[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.
* * * * * * *