II 

115TH CONGRESS 

2D SESSION H. R. 1318 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 12, 2018 

Received 

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. 


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HR 1318 RDS

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 ‘‘Preventing Maternal 

5 Deaths Act of 2018’’. 

6 SEC. 2. SAFE MOTHERHOOD. 

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

8 U.S.C. 247b–12) is amended— 

9 (1) in subsection (a)— 

10 (A) in paragraph (1)— 

11 (i) by striking ‘‘purpose of this sub12 section is to develop’’ and inserting ‘‘pur13 poses of this subsection are to establish or 

14 continue a Federal initiative to support 

15 State and tribal maternal mortality review 

16 committees, to improve data collection and 

17 reporting around maternal mortality, and 

18 to develop or support’’; 

19 (ii) by striking ‘‘population at risk of 

20 death and’’ and inserting ‘‘populations at 

21 risk of death and severe’’; and 

22 (B) in paragraph (2)— 

23 (i) by amending subparagraph (A) to 

24 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 

5 pregnancy-associated deaths and pregnancy-re6 lated deaths that occur during, or within 1 year 

7 following, pregnancy.’’; and 

8 (ii) by inserting after subparagraph 

9 (C) the following: 

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

11 with States, Indian tribes, and tribal organiza12 tions, develop a program to support States, In13 dian tribes, and tribal organizations in estab14 lishing or operating maternal mortality review 

15 committees, in accordance with subsection 

16 (d).’’; 

17 (2) in subsection (b)(2)— 

18 (A) in subparagraph (A)— 

19 (i) by striking ‘‘encouraging pre20 conception’’ and inserting ‘‘prepregnancy’’; 

21 and 

22 (ii) by striking ‘‘diabetics’’ and insert23 ing ‘‘women with diabetes and women with 

24 substance use disorder’’ before the semi25 colon; 


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1 (B) in subparagraph (H)— 

2 (i) by inserting ‘‘the identification of 

3 the determinants of disparities in maternal 

4 care, health risks, and health outcomes, in5 cluding’’ before ‘‘an examination’’; and 

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

7 women with disproportionately high rates 

8 of maternal mortality’’ before the semi9 colon; 

10 (C) in subparagraph (I), by striking ‘‘do11 mestic’’ and inserting ‘‘interpersonal’’; 

12 (D) by redesignating subparagraphs (I) 

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

14 respectively; 

15 (E) by inserting after subparagraph (H) 

16 the following: 

17 ‘‘(I) activities to reduce disparities in ma18 ternity services and outcomes;’’; and 

19 (F) in subparagraph (K), as so redesig20 nated, by striking ‘‘, alcohol and illegal drug 

21 use’’ and inserting ‘‘and substance abuse and 

22 misuse’’; 

23 (3) in subsection (c)— 

24 (A) by striking ‘‘(1) IN GENERAL—The 

25 Secretary’’ and inserting ‘‘The Secretary’’; 


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1 (B) by redesignating subparagraphs (A) 

2 through (C) as paragraphs (1) through (3), re3 spectively, and adjusting the margins accord4 ingly; 

5 (C) in paragraph (1), as so redesignated, 

6 by striking ‘‘and the building of partnerships 

7 with outside organizations concerned about safe 

8 motherhood’’; 

9 (D) in paragraph (2), as so redesignated, 

10 by striking ‘‘; and’’ and inserting a semicolon; 

11 (E) in paragraph (3), as so redesignated, 

12 by striking the period and inserting ‘‘; and’’; 

13 and 

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

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

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

17 pregnancy, with an emphasis on prevention of, and 

18 treatment for, mental health disorders and sub19 stance use disorder.’’; 

20 (4) by redesignating subsection (d) as sub21 section (f); 

22 (5) by inserting after subsection (c) the fol23 lowing: 

24 ‘‘(d) MATERNAL MORTALITY REVIEW COMMIT25 TEES.— 


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

2 the program under subsection (a)(2)(D), the applica3 ble maternal mortality review committee of the 

4 State, Indian tribe, or tribal organization shall— 

5 ‘‘(A) include multidisciplinary and diverse 

6 membership that represents a variety of clinical 

7 specialties, State, tribal, or local public health 

8 officials, epidemiologists, statisticians, commu9 nity organizations, geographic regions within 

10 the area covered by such committee, and indi11 viduals or organizations that represent the pop12 ulations in the area covered by such committee 

13 that are most affected by pregnancy-related 

14 deaths or pregnancy-associated deaths and lack 

15 of access to maternal health care services; and 

16 ‘‘(B) demonstrate to the Centers for Dis17 ease Control and Prevention that such maternal 

18 mortality review committee’s methods and proc19 esses for data collection and review, as required 

20 under paragraph (3), use best practices to reli21 ably determine and include all pregnancy-asso22 ciated deaths and pregnancy-related deaths, re23 gardless of the outcome of the pregnancy. 

24 ‘‘(2) PROCESS FOR CONFIDENTIAL REPORT25 ING.—States, Indian tribes, and tribal organizations 


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1 that participate in the program described in this 

2 subsection shall, through the State maternal mor3 tality review committee, develop a process that— 

4 ‘‘(A) provides for confidential case report5 ing of pregnancy-associated and pregnancy-re6 lated deaths to the appropriate State or tribal 

7 health agency, including such reporting by— 

8 ‘‘(i) health care professionals; 

9 ‘‘(ii) health care facilities; 

10 ‘‘(iii) any individual responsible for 

11 completing death records, including med12 ical examiners and medical coroners; and 

13 ‘‘(iv) other appropriate individuals or 

14 entities; and 

15 ‘‘(B) provides for voluntary and confiden16 tial case reporting of pregnancy-associated 

17 deaths and pregnancy-related deaths to the ap18 propriate State or tribal health agency by fam19 ily members of the deceased, and other appro20 priate individuals, for purposes of review by the 

21 applicable maternal mortality review committee; 

22 and 

23 ‘‘(C) shall include— 


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1 ‘‘(i) making publicly available contact 

2 information of the committee for use in 

3 such reporting; and 

4 ‘‘(ii) conducting outreach to local pro5 fessional organizations, community organi6 zations, and social services agencies re7 garding the availability of the review com8 mittee. 

