I 

113TH CONGRESS 

2D SESSION H. R. 4216 

To amend title V of the Social Security Act to provide grants to States 

to establish State maternal mortality review committees on pregnancyrelated deaths occurring within such States; to develop definitions of 

severe maternal morbidity and data collection protocols; and to eliminate 

disparities in maternal health outcomes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 12, 2014 

Mr. CONYERS (for himself and Ms. DEGETTE) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title V of the Social Security Act to provide 

grants to States to establish State maternal mortality 

review committees on pregnancy-related deaths occurring 

within such States; to develop definitions of severe maternal morbidity and data collection protocols; and to eliminate disparities in maternal health outcomes. 

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 2014’’. 


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1 SEC. 2. FINDINGS; PURPOSES. 

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

3 (1) The aggregate pregnancy-related mortality 

4 ratio in the United States as measured by the Cen5 ters for Disease Control and Prevention Pregnancy 

6 Mortality Surveillance System was 14.5 for the 8- 

7 year period 1998 through 2005, higher than any 

8 other period in the previous 20 years. Although this 

9 increase may reflect changes in data collection meth10 ods by the States, this reported increase, along with 

11 no improvement in previous years remains a source 

12 of great concern for the Centers for Disease Control 

13 and Prevention, and registered nurses, health care 

14 providers, and patient advocates such as the Joint 

15 Commission, the American College of Obstetricians 

16 and Gynecologists, and Amnesty International. 

17 (2) The Centers for Disease Control and Pre18 vention has found that maternal deaths should be 

19 investigated through State-based maternal death re20 views and maternal quality collaboratives, as these 

21 entities are well-situated to identify deaths, review 

22 the factors associated with them, and take action 

23 with the findings in order to institute the systemic 

24 changes needed to decrease pregnancy-related and 

25 pregnancy-associated mortality. 


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1 (3) Women of color and low-income women face 

2 added risks in terms of death, complications, and ac3 cess to quality health care. African-American women 

4 are three to four times more likely to die of preg5 nancy-related complications than White women. In 

6 2006 the Centers for Disease Control and Preven7 tion reported that the maternal mortality ratio for 

8 non-Hispanic White women was 9.1 deaths per 

9 100,000 births compared with 34.8 deaths per 

10 100,000 births for non-Hispanic Black women. 

11 These rates and disparities have not improved in 

12 more than 20 years. 

13 (4) Healthy People 2010, a comprehensive, na14 tionwide health promotion and disease prevention 

15 agenda launched by the Department of Health and 

16 Human Services, set a target goal of reducing ma17 ternal mortality in the United States to 4.3 deaths 

18 per 100,000 live births by 2010. In 2007, the na19 tional maternal mortality ratio was 12.7 deaths per 

20 100,000 live births. 

21 (5) Severe complications that result in women 

22 nearly dying, known as a ‘‘near miss’’ or severe ma23 ternal morbidity has increased by 75 percent for de24 livery (based on data comparing 1998 through 1999) 

25 and 114 percent for postpartum hospitalizations 


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1 (based on data comparing 2008 through 2009). 

2 Such data also estimates that severe morbidity af3 fects 52,000 women a year and is expected to con4 tinue to increase. Moreover, there is no scientific 

5 consensus on uniform definitions of severe maternal 

6 morbidity and best practices for data collection, 

7 making it difficult to measure the full extent of se8 vere morbidity and developing evidence-based inter9 ventions. 

10 (b) PURPOSES.—The purposes of this Act are the fol11 lowing: 

12 (1) To establish governmental accountability 

13 and a shared responsibility between States and the 

14 Federal Government to identify opportunities for im15 provement in quality of care and system changes, 

16 and to educate and inform health institutions and 

17 professionals, women, and families about preventing 

18 pregnancy-related deaths and complications and re19 ducing disparities. 

20 (2) To develop a model for States to operate 

21 maternal mortality reviews and assess the various 

22 factors that may have contributed to maternal mor23 tality, including quality of care, racial disparities, 

24 and systemic problems in the delivery of health care, 


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1 and to develop appropriate interventions to reduce 

2 and prevent such deaths. 

