II 

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 materVerDate Sep 11 2014 22:17 Jul 09, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\S1112.RS S1112

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nal 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Maternal Health Ac5 countability Act of 2017’’. 

6 SEC. 2. FINDINGS; PURPOSES. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) The United States is ranked 50th globally 

9 for its maternal mortality rate, and it is one of eight 

10 countries in which the maternal mortality rate has 

11 been on the rise. 

12 (2) In recent studies, the estimated maternal 

13 mortality rate in the United States increased by ap14 proximately 26.6 percent from 2000 to 2014, with 

15 the rate increasing in nearly all States. This re16 ported increase, along with no improvement in pre17 vious years, remains a source of great concern for 

18 the Centers for Disease Control and Prevention 

19 (CDC), health care providers, and patient advocates 

20 such as the American Congress of Obstetricians and 

21 Gynecologists, the Association of Women’s Health, 


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1 Obstetric, and Neonatal Nurses, and the 

2 Preeclampsia Foundation. 

3 (3) Maternal deaths in the United States result 

4 from pregnancy-related causes such as hemorrhage, 

5 hypertensive disease and preeclampsia, embolic dis6 ease, sepsis, and substance use disorder and over7 dose, and violent causes such as motor vehicle acci8 dents, homicide, and suicide. 

9 (4) As of 2017, less than 25 States conduct 

10 systematic reviews of maternal deaths and/or have 

11 standing maternal mortality review committees in 

12 order to develop the data needed to work toward 

13 management and solutions. 

14 (5) Review of pregnancy-related and pregnancy15 associated deaths is essential to determining strate16 gies for developing prevention efforts and quality im17 provement and quality control programs. The United 

18 States must identify at-risk populations and under19 stand how to support them to make pregnancy and 

20 the postpartum period safer. 

21 (6) The most severe complications of preg22 nancy, generally referred to as severe maternal mor23 bidity (SMM), affect more than 65,000 women in 

24 the United States every year. The CDC uses ICD– 

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1 ening maternal condition or complication, to define 

2 SMM. 

3 (7) Data from the CDC shows Black women 

4 are three times more likely to die from complications 

5 of pregnancy or childbirth than White women: 42.8 

6 Black women per 100,000 live births, as opposed to 

7 12.5 White women and 17.3 women of other races. 

8 (8) The CDC recommends that maternal deaths 

9 be investigated through State collaboratives. These 

10 State collaboratives would bring together leaders in 

11 obstetric and neonatal health care from private, aca12 demic, and public health care settings to make rec13 ommendations for preventing pregnancy-related and 

14 pregnancy-associated deaths and health complica15 tions and identify ways to improve quality of care 

16 for women and infants. 

17 (9) A few States, including California, have 

18 worked to develop and strengthen maternal mor19 bidity and mortality review systems and utilize data 

20 to reduce maternal deaths and injuries to address 

21 leading issues such as maternal hemorrhage, hyper22 tension and preeclampsia, and health and racial dis23 parities. 

24 (b) PURPOSES.—The purposes of this Act are the fol25 lowing: 


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1 (1) To establish a shared responsibility between 

2 States and the Federal Government to identify op3 portunities for improvement in quality of care and 

4 system changes, and to educate and inform health 

5 institutions and professionals, women, and families 

6 about preventing pregnancy-related and pregnancy7 associated deaths and complications and reducing 

8 disparities. 

9 (2) To develop a model for States and Federally 

10 recognized Indian tribes and tribal organizations to 

11 operate maternal mortality reviews and assess the 

12 various factors that may have contributed to mater13 nal mortality, including quality of care, racial dis14 parities, and systemic problems in the delivery of 

15 health care, and to develop appropriate interventions 

16 to reduce and prevent such deaths. 

17 SEC. 3. STATE MATERNAL MORTALITY REVIEW COMMIT18 TEES ON PREGNANCY-RELATED AND PREG19 NANCY-ASSOCIATED DEATHS. 

20 (a) PROGRAM AUTHORIZED.— 

21 (1) IN GENERAL.—The Secretary of Health and 

22 Human Services, through the Director of the Cen23 ters for Disease Control and Prevention, shall estab24 lish a grant program under which the Secretary may 

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1 dian tribes and tribal organizations, for the purpose 

2 of— 

3 (A) carrying out the activities described in 

4 subsection (b)(1); 

5 (B) establishing and sustaining a State 

6 maternal mortality review committee, in accord7 ance with subsection (b)(2); 

8 (C) ensuring that the State department of 

9 health carries out the activities described in 

10 subsection (b)(3); 

11 (D) disseminating the case abstraction 

12 form developed under subsection (c); and 

13 (E) providing for the public disclosure of 

14 information, in accordance with subsection (d). 

15 (2) CRITERIA.—The Secretary shall establish 

16 criteria for determining eligibility for, and the 

17 amount of a grant awarded to, a State under para18 graph (1). Such criteria shall provide that in the 

19 case of a State that receives a grant under para20 graph (1) for a fiscal year and is determined by the 

21 Secretary to have not used such grant in accordance 

22 with this section, such State may not be eligible for 

23 such a grant for any subsequent fiscal year. 

