H. R. 1318 

One Hundred Fifteenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Wednesday, 

the third day of January, two thousand and eighteen 

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 pregnancyrelated 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)— 
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(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 
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‘‘(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 pregnancyrelated 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 pregnancyrelated 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); 
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‘‘(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’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.