3 SEC. 3. UNIFORM STATE MATERNAL MORTALITY REVIEW 

4 COMMITTEES ON PREGNANCY-RELATED 

5 DEATHS. 

6 (a) CONDITION OF RECEIPT OF PAYMENTS FROM

7 ALLOTMENT UNDER MATERNAL AND CHILD HEALTH

8 SERVICE BLOCK GRANT.—Title V of the Social Security 

9 Act (42 U.S.C. 701 et seq.) is amended by adding at the 

10 end the following new section: 

11 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE12 VIEW COMMITTEES ON PREGNANCY-RE13 LATED DEATHS. 

14 ‘‘(a) GRANTS.— 

15 ‘‘(1) IN GENERAL.—Notwithstanding any other 

16 provision of this title, for each of fiscal years 2015 

17 through 2021, in addition to payments from allot18 ments for States under section 502 for such year, 

19 the Secretary shall, subject to paragraph (3) and in 

20 accordance with the criteria established under para21 graph (2), award grants to States to— 

22 ‘‘(A) carry out the activities described in 

23 subsection (b)(1); 

24 ‘‘(B) establish a State maternal mortality 

25 review committee, in accordance with subsection 


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1 (b)(2), to carry out the activities described in 

2 subsection (b)(2)(A), and to establish the proc3 esses described in subsection (b)(1); 

4 ‘‘(C) ensure the State department of 

5 health carries out the applicable activities de6 scribed in subsection (b)(3), with respect to 

7 pregnancy-related deaths occurring within the 

8 State during such fiscal year; 

9 ‘‘(D) implement and use the comprehensive 

10 case abstraction form developed under sub11 section (c), in accordance with such subsection; 

12 ‘‘(E) provide for public disclosure of infor13 mation, in accordance with subsection (e); and 

14 ‘‘(F) collect, analyze, and report to the 

15 Secretary cases of maternal morbidity, includ16 ing reports of maternal morbidity data on ad17 missions to an intensive care unit or the trans18 fusion of more than three units of blood prod19 ucts. 

20 ‘‘(2) CRITERIA.—The Secretary shall establish 

21 criteria for determining eligibility for and the 

22 amount of a grant awarded to a State under para23 graph (1). Such criteria shall provide that in the 

24 case of a State that receives such a grant for a fiscal 

25 year and is determined by the Secretary to have not 


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1 used such grant in accordance with this section, 

2 such State shall not be eligible for such a grant for 

3 any subsequent fiscal year. 

4 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

5 For purposes of carrying out the grant program 

6 under this section, including for administrative pur7 poses, there is authorized to be appropriated 

8 $10,000,000 for each of fiscal years 2015 through 

9 2021. 

10 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 

11 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH

12 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 

13 purposes of subsection (a), with respect to a State 

14 that receives a grant under subsection (a), the fol15 lowing shall apply: 

16 ‘‘(A) MANDATORY REPORTING OF PREG17 NANCY-RELATED DEATHS.— 

18 ‘‘(i) IN GENERAL.—The State shall, 

19 through the State maternal mortality re20 view committee, develop a process, sepa21 rate from any reporting process established 

22 by the State department of health prior to 

23 the date of the enactment of this section, 

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1 ties described in clause (ii) of pregnancy2 related deaths to the State department of 

3 health. 

4 ‘‘(ii) INDIVIDUALS AND ENTITIES DE5 SCRIBED.—Individuals and entities de6 scribed in this clause include each of the 

7 following: 

8 ‘‘(I) Health care providers. 

9 ‘‘(II) Medical examiners. 

10 ‘‘(III) Medical coroners. 

11 ‘‘(IV) Hospitals. 

12 ‘‘(V) Free-standing birth centers. 

13 ‘‘(VI) Other health care facilities. 

14 ‘‘(VII) Any other individuals re15 sponsible for completing death certifi16 cates. 

