```

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1318 Introduced in House (IH)]

<DOC>

115th CONGRESS
  1st Session
                                H. R. 1318

   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 HOUSE OF REPRESENTATIVES

                             March 2, 2017

    Ms. Herrera Beutler (for herself, Mr. Conyers, Mr. Costello of 
Pennsylvania, and Ms. DeGette) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 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 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 
2017''.

SEC. 2. FINDINGS; PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) The United States is ranked 50th globally for its 
        maternal mortality rate, and it is one of eight countries in 
        which the maternal mortality rate has been on the rise.
            (2) In recent studies, the estimated maternal mortality 
        rate in the United States increased by approximately 26.6 
        percent from 2000 to 2014, with the rate increasing in nearly 
        all States. This reported increase, along with no improvement 
        in previous years, remains a source of great concern for the 
        Centers for Disease Control and Prevention (CDC), health care 
        providers, and patient advocates such as the American Congress 
        of Obstetricians and Gynecologists, the Association of Women's 
        Health, Obstetric, and Neonatal Nurses, and the Preeclampsia 
        Foundation.
            (3) Maternal deaths in the United States result from 
        pregnancy-related causes such as hemorrhage, hypertensive 
        disease and preeclampsia, embolic disease, sepsis, and 
        substance use disorder and overdose, and violent causes such as 
        motor vehicle accidents, homicide, and suicide.
            (4) Review of pregnancy-related and pregnancy-associated 
        deaths is essential to determining strategies for developing 
        prevention efforts and quality improvement and quality control 
        programs. The United States must identify at-risk populations 
        and understand how to support them to make pregnancy and the 
        postpartum period safer.
            (5) The most severe complications of pregnancy, generally 
        referred to as severe maternal morbidity (SMM), affect more 
        than 65,000 women in the United States every year. The CDC uses 
        ICD-9-CM codes, which indicate a potentially life-threatening 
        maternal condition or complication, to define SMM.
            (6) Data from the CDC shows Black women are three times 
        more likely to die from complications of pregnancy or 
        childbirth than White women: 42.8 Black women per 100,000 live 
        births, as opposed to 12.5 White women and 17.3 women of other 
        races.
            (7) The CDC recommends that maternal deaths be investigated 
        through State collaboratives. These State collaboratives would 
        bring together leaders in obstetric and neonatal health care 
        from private, academic, and public health care settings to make 
        recommendations for preventing pregnancy-related and pregnancy-
        associated deaths and health complications and identify ways to 
        improve quality of care for women and infants.
            (8) A few States, including California, have worked to 
        develop and strengthen maternal morbidity and mortality review 
        systems and utilize data to reduce maternal deaths and injuries 
        to address leading issues such as maternal hemorrhage, 
        hypertension and preeclampsia, and health and racial 
        disparities.
    (b) Purposes.--The purposes of this Act are the following:
            (1) To establish a shared responsibility between States and 
        the Federal Government to identify opportunities for 
        improvement in quality of care and system changes, and to 
        educate and inform health institutions and professionals, 
        women, and families about preventing pregnancy-related and 
        pregnancy-associated deaths and complications and reducing 
        disparities.
            (2) To develop a model for States to operate maternal 
        mortality reviews and assess the various factors that may have 
        contributed to maternal mortality, including quality of care, 
        racial disparities, and systemic problems in the delivery of 
        health care, and to develop appropriate interventions to reduce 
        and prevent such deaths.

SEC. 3. STATE MATERNAL MORTALITY REVIEW COMMITTEES ON PREGNANCY-RELATED 
              AND PREGNANCY-ASSOCIATED DEATHS.

    (a) Program Authorized.--
            (1) In general.--The Secretary of Health and Human 
        Services, through the Director of the Centers for Disease 
        Control and Prevention, shall establish a grant program under 
        which the Secretary may make grants to States for the purpose 
        of--
                    (A) carrying out the activities described in 
                subsection (b)(1);
                    (B) establishing and sustaining a State maternal 
                mortality review committee, in accordance with 
                subsection (b)(2);
                    (C) ensuring that the State department of health 
                carries out the activities described in subsection 
                (b)(3);
                    (D) disseminating the case abstraction form 
                developed under subsection (c); and
                    (E) providing for the public disclosure of 
                information, in accordance with subsection (d).