24 (b) USE OF FUNDS.— 


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1 (1) REVIEW OF PREGNANCY-RELATED AND

2 PREGNANCY-ASSOCIATED DEATHS.—With respect to 

3 a State that receives a grant under subsection 

4 (a)(1), the following shall apply: 

5 (A) PROCESS FOR MANDATORY REPORTING

6 OF PREGNANCY-RELATED AND PREGNANCY-AS7 SOCIATED DEATHS.— 

8 (i) IN GENERAL.—The State, through 

9 the State maternal mortality review com10 mittee established under subsection (a)(1), 

11 shall develop a process that provides for 

12 mandatory and confidential case reporting 

13 to the State department of health by indi14 viduals and entities described in clause (ii) 

15 with respect to pregnancy-related and 

16 pregnancy-associated deaths. 

17 (ii) INDIVIDUALS AND ENTITIES DE18 SCRIBED.—Individuals and entities de19 scribed in this clause include each of the 

20 following: 

21 (I) Health care professionals. 

22 (II) Medical examiners. 

23 (III) Medical coroners. 

24 (IV) Hospitals. 

25 (V) Birth centers. 


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1 (VI) Other health care facilities. 

2 (VII) Other individuals respon3 sible for completing death records. 

4 (VIII) Other appropriate individ5 uals or entities specified by the Sec6 retary. 

7 (B) PROCESS FOR VOLUNTARY REPORTING

8 OF PREGNANCY-RELATED AND PREGNANCY-AS9 SOCIATED DEATHS.—The State, through the 

10 State maternal mortality review committee es11 tablished under subsection (a)(1), shall develop 

12 a process that provides for voluntary and con13 fidential case reporting to the State department 

14 of health by family members of the deceased 

15 and other individuals on possible pregnancy-re16 lated and pregnancy-associated deaths. Such 

17 process shall include— 

18 (i) making publicly available on the 

19 website of the State department of health 

20 a telephone number, Internet web link, and 

21 email address for such reporting; and 

22 (ii) publicizing to local professional or23 ganizations, community organizations, and 

24 social services agencies the availability of 

25 the telephone number, Internet web link, 


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1 and email address made available under 

2 clause (i). 

3 (C) IDENTIFICATION OF PREGNANCY-RE4 LATED AND PREGNANCY-ASSOCIATED DEATHS

5 BY STATE VITAL STATISTICS UNIT.—The State, 

6 through the vital statistics unit of the State, 

7 shall annually identify pregnancy-related and 

8 pregnancy-associated deaths occurring in such 

9 State in the year involved by— 

10 (i) matching each death record of a 

11 woman in such year to a live birth certifi12 cate or an infant death record for the pur13 pose of identifying deaths of women that 

14 occurred during pregnancy and within one 

15 year after the end of a pregnancy; 

16 (ii) identifying each death of a woman 

17 reported during such year as having an un18 derlying or contributing cause of death re19 lated to pregnancy, regardless of the time 

20 that has passed between the end of the 

21 pregnancy and the death; 

22 (iii) collecting data from medical ex23 aminer and coroner reports; and 

24 (iv) using any other method the State 

25 may devise to identify maternal deaths 


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1 such as reviewing a random sample of re2 ported deaths of women to ascertain cases 

3 of pregnancy-related and pregnancy-associ4 ated deaths that are not discernable from 

5 a review of death records alone. 

6 For purposes of effectively collecting and ob7 taining data on pregnancy-related and preg8 nancy-associated deaths, the State shall adopt 

9 the most recent standardized birth and death 

10 records, as issued by the National Center for 

11 Vital Health Statistics, including the rec12 ommended checkbox section for pregnancy on 

13 each death record. 

14 (D) CASE INVESTIGATION AND DEVELOP15 MENT OF CASE SUMMARIES.— 

16 (i) IN GENERAL.—Following the re17 ceipt of reports by the State department of 

18 health pursuant to subparagraph (A) or 

19 (B) and the collection of cases of preg20 nancy-related and pregnancy-associated 

21 deaths by the vital statistics unit of the 

22 State under subparagraph (C), the State, 

23 through the State maternal mortality re24 view committee established under sub25 section (a)(1), shall investigate each case, 


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1 using the case abstraction form described 

2 in subsection (c), and prepare a de-identi3 fied case summary for each case, which 

4 shall be reviewed by the committee and in5 cluded in applicable reports. The State de6 partment of health or vital statistics unit 

7 of the State, as the case may be, shall pro8 vide the State maternal mortality review 

9 committee with access to the information 

10 collected pursuant to subparagraphs (A) or 

11 (B), or under subparagraph (C), as nec12 essary to carry out this subparagraph. 

13 (ii) MANDATORY DATA AND INFORMA14 TION.—Each case investigation under this 

15 subparagraph shall, subject to availability, 

16 include data and information obtained 

17 through— 

18 (I) medical examiner and autopsy 

19 reports of the woman involved; 

20 (II) medical records of the 

21 woman, including such records related 

22 to health care prior to pregnancy, pre23 natal and postnatal care, labor and 

24 delivery care, emergency room care, 

25 hospital discharge records, and any 


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1 care delivered up until the time of 

2 death of the woman; 

3 (III) oral and written interviews 

4 of individuals directly involved in the 

5 maternal care of the woman during 

6 and immediately following the preg7 nancy of the woman, including health 

8 care, mental health, and social service 

9 providers, as applicable; 

10 (IV) socioeconomic and other rel11 evant background information about 

12 the woman; 

13 (V) any information collected 

14 under subparagraph (C)(i); and 

15 (VI) any other information on 

16 the cause of death of the woman, such 

17 as social services and child welfare re18 ports. 

