[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1112 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 502
115th CONGRESS
  2d Session
                                S. 1112

   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 SENATE OF THE UNITED STATES

                              May 11, 2017

 Ms. Heitkamp (for herself, Mrs. Capito, Mr. Booker, Mrs. Gillibrand, 
 Ms. Hassan, Mr. Brown, Ms. Duckworth, Mr. Bennet, Mr. Coons, Mr. Van 
  Hollen, Mr. Blumenthal, Ms. Cantwell, Ms. Warren, Mr. Manchin, Mr. 
    Reed, Ms. Collins, Mr. Tester, Ms. Klobuchar, Ms. Baldwin, Mr. 
   Whitehouse, Ms. Smith, Mr. Jones, Mrs. Feinstein, Mr. Carper, Mr. 
Markey, Mr. Nelson, Ms. Stabenow, Mrs. Shaheen, Mr. Cassidy, Ms. Cortez 
 Masto, Mr. Casey, Mr. Durbin, Mr. Menendez, Mr. Merkley, Mr. Murphy, 
 Ms. Murkowski, Mrs. Murray, and Mr. Peters) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

                              July 9, 2018

              Reported by Mr. Alexander, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Maternal Health 
Accountability Act of 2017''.</DELETED>

<DELETED>SEC. 2. FINDINGS; PURPOSES.</DELETED>

<DELETED>    (a) Findings.--Congress finds the following:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (4) As of 2017, less than 25 States conduct 
        systematic reviews of maternal deaths and/or have standing 
        maternal mortality review committees in order to develop the 
        data needed to work toward management and solutions.</DELETED>
        <DELETED>    (5) 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.</DELETED>
        <DELETED>    (6) 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.</DELETED>
        <DELETED>    (7) 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.</DELETED>
        <DELETED>    (8) 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.</DELETED>
        <DELETED>    (9) 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.</DELETED>
<DELETED>    (b) Purposes.--The purposes of this Act are the 
following:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (2) To develop a model for States and Federally 
        recognized Indian tribes and tribal organizations 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.</DELETED>

<DELETED>SEC. 3. STATE MATERNAL MORTALITY REVIEW COMMITTEES ON 
              PREGNANCY-RELATED AND PREGNANCY-ASSOCIATED 
              DEATHS.</DELETED>

