[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4216 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4216

To amend title V of the Social Security Act to provide grants to States 
 to establish State maternal mortality review committees on pregnancy-
related deaths occurring within such States; to develop definitions of 
    severe maternal morbidity and data collection protocols; and to 
           eliminate disparities in maternal health outcomes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 12, 2014

  Mr. Conyers (for himself and Ms. DeGette) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title V of the Social Security Act to provide grants to States 
 to establish State maternal mortality review committees on pregnancy-
related deaths occurring within such States; to develop definitions of 
    severe maternal morbidity and data collection protocols; and to 
           eliminate disparities in maternal health outcomes.

    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 ``Maternal Health Accountability Act 
of 2014''.

SEC. 2. FINDINGS; PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) The aggregate pregnancy-related mortality ratio in the 
        United States as measured by the Centers for Disease Control 
        and Prevention Pregnancy Mortality Surveillance System was 14.5 
        for the 8-year period 1998 through 2005, higher than any other 
        period in the previous 20 years. Although this increase may 
        reflect changes in data collection methods by the 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, and registered nurses, health care 
        providers, and patient advocates such as the Joint Commission, 
        the American College of Obstetricians and Gynecologists, and 
        Amnesty International.
            (2) The Centers for Disease Control and Prevention has 
        found that maternal deaths should be investigated through 
        State-based maternal death reviews and maternal quality 
        collaboratives, as these entities are well-situated to identify 
        deaths, review the factors associated with them, and take 
        action with the findings in order to institute the systemic 
        changes needed to decrease pregnancy-related and pregnancy-
        associated mortality.
            (3) Women of color and low-income women face added risks in 
        terms of death, complications, and access to quality health 
        care. African-American women are three to four times more 
        likely to die of pregnancy-related complications than White 
        women. In 2006 the Centers for Disease Control and Prevention 
        reported that the maternal mortality ratio for non-Hispanic 
        White women was 9.1 deaths per 100,000 births compared with 
        34.8 deaths per 100,000 births for non-Hispanic Black women. 
        These rates and disparities have not improved in more than 20 
        years.
            (4) Healthy People 2010, a comprehensive, nationwide health 
        promotion and disease prevention agenda launched by the 
        Department of Health and Human Services, set a target goal of 
        reducing maternal mortality in the United States to 4.3 deaths 
        per 100,000 live births by 2010. In 2007, the national maternal 
        mortality ratio was 12.7 deaths per 100,000 live births.
            (5) Severe complications that result in women nearly dying, 
        known as a ``near miss'' or severe maternal morbidity has 
        increased by 75 percent for delivery (based on data comparing 
        1998 through 1999) and 114 percent for postpartum 
        hospitalizations (based on data comparing 2008 through 2009). 
        Such data also estimates that severe morbidity affects 52,000 
        women a year and is expected to continue to increase. Moreover, 
        there is no scientific consensus on uniform definitions of 
        severe maternal morbidity and best practices for data 
        collection, making it difficult to measure the full extent of 
        severe morbidity and developing evidence-based interventions.
    (b) Purposes.--The purposes of this Act are the following:
            (1) To establish governmental accountability and 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 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. UNIFORM STATE MATERNAL MORTALITY REVIEW COMMITTEES ON 
              PREGNANCY-RELATED DEATHS.

    (a) Condition of Receipt of Payments From Allotment Under Maternal 
and Child Health Service Block Grant.--Title V of the Social Security 
Act (42 U.S.C. 701 et seq.) is amended by adding at the end the 
following new section:

``SEC. 514. UNIFORM STATE MATERNAL MORTALITY REVIEW COMMITTEES ON 
              PREGNANCY-RELATED DEATHS.