19 (iii) DISCRETIONARY DATA AND IN20 FORMATION.—Each case investigation 

21 under this subparagraph may include data 

22 and information obtained through oral or 

23 written interviews of the family of the 

24 woman. 


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1 (2) STATE MATERNAL MORTALITY REVIEW

2 COMMITTEES.— 

3 (A) MANDATORY ACTIVITIES.—A State 

4 maternal mortality review committee established 

5 under subsection (a)(1) shall carry out the fol6 lowing activities: 

7 (i) Develop the processes described in 

8 subparagraphs (A) and (B) of paragraph 

9 (1). 

10 (ii) Review the data and information 

11 collected by the vital statistics unit of the 

12 State under paragraph (1)(C) regarding 

13 pregnancy-related and pregnancy-associ14 ated deaths to identify trends, patterns, 

15 and disparities in adverse outcomes and 

16 address medical, non-medical, and system17 related factors that may have contributed 

18 to such pregnancy-related and pregnancy19 associated deaths and disparities. 

20 (iii) Carry out the activities described 

21 in paragraph (1)(D). 

22 (iv) Develop recommendations, based 

23 on the case summaries prepared under 

24 paragraph (1)(D) and the data and infor25 mation collected under paragraph (1)(C), 


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1 to improve maternal care, social and health 

2 services, and public health policy and insti3 tutions, including improving access to ma4 ternal care and social and health services 

5 and identifying disparities in maternal care 

6 and outcomes. 

7 (B) DISCRETIONARY ACTIVITIES.— 

8 (i) IN GENERAL.—A State maternal 

9 mortality review committee established 

10 under subsection (a)(1) may, while subject 

11 to confidentiality requirements, present 

12 findings and recommendations based on 

13 the case summaries prepared under para14 graph (1)(D) directly to a health care facil15 ity or its local or State professional organi16 zation for the purpose of— 

17 (I) instituting policy changes, 

18 educational activities, and improve19 ments in the quality of care provided 

20 by the facility; and 

21 (II) exploring and forming re22 gional collaborations. 

23 (ii) INVESTIGATION OF CASES OF SE24 VERE MATERNAL MORBIDITY.—A State 

25 maternal mortality review committee may 


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1 investigate cases of severe maternal mor2 bidity and any such investigation may in3 clude data and information obtained 

4 through— 

5 (I) identified patient registries; 

6 or 

7 (II) oral or written interviews of 

8 the woman concerned and the family 

9 of such woman. 

10 (C) COMPOSITION OF STATE MATERNAL

11 MORTALITY REVIEW COMMITTEES.— 

12 (i) IN GENERAL.—A State maternal 

13 mortality review committee established 

14 under subsection (a)(1) shall be multidisci15 plinary and diverse. Membership on the 

16 State maternal mortality review committee 

17 shall be reviewed annually by the State de18 partment of health to ensure that member19 ship representation requirements are being 

20 fulfilled in accordance with this subpara21 graph. 

22 (ii) REQUIRED MEMBERSHIP.—Each 

23 State maternal mortality review committee 

24 shall include— 


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1 (I) representatives from medical 

2 specialties providing care to pregnant 

3 and postpartum patients, including 

4 obstetricians (including generalists 

5 and maternal fetal medicine special6 ists) and family practice physicians; 

7 (II) certified nurse midwives, cer8 tified midwives, and advanced practice 

9 nurses; 

10 (III) hospital-based registered 

11 nurses; 

12 (IV) representatives of the ma13 ternal and child health department of 

14 the State department of health; 

15 (V) social service providers or so16 cial workers, including those with ex17 perience working with communities di18 verse with respect to race, ethnicity, 

19 and limited English proficiency; 

20 (VI) chief medical examiners or 

21 designees; 

22 (VII) facility representatives, 

23 such as from hospitals or birth cen24 ters; 


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1 (VIII) patient advocates, commu2 nity maternal health organizations, 

3 and minority advocacy groups that 

4 represent those diverse racial and eth5 nic communities within the State that 

6 are the most affected by pregnancy7 related or pregnancy-associated deaths 

8 and by a lack of access to maternal 

9 health care services; and 

10 (IX) representatives of the de11 partments of health or public health 

12 of major cities in the State. 

13 (iii) DISCRETIONARY MEMBERSHIP.— 

14 Each State maternal mortality review com15 mittee may also include representatives 

16 from other relevant academic, health, so17 cial service, or policy professions or com18 munity organizations on an ongoing basis, 

19 or as needed, as determined beneficial by 

20 the committee, including— 

21 (I) anesthesiologists; 

22 (II) emergency physicians; 

23 (III) pathologists; 

24 (IV) epidemiologists; 

25 (V) intensivists; 


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1 (VI) nutritionists; 

2 (VII) mental health professionals; 

3 (VIII) substance use disorder 

4 treatment specialists; 

5 (IX) representatives of relevant 

6 patient and provider advocacy groups; 

7 (X) academics; 

8 (XI) paramedics; 

9 (XII) risk management special10 ists; and 

11 (XIII) representatives of Feder12 ally recognized Indian tribes and trib13 al organizations. 