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

10 Indian tribes, and tribal organizations that partici11 pate in the program described in this subsection 

12 shall— 

13 ‘‘(A) annually identify pregnancy-associ14 ated deaths and pregnancy-related deaths— 

15 ‘‘(i) through the appropriate vital sta16 tistics unit by— 

17 ‘‘(I) matching each death record 

18 related to a pregnancy-associated 

19 death or pregnancy-related death in 

20 the State or tribal area in the applica21 ble year to a birth certificate of an in22 fant or fetal death record, as applica23 ble; 

24 ‘‘(II) to the extent practicable, 

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1 uting cause of each pregnancy-associ2 ated death and each pregnancy-related 

3 death in the State or tribal area in 

4 the applicable year; and 

5 ‘‘(III) collecting data from med6 ical examiner and coroner reports, as 

7 appropriate; 

8 ‘‘(ii) using other appropriate methods 

9 or information to identify pregnancy-asso10 ciated deaths and pregnancy-related 

11 deaths, including deaths from pregnancy 

12 outcomes not identified through clause 

13 (i)(I); 

14 ‘‘(B) through the maternal mortality re15 view committee, review data and information to 

16 identify adverse outcomes that may contribute 

17 to pregnancy-associated death and pregnancy18 related death, and to identify trends, patterns, 

19 and disparities in such adverse outcomes to 

20 allow the State, Indian tribe, or tribal organiza21 tion to make recommendations to individuals 

22 and entities described in paragraph (2)(A), as 

23 appropriate, to improve maternal care and re24 duce pregnancy-associated death and preg25 nancy-related death; 


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1 ‘‘(C) identify training available to the indi2 viduals and entities described in paragraph 

3 (2)(A) for accurate identification and reporting 

4 of pregnancy-associated and pregnancy-related 

5 deaths; 

6 ‘‘(D) ensure that, to the extent practicable, 

7 the data collected and reported under this para8 graph is in a format that allows for analysis by 

9 the Centers for Disease Control and Prevention; 

10 and 

11 ‘‘(E) publicly identify the methods used to 

12 identify pregnancy-associated deaths and preg13 nancy-related deaths in accordance with this 

14 section. 

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

16 and tribal organizations participating in the program 

17 described in this subsection shall establish confiden18 tiality protections to ensure, at a minimum, that— 

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

20 mortality review committee, including any indi21 vidual members of the committee, to any per22 son, including any government official, of any 

23 identifying information about any specific ma24 ternal mortality case; and 


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1 ‘‘(B) no information from committee pro2 ceedings, including deliberation or records, is 

3 made public unless specifically authorized under 

4 State and Federal law. 

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

6 and each subsequent fiscal year, each maternal mor7 tality review committee participating in the program 

8 described in this subsection shall submit to the Di9 rector of the Centers for Disease Control and Pre10 vention a report that includes— 

11 ‘‘(A) data, findings, and any recommenda12 tions of such committee; and 

13 ‘‘(B) as applicable, information on the im14 plementation during such year of any rec15 ommendations submitted by the committee in a 

16 previous year. 

17 ‘‘(6) STATE PARTNERSHIPS.—States may part18 ner with one or more neighboring States to carry out 

19 the activities under this subparagraph. With respect 

20 to the States in such a partnership, any requirement 

21 under this subparagraph relating to the reporting of 

22 information related to such activities shall be 

23 deemed to be fulfilled by each such State if a single 

24 such report is submitted for the partnership. 


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1 ‘‘(7) APPROPRIATE MECHANISMS FOR INDIAN

2 TRIBES AND TRIBAL ORGANIZATIONS.—The Sec3 retary, in consultation with Indian tribes, shall iden4 tify and establish appropriate mechanisms for Indian 

5 tribes and tribal organizations to demonstrate, re6 port data, and conduct the activities as required for 

7 participation in the program described in this sub8 section. Such mechanisms may include technical as9 sistance with respect to grant application and sub10 mission procedures, and award management activi11 ties. 

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

13 shall develop a process to ensure that data collected 

14 under paragraph (5) is made available, as appro15 priate and practicable, for research purposes, in a 

16 manner that protects individually identifiable or po17 tentially identifiable information and that is con18 sistent with State and Federal privacy law. 

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

20 ‘‘(1) the terms ‘Indian tribe’ and ‘tribal organi21 zation’ have the meanings given such terms in sec22 tion 4 of the Indian Self-Determination and Edu23 cation Assistance Act; 

24 ‘‘(2) the term ‘pregnancy-associated death’ 

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1 curs during, or within 1 year following, her preg2 nancy, regardless of the outcome, duration, or site of 

3 the pregnancy; and 

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

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

6 year following, her pregnancy, regardless of the out7 come, duration, or site of the pregnancy— 

8 ‘‘(A) from any cause related to, or aggra9 vated by, the pregnancy or its management; 

10 and 

11 ‘‘(B) not from accidental or incidental 

12 causes.’’; and 

13 (6) in subsection (f), as so redesignated, by 

14 striking ‘‘such sums as may be necessary for each of 

15 the fiscal years 2001 through 2005’’ and inserting 

16 ‘‘$58,000,000 for each of fiscal years 2019 through 

17 2023’’. 

Passed the House of Representatives December 11, 

2018. 

Attest: KAREN L. HAAS, 

Clerk. 


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