    ``(a) Grants.--
            ``(1) In general.--Notwithstanding any other provision of 
        this title, for each of fiscal years 2015 through 2021, in 
        addition to payments from allotments for States under section 
        502 for such year, the Secretary shall, subject to paragraph 
        (3) and in accordance with the criteria established under 
        paragraph (2), award grants to States to--
                    ``(A) carry out the activities described in 
                subsection (b)(1);
                    ``(B) establish a State maternal mortality review 
                committee, in accordance with subsection (b)(2), to 
                carry out the activities described in subsection 
                (b)(2)(A), and to establish the processes described in 
                subsection (b)(1);
                    ``(C) ensure the State department of health carries 
                out the applicable activities described in subsection 
                (b)(3), with respect to pregnancy-related deaths 
                occurring within the State during such fiscal year;
                    ``(D) implement and use the comprehensive case 
                abstraction form developed under subsection (c), in 
                accordance with such subsection;
                    ``(E) provide for public disclosure of information, 
                in accordance with subsection (e); and
                    ``(F) collect, analyze, and report to the Secretary 
                cases of maternal morbidity, including reports of 
                maternal morbidity data on admissions to an intensive 
                care unit or the transfusion of more than three units 
                of blood products.
            ``(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 such a grant for a 
        fiscal year and is determined by the Secretary to have not used 
        such grant in accordance with this section, such State shall 
        not be eligible for such a grant for any subsequent fiscal 
        year.
            ``(3) Authorization of appropriations.--For purposes of 
        carrying out the grant program under this section, including 
        for administrative purposes, there is authorized to be 
        appropriated $10,000,000 for each of fiscal years 2015 through 
        2021.
    ``(b) Pregnancy-Related Death Review.--
            ``(1) Review of pregnancy-related death and pregnancy-
        associated death cases.--For purposes of subsection (a), with 
        respect to a State that receives a grant under subsection (a), 
        the following shall apply:
                    ``(A) Mandatory reporting of pregnancy-related 
                deaths.--
                            ``(i) In general.--The State shall, through 
                        the State maternal mortality review committee, 
                        develop a process, separate from any reporting 
                        process established by the State department of 
                        health prior to the date of the enactment of 
                        this section, that provides for mandatory and 
                        confidential case reporting by individuals and 
                        entities described in clause (ii) of pregnancy-
                        related deaths to the State department of 
                        health.
                            ``(ii) Individuals and entities 
                        described.--Individuals and entities described 
                        in this clause include each of the following:
                                    ``(I) Health care providers.
                                    ``(II) Medical examiners.
                                    ``(III) Medical coroners.
                                    ``(IV) Hospitals.
                                    ``(V) Free-standing birth centers.
                                    ``(VI) Other health care 
                                facilities.
                                    ``(VII) Any other individuals 
                                responsible for completing death 
                                certificates.
                                    ``(VIII) Any other appropriate 
                                individuals or entities specified by 
                                the Secretary.
                    ``(B) Voluntary reporting of pregnancy-related and 
                pregnancy-associated deaths.--
                            ``(i) The State shall, through the State 
                        maternal mortality review committee, develop a 
                        process for and encourage, separate from any 
                        reporting process established by the State 
                        department of health prior to the date of the 
                        enactment of this section, voluntary and 
                        confidential case reporting by individuals 
                        described in clause (ii) of pregnancy-
                        associated deaths to the State department of 
                        health.
                            ``(ii) The State shall, through the State 
                        maternal mortality review committee, develop a 
                        process for voluntary and confidential 
                        reporting by family members of the deceased and 
                        by other individuals on possible pregnancy-
                        related and pregnancy-associated deaths to the 
                        State department of health. Such process shall 
                        include--
                                    ``(I) making publicly available on 
                                the Internet Web site 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 
                                subclause (I).
                    ``(C) Development of case-finding.--The State, 
                through the vital statistics unit of the State, shall 
                annually identify pregnancy-related and pregnancy-
                associated deaths occurring in such State during the 
                year involved by--
                            ``(i) matching all death records, with 
                        respect to such year, for women of childbearing 
                        age to live birth certificates and infant death 
                        certificates to identify deaths of women that 
                        occurred during pregnancy and within one year 
                        after the end of a pregnancy;
                            ``(ii) identifying deaths 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) any other methods the States may 
                        devise to identify maternal deaths, such as 
                        through review of a random sample of reported 
                        deaths of women of childbearing age to 
                        ascertain cases of pregnancy-related and 
                        pregnancy-associated deaths that are not 
                        discernable from a review of death certificates 
                        alone.
                When feasible and 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 certificates, 
                as issued by the National Center for Vital Health 
                Statistics, including the recommended checkbox section 
                for pregnancy on the death certificates.
                    ``(D) Case investigation and development of case 
                summaries.--Following receipt of reports by the State 
                department of health pursuant to subparagraph (A) or 
                (B) and collection by the vital statistics unit of the 
                State of possible cases of pregnancy-related and 
                pregnancy-associated deaths pursuant to subparagraph 
                (C), the State, through the State maternal mortality 
                review committee established under subsection (a), 
                shall investigate each case, utilizing the case 
                abstraction form described in subsection (c), and 
                prepare de-identified case summaries, which shall be 