14 (iv) STAFF.—Staff of each State ma15 ternal mortality review committee shall in16 clude— 

17 (I) vital health statisticians, ma18 ternal child health statisticians, or 

19 epidemiologists; 

20 (II) a coordinator of the State 

21 maternal mortality review committee, 

22 to be designated by the State; and 

23 (III) administrative staff. 

24 (D) OPTION FOR STATES TO ESTABLISH

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1 MITTEES.—States may choose to partner with 

2 one or more neighboring States to carry out the 

3 activities required of a State maternal mortality 

4 review committee under this section. In such a 

5 case, with respect to the States in such a part6 nership, any requirement under this section re7 lating to the reporting of information related to 

8 such activities shall be deemed to be fulfilled by 

9 each such State if a single such report is sub10 mitted for the partnership. 

11 (E) TREATMENT AS PUBLIC HEALTH AU12 THORITY FOR PURPOSES OF HIPAA.—For pur13 poses of applying HIPAA privacy and security 

14 law (as defined in section 3009(a)(2) of the 

15 Public Health Service Act (42 U.S.C. 300jj– 

16 19)), each State maternal mortality review com17 mittee and regional maternal mortality review 

18 committee established under subsection (a)(1) 

19 or subsection (b)(2)(D), as the case may be, 

20 shall be deemed to be a public health authority 

21 described in section 164.501 (and referenced in 

22 section 164.512(b)(1)(i)) of title 45, Code of 

23 Federal Regulations (or any successor regula24 tion), carrying out public health activities and 

25 purposes described in such section 


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1 164.512(b)(1)(i) (or any such successor regula2 tion). 

3 (3) STATE DEPARTMENT OF HEALTH ACTIVI4 TIES.—With respect to a State that receives a grant 

5 under subsection (a)(1), the State department of 

6 health shall— 

7 (A) in consultation with the State maternal 

8 mortality review committee and in conjunction 

9 with relevant professional organizations and pa10 tient advocacy organizations, develop a plan for 

11 ongoing health care provider education, based 

12 on the findings and recommendations of the 

13 committee, in order to improve the quality of 

14 maternal care; and 

15 (B) take steps to widely disseminate the 

16 findings and recommendations of the State ma17 ternal mortality review committee and imple18 ment the recommendations of the committee. 

19 (c) CASE ABSTRACTION FORM.— 

20 (1) DISSEMINATION.—The Director of the Cen21 ters for Disease Control and Prevention shall dis22 seminate a uniform case abstraction form to States 

23 and State maternal mortality review committees for 

24 the purpose of— 


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1 (A) ensuring that the data and information 

2 collected and reviewed by such committees can 

3 be pooled for review by the Department of 

4 Health and Human Services and its agencies; 

5 and 

6 (B) preserving the uniformity of the infor7 mation collected for Federal public health pur8 poses. 

9 (2) PERMISSIBLE STATE MODIFICATION.—Each 

10 State may modify the form developed under para11 graph (1) for implementation and use by such State 

12 or by the State maternal mortality review committee 

13 of such State by including on such form additional 

14 information to be collected, but may not alter the 

15 standard questions on such form, in order to ensure 

16 that the information can be collected and reviewed 

17 centrally at the Federal level. 

18 (d) PUBLIC DISCLOSURE OF INFORMATION.— 

19 (1) IN GENERAL.—For fiscal year 2018, or a 

20 subsequent fiscal year, each State receiving a grant 

21 under this section for such year shall, subject to 

22 paragraph (3), provide for the public disclosure, and 

23 submission to the information clearinghouse estab24 lished under paragraph (2), of the information inVerDate Sep 11 2014 22:17 Jul 09, 2018 Jkt 079200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6401 E:\BILLS\S1112.RS S1112

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1 cluded in the report of the State under subsection 

2 (f)(1) for such year. 

3 (2) INFORMATION CLEARINGHOUSE.—The Sec4 retary shall establish an information clearinghouse, 

5 to be administered by the Director of the Centers for 

6 Disease Control and Prevention, that will maintain 

7 findings and recommendations submitted pursuant 

8 to paragraph (1) and provide such findings and rec9 ommendations for public review and research pur10 poses by State departments of health, State mater11 nal mortality review committees, and health pro12 viders and institutions. 

13 (3) CONFIDENTIALITY OF INFORMATION.—In 

14 no case may any individually identifiable health in15 formation be provided to the public, or submitted to 

16 the information clearinghouse, under this subsection. 