            (2) Criteria.--The Secretary shall establish criteria for 
        determining eligibility for, and the amount of a grant awarded 
        to, a State under paragraph (1). Such criteria shall provide 
        that in the case of a State that receives a grant under 
        paragraph (1) for a fiscal year and is determined by the 
        Secretary to have not used such grant in accordance with this 
        section, such State may not be eligible for such a grant for 
        any subsequent fiscal year.
    (b) Use of Funds.--
            (1) Review of pregnancy-related and pregnancy-associated 
        deaths.--With respect to a State that receives a grant under 
        subsection (a)(1), the following shall apply:
                    (A) Process for mandatory reporting of pregnancy-
                related and pregnancy-associated deaths.--
                            (i) In general.--The State, through the 
                        State maternal mortality review committee 
                        established under subsection (a)(1), shall 
                        develop a process that provides for mandatory 
                        and confidential case reporting to the State 
                        department of health by individuals and 
                        entities described in clause (ii) with respect 
                        to pregnancy-related and pregnancy-associated 
                        deaths.
                            (ii) Individuals and entities described.--
                        Individuals and entities described in this 
                        clause include each of the following:
                                    (I) Health care professionals.
                                    (II) Medical examiners.
                                    (III) Medical coroners.
                                    (IV) Hospitals.
                                    (V) Birth centers.
                                    (VI) Other health care facilities.
                                    (VII) Other individuals responsible 
                                for completing death records.
                                    (VIII) Other appropriate 
                                individuals or entities specified by 
                                the Secretary.
                    (B) Process for voluntary reporting of pregnancy-
                related and pregnancy-associated deaths.--The State, 
                through the State maternal mortality review committee 
                established under subsection (a)(1), shall develop a 
                process that provides for voluntary and confidential 
                case reporting to the State department of health by 
                family members of the deceased and other individuals on 
                possible pregnancy-related and pregnancy-associated 
                deaths. Such process shall include--
                            (i) making publicly available on the 
                        website of the State department of health a 
                        telephone number, Internet web link, and email 
                        address for such reporting; and
                            (ii) publicizing to local professional 
                        organizations, community organizations, and 
                        social services agencies the availability of 
                        the telephone number, Internet web link, and 
                        email address made available under clause (i).
                    (C) Identification of pregnancy-related and 
                pregnancy-associated deaths by state vital statistics 
                unit.--The State, through the vital statistics unit of 
                the State, shall annually identify pregnancy-related 
                and pregnancy-associated deaths occurring in such State 
                in the year involved by--
                            (i) matching each death record of a woman 
                        in such year to a live birth certificate or an 
                        infant death record for the purpose of 
                        identifying deaths of women that occurred 
                        during pregnancy and within one year after the 
                        end of a pregnancy;
                            (ii) identifying each death of a woman 
                        reported during such year as having an 
                        underlying or contributing cause of death 
                        related to pregnancy, regardless of the time 
                        that has passed between the end of the 
                        pregnancy and the death;
                            (iii) collecting data from medical examiner 
                        and coroner reports; and
                            (iv) using any other method the State may 
                        devise to identify maternal deaths such as 
                        reviewing a random sample of reported deaths of 
                        women to ascertain cases of pregnancy-related 
                        and pregnancy-associated deaths that are not 
                        discernable from a review of death records 
                        alone.
                For purposes of effectively collecting and obtaining 
                data on pregnancy-related and pregnancy-associated 
                deaths, the State shall adopt the most recent 
                standardized birth and death records, as issued by the 
                National Center for Vital Health Statistics, including 
                the recommended checkbox section for pregnancy on each 
                death record.
