    [United States Statutes at Large, Volume 132, 115th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    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. <>

    Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <>
    SECTION 1. SHORT TITLE.

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

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

    [[Page 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) <>  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 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) <>  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 5050]]

    ``(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

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    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.