17 (e) CONFIDENTIALITY OF PROCEEDINGS OF STATE

18 MATERNAL MORTALITY REVIEW COMMITTEES.— 

19 (1) IN GENERAL.—All proceedings and activi20 ties of a State maternal mortality review committee 

21 established under subsection (a)(1), opinions of 

22 members of such a committee formed as a result of 

23 such proceedings and activities, and records ob24 tained, created, or maintained pursuant to this sec25 tion, including records of interviews, written reports, 


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1 and statements procured by the Department of 

2 Health and Human Services or by any other person, 

3 agency, or organization acting jointly with the De4 partment, in connection with morbidity and mor5 tality reviews under this section, shall be confidential 

6 and may not be subject to discovery, subpoena, or 

7 introduction into evidence in any civil, criminal, leg8 islative, or other proceeding. Such records shall not 

9 be open to public inspection. 

10 (2) TESTIMONY OF MEMBERS OF COM11 MITTEE.— 

12 (A) IN GENERAL.—Members of a State 

13 maternal mortality review committee established 

14 under subsection (a)(1) may not be questioned 

15 in any civil, criminal, legislative, or other pro16 ceeding regarding information presented in, or 

17 opinions formed as a result of, a meeting or 

18 communication of the committee. 

19 (B) CLARIFICATION.—Nothing in this sub20 section may be construed to prevent a member 

21 of a State maternal mortality review committee 

22 established under subsection (a)(1) from testi23 fying regarding information that was obtained 

24 independent of such member’s participation on 

25 the committee, or public information. 


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1 (3) AVAILABILITY OF INFORMATION FOR RE2 SEARCH PURPOSES.—Nothing in this subsection may 

3 prohibit a State maternal mortality review com4 mittee established under subsection (a)(1) or the De5 partment of Health and Human Services from pub6 lishing statistical compilations and research reports 

7 that— 

8 (A) are based on confidential information, 

9 relating to morbidity and mortality reviews 

10 under this section; and 

11 (B) do not contain identifying information 

12 or any other information that could be used to 

13 ultimately identify the individuals concerned. 

14 (f) REPORTS.— 

15 (1) STATE REPORTS.—For fiscal year 2018, 

16 and each subsequent fiscal year, each State maternal 

17 mortality review committee established under sub18 section (a)(1) and receiving a grant under this sec19 tion for such year, shall submit to the Director of 

20 the Centers for Disease Control and Prevention a re21 port on the findings and recommendations of such 

22 committee and information on the implementation of 

23 such recommendations during such year. 

24 (2) ANNUAL REPORTS TO CONGRESS.—For fis25 cal year 2018, and each subsequent fiscal year, the 


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1 Secretary of Health and Human Services shall sub2 mit to Congress a report on— 

3 (A) the findings, recommendations, and 

4 implementation information submitted by any 

5 State pursuant to paragraph (1); and 

6 (B) the status of pregnancy-related and 

7 pregnancy-associated deaths in the United 

8 States, including recommendations on methods 

9 to prevent such deaths in the United States. 

10 (g) DEFINITIONS.—In this section: 

11 (1) The term ‘‘pregnancy-associated death’’ 

12 means the death of a woman while pregnant or dur13 ing the one-year period following the date of the end 

14 of pregnancy, irrespective of the cause of such death. 

15 (2) The term ‘‘pregnancy-related death’’ means 

16 the death of a woman while pregnant or during the 

17 one-year period following the date of the end of 

18 pregnancy, irrespective of the duration of the preg19 nancy, from any cause related to, or aggravated by, 

20 the pregnancy or its management, excluding any ac21 cidental or incidental cause. 

22 (3) The term ‘‘Secretary’’ means the Secretary 

23 of Health and Human Services. 

24 (4) The term ‘‘severe maternal morbidity’’ 

25 means the physical and psychological conditions that 


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1 result from, or are aggravated by, pregnancy and 

2 have an adverse effect on the health of a woman. 

3 (5) The term ‘‘State’’ means each of the 50 

4 States, the District of Columbia, and each of the 

5 territories, and shall include Federally recognized In6 dian tribes and tribal organizations that receive a 

7 grant under subsection (a)(1). Such tribes and orga8 nizations shall meet the requirements applicable to 

9 States under this section as determined appropriate 

10 by the Secretary. 

11 (6) The term ‘‘vital statistics unit’’ means the 

12 entity that is responsible for maintaining vital 

13 records for a State, including official records of live 

14 births, deaths, fetal deaths, marriages, divorces, and 

15 annulments. 

16 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

17 authorized to be appropriated to carry out this section 

18 $7,000,000 for each of fiscal years 2018 through 2022. 

19 SEC. 4. ELIMINATING DISPARITIES IN MATERNITY HEALTH 

20 OUTCOMES. 

21 Part B of title III of the Public Health Service Act 

22 is amended by inserting after section 317T of such Act 

23 (42 U.S.C. 247b–22) the following new section: 


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1 ‘‘SEC. 317U. ELIMINATING DISPARITIES IN MATERNAL 

2 HEALTH OUTCOMES. 

3 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta4 tion with relevant national stakeholder organizations, such 

5 as national medical specialty organizations, national ma6 ternal child health organizations, national patient advo7 cacy organizations, and national health disparity organiza8 tions, carry out the following activities to eliminate dis9 parities in maternal health outcomes: 

10 ‘‘(1) Conduct research into the determinants 

11 and the distribution of disparities in maternal care, 

12 health risks, and health outcomes, and improve the 

13 capacity of the performance measurement infrastruc14 ture to measure such disparities. 