                    (D) Case investigation and development of case 
                summaries.--
                            (i) In general.--Following the receipt of 
                        reports by the State department of health 
                        pursuant to subparagraph (A) or (B) and the 
                        collection of cases of pregnancy-related and 
                        pregnancy-associated deaths by the vital 
                        statistics unit of the State under subparagraph 
                        (C), the State, through the State maternal 
                        mortality review committee established under 
                        subsection (a)(1), shall investigate each case, 
                        using the case abstraction form described in 
                        subsection (c), and prepare a de-identified 
                        case summary for each case, which shall be 
                        reviewed by the committee and included in 
                        applicable reports. The State department of 
                        health or vital statistics unit of the State, 
                        as the case may be, shall provide the State 
                        maternal mortality review committee with access 
                        to the information collected pursuant to 
                        subparagraph (A) or (B), or under subparagraph 
                        (C), as necessary to carry out this 
                        subparagraph.
                            (ii) Mandatory data and information.--Each 
                        case investigation under this subparagraph 
                        shall, subject to availability, include data 
                        and information obtained through--
                                    (I) medical examiner and autopsy 
                                reports of the woman involved;
                                    (II) medical records of the woman, 
                                including such records related to 
                                health care prior to pregnancy, 
                                prenatal and postnatal care, labor and 
                                delivery care, emergency room care, 
                                hospital discharge records, and any 
                                care delivered up until the time of 
                                death of the woman;
                                    (III) oral and written interviews 
                                of individuals directly involved in the 
                                maternal care of the woman during and 
                                immediately following the pregnancy of 
                                the woman, including health care, 
                                mental health, and social service 
                                providers, as applicable;
                                    (IV) socioeconomic and other 
                                relevant background information about 
                                the woman;
                                    (V) any information collected under 
                                subparagraph (C)(i); and
                                    (VI) any other information on the 
                                cause of death of the woman, such as 
                                social services and child welfare 
                                reports.
                            (iii) Discretionary data and information.--
                        Each case investigation under this subparagraph 
                        may include data and information obtained 
                        through oral or written interviews of the 
                        family of the woman.
            (2) State maternal mortality review committees.--
                    (A) Mandatory activities.--A State maternal 
                mortality review committee established under subsection 
                (a)(1) shall carry out the following activities:
                            (i) Develop the processes described in 
                        subparagraphs (A) and (B) of paragraph (1).
                            (ii) Review the data and information 
                        collected by the vital statistics unit of the 
                        State under paragraph (1)(C) regarding 
                        pregnancy-related and pregnancy-associated 
                        deaths to identify trends, patterns, and 
                        disparities in adverse outcomes and address 
                        medical, non-medical, and system-related 
                        factors that may have contributed to such 
                        pregnancy-related and pregnancy-associated 
                        deaths and disparities.
                            (iii) Carry out the activities described in 
                        paragraph (1)(D).
                            (iv) Develop recommendations, based on the 
                        case summaries prepared under paragraph (1)(D) 
                        and the data and information collected under 
                        paragraph (1)(C), to improve maternal care, 
                        social and health services, and public health 
                        policy and institutions, including improving 
                        access to maternal care and social and health 
                        services and identifying disparities in 
                        maternal care and outcomes.
                    (B) Discretionary activities.--
                            (i) In general.--A State maternal mortality 
                        review committee established under subsection 
                        (a)(1) may, while subject to confidentiality 
                        requirements, present findings and 
                        recommendations based on the case summaries 
                        prepared under paragraph (1)(D) directly to a 
                        health care facility or its local or State 
                        professional organization for the purpose of--
                                    (I) instituting policy changes, 
                                educational activities, and 
                                improvements in the quality of care 
                                provided by the facility; and
                                    (II) exploring and forming regional 
                                collaborations.
                            (ii) Investigation of cases of severe 
                        maternal morbidity.--A State maternal mortality 
                        review committee may investigate cases of 
                        severe maternal morbidity and any such 
                        investigation may include data and information 
                        obtained through--
                                    (I) identified patient registries; 
                                or
                                    (II) oral or written interviews of 
                                the woman concerned and the family of 
                                such woman.
                    (C) Composition of state maternal mortality review 
                committees.--
                            (i) In general.--A State maternal mortality 
                        review committee established under subsection 
                        (a)(1) shall be multidisciplinary and diverse. 
                        Membership on the State maternal mortality 
                        review committee shall be reviewed annually by 
                        the State department of health to ensure that 
                        membership representation requirements are 
                        being fulfilled in accordance with this 
                        subparagraph.