<DELETED>    (a) Program Authorized.--</DELETED>
        <DELETED>    (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, and Federally 
        recognized Indian tribes and tribal organizations, for the 
        purpose of--</DELETED>
                <DELETED>    (A) carrying out the activities described 
                in subsection (b)(1);</DELETED>
                <DELETED>    (B) establishing and sustaining a State 
                maternal mortality review committee, in accordance with 
                subsection (b)(2);</DELETED>
                <DELETED>    (C) ensuring that the State department of 
                health carries out the activities described in 
                subsection (b)(3);</DELETED>
                <DELETED>    (D) disseminating the case abstraction 
                form developed under subsection (c); and</DELETED>
                <DELETED>    (E) providing for the public disclosure of 
                information, in accordance with subsection 
                (d).</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (b) Use of Funds.--</DELETED>
        <DELETED>    (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:</DELETED>
                <DELETED>    (A) Process for mandatory reporting of 
                pregnancy-related and pregnancy-associated deaths.--
                </DELETED>
                        <DELETED>    (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.</DELETED>
                        <DELETED>    (ii) Individuals and entities 
                        described.--Individuals and entities described 
                        in this clause include each of the 
                        following:</DELETED>
                                <DELETED>    (I) Health care 
                                professionals.</DELETED>
                                <DELETED>    (II) Medical 
                                examiners.</DELETED>
                                <DELETED>    (III) Medical 
                                coroners.</DELETED>
                                <DELETED>    (IV) Hospitals.</DELETED>
                                <DELETED>    (V) Birth 
                                centers.</DELETED>
                                <DELETED>    (VI) Other health care 
                                facilities.</DELETED>
                                <DELETED>    (VII) Other individuals 
                                responsible for completing death 
                                records.</DELETED>
                                <DELETED>    (VIII) Other appropriate 
                                individuals or entities specified by 
                                the Secretary.</DELETED>
                <DELETED>    (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--</DELETED>
                        <DELETED>    (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</DELETED>
                        <DELETED>    (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).</DELETED>
                <DELETED>    (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--
                </DELETED>
                        <DELETED>    (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;</DELETED>
                        <DELETED>    (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;</DELETED>
                        <DELETED>    (iii) collecting data from medical 
                        examiner and coroner reports; and</DELETED>
                        <DELETED>    (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.</DELETED>
                <DELETED>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.</DELETED>
                <DELETED>    (D) Case investigation and development of 
                case summaries.--</DELETED>
                        <DELETED>    (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 
                        subparagraphs (A) or (B), or under subparagraph 
                        (C), as necessary to carry out this 
                        subparagraph.</DELETED>
                        <DELETED>    (ii) Mandatory data and 
                        information.--Each case investigation under 
                        this subparagraph shall, subject to 
                        availability, include data and information 
                        obtained through--</DELETED>
                                <DELETED>    (I) medical examiner and 
                                autopsy reports of the woman 
                                involved;</DELETED>
                                <DELETED>    (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;</DELETED>
                                <DELETED>    (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;</DELETED>
                                <DELETED>    (IV) socioeconomic and 
                                other relevant background information 
                                about the woman;</DELETED>
                                <DELETED>    (V) any information 
                                collected under subparagraph (C)(i); 
                                and</DELETED>
                                <DELETED>    (VI) any other information 
                                on the cause of death of the woman, 
                                such as social services and child 
                                welfare reports.</DELETED>
                        <DELETED>    (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.</DELETED>
        <DELETED>    (2) State maternal mortality review committees.--
        </DELETED>
                <DELETED>    (A) Mandatory activities.--A State 
                maternal mortality review committee established under 
                subsection (a)(1) shall carry out the following 
                activities:</DELETED>
                        <DELETED>    (i) Develop the processes 
                        described in subparagraphs (A) and (B) of 
                        paragraph (1).</DELETED>
                        <DELETED>    (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.</DELETED>
                        <DELETED>    (iii) Carry out the activities 
                        described in paragraph (1)(D).</DELETED>
                        <DELETED>    (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.</DELETED>
                <DELETED>    (B) Discretionary activities.--</DELETED>
                        <DELETED>    (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--
                        </DELETED>
                                <DELETED>    (I) instituting policy 
                                changes, educational activities, and 
                                improvements in the quality of care 
                                provided by the facility; and</DELETED>
                                <DELETED>    (II) exploring and forming 
                                regional collaborations.</DELETED>
                        <DELETED>    (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--</DELETED>
                                <DELETED>    (I) identified patient 
                                registries; or</DELETED>
                                <DELETED>    (II) oral or written 
                                interviews of the woman concerned and 
                                the family of such woman.</DELETED>
                <DELETED>    (C) Composition of state maternal 
                mortality review committees.--</DELETED>
                        <DELETED>    (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.</DELETED>
                        <DELETED>    (ii) Required membership.--Each 
                        State maternal mortality review committee shall 
                        include--</DELETED>
                                <DELETED>    (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;</DELETED>
                                <DELETED>    (II) certified nurse 
                                midwives, certified midwives, and 
                                advanced practice nurses;</DELETED>
                                <DELETED>    (III) hospital-based 
                                registered nurses;</DELETED>
                                <DELETED>    (IV) representatives of 
                                the maternal and child health 
                                department of the State department of 
                                health;</DELETED>
                                <DELETED>    (V) social service 
                                providers or social workers, including 
                                those with experience working with 
                                communities diverse with respect to 
                                race, ethnicity, and limited English 
                                proficiency;</DELETED>
                                <DELETED>    (VI) chief medical 
                                examiners or designees;</DELETED>
                                <DELETED>    (VII) facility 
                                representatives, such as from hospitals 
                                or birth centers;</DELETED>
                                <DELETED>    (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</DELETED>
                                <DELETED>    (IX) representatives of 
                                the departments of health or public 
                                health of major cities in the 
                                State.</DELETED>
                        <DELETED>    (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--</DELETED>
                                <DELETED>    (I) 
                                anesthesiologists;</DELETED>
                                <DELETED>    (II) emergency 
                                physicians;</DELETED>
                                <DELETED>    (III) 
                                pathologists;</DELETED>
                                <DELETED>    (IV) 
                                epidemiologists;</DELETED>
                                <DELETED>    (V) 
                                intensivists;</DELETED>
                                <DELETED>    (VI) 
                                nutritionists;</DELETED>
                                <DELETED>    (VII) mental health 
                                professionals;</DELETED>
                                <DELETED>    (VIII) substance use 
                                disorder treatment 
                                specialists;</DELETED>
                                <DELETED>    (IX) representatives of 
                                relevant patient and provider advocacy 
                                groups;</DELETED>
                                <DELETED>    (X) academics;</DELETED>
                                <DELETED>    (XI) paramedics;</DELETED>
                                <DELETED>    (XII) risk management 
                                specialists; and</DELETED>
                                <DELETED>    (XIII) representatives of 
                                Federally recognized Indian tribes and 
                                tribal organizations.</DELETED>
                        <DELETED>    (iv) Staff.--Staff of each State 
                        maternal mortality review committee shall 
                        include--</DELETED>
                                <DELETED>    (I) vital health 
                                statisticians, maternal child health 
                                statisticians, or 
                                epidemiologists;</DELETED>
                                <DELETED>    (II) a coordinator of the 
                                State maternal mortality review 
                                committee, to be designated by the 
                                State; and</DELETED>
                                <DELETED>    (III) administrative 
                                staff.</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (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).</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (B) take steps to widely disseminate the 
                findings and recommendations of the State maternal 
                mortality review committee and implement the 
                recommendations of the committee.</DELETED>
<DELETED>    (c) Case Abstraction Form.--</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (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</DELETED>
                <DELETED>    (B) preserving the uniformity of the 
                information collected for Federal public health 
                purposes.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (d) Public Disclosure of Information.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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, and health providers and institutions.</DELETED>
        <DELETED>    (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.</DELETED>
<DELETED>    (e) Confidentiality of Proceedings of State Maternal 
Mortality Review Committees.--</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (2) Testimony of members of committee.--</DELETED>
                <DELETED>    (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.</DELETED>
                <DELETED>    (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.</DELETED>
        <DELETED>    (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--</DELETED>
                <DELETED>    (A) are based on confidential information, 
                relating to morbidity and mortality reviews under this 
                section; and</DELETED>
                <DELETED>    (B) do not contain identifying information 
                or any other information that could be used to 
                ultimately identify the individuals 
                concerned.</DELETED>
<DELETED>    (f) Reports.--</DELETED>
        <DELETED>    (1) State reports.--For 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.</DELETED>
        <DELETED>    (2) Annual reports to congress.--For fiscal year 
        2018, and each subsequent fiscal year, the Secretary of Health 
        and Human Services shall submit to Congress a report on--
        </DELETED>
                <DELETED>    (A) the findings, recommendations, and 
                implementation information submitted by any State 
                pursuant to paragraph (1); and</DELETED>
                <DELETED>    (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.</DELETED>
<DELETED>    (g) Definitions.--In this section:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (3) The term ``Secretary'' means the Secretary of 
        Health and Human Services.</DELETED>
        <DELETED>    (4) 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.</DELETED>
        <DELETED>    (5) The term ``State'' means each of the 50 
        States, the District of Columbia, and each of the territories, 
        and shall include Federally recognized Indian tribes and tribal 
        organizations that receive a grant under subsection (a)(1). 
        Such tribes and organizations shall meet the requirements 
        applicable to States under this section as determined 
        appropriate by the Secretary.</DELETED>
        <DELETED>    (6) 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.</DELETED>
<DELETED>    (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.</DELETED>