15 ‘‘(2) Expand access to health care services, re16 sources, and information that have been dem17 onstrated to improve the quality and outcomes of 

18 maternity care for vulnerable populations. 

19 ‘‘(3) Establish a demonstration project to com20 pare the effectiveness of interventions to reduce dis21 parities in maternity services and outcomes and to 

22 implement and assess effective interventions. 

23 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM24 ONSTRATION PROJECT.—The demonstration project 

25 under subsection (a)(3) shall be conducted in no more 


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1 than 8 States, which shall be selected by the Secretary 

2 based on— 

3 ‘‘(1) applications submitted by States, which 

4 specify which regions and populations the State in5 volved will serve under the demonstration project; 

6 ‘‘(2) criteria designed by the Secretary to en7 sure that, as a whole, the demonstration project is, 

8 to the greatest extent possible, representative of the 

9 demographic and geographic composition of commu10 nities most affected by disparities; 

11 ‘‘(3) criteria designed by the Secretary to en12 sure that a variety of models are tested through the 

13 demonstration project and that such models include 

14 interventions that have an existing evidence base for 

15 effectiveness; and 

16 ‘‘(4) criteria designed by the Secretary to en17 sure that the demonstration projects and models will 

18 be carried out in consultation with local and regional 

19 provider organizations, such as community health 

20 centers, hospital systems, and medical societies rep21 resenting providers of maternity services. 

22 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 

23 The demonstration project under subsection (a)(3) shall 

24 begin on January 1, 2018, and end on December 31, 

25 2021. 


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1 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 

2 The Secretary may make grants to States and health care 

3 providers participating in the demonstration project under 

4 subsection (a)(3) for the purpose of collecting data nec5 essary for the evaluation and monitoring of such project. 

6 ‘‘(e) REPORTS.— 

7 ‘‘(1) STATE REPORTS.—Each State that par8 ticipates in the demonstration project under sub9 section (a)(3) shall report to the Secretary, in a 

10 time, form, and manner specified by the Secretary, 

11 the data necessary to— 

12 ‘‘(A) monitor the— 

13 ‘‘(i) outcomes of the project; 

14 ‘‘(ii) costs of the project; and 

15 ‘‘(iii) quality of maternity care pro16 vided under the project; and 

17 ‘‘(B) evaluate the rationale for the selec18 tion of the items and services included in any 

19 bundled payment made by the State under the 

20 project. 

21 ‘‘(2) FINAL REPORT.—Not later than December 

22 31, 2022, the Secretary shall submit to Congress a 

23 report on the results of the demonstration project 

24 under subsection (a)(3).’’. 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Maternal Health Ac3 countability Act of 2017’’. 

4 SEC. 2. SAFE MOTHERHOOD. 

5 Section 317K of the Public Health Service Act (42 

6 U.S.C. 247b–12) is amended— 

7 (1) in subsection (a)— 

8 (A) in paragraph (1)— 

9 (i) by striking ‘‘purpose of this sub10 section is to develop’’ and inserting ‘‘pur11 poses of this subsection are to establish or 

12 continue a Federal initiative to support 

13 State and tribal maternal mortality review 

14 committees, to improve data collection and 

15 reporting around maternal mortality, and 

16 to develop or support’’; 

17 (ii) by inserting ‘‘, including severe 

18 maternal morbidities,’’ after ‘‘maternal 

19 complications’’; and 

20 (iii) by striking ‘‘population at risk of 

21 death and’’ and inserting ‘‘populations at 

22 risk of death and severe’’; and 

23 (B) in paragraph (2)— 

24 (i) by amending subparagraph (A) to 

25 read as follows: 


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1 ‘‘(A) The Secretary may continue and im2 prove activities related to a national maternal 

3 mortality data collection and surveillance pro4 gram to identify and support the review of preg5 nancy-associated deaths and pregnancy-related 

6 deaths and severe maternal morbidity that occur 

7 during, or within 1 year following, pregnancy.’’; 

8 and 

9 (ii) by inserting after subparagraph 

10 (C) the following: 

11 ‘‘(D) The Secretary may, in cooperation 

12 with States, Indian tribes, and tribal organiza13 tions, develop a program to support States, In14 dian tribes, and tribal organizations in estab15 lishing or operating maternal mortality review 

16 committees, in accordance with subsection (d).’’; 

17 (2) in subsection (b)(2)— 

18 (A) in subparagraph (A)— 

19 (i) by striking ‘‘preconception’’ and in20 serting ‘‘prepregnancy’’; and 

21 (ii) by inserting ‘‘and women with 

22 substance use disorder’’ before the semicolon; 

23 (B) in subparagraph (H)— 

24 (i) by inserting ‘‘the identification of 

25 the determinants of disparities in maternal 


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1 care, health risks, and health outcomes, in2 cluding’’ before ‘‘an examination’’; and 

3 (ii) by inserting ‘‘and other groups of 

4 women with disproportionately high rates of 

5 maternal mortality’’ before the semicolon; 

6 (C) by redesignating subparagraphs (I) 

7 through (L) as subparagraphs (J) through (M), 

8 respectively; 

9 (D) by inserting after subparagraph (H) the 

10 following: 