                            (ii) Required membership.--Each State 
                        maternal mortality review committee shall 
                        include--
                                    (I) representatives from medical 
                                specialties providing care to pregnant 
                                and postpartum patients, including 
                                obstetricians (including generalists 
                                and maternal fetal medicine 
                                specialists) and family practice 
                                physicians;
                                    (II) certified nurse midwives, 
                                certified midwives, and advanced 
                                practice nurses;
                                    (III) hospital-based registered 
                                nurses;
                                    (IV) representatives of the 
                                maternal and child health department of 
                                the State department of health;
                                    (V) social service providers or 
                                social workers, including those with 
                                experience working with communities 
                                diverse with respect to race, 
                                ethnicity, and limited English 
                                proficiency;
                                    (VI) chief medical examiners or 
                                designees;
                                    (VII) facility representatives, 
                                such as from hospitals or birth 
                                centers;
                                    (VIII) patient advocates, community 
                                maternal health organizations, and 
                                minority advocacy groups that represent 
                                those diverse racial and ethnic 
                                communities within the State that are 
                                the most affected by pregnancy-related 
                                or pregnancy-associated deaths and by a 
                                lack of access to maternal health care 
                                services; and
                                    (IX) representatives of the 
                                departments of health or public health 
                                of major cities in the State.
                            (iii) Discretionary membership.--Each State 
                        maternal mortality review committee may also 
                        include representatives from other relevant 
                        academic, health, social service, or policy 
                        professions or community organizations on an 
                        ongoing basis, or as needed, as determined 
                        beneficial by the committee, including--
                                    (I) anesthesiologists;
                                    (II) emergency physicians;
                                    (III) pathologists;
                                    (IV) epidemiologists;
                                    (V) intensivists;
                                    (VI) nutritionists;
                                    (VII) mental health professionals;
                                    (VIII) substance use disorder 
                                treatment specialists;
                                    (IX) representatives of relevant 
                                patient and provider advocacy groups;
                                    (X) academics;
                                    (XI) paramedics; and
                                    (XII) risk management specialists.
                            (iv) Staff.--Staff of each State maternal 
                        mortality review committee shall include--
                                    (I) vital health statisticians, 
                                maternal child health statisticians, or 
                                epidemiologists;
                                    (II) a coordinator of the State 
                                maternal mortality review committee, to 
                                be designated by the State; and
                                    (III) administrative staff.
                    (D) Option for states to establish regional 
                maternal mortality review committees.--States may 
                choose to partner with one or more neighboring States 
                to carry out the activities required of a State 
                maternal mortality review committee under this section. 
                In such a case, with respect to the States in such a 
                partnership, any requirement under this section 
                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.
                    (E) Treatment as public health authority for 
                purposes of hipaa.--For purposes of applying HIPAA 
                privacy and security law (as defined in section 
                3009(a)(2) of the Public Health Service Act (42 U.S.C. 
                300jj-19)), each State maternal mortality review 
                committee and regional maternal mortality review 
                committee established under subsection (a)(1) or 
                subsection (b)(2)(D), as the case may be, shall be 
                deemed to be a public health authority described in 
                section 164.501 (and referenced in section 
                164.512(b)(1)(i)) of title 45, Code of Federal 
                Regulations (or any successor regulation), carrying out 
                public health activities and purposes described in such 
                section 164.512(b)(1)(i) (or any such successor 
                regulation).
            (3) State department of health activities.--With respect to 
        a State that receives a grant under subsection (a)(1), the 
        State department of health shall--
                    (A) in consultation with the State maternal 
                mortality review committee and in conjunction with 
                relevant professional organizations and patient 
                advocacy organizations, develop a plan for ongoing 
                health care provider education, based on the findings 
                and recommendations of the committee, in order to 
                improve the quality of maternal care; and
                    (B) take steps to widely disseminate the findings 
                and recommendations of the State maternal mortality 
                review committee and implement the recommendations of 
                the committee.
    (c) Case Abstraction Form.--
            (1) Dissemination.--The Director of the Centers for Disease 
        Control and Prevention shall disseminate a uniform case 
        abstraction form to States and State maternal mortality review 
        committees for the purpose of--
                    (A) ensuring that the data and information 
                collected and reviewed by such committees can be pooled 
                for review by the Department of Health and Human 
                Services and its agencies; and
                    (B) preserving the uniformity of the information 
                collected for Federal public health purposes.
