[House Report 118-246]
[From the U.S. Government Publishing Office]


118th Congress }                                              {    Report
                        HOUSE OF REPRESENTATIVES
 1st Session   }                                               {  118-246

======================================================================



 
         PREVENTING MATERNAL DEATHS REAUTHORIZATION ACT OF 2023

                                _______
                                

October 25, 2023.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3838]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3838) to amend title III of the Public Health 
Service Act to reauthorize Federal support of States in their 
work to save and sustain the health of mothers during 
pregnancy, childbirth, and 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, having considered the same, reports 
favorably thereon with an amendment and recommends that the 
bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Committee Action.................................................     3
Committee Votes..................................................     3
Oversight Findings and Recommendations...........................     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Statement of General Performance Goals and Objectives............     5
Duplication of Federal Programs..................................     5
Related Committee and Subcommittee Hearings......................     5
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Preventing Maternal Deaths 
Reauthorization Act of 2023''.

SEC. 2. SAFE MOTHERHOOD.

  (a) Maternal Mortality Review Committees.--Section 317K(d) of the 
Public Health Service Act (42 U.S.C. 247b-12(d)) is amended--
          (1) in paragraph (1)(A), by inserting ``(including 
        obstetricians and gynecologists)'' after ``clinical 
        specialties''; and
          (2) in paragraph (3)(A)(i)--
                  (A) in subclause (I), by striking ``as applicable'' 
                and inserting ``if available''; and
                  (B) in subclause (III), by striking ``, as 
                appropriate'' and inserting ``and coordinating with 
                death certifiers to improve the collection of death 
                record reports and the quality of death records, 
                including by amending cause-of-death information on a 
                death certificate, as appropriate''.
  (b) Best Practices Relating to the Prevention of Maternal 
Mortality.--Section 317K of the Public Health Service Act (42 U.S.C. 
247b-12) is amended--
          (1) by redesignating subsections (e) and (f) as subsections 
        (f) and (g), respectively; and
          (2) by inserting after subsection (d) the following:
  ``(e) Best Practices Relating to the Prevention of Maternal 
Mortality.--
          ``(1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall, in 
        consultation with the Administrator of the Health Resources and 
        Services Administration, disseminate to hospitals, State 
        professional society groups, and perinatal quality 
        collaboratives, best practices on how to prevent maternal 
        mortality and morbidity that consider and reflect best 
        practices identified through other relevant Federal maternal 
        health programs.
          ``(2) Frequency.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        disseminate the best practices referred to in paragraph (1) not 
        less than once per fiscal year.''.
  (c) Extension.--Subsection (g) of section 317K of the Public Health 
Service Act (42 U.S.C. 247b-12), as redesignated by subsection (b), is 
amended by striking ``$58,000,000 for each of fiscal years 2019 through 
2023'' and inserting ``$108,000,000 for each of fiscal years 2024 
through 2028''.

                          Purpose and Summary

    H.R. 3838 reauthorizes federal support for states to 
address disparities in maternal health outcomes and preserve 
the health of mothers during pregnancy, childbirth, and the 
postpartum period for fiscal years 2024-2028. The bill also 
requires the CDC to work in consultation with the Health 
Resources Administration (HRSA) to disseminate best practices 
relating to the prevention of maternal mortality to hospitals 
and other health care providers.

                  Background and Need for Legislation

    The programs reauthorized under the Preventing Maternal 
Deaths Reauthorization Act of 2023 assist states in preserving 
maternal health throughout pregnancy, childbirth, and the 
postpartum period and working to better understand the burden 
of maternal complications and mortality through research, 
education, best practices, and prevention efforts. In 2021, 
1,205 women died of maternal causes in the United States, 
compared with 861 in 2020 and 754 in 2019. This reflects an 
increase of nearly 89 percent in the maternal mortality rate 
since 2018.\1\ Additionally, disparities in maternal mortality 
continue to persist. For example, the maternal mortality rate 
for Black women is 2.6 times that of other women.\2\
---------------------------------------------------------------------------
    \1\Maternal Mortality Rates in the United States, 2021, Centers for 
Disease Control and Prevention, https://www.cdc.gov/nchs/data/hestat/
maternal-mortality/2021/maternal-mortality-rates-2021.htm.
    \2\Id.
---------------------------------------------------------------------------