11 ‘‘(I) activities to reduce disparities in ma12 ternity services and outcomes;’’; and 

13 (E) in subparagraph (K), as so redesig14 nated, by striking ‘‘, alcohol and illegal drug 

15 use’’ and inserting ‘‘and substance abuse and 

16 misuse’’; 

17 (3) in subsection (c)— 

18 (A) by striking ‘‘(1) IN GENERAL—The Sec19 retary’’ and inserting ‘‘The Secretary’’; 

20 (B) by redesignating subparagraphs (A) 

21 through (C) as paragraphs (1) through (3), re22 spectively, and adjusting the margins accord23 ingly; 

24 (C) in paragraph (1), as so redesignated, by 

25 striking ‘‘and the building of partnerships with 


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1 outside organizations concerned about safe moth2 erhood’’; 

3 (D) in paragraph (2), as so redesignated, by 

4 striking ‘‘; and’’ and inserting a semicolon; 

5 (E) in paragraph (3), as so redesignated, by 

6 striking the period and inserting ‘‘; and’’; and 

7 (F) by adding at the end the following: 

8 ‘‘(4) activities to promote physical, mental, and 

9 behavioral health during, and up to 1 year following, 

10 pregnancy, with an emphasis on prevention of, and 

11 treatment for, depression and substance use dis12 order.’’; 

13 (4) by redesignating subsection (d) as subsection 

14 (f); 

15 (5) by inserting after subsection (c) the fol16 lowing: 

17 ‘‘(d) MATERNAL MORTALITY REVIEW COMMITTEES.— 

18 ‘‘(1) IN GENERAL.—In order to participate in 

19 the program under subsection (a)(2)(D), the applica20 ble maternal mortality review committee of the State, 

21 Indian tribe, or tribal organization shall— 

22 ‘‘(A) include multidisciplinary and diverse 

23 membership that represents, as appropriate, a 

24 variety of clinical specialties, State, tribal, or 

25 local public health officials, epidemiologists, statVerDate Sep 11 2014 22:17 Jul 09, 2018 Jkt 079200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6203 E:\BILLS\S1112.RS S1112

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1 isticians, community organizations, geographic 

2 regions within the area covered by such com3 mittee, and individuals or organizations that 

4 represent the populations in the area covered by 

5 such committee that is most affected by preg6 nancy-related deaths or pregnancy-associated 

7 deaths and lack of access to maternal health care 

8 services; and 

9 ‘‘(B) to the extent practicable, use evidence10 based practices to demonstrate that such mater11 nal mortality review committee’s methods and 

12 processes for the data collection and review, as 

13 required under paragraph (3), will reliably de14 termine and include all pregnancy-associated 

15 deaths and associated pregnancy-related deaths, 

16 regardless of the outcome of the pregnancy. 

17 ‘‘(2) PROCESS FOR CONFIDENTIAL REPORTING.— 

18 States, Indian tribes, and tribal organizations that 

19 participate in the program described in this sub20 section shall, through the State maternal mortality re21 view committee, develop a process that— 

22 ‘‘(A) provides for confidential case reporting 

23 of pregnancy-associated and pregnancy-related 

24 deaths to the appropriate State or tribal health 

25 agency, including such reporting by— 


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1 ‘‘(i) health care professionals prac2 ticing in women’s health, including obstetri3 cians, gynecologists, nurse practitioners, 

4 clinical nurse specialists, certified registered 

5 nurse anesthetists, and certified nurse mid6 wives; 

7 ‘‘(ii) medical examiners; 

8 ‘‘(iii) medical coroners; 

9 ‘‘(iv) hospitals; 

10 ‘‘(v) birth centers; 

11 ‘‘(vi) other health care facilities; 

12 ‘‘(vii) other individuals responsible for 

13 completing death records; and 

14 ‘‘(viii) other appropriate individuals 

15 or entities; and 

16 ‘‘(B) provides for voluntary and confiden17 tial case reporting of pregnancy-associated 

18 deaths and pregnancy-related deaths to the ap19 propriate State or tribal health agency by family 

20 members of the deceased, and other appropriate 

21 individuals, for purposes of review by the appli22 cable maternal mortality review committee; and 

23 ‘‘(C) may include— 


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1 ‘‘(i) making publicly available contact 

2 information of the committee for use in such 

3 reporting; and 

4 ‘‘(ii) conducting outreach to local pro5 fessional organizations, community organi6 zations, and social services agencies regard7 ing the availability of the review committee. 