            (2) Permissible state modification.--Each State may modify 
        the form developed under paragraph (1) for implementation and 
        use by such State or by the State maternal mortality review 
        committee of such State by including on such form additional 
        information to be collected, but may not alter the standard 
        questions on such form, in order to ensure that the information 
        can be collected and reviewed centrally at the Federal level.
    (d) Public Disclosure of Information.--
            (1) In general.--For fiscal year 2018, or a subsequent 
        fiscal year, each State receiving a grant under this section 
        for such year shall, subject to paragraph (3), provide for the 
        public disclosure, and submission to the information 
        clearinghouse established under paragraph (2), of the 
        information included in the report of the State under 
        subsection (f)(1) for such year.
            (2) Information clearinghouse.--The Secretary shall 
        establish an information clearinghouse, to be administered by 
        the Director of the Centers for Disease Control and Prevention, 
        that will maintain findings and recommendations submitted 
        pursuant to paragraph (1) and provide such findings and 
        recommendations for public review and research purposes by 
        State departments of health, State maternal mortality review 
        committees, health providers and institutions, and national 
        patient and provider advocacy groups.
            (3) Confidentiality of information.--In no case may any 
        individually identifiable health information be provided to the 
        public, or submitted to the information clearinghouse, under 
        this subsection.
    (e) Confidentiality of Proceedings of State Maternal Mortality 
Review Committees.--
            (1) In general.--All proceedings and activities of a State 
        maternal mortality review committee established under 
        subsection (a)(1), opinions of members of such a committee 
        formed as a result of such proceedings and activities, and 
        records obtained, created, or maintained pursuant to this 
        section, including records of interviews, written reports, and 
        statements procured by the Department of Health and Human 
        Services or by any other person, agency, or organization acting 
        jointly with the Department, in connection with morbidity and 
        mortality reviews under this section, shall be confidential and 
        may not be subject to discovery, subpoena, or introduction into 
        evidence in any civil, criminal, legislative, or other 
        proceeding. Such records shall not be open to public 
        inspection.
            (2) Testimony of members of committee.--
                    (A) In general.--Members of a State maternal 
                mortality review committee established under subsection 
                (a)(1) may not be questioned in any civil, criminal, 
                legislative, or other proceeding regarding information 
                presented in, or opinions formed as a result of, a 
                meeting or communication of the committee.
                    (B) Clarification.--Nothing in this subsection may 
                be construed to prevent a member of a State maternal 
                mortality review committee established under subsection 
                (a)(1) from testifying regarding information that was 
                obtained independent of such member's participation on 
                the committee, or public information.
            (3) Availability of information for research purposes.--
        Nothing in this subsection may prohibit a State maternal 
        mortality review committee established under subsection (a)(1) 
        or the Department of Health and Human Services from publishing 
        statistical compilations and research reports that--
                    (A) are based on confidential information, relating 
                to morbidity and mortality reviews under this section; 
                and
                    (B) do not contain identifying information or any 
                other information that could be used to ultimately 
                identify the individuals concerned.
    (f) Reports.--
            (1) State reports.--Not later than one year after the end 
        of fiscal year 2018, and each subsequent fiscal year, each 
        State maternal mortality review committee established under 
        subsection (a)(1) and receiving a grant under this section for 
        such year, shall submit to the Director of the Centers for 
        Disease Control and Prevention a report on the findings and 
        recommendations of such committee and information on the 
        implementation of such recommendations during such year.
            (2) Annual reports to congress.--Not later than 60 days 
        after the deadline for State reports under paragraph (1) for 
        fiscal year 2018, and each subsequent fiscal year, the 
        Secretary of Health and Human Services shall submit to Congress 
        a report on--
                    (A) the findings, recommendations, and 
                implementation information submitted by any State 
                pursuant to paragraph (1); and
                    (B) the status of pregnancy-related and pregnancy-
                associated deaths in the United States, including 
                recommendations on methods to prevent such deaths in 
                the United States.