                reviewed by the committee and included in applicable 
                reports. For purposes of subsection (a), under the 
                processes established under subparagraphs (A), (B), and 
                (C), a State department of health or vital statistics 
                unit of a State shall provide to the State maternal 
                mortality review committee access to information 
                collected pursuant to such subparagraphs as necessary 
                to carry out this subparagraph. Data and information 
                collected for the case summary and review are for 
                purposes of public health activities, in accordance 
                with HIPAA privacy and security law (as defined in 
                section 3009(a)(2) of the Public Health Service Act). 
                Such case investigations shall 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 for purposes of public health activities, 
                        in accordance with HIPAA privacy and security 
                        law (as defined in section 3009(a)(2) of the 
                        Public Health Service Act);
                            ``(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) optional oral or written interviews 
                        of the family of the woman;
                            ``(v) socioeconomic and other relevant 
                        background information about the woman;
                            ``(vi) information collected in 
                        subparagraph (C)(i); and
                            ``(vii) other information on the cause of 
                        death of the woman, such as social services and 
                        child welfare reports.
            ``(2) State maternal mortality review committees.--
                    ``(A) Duties.--
                            ``(i) Required committee activities.--For 
                        purposes of subsection (a), a maternal 
                        mortality review committee established by a 
                        State pursuant to a grant under such subsection 
                        shall carry out the following pregnancy-related 
                        death and pregnancy-associated death review 
                        activities and shall include all information 
                        relevant to the death involved on the case 
                        abstraction form developed under subsection 
                        (d):
                                    ``(I) With respect to a case of 
                                pregnancy-related or pregnancy-
                                associated death of a woman, review the 
                                case summaries prepared under 
                                subparagraphs (A), (B), (C), and (D) of 
                                paragraph (1).
                                    ``(II) Review aggregate statistical 
                                reports developed 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) Develop recommendations, 
                                based on the review of the case 
                                summaries under paragraph (1)(D) and 
                                aggregate statistical reports under 
                                subclause (II), to improve maternal 
                                care, social and health services, and 
                                public health policy and institutions, 
                                including with respect to improving 
                                access to maternal care, improving the 
                                availability of social services, and 
                                eliminating disparities in maternal 
                                care and outcomes.
                            ``(ii) Optional committee activities.--For 
                        purposes of subsection (a), a maternal 
                        mortality review committee established by a 
                        State under such subsection may present 
                        findings and recommendations regarding a 
                        specific case or set of circumstances directly 
                        to a health care facility or its local or State 
                        professional organization for the purpose of 
                        instituting policy changes, educational 
                        activities, or otherwise improving the quality 
                        of care provided by the facilities.
                    ``(B) Composition of maternal mortality review 
                committees.--
                            ``(i) In general.--Each State maternal 
                        mortality review committee established pursuant 
                        to a grant under subsection (a) shall be multi-
                        disciplinary, consisting of health care and 
                        social service providers, public health 
                        officials, other persons with professional 
                        expertise on maternal health and mortality, and 
                        patient and community advocates who represent 
                        those communities within such State that are 
                        the most affected by maternal mortality. 
                        Membership on such a committee of a State shall 
                        be reviewed annually by the State department of 
                        health to ensure that membership representation 
                        requirements are being fulfilled in accordance 
                        with this paragraph.
                            ``(ii) Required membership.--Each such 
                        review committee shall include--
                                    ``(I) representatives from medical 
                                specialities 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 State 
                                department of health maternal and child 
                                health department;
                                    ``(V) social service providers or 
                                social workers;
                                    ``(VI) the chief medical examiners 
                                or designees;
                                    ``(VII) facility representatives, 
                                such as from hospitals or free-standing 
                                birth centers; and
                                    ``(VIII) community or patient 
                                advocates who represent those 
                                communities within the State that are 
                                the most affected by maternal 
                                mortality.
                            ``(iii) Additional members.--Each such 
                        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 review committee, including--
                                    ``(I) anesthesiologists;
                                    ``(II) emergency physicians;
                                    ``(III) pathologists;
                                    ``(IV) epidemiologists or 
                                biostatisticians;
                                    ``(V) intensivists;
                                    ``(VI) vital statistics officers;
                                    ``(VII) nutritionists;
                                    ``(VIII) mental health 
                                professionals;
                                    ``(IX) substance abuse treatment 
                                specialists;
                                    ``(X) representatives of relevant 
                                advocacy groups;
                                    ``(XI) academics;
                                    ``(XII) representatives of 
                                beneficiaries of the State plan under 
                                the Medicaid program under title XIX;
                                    ``(XIII) paramedics;
                                    ``(XIV) lawyers;