17 ‘‘(VIII) Any other appropriate in18 dividuals or entities specified by the 

19 Secretary. 

20 ‘‘(B) VOLUNTARY REPORTING OF PREG21 NANCY-RELATED AND PREGNANCY-ASSOCIATED

22 DEATHS.— 

23 ‘‘(i) The State shall, through the 

24 State maternal mortality review committee, 

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1 rate from any reporting process established 

2 by the State department of health prior to 

3 the date of the enactment of this section, 

4 voluntary and confidential case reporting 

5 by individuals described in clause (ii) of 

6 pregnancy-associated deaths to the State 

7 department of health. 

8 ‘‘(ii) The State shall, through the 

9 State maternal mortality review committee, 

10 develop a process for voluntary and con11 fidential reporting by family members of 

12 the deceased and by other individuals on 

13 possible pregnancy-related and pregnancy14 associated deaths to the State department 

15 of health. Such process shall include— 

16 ‘‘(I) making publicly available on 

17 the Internet Web site of the State de18 partment of health a telephone num19 ber, Internet Web link, and email ad20 dress for such reporting; and 

21 ‘‘(II) publicizing to local profes22 sional organizations, community orga23 nizations, and social services agencies 

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1 dress made available under subclause 

2 (I). 

3 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 

4 The State, through the vital statistics unit of 

5 the State, shall annually identify pregnancy-re6 lated and pregnancy-associated deaths occur7 ring in such State during the year involved 

8 by— 

9 ‘‘(i) matching all death records, with 

10 respect to such year, for women of child11 bearing age to live birth certificates and in12 fant death certificates to identify deaths of 

13 women that occurred during pregnancy 

14 and within one year after the end of a 

15 pregnancy; 

16 ‘‘(ii) identifying deaths reported dur17 ing such year as having an underlying or 

18 contributing cause of death related to 

19 pregnancy, regardless of the time that has 

20 passed between the end of the pregnancy 

21 and the death; 

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

24 ‘‘(iv) any other methods the States 

25 may devise to identify maternal deaths, 


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1 such as through review of a random sam2 ple of reported deaths of women of child3 bearing age to ascertain cases of preg4 nancy-related and pregnancy-associated 

5 deaths that are not discernable from a re6 view of death certificates alone. 

7 When feasible and for purposes of effectively 

8 collecting and obtaining data on pregnancy-re9 lated and pregnancy-associated deaths, the 

10 State shall adopt the most recent standardized 

11 birth and death certificates, as issued by the 

12 National Center for Vital Health Statistics, in13 cluding the recommended checkbox section for 

14 pregnancy on the death certificates. 

15 ‘‘(D) CASE INVESTIGATION AND DEVELOP16 MENT OF CASE SUMMARIES.—Following receipt 

17 of reports by the State department of health 

18 pursuant to subparagraph (A) or (B) and col19 lection by the vital statistics unit of the State 

20 of possible cases of pregnancy-related and preg21 nancy-associated deaths pursuant to subpara22 graph (C), the State, through the State mater23 nal mortality review committee established 

24 under subsection (a), shall investigate each 

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1 scribed in subsection (c), and prepare de-identi2 fied case summaries, which shall be reviewed by 

3 the committee and included in applicable re4 ports. For purposes of subsection (a), under the 

5 processes established under subparagraphs (A), 

6 (B), and (C), a State department of health or 

7 vital statistics unit of a State shall provide to 

8 the State maternal mortality review committee 

9 access to information collected pursuant to such 

10 subparagraphs as necessary to carry out this 

11 subparagraph. Data and information collected 

12 for the case summary and review are for pur13 poses of public health activities, in accordance 

14 with HIPAA privacy and security law (as de15 fined in section 3009(a)(2) of the Public Health 

16 Service Act). Such case investigations shall in17 clude data and information obtained through— 

18 ‘‘(i) medical examiner and autopsy re19 ports of the woman involved; 

20 ‘‘(ii) medical records of the woman, 

21 including such records related to health 

22 care prior to pregnancy, prenatal and post23 natal care, labor and delivery care, emer24 gency room care, hospital discharge 

25 records, and any care delivered up until 


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1 the time of death of the woman for pur2 poses of public health activities, in accord3 ance with HIPAA privacy and security law 

