[115th Congress Public Law 344]
[From the U.S. Government Publishing Office]



[[Page 132 STAT. 5047]]

Public Law 115-344
115th Congress

                                 An Act


 
   To support States in their work to save and sustain the health of 
 mothers during pregnancy, childbirth, and in the postpartum period, to 
eliminate disparities in maternal health outcomes for pregnancy-related 
and pregnancy-associated deaths, to identify solutions to improve health 
      care quality and health outcomes for mothers, and for other 
            purposes. <<NOTE: Dec. 21, 2018 -  [H.R. 1318]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Preventing 
Maternal Deaths Act of 2018. 42 USC 201 note.>> 
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preventing Maternal Deaths Act of 
2018''.
SEC. 2. SAFE MOTHERHOOD.

    Section 317K of the Public Health Service Act (42 U.S.C. 247b-12) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                          (i) by striking ``purpose of this subsection 
                      is to develop'' and inserting ``purposes of this 
                      subsection are to establish or continue a Federal 
                      initiative to support State and tribal maternal 
                      mortality review committees, to improve data 
                      collection and reporting around maternal 
                      mortality, and to develop or support'';
                          (ii) by striking ``population at risk of death 
                      and'' and inserting ``populations at risk of death 
                      and severe''; and
                    (B) in paragraph (2)--
                          (i) by amending subparagraph (A) to read as 
                      follows:
                    ``(A) <<NOTE: Time period.>>  The Secretary may 
                continue and improve activities related to a national 
                maternal mortality data collection and surveillance 
                program to identify and support the review of pregnancy-
                associated deaths and pregnancy-related deaths that 
                occur during, or within 1 year following, pregnancy.''; 
                and
                          (ii) by inserting after subparagraph (C) the 
                      following:
                    ``(D) <<NOTE: Cooperation.>>  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)--

[[Page 132 STAT. 5048]]

                          (i) by striking ``encouraging preconception'' 
                      and inserting ``prepregnancy''; and
                          (ii) by striking ``diabetics'' and inserting 
                      ``women with diabetes and women with substance use 
                      disorder'' before the semicolon;
                    (B) in subparagraph (H)--
                          (i) by inserting ``the identification of the 
                      determinants of disparities in maternal care, 
                      health risks, and health outcomes, including'' 
                      before ``an examination''; and
                          (ii) by inserting ``and other groups of women 
                      with disproportionately high rates of maternal 
                      mortality'' before the semicolon;
                    (C) in subparagraph (I), by striking ``domestic'' 
                and inserting ``interpersonal'';
                    (D) by redesignating subparagraphs (I) through (L) 
                as subparagraphs (J) through (M), respectively;
                    (E) by inserting after subparagraph (H) the 
                following:
                    ``(I) activities to reduce disparities in maternity 
                services and outcomes;''; and
                    (F) in subparagraph (K), as so redesignated, by 
                striking ``, alcohol and illegal drug use'' and 
                inserting ``and substance abuse and misuse'';
            (3) in subsection (c)--
                    (A) by striking ``(1) In general--The Secretary'' 
                and inserting ``The Secretary'';
                    (B) by redesignating subparagraphs (A) through (C) 
                as paragraphs (1) through (3), respectively, and 
                adjusting the margins accordingly;
                    (C) in paragraph (1), as so redesignated, by 
                striking ``and the building of partnerships with outside 
                organizations concerned about safe motherhood'';
                    (D) in paragraph (2), as so redesignated, by 
                striking ``; and'' and inserting a semicolon;
                    (E) in paragraph (3), as so redesignated, by 
                striking the period and inserting ``; and''; and
                    (F) by adding at the end the following:
            ``(4) <<NOTE: Time period.>>  activities to promote 
        physical, mental, and behavioral health during, and up to 1 year 
        following, pregnancy, with an emphasis on prevention of, and 
        treatment for, mental health disorders and substance use 
        disorder.'';
            (4) by redesignating subsection (d) as subsection (f);
            (5) by inserting after subsection (c) the following:

    ``(d) Maternal Mortality Review Committees.--
            ``(1) In general.--In order to participate in the program 
        under subsection (a)(2)(D), the applicable maternal mortality 
        review committee of the State, Indian tribe, or tribal 
        organization shall--
                    ``(A) include multidisciplinary and diverse 
                membership that represents a variety of clinical 
                specialties, State, tribal, or local public health 
                officials, epidemiologists, statisticians, community 
                organizations, geographic regions within the area 
                covered by such committee, and individuals or 
                organizations that represent the populations in the area 
                covered by such committee that are most affected by 
                pregnancy-related deaths or pregnancy-associated deaths 
                and lack of access to maternal health care services; and