                                    ``(XV) risk management specialists;
                                    ``(XVI) representatives of the 
                                departments of health or public health 
                                of major cities in the State involved; 
                                and
                                    ``(XVII) policy makers.
                            ``(iv) Diverse community membership.--The 
                        composition of such a committee, with respect 
                        to a State, shall include--
                                    ``(I) representatives from diverse 
                                communities, particularly those 
                                communities within such State most 
                                severely affected by pregnancy-related 
                                deaths or pregnancy-associated deaths 
                                and by a lack of access to relevant 
                                maternal care services, from community 
                                maternal child health organizations, 
                                and from minority advocacy groups;
                                    ``(II) members, including health 
                                care providers, from different 
                                geographic regions in the State, 
                                including any rural, urban, and tribal 
                                areas; and
                                    ``(III) health care and social 
                                service providers who work in 
                                communities that are diverse with 
                                regard to race, ethnicity, immigration 
                                status, Indigenous status, and English 
                                proficiency.
                            ``(v) Maternal mortality review staff.--
                        Staff of each such 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.
                    ``(C) Option for states to form regional maternal 
                mortality reviews.--States with a low rate of 
                occurrence of pregnancy-associated or pregnancy-related 
                deaths may choose to partner with one or more 
                neighboring States to fulfill the activities described 
                in paragraph (1)(C). In such a case, with respect to 
                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.
            ``(3) State department of health activities.--For purposes 
        of subsection (a), a State department of health of a State 
        receiving a grant under such subsection shall--
                    ``(A) in consultation with the maternal mortality 
                review committee of the State and in conjunction with 
                relevant professional 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 committees of the State and to implement the 
                recommendations of such committee.
    ``(c) Case Abstraction Form.--
            ``(1) Development.--The Director of the Centers for Disease 
        Control and Prevention shall develop a uniform, comprehensive 
        case abstraction form and make such form available to States 
        for State maternal mortality review committees for use by such 
        committees in order to--
                    ``(A) ensure that the cases 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) preserve the uniformity of the information 
                and its use 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) 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), a State maternal 
mortality review committee of a State established pursuant to this 
section to carry out activities described in subsection (b)(2)(A) 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).
    ``(e) Public Disclosure of Information.--
            ``(1) In general.--For fiscal year 2015 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 section 
        506(a)(2)(F) for such year (relating to the findings for such 
        year of the State maternal mortality review committee 
        established by the State under this section).
            ``(2) Information clearinghouse.--The Secretary of Health 
        and Human Services shall establish an information 
        clearinghouse, that shall 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 health 
        departments, maternal mortality review committees, and health 
        providers and institutions.
            ``(3) Confidentiality of information.--In no case shall any 
        individually identifiable health information be provided to the 
        public, or submitted to the information clearinghouse, under 
        paragraph (1).
    ``(f) Confidentiality of Review Committee Proceedings.--
            ``(1) In general.--All proceedings and activities of a 
        State maternal mortality review committee under this section, 
        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 not 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 under this section 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 
                shall be construed to prevent a member of such a 
                committee from testifying regarding information that 
                was obtained independent of such member's participation 
                on the committee, or that is public information.
            ``(3) Availability of information for research purposes.--
        Nothing in this subsection shall prohibit the publishing by 
        such a committee or the Department of Health and Human Services 
        of statistical compilations and research reports that--
                    ``(A) are based on confidential information, 
                relating to morbidity and mortality review; and
                    ``(B) do not contain identifying information or any 
                other information that could be used to ultimately 
                identify the individuals concerned.
    ``(g) Definitions.--For purposes of 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 
        or site of the pregnancy, from any cause related to or 
        aggravated by the pregnancy or its management, but not from any 
        accidental or incidental cause.
            ``(3) The term `woman of childbearing age' means a woman 
        who is at least 10 years of age and not more than 54 years of 
        age.''.
    (b) Inclusion of Findings of Review Committees in Required 
Reports.--
            (1) State triennial reports.--Paragraph (2) of section 
        506(a) of such Act (42 U.S.C. 706(a)) is amended by inserting 
        after subparagraph (E) the following new subparagraph:
                    ``(F) In the case of a State receiving a grant 
                under section 514, beginning for the first fiscal year 
                beginning after 3 years after the date of establishment 
                of the State maternal mortality review committee 
                established by the State pursuant to such grant and 
                once every 3 years thereafter, information containing 
                the findings and recommendations of such committee and 
                information on the implementation of such 
                recommendations during the period involved.''.
            (2) Annual reports to congress.--Paragraph (3) of such 
        section is amended--
                    (A) in subparagraph (D), at the end, by striking 
                ``and'';
                    (B) in subparagraph (E), at the end, by striking 
                the period and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) For fiscal year 2015 and each subsequent 
                fiscal year, taking into account the findings, 
                recommendations, and implementation information 
                submitted by States pursuant to paragraph (2)(F), on 
                the status of pregnancy-related deaths and pregnancy-
                associated deaths in the United States and including 
                recommendations on methods to prevent such deaths in 
                the United States.''.

