[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1318 Enrolled Bill (ENR)]

        H.R.1318

                     One Hundred Fifteenth Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

         Begun and held at the City of Washington on Wednesday,
           the third day of January, two thousand and eighteen


                                 An Act


 
   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 
2018''.
SEC. 2. SAFE MOTHERHOOD.
    Section 317K of the Public Health Service Act (42 U.S.C. 247b-12) 
is amended--
        (1) in subsection (a)--
            (A) in paragraph (1)--
                (i) by striking ``purpose of this subsection is to 
            develop'' and inserting ``purposes of this subsection are 
            to establish or continue a Federal initiative to support 
            State and tribal maternal mortality review committees, to 
            improve data collection and reporting around maternal 
            mortality, and to develop or support'';
                (ii) by striking ``population at risk of death and'' 
            and inserting ``populations at risk of death and severe''; 
            and
            (B) in paragraph (2)--
                (i) by amending subparagraph (A) to read as follows:
            ``(A) The Secretary may continue and improve activities 
        related to a national maternal mortality data collection and 
        surveillance program to identify and support the review of 
        pregnancy-associated deaths and pregnancy-related deaths that 
        occur during, or within 1 year following, pregnancy.''; and
                (ii) by inserting after subparagraph (C) the following:
            ``(D) The Secretary may, in cooperation with States, Indian 
        tribes, and tribal organizations, develop a program to support 
        States, Indian tribes, and tribal organizations in establishing 
        or operating maternal mortality review committees, in 
        accordance with subsection (d).'';
        (2) in subsection (b)(2)--
            (A) in subparagraph (A)--
                (i) by striking ``encouraging preconception'' and 
            inserting ``prepregnancy''; and
                (ii) by striking ``diabetics'' and inserting ``women 
            with diabetes and women with substance use disorder'' 
            before the semicolon;
            (B) in subparagraph (H)--
                (i) by inserting ``the identification of the 
            determinants of disparities in maternal care, health risks, 
            and health outcomes, including'' before ``an examination''; 
            and
                (ii) by inserting ``and other groups of women with 
            disproportionately high rates of maternal mortality'' 
            before the semicolon;
            (C) in subparagraph (I), by striking ``domestic'' and 
        inserting ``interpersonal'';
            (D) by redesignating subparagraphs (I) through (L) as 
        subparagraphs (J) through (M), respectively;
            (E) by inserting after subparagraph (H) the following:
            ``(I) activities to reduce disparities in maternity 
        services and outcomes;''; and
            (F) in subparagraph (K), as so redesignated, by striking 
        ``, alcohol and illegal drug use'' and inserting ``and 
        substance abuse and misuse'';
        (3) in subsection (c)--
            (A) by striking ``(1) In general--The Secretary'' and 
        inserting ``The Secretary'';
            (B) by redesignating subparagraphs (A) through (C) as 
        paragraphs (1) through (3), respectively, and adjusting the 
        margins accordingly;
            (C) in paragraph (1), as so redesignated, by striking ``and 
        the building of partnerships with outside organizations 
        concerned about safe motherhood'';
            (D) in paragraph (2), as so redesignated, by striking ``; 
        and'' and inserting a semicolon;
            (E) in paragraph (3), as so redesignated, by striking the 
        period and inserting ``; and''; and
            (F) by adding at the end the following:
        ``(4) activities to promote physical, mental, and behavioral 
    health during, and up to 1 year following, pregnancy, with an 
    emphasis on prevention of, and treatment for, mental health 
    disorders and substance use disorder.'';
        (4) by redesignating subsection (d) as subsection (f);
        (5) by inserting after subsection (c) the following:
    ``(d) Maternal Mortality Review Committees.--
        ``(1) In general.--In order to participate in the program under 
    subsection (a)(2)(D), the applicable maternal mortality review 
    committee of the State, Indian tribe, or tribal organization 
    shall--
            ``(A) include multidisciplinary and diverse membership that 
        represents a variety of clinical specialties, State, tribal, or 
        local public health officials, epidemiologists, statisticians, 
        community organizations, geographic regions within the area 
        covered by such committee, and individuals or organizations 
        that represent the populations in the area covered by such 
        committee that are most affected by pregnancy-related deaths or 
        pregnancy-associated deaths and lack of access to maternal 
        health care services; and
            ``(B) demonstrate to the Centers for Disease Control and 
        Prevention that such maternal mortality review committee's 
        methods and processes for data collection and review, as 
        required under paragraph (3), use best practices to reliably 
        determine and include all pregnancy-associated deaths and 
        pregnancy-related deaths, regardless of the outcome of the 
        pregnancy.
        ``(2) Process for confidential reporting.--States, Indian 
    tribes, and tribal organizations that participate in the program 
    described in this subsection shall, through the State maternal 
    mortality review committee, develop a process that--
            ``(A) provides for confidential case reporting of 
        pregnancy-associated and pregnancy-related deaths to the 
        appropriate State or tribal health agency, including such 
        reporting by--
                ``(i) health care professionals;
                ``(ii) health care facilities;
                ``(iii) any individual responsible for completing death 
            records, including medical examiners and medical coroners; 
            and
                ``(iv) other appropriate individuals or entities; and
            ``(B) provides for voluntary and confidential case 
        reporting of pregnancy-associated deaths and pregnancy-related 
        deaths to the appropriate State or tribal health agency by 
        family members of the deceased, and other appropriate 
        individuals, for purposes of review by the applicable maternal 
        mortality review committee; and
            ``(C) shall include--
                ``(i) making publicly available contact information of 
            the committee for use in such reporting; and
                ``(ii) conducting outreach to local professional 
            organizations, community organizations, and social services 
            agencies regarding the availability of the review 
            committee.
        ``(3) Data collection and review.--States, Indian tribes, and 
    tribal organizations that participate in the program described in 
    this subsection shall--
            ``(A) annually identify pregnancy-associated deaths and 
        pregnancy-related deaths--
                ``(i) through the appropriate vital statistics unit 
            by--

