[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1318 Received in Senate (RDS)]

<DOC>
115th CONGRESS
  2d Session
                                H. R. 1318


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           December 12, 2018

                                Received

_______________________________________________________________________

                                 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''.

            Passed the House of Representatives December 11, 2018.

            Attest:

                                                 KAREN L. HAAS,

                                                                 Clerk.