<DELETED>SEC. 4. ELIMINATING DISPARITIES IN MATERNITY HEALTH 
              OUTCOMES.</DELETED>

<DELETED>    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:</DELETED>

<DELETED>``SEC. 317U. ELIMINATING DISPARITIES IN MATERNAL HEALTH 
              OUTCOMES.</DELETED>

<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) applications submitted by States, which 
        specify which regions and populations the State involved will 
        serve under the demonstration project;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Duration of Demonstration Project.--The 
demonstration project under subsection (a)(3) shall begin on January 1, 
2018, and end on December 31, 2021.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Reports.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) monitor the--</DELETED>
                        <DELETED>    ``(i) outcomes of the 
                        project;</DELETED>
                        <DELETED>    ``(ii) costs of the project; 
                        and</DELETED>
                        <DELETED>    ``(iii) quality of maternity care 
                        provided under the project; and</DELETED>
                <DELETED>    ``(B) evaluate the rationale for the 
                selection of the items and services included in any 
                bundled payment made by the State under the 
                project.</DELETED>
        <DELETED>    ``(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).''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Maternal Health Accountability Act 
of 2017''.

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 inserting ``, including severe 
                        maternal morbidities,'' after ``maternal 
                        complications''; and
                            (iii) 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 and severe maternal 
                morbidity 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 ``preconception'' and 
                        inserting ``prepregnancy''; and
                            (ii) by inserting ``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) by redesignating subparagraphs (I) through (L) 
                as subparagraphs (J) through (M), respectively;
                    (D) by inserting after subparagraph (H) the 
                following:
                    ``(I) activities to reduce disparities in maternity 
                services and outcomes;''; and
                    (E) 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, depression 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, as appropriate, 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 is most affected by 
                pregnancy-related deaths or pregnancy-associated deaths 
                and lack of access to maternal health care services; 
                and
                    ``(B) to the extent practicable, use evidence-based 
                practices to demonstrate that such maternal mortality 
                review committee's methods and processes for the data 
                collection and review, as required under paragraph (3), 
                will reliably determine and include all pregnancy-
                associated deaths and associated 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 practicing 
                        in women's health, including obstetricians, 
                        gynecologists, nurse practitioners, clinical 
                        nurse specialists, certified registered nurse 
                        anesthetists, and certified nurse midwives;
                            ``(ii) medical examiners;
                            ``(iii) medical coroners;
                            ``(iv) hospitals;
                            ``(v) birth centers;
                            ``(vi) other health care facilities;
                            ``(vii) other individuals responsible for 
                        completing death records; and
                            ``(viii) 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) may 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; and
                            ``(ii) using other appropriate methods or 
                        information to identify pregnancy-associated 
                        deaths and pregnancy-related deaths;
                    ``(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; 
                and
                    ``(C) 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.
            ``(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 organizations' 
        have the meanings given such terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 
        5304);
            ``(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''.
                                                       Calendar No. 502

115th CONGRESS

  2d Session

                                S. 1112

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                              July 9, 2018

                       Reported with an amendment