                    ``(I) matching each death record related to a 
                pregnancy-associated death or pregnancy-related death 
                in the State or tribal area in the applicable year to a 
                birth certificate of an infant or fetal death record, 
                as applicable;
                    ``(II) to the extent practicable, identifying an 
                underlying or contributing cause of each pregnancy-
                associated death and each pregnancy-related death in 
                the State or tribal area in the applicable year; and
                    ``(III) collecting data from medical examiner and 
                coroner reports, as appropriate;

                ``(ii) using other appropriate methods or information 
            to identify pregnancy-associated deaths and pregnancy-
            related deaths, including deaths from pregnancy outcomes 
            not identified through clause (i)(I);
            ``(B) through the maternal mortality review committee, 
        review data and information to identify adverse outcomes that 
        may contribute to pregnancy-associated death and pregnancy-
        related death, and to identify trends, patterns, and 
        disparities in such adverse outcomes to allow the State, Indian 
        tribe, or tribal organization to make recommendations to 
        individuals and entities described in paragraph (2)(A), as 
        appropriate, to improve maternal care and reduce pregnancy-
        associated death and pregnancy-related death;
            ``(C) identify training available to the individuals and 
        entities described in paragraph (2)(A) for accurate 
        identification and reporting of pregnancy-associated and 
        pregnancy-related deaths;
            ``(D) ensure that, to the extent practicable, the data 
        collected and reported under this paragraph is in a format that 
        allows for analysis by the Centers for Disease Control and 
        Prevention; and
            ``(E) publicly identify the methods used to identify 
        pregnancy-associated deaths and pregnancy-related deaths in 
        accordance with this section.
        ``(4) Confidentiality.--States, Indian tribes, and tribal 
    organizations participating in the program described in this 
    subsection shall establish confidentiality protections to ensure, 
    at a minimum, that--
            ``(A) there is no disclosure by the maternal mortality 
        review committee, including any individual members of the 
        committee, to any person, including any government official, of 
        any identifying information about any specific maternal 
        mortality case; and
            ``(B) no information from committee proceedings, including 
        deliberation or records, is made public unless specifically 
        authorized under State and Federal law.
        ``(5) Reports to cdc.--For fiscal year 2019, and each 
    subsequent fiscal year, each maternal mortality review committee 
    participating in the program described in this subsection shall 
    submit to the Director of the Centers for Disease Control and 
    Prevention a report that includes--
            ``(A) data, findings, and any recommendations of such 
        committee; and
            ``(B) as applicable, information on the implementation 
        during such year of any recommendations submitted by the 
        committee in a previous year.
        ``(6) State partnerships.--States may partner with one or more 
    neighboring States to carry out the activities under this 
    subparagraph. With respect to the States in such a partnership, any 
    requirement under this subparagraph 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.
        ``(7) Appropriate mechanisms for indian tribes and tribal 
    organizations.--The Secretary, in consultation with Indian tribes, 
    shall identify and establish appropriate mechanisms for Indian 
    tribes and tribal organizations to demonstrate, report data, and 
    conduct the activities as required for participation in the program 
    described in this subsection. Such mechanisms may include technical 
    assistance with respect to grant application and submission 
    procedures, and award management activities.
        ``(8) Research availability.--The Secretary shall develop a 
    process to ensure that data collected under paragraph (5) is made 
    available, as appropriate and practicable, for research purposes, 
    in a manner that protects individually identifiable or potentially 
    identifiable information and that is consistent with State and 
    Federal privacy law.
    ``(e) Definitions.--In this section--
        ``(1) the terms `Indian tribe' and `tribal organization' have 
    the meanings given such terms in section 4 of the Indian Self-
    Determination and Education Assistance Act;
        ``(2) the term `pregnancy-associated death' means a death of a 
    woman, by any cause, that occurs during, or within 1 year 
    following, her pregnancy, regardless of the outcome, duration, or 
    site of the pregnancy; and
        ``(3) the term `pregnancy-related death' means a death of a 
    woman that occurs during, or within 1 year following, her 
    pregnancy, regardless of the outcome, duration, or site of the 
    pregnancy--
            ``(A) from any cause related to, or aggravated by, the 
        pregnancy or its management; and
            ``(B) not from accidental or incidental causes.''; and
        (6) in subsection (f), as so redesignated, by striking ``such 
    sums as may be necessary for each of the fiscal years 2001 through 
    2005'' and inserting ``$58,000,000 for each of fiscal years 2019 
    through 2023''.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.