    (g) Definitions.--In this section:
            (1) The term ``pregnancy-associated death'' means the death 
        of a woman while pregnant or during the one-year period 
        following the date of the end of pregnancy, irrespective of the 
        cause of such death.
            (2) The term ``pregnancy-related death'' means the death of 
        a woman while pregnant or during the one-year period following 
        the date of the end of pregnancy, irrespective of the duration 
        of the pregnancy, from any cause related to, or aggravated by, 
        the pregnancy or its management, excluding any accidental or 
        incidental cause.
            (3) The term ``severe maternal morbidity'' means the 
        physical and psychological conditions that result from, or are 
        aggravated by, pregnancy and have an adverse effect on the 
        health of a woman.
            (4) The term ``State'' means each of the 50 States, the 
        District of Columbia, and each of the territories.
            (5) The term ``vital statistics unit'' means the entity 
        that is responsible for maintaining vital records for a State, 
        including official records of live births, deaths, fetal 
        deaths, marriages, divorces, and annulments.
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $7,000,000 for each of fiscal 
years 2018 through 2022.

SEC. 4. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.

    Part B of title III of the Public Health Service Act is amended by 
inserting after section 317T of such Act (42 U.S.C. 247b-22) the 
following new section:

``SEC. 317U. ELIMINATING DISPARITIES IN MATERNAL HEALTH OUTCOMES.

    ``(a) In General.--The Secretary shall, in consultation with 
relevant national stakeholder organizations, such as national medical 
specialty organizations, national maternal child health organizations, 
national patient advocacy organizations, and national health disparity 
organizations, carry out the following activities to eliminate 
disparities in maternal health outcomes:
            ``(1) Conduct research into the determinants and the 
        distribution of disparities in maternal care, health risks, and 
        health outcomes, and improve the capacity of the performance 
        measurement infrastructure to measure such disparities.
            ``(2) Expand access to health care services, resources, and 
        information that have been demonstrated to improve the quality 
        and outcomes of maternity care for vulnerable populations.
            ``(3) Establish a demonstration project to compare the 
        effectiveness of interventions to reduce disparities in 
        maternity services and outcomes and to implement and assess 
        effective interventions.
    ``(b) Scope and Selection of States for Demonstration Project.--The 
demonstration project under subsection (a)(3) shall be conducted in no 
more than 8 States, which shall be selected by the Secretary based on--
            ``(1) applications submitted by States, which specify which 
        regions and populations the State involved will serve under the 
        demonstration project;
            ``(2) criteria designed by the Secretary to ensure that, as 
        a whole, the demonstration project is, to the greatest extent 
        possible, representative of the demographic and geographic 
        composition of communities most affected by disparities;
            ``(3) criteria designed by the Secretary to ensure that a 
        variety of models are tested through the demonstration project 
        and that such models include interventions that have an 
        existing evidence base for effectiveness; and
            ``(4) criteria designed by the Secretary to ensure that the 
        demonstration projects and models will be carried out in 
        consultation with local and regional provider organizations, 
        such as community health centers, hospital systems, and medical 
        societies representing providers of maternity services.
    ``(c) Duration of Demonstration Project.--The demonstration project 
under subsection (a)(3) shall begin on January 1, 2018, and end on 
December 31, 2021.
    ``(d) Grants for Evaluation and Monitoring.--The Secretary may make 
grants to States and health care providers participating in the 
demonstration project under subsection (a)(3) for the purpose of 
collecting data necessary for the evaluation and monitoring of such 
project.
    ``(e) Reports.--
            ``(1) State reports.--Each State that participates in the 
        demonstration project under subsection (a)(3) shall report to 
        the Secretary, in a time, form, and manner specified by the 
        Secretary, the data necessary to--
                    ``(A) monitor the--
                            ``(i) outcomes of the project;
                            ``(ii) costs of the project; and
                            ``(iii) quality of maternity care provided 
                        under the project; and
                    ``(B) evaluate the rationale for the selection of 
                the items and services included in any bundled payment 
                made by the State under the project.
            ``(2) Final report.--Not later than December 31, 2022, the 
        Secretary shall submit to Congress a report on the results of 
        the demonstration project under subsection (a)(3).''.
                                 <all>
```