[[Page 132 STAT. 5049]]

                    ``(B) demonstrate to the Centers for Disease Control 
                and Prevention that such maternal mortality review 
                committee's methods and processes for data collection 
                and review, as required under paragraph (3), use best 
                practices to reliably determine and include all 
                pregnancy-associated deaths and pregnancy-related 
                deaths, regardless of the outcome of the pregnancy.
            ``(2) Process for confidential reporting.--States, Indian 
        tribes, and tribal organizations that participate in the program 
        described in this subsection shall, through the State maternal 
        mortality review committee, develop a process that--
                    ``(A) provides for confidential case reporting of 
                pregnancy-associated and pregnancy-related deaths to the 
                appropriate State or tribal health agency, including 
                such reporting by--
                          ``(i) health care professionals;
                          ``(ii) health care facilities;
                          ``(iii) any individual responsible for 
                      completing death records, including medical 
                      examiners and medical coroners; and
                          ``(iv) other appropriate individuals or 
                      entities; and
                    ``(B) provides for voluntary and confidential case 
                reporting of pregnancy-associated deaths and pregnancy-
                related deaths to the appropriate State or tribal health 
                agency by family members of the deceased, and other 
                appropriate individuals, for purposes of review by the 
                applicable maternal mortality review committee; and
                    ``(C) shall include--
                          ``(i) <<NOTE: Public information.>>  making 
                      publicly available contact information of the 
                      committee for use in such reporting; and
                          ``(ii) conducting outreach to local 
                      professional organizations, community 
                      organizations, and social services agencies 
                      regarding the availability of the review 
                      committee.
            ``(3) Data collection and review.--States, Indian tribes, 
        and tribal organizations that participate in the program 
        described in this subsection shall--
                    ``(A) annually identify pregnancy-associated deaths 
                and pregnancy-related deaths--
                          ``(i) through the appropriate vital statistics 
                      unit by--
                                    ``(I) matching each death record 
                                related to a pregnancy-associated death 
                                or pregnancy-related death in the State 
                                or tribal area in the applicable year to 
                                a birth certificate of an infant or 
                                fetal death record, as applicable;
                                    ``(II) to the extent practicable, 
                                identifying an underlying or 
                                contributing cause of each pregnancy-
                                associated death and each pregnancy-
                                related death in the State or tribal 
                                area in the applicable year; and
                                    ``(III) collecting data from medical 
                                examiner and coroner reports, as 
                                appropriate;
                          ``(ii) using other appropriate methods or 
                      information to identify pregnancy-associated 
                      deaths and pregnancy-related deaths, including 
                      deaths from pregnancy outcomes not identified 
                      through clause (i)(I);

[[Page 132 STAT. 5050]]

                    ``(B) <<NOTE: Recommenda- tions.>>  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) <<NOTE: Public information.>>  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) <<NOTE: Recommenda- tions.>>  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, <<NOTE: Consultation.>>  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

[[Page 132 STAT. 5051]]

        application and submission procedures, and award management 
        activities.
            ``(8) Research availability.--The Secretary shall develop a 
        process to ensure that data collected under paragraph (5) is 
        made available, as appropriate and practicable, for research 
        purposes, in a manner that protects individually identifiable or 
        potentially identifiable information and that is consistent with 
        State and Federal privacy law.

    ``(e) Definitions.--In this section--
            ``(1) the terms `Indian tribe' and `tribal organization' 
        have the meanings given such terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act;
            ``(2) the term `pregnancy-associated death' means a death of 
        a woman, by any cause, that occurs during, or within 1 year 
        following, her pregnancy, regardless of the outcome, duration, 
        or site of the pregnancy; and
            ``(3) the term `pregnancy-related death' means a death of a 
        woman that occurs during, or within 1 year following, her 
        pregnancy, regardless of the outcome, duration, or site of the 
        pregnancy--
                    ``(A) from any cause related to, or aggravated by, 
                the pregnancy or its management; and
                    ``(B) not from accidental or incidental causes.''; 
                and
            (6) in subsection (f), as so redesignated, by striking 
        ``such sums as may be necessary for each of the fiscal years 
        2001 through 2005'' and inserting ``$58,000,000 for each of 
        fiscal years 2019 through 2023''.

    Approved December 21, 2018.

LEGISLATIVE HISTORY--H.R. 1318:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 164 (2018):
            Dec. 11, considered and passed House.
            Dec. 13, considered and passed Senate.

                                  <all>