                            Committee Action

    On June 14, 2023, the Subcommittee on Health held a hearing 
on H.R. 3838. The hearing title was ``Examining Proposals that 
Provide Access to Care for Patients and Support Research for 
Rare Diseases.'' The Subcommittee received testimony from:
           Dr. Elizabeth Cherot, MD, MBA, Senior Vice 
        President and Chief Medical Health Officer, March of 
        Dimes;
           Dr. Alexis A. Thompson, MD, MPH, Chief of 
        Division of Hematology, Elias Schwartz MD Endowed Chair 
        in Hematology, Children's Hospital of Philadelphia, 
        Professor of Pediatrics, University of Pennsylvania 
        Perelman School of Medicine;
           Dr. Meredithe McNamara, MD, MS, FAAP, 
        Assistant Professor, Yale School of Medicine;
           Dr. Miriam Grossman, MD, Child, Adolescent, 
        and Adult Psychiatrist;
           Mr. George Manahan, Parkinson's Advocate and 
        Patient; and
           Mr. Kevin O'Connor, Assistant to the General 
        President for Government Affairs and Political Action, 
        International Association of Fire Fighters.
    On July 13, 2023, the Subcommittee on Health met in open 
markup session and forwarded H.R. 3838, as amended, to the full 
Committee by a record vote of 28 yeas and 0 nays. On July 19, 
2023, the full Committee on Energy and Commerce met in open 
markup session and ordered H.R. 3838, as amended, favorably 
reported to the House by a record vote of 50 yeas and 0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:




                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 3838 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to improve 
and address disparities in maternal health outcomes by 
reauthorizing Federal support for states to work to save and 
sustain the health of mothers during pregnancy, childbirth, and 
the postpartum period.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3838 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 3838:
           On June 14, 2023, the Subcommittee on Health 
        held a hearing on H.R. 3838. The title of the hearing 
        was ``Examining Proposals that Provide Access to Care 
        for Patients and Support Research for Rare Diseases.'' 
        The Subcommittee received testimony from:
                   Dr. Elizabeth Cherot, MD, MBA, 
                Senior Vice President and Chief Medical Health 
                Officer, March of Dimes;
                   Dr. Alexis A. Thompson, MD, MPH, 
                Chief of Division of Hematology, Elias Schwartz 
                MD Endowed Chair in Hematology, Children's 
                Hospital of Philadelphia, Professor of 
                Pediatrics, University of Pennsylvania Perelman 
                School of Medicine;
                   Dr. Meredithe McNamara, MD, MS, 
                FAAP, Assistant Professor, Yale School of 
                Medicine;
                   Dr. Miriam Grossman, MD, Child, 
                Adolescent, and Adult Psychiatrist;
                   Mr. George Manahan, Parkinson's 
                Advocate and Patient; and
                   Mr. Kevin O'Connor, Assistant to 
                the General President for Government Affairs 
                and Political Action, International Association 
                of Fire Fighters

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974. At the time this report was 
filed, the estimate was not available.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 3838 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 provides a short title of ``Preventing Maternal 
Deaths Reauthorization Act of 2023''.