4 (as defined in section 3009(a)(2) of the 

5 Public Health Service Act); 

6 ‘‘(iii) oral and written interviews of in7 dividuals directly involved in the maternal 

8 care of the woman during and immediately 

9 following the pregnancy of the woman, in10 cluding health care, mental health, and so11 cial service providers, as applicable; 

12 ‘‘(iv) optional oral or written inter13 views of the family of the woman; 

14 ‘‘(v) socioeconomic and other relevant 

15 background information about the woman; 

16 ‘‘(vi) information collected in subpara17 graph (C)(i); and 

18 ‘‘(vii) other information on the cause 

19 of death of the woman, such as social serv20 ices and child welfare reports. 

21 ‘‘(2) STATE MATERNAL MORTALITY REVIEW

22 COMMITTEES.— 

23 ‘‘(A) DUTIES.— 

24 ‘‘(i) REQUIRED COMMITTEE ACTIVI25 TIES.—For purposes of subsection (a), a 


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1 maternal mortality review committee estab2 lished by a State pursuant to a grant 

3 under such subsection shall carry out the 

4 following pregnancy-related death and 

5 pregnancy-associated death review activi6 ties and shall include all information rel7 evant to the death involved on the case ab8 straction form developed under subsection 

9 (d): 

10 ‘‘(I) With respect to a case of 

11 pregnancy-related or pregnancy-asso12 ciated death of a woman, review the 

13 case summaries prepared under sub14 paragraphs (A), (B), (C), and (D) of 

15 paragraph (1). 

16 ‘‘(II) Review aggregate statistical 

17 reports developed by the vital statis18 tics unit of the State under paragraph 

19 (1)(C) regarding pregnancy-related 

20 and pregnancy-associated deaths to 

21 identify trends, patterns, and dispari22 ties in adverse outcomes and address 

23 medical, non-medical, and system-re24 lated factors that may have contrib25 uted to such pregnancy-related and 


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1 pregnancy-associated deaths and dis2 parities. 

3 ‘‘(III) Develop recommendations, 

4 based on the review of the case sum5 maries under paragraph (1)(D) and 

6 aggregate statistical reports under 

7 subclause (II), to improve maternal 

8 care, social and health services, and 

9 public health policy and institutions, 

10 including with respect to improving 

11 access to maternal care, improving the 

12 availability of social services, and 

13 eliminating disparities in maternal 

14 care and outcomes. 

15 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI16 TIES.—For purposes of subsection (a), a 

17 maternal mortality review committee estab18 lished by a State under such subsection 

19 may present findings and recommendations 

20 regarding a specific case or set of cir21 cumstances directly to a health care facil22 ity or its local or State professional organi23 zation for the purpose of instituting policy 

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1 wise improving the quality of care provided 

2 by the facilities. 

3 ‘‘(B) COMPOSITION OF MATERNAL MOR4 TALITY REVIEW COMMITTEES.— 

5 ‘‘(i) IN GENERAL.—Each State mater6 nal mortality review committee established 

7 pursuant to a grant under subsection (a) 

8 shall be multi-disciplinary, consisting of 

9 health care and social service providers, 

10 public health officials, other persons with 

11 professional expertise on maternal health 

12 and mortality, and patient and community 

13 advocates who represent those communities 

14 within such State that are the most af15 fected by maternal mortality. Membership 

16 on such a committee of a State shall be re17 viewed annually by the State department 

18 of health to ensure that membership rep19 resentation requirements are being fulfilled 

20 in accordance with this paragraph. 

21 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 

22 such review committee shall include— 

23 ‘‘(I) representatives from medical 

24 specialities providing care to pregnant 

25 and postpartum patients, including 


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1 obstetricians (including generalists 

2 and maternal fetal medicine special3 ists), and family practice physicians; 

4 ‘‘(II) certified nurse midwives, 

5 certified midwives, and advanced prac6 tice nurses; 

7 ‘‘(III) hospital-based registered 

8 nurses; 

9 ‘‘(IV) representatives of the State 

10 department of health maternal and 

11 child health department; 

12 ‘‘(V) social service providers or 

13 social workers; 

14 ‘‘(VI