintaining vital records for a State,
including official records of live births, deaths, fetal
deaths, marriages, divorces, and annulments.
(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $7,000,000 for each of fiscal
years 2018 through 2022.
SEC. 4. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.
Part B of title III of the Public Health Service Act is amended by
inserting after section 317T of such Act (42 U.S.C. 247b-22) the
following new section:
``SEC. 317U. ELIMINATING DISPARITIES IN MATERNAL HEALTH OUTCOMES.
``(a) In General.--The Secretary shall, in consultation with
relevant national stakeholder organizations, such as national medical
specialty organizations, national maternal child health organizations,
national patient advocacy organizations, and national health disparity
organizations, carry out the following activities to eliminate
disparities in maternal health outcomes:
``(1) Conduct research into the determinants and the
distribution of disparities in maternal care, health risks, and
health outcomes, and improve the capacity of the performance
measurement infrastructure to measure such disparities.
``(2) Expand access to health care services, resources, and
information that have been demonstrated to improve the quality
and outcomes of maternity care for vulnerable populations.
``(3) Establish a demonstration project to compare the
effectiveness of interventions to reduce disparities in
maternity services and outcomes and to implement and assess
effective interventions.
``(b) Scope and Selection of States for Demonstration Project.--The
demonstration project under subsection (a)(3) shall be conducted in no
more than 8 States, which shall be selected by the Secretary based on--
``(1) applications submitted by States, which specify which
regions and populations the State involved will serve under the
demonstration project;
``(2) criteria designed by the Secretary to ensure that, as
a whole, the demonstration project is, to the greatest extent
possible, representative of the demographic and geographic
composition of communities most affected by disparities;
``(3) criteria designed by the Secretary to ensure that a
variety of models are tested through the demonstration project
and that such models include interventions that have an
existing evidence base for effectiveness; and
``(4) criteria designed by the Secretary to ensure that the
demonstration projects and models will be carried out in
consultation with local and regional provider organizations,
such as community health centers, hospital systems, and medical
societies representing providers of maternity services.
``(c) Duration of Demonstration Project.--The demonstration project
under subsection (a)(3) shall begin on January 1, 2018, and end on
December 31, 2021.
``(d) Grants for Evaluation and Monitoring.--The Secretary may make
grants to States and health care providers participating in the
demonstration project under subsection (a)(3) for the purpose of
collecting data necessary for the evaluation and monitoring of such
project.
``(e) Reports.--
``(1) State reports.--Each State that participates in the
demonstration project under subsection (a)(3) shall report to
the Secretary, in a time, form, and manner specified by the
Secretary, the data necessary to--
``(A) monitor the--
``(i) outcomes of the project;
``(ii) costs of the project; and
``(iii) quality of maternity care provided
under the project; and
``(B) evaluate the rationale for the selection of
the items and services included in any bundled payment
made by the State under the project.
``(2) Final report.--Not later than December 31, 2022, the
Secretary shall submit to Congress a report on the results of
the demonstration project under subsection (a)(3).''.
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