Section 2. Safe motherhood

    Section 2 amends Title III of the Public Health Service Act 
to reauthorize Federal support for states to preserve maternal 
health throughout pregnancy, childbirth, and postpartum, and 
identify solutions to improve health care quality and health 
outcomes for mothers.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the House of 
Representatives, changes in existing law made by the bill, as 
reported, are shown as follows (existing law proposed to be 
omitted is enclosed in black brackets, new matter is printed in 
italics, and existing law in which no change is proposed is 
shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *


TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


Part B--Federal-State Cooperation

           *       *       *       *       *       *       *



                            SAFE MOTHERHOOD

    Sec. 317K. (a) Surveillance.--
          (1) Purpose.--The 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 
        surveillance systems at the local, State, and national 
        level to better understand the burden of maternal 
        complications and mortality and to decrease the 
        disparities among populations at risk of death and 
        severe complications from pregnancy.
          (2) Activities.--For the purpose described in 
        paragraph (1) the Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, may carry out the following activities:
                  (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, including improving 
                disaggregation of data (in a manner consistent 
                with applicable State and Federal privacy 
                laws).
                  (B) The Secretary may expand the Pregnancy 
                Risk Assessment Monitoring System to provide 
                surveillance and collect data in each State.
                  (C) The Secretary may expand the Maternal and 
                Child Health Epidemiology Program to provide 
                technical support, financial assistance, or the 
                time-limited assignment of senior 
                epidemiologists to maternal and child health 
                programs in each State.
          (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).
    (b) Prevention Research.--
          (1) Purpose.--The purpose of this subsection is to 
        provide the Secretary with the authority to further 
        expand research concerning risk factors, prevention 
        strategies, and the roles of the family, health care 
        providers and the community in safe motherhood.
          (2) Research.--The Secretary may carry out activities 
        to expand research relating to--
                  (A) prepregnancy counseling, especially for 
                at risk populations such as women with diabetes 
                and women with substance use disorder;
                  (B) the identification of critical components 
                of prenatal delivery and postpartum care;
                  (C) the identification of outreach and 
                support services, such as folic acid education, 
                that are available for pregnant women;
                  (D) the identification of women who are at 
                high risk for complications;
                  (E) preventing preterm delivery;
                  (F) preventing urinary tract infections;
                  (G) preventing unnecessary caesarean 
                sections;
                  (H) the identification of the determinants of 
                disparities in maternal care, health risks, and 
                health outcomes, including an examination of 
                the higher rates of maternal mortality among 
                African American women and other groups of 
                women with disproportionately high rates of 
                maternal mortality;
                  (I) activities to reduce disparities in 
                maternity services and outcomes;
                  (J) an examination of the relationship 
                between interpersonal violence and maternal 
                complications and mortality;
                  (K) preventing and reducing adverse health 
                consequences that may result from smoking and 
                substance abuse and misuse before, during and 
                after pregnancy;
                  (L) preventing infections that cause maternal 
                and infant complications;
                  (M) an examination of the relationship 
                between maternaI health and obstetric services 
                in rural areas and outcomes in delivery and 
                postpartum care; and
                  (N) other areas determined appropriate by the 
                Secretary.
    (c) Prevention Programs.--The Secretary may carry out 
activities to promote safe motherhood, including--
          (1) public education campaigns on healthy 
        pregnancies;
          (2) education programs for physicians, nurses and 
        other health care providers;
          (3) activities to promote community support services 
        for pregnant women; and
          (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.
    (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 (including obstetricians 
                and gynecologists), 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 member 
                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] if 
                                available;
                                  (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 
                                coordinating with death 
                                certifiers to improve the 
                                collection of death record 
                                reports and the quality of 
                                death records, including by 
                                amending cause-of death 
                                information on a death 
                                certificate, 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) Best Practices Relating to the Prevention of Maternal 
Mortality.--
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, shall, in consultation with the 
        Administrator of the Health Resources and Services 
        Administration, disseminate to hospitals, State 
        professional society groups, and perinatal quality 
        collaboratives, best practices on how to prevent 
        maternal mortality and morbidity that consider and 
        reflect best practices identified through other 
        relevant Federal maternal health programs.
          (2) Frequency.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, shall disseminate the best practices 
        referred to in paragraph (1) not less than once per 
        fiscal year.
    [(e)] (f) 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.
    [(f)] (g) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated [$58,000,000 for each of fiscal years 2019 through 
2023] $108,000,000 for each of fiscal years 2024 through 2028.

           *       *       *       *       *       *       *