SEC. 4. NIH WORKSHOP AND RESEARCH PLAN DEVELOPMENT ON SEVERE MATERNAL 
              MORBIDITY.

    (a) Workshop.--The Secretary of Health and Human Services, acting 
through the Director of NIH and in consultation with the Administrator 
of the Health Resources and Services Administration, the Director of 
the Centers for Disease Control and Prevention, the heads of other 
Federal agencies that administer Federal health programs, and relevant 
national professional organizations dealing with maternal morbidity, 
shall organize a national workshop to identify definitions for severe 
maternal morbidity and make recommendations for a research plan to 
identify and monitor severe maternal morbidity in the United States.
    (b) Research Plan and Data Collection Protocols.--The Secretary, 
taking into account the findings of the workshop under paragraph (1), 
shall develop uniform definitions of severe maternal morbidity, a 
research plan on severe maternal morbidity, and possible data 
collection protocols to assist States in identifying and monitoring 
cases of severe maternal morbidity and to develop recommendations on 
addressing such cases.
    (c) Report.--Not later than 2 years after the date of enactment of 
this Act, the Secretary shall prepare and submit to the appropriate 
committees of Congress a report concerning the definitions and research 
plan developed under this section.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated for fiscal year 2015--
            (1) $50,000 to carry out subsection (a); and
            (2) $100,000 to carry out subsection (b).

SEC. 5. 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 MATERNITY 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, 
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 services 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 implement and assessing 
        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 type 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 assure 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, 2015, and end on 
December 31, 2019.
    ``(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, 2020, the 
        Secretary shall submit to Congress a report on the results of 
        the demonstration project under subsection (a)(3).''.
                                 <all>