8 ‘‘(3) DATA COLLECTION AND REVIEW.—States, 

9 Indian tribes, and tribal organizations that partici10 pate in the program described in this subsection 

11 shall— 

12 ‘‘(A) annually identify pregnancy-associ13 ated deaths and pregnancy-related deaths— 

14 ‘‘(i) through the appropriate vital sta15 tistics unit by— 

16 ‘‘(I) matching each death record 

17 related to a pregnancy-associated death 

18 or pregnancy-related death in the State 

19 or tribal area in the applicable year to 

20 a birth certificate of an infant or fetal 

21 death record, as applicable; 

22 ‘‘(II) to the extent practicable, 

23 identifying an underlying or contrib24 uting cause of each pregnancy-associ25 ated death and each pregnancy-related 


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1 death in the State or tribal area in the 

2 applicable year; and 

3 ‘‘(III) collecting data from med4 ical examiner and coroner reports, as 

5 appropriate; and 

6 ‘‘(ii) using other appropriate methods 

7 or information to identify pregnancy-associ8 ated deaths and pregnancy-related deaths; 

9 ‘‘(B) through the maternal mortality review 

10 committee, review data and information to iden11 tify adverse outcomes that may contribute to 

12 pregnancy-associated death and pregnancy-re13 lated death, and to identify trends, patterns, and 

14 disparities in such adverse outcomes to allow the 

15 State, Indian tribe, or tribal organization to 

16 make recommendations to individuals and enti17 ties described in paragraph (2)(A), as appro18 priate, to improve maternal care and reduce 

19 pregnancy-associated death and pregnancy-re20 lated death; and 

21 ‘‘(C) ensure that, to the extent practicable, 

22 the data collected and reported under this para23 graph is in a format that allows for analysis by 

24 the Centers for Disease Control and Prevention. 


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1 ‘‘(4) CONFIDENTIALITY.—States, Indian tribes, 

2 and tribal organizations participating in the pro3 gram described in this subsection shall establish con4 fidentiality protections to ensure, at a minimum, 

5 that— 

6 ‘‘(A) there is no disclosure by the maternal 

7 mortality review committee, including any indi8 vidual members of the committee, to any person, 

9 including any government official, of any identi10 fying information about any specific maternal 

11 mortality case; and 

12 ‘‘(B) no information from committee pro13 ceedings, including deliberation or records, is 

14 made public unless specifically authorized under 

15 State and Federal law. 

16 ‘‘(5) REPORTS TO CDC.—For fiscal year 2019, 

17 and each subsequent fiscal year, each maternal mor18 tality review committee participating in the program 

19 described in this subsection shall submit to the Direc20 tor of the Centers for Disease Control and Prevention 

21 a report that includes— 

22 ‘‘(A) data, findings, and any recommenda23 tions of such committee; and 

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1 ommendations submitted by the committee in a 

2 previous year. 

3 ‘‘(6) STATE PARTNERSHIPS.—States may part4 ner with one or more neighboring States to carry out 

5 the activities under this subparagraph. With respect 

6 to the States in such a partnership, any requirement 

7 under this subparagraph relating to the reporting of 

8 information related to such activities shall be deemed 

9 to be fulfilled by each such State if a single such re10 port is submitted for the partnership. 

11 ‘‘(7) APPROPRIATE MECHANISMS FOR INDIAN

12 TRIBES AND TRIBAL ORGANIZATIONS.—The Secretary, 

13 in consultation with Indian tribes, shall identify and 

14 establish appropriate mechanisms for Indian tribes 

15 and tribal organizations to demonstrate, report data, 

16 and conduct the activities as required for participa17 tion in the program described in this subsection. Such 

18 mechanisms may include technical assistance with re19 spect to grant application and submission procedures, 

20 and award management activities. 

21 ‘‘(8) RESEARCH AVAILABILITY.—The Secretary 

22 shall develop a process to ensure that data collected 

23 under paragraph (5) is made available, as appro24 priate and practicable, for research purposes, in a 

25 manner that protects individually identifiable or poVerDate Sep 11 2014 22:17 Jul 09, 2018 Jkt 079200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6203 E:\BILLS\S1112.RS S1112

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1 tentially identifiable information and that is con2 sistent with State and Federal privacy law. 

3 ‘‘(e) DEFINITIONS.—In this section— 

4 ‘‘(1) the terms ‘Indian tribe’ and ‘tribal organi5 zations’ have the meanings given such terms in sec6 tion 4 of the Indian Self-Determination and Edu7 cation Assistance Act (25 U.S.C. 5304); 

8 ‘‘(2) the term ‘pregnancy-associated death’ means 

9 a death of a woman, by any cause, that occurs dur10 ing, or within 1 year following, her pregnancy, re11 gardless of the outcome, duration, or site of the preg12 nancy; and 

13 ‘‘(3) the term ‘pregnancy-related death’ means a 

14 death of a woman that occurs during, or within 1 

15 year following, her pregnancy, regardless of the out16 come, duration, or site of the pregnancy— 

17 ‘‘(A) from any cause related to, or aggra18 vated by, the pregnancy or its management; and 

19 ‘‘(B) not from accidental or incidental 

20 causes.’’; and 

21 (6) in subsection (f), as so redesignated, by strik22 ing ‘‘such sums as may be necessary for each of the 

23 fiscal years 2001 through 2005’’ and inserting 

24 ‘‘$58,000,000 for each of fiscal years 2019 through 

25 2023’’. 


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Calendar No. 502 

115TH CONGRESS 

2D SESSION S. 1112 

A BILL 

To support States in their work to save and sustain 

other purposes. ity and health outcomes for mothers, and for to identify solutions to improve health care qualnancy-related and pregnancy-associated deaths, disparities in maternal health outcomes for pregbirth, and in the postpartum period, to eliminate the health of mothers during pregnancy, childJULY 9, 2018 

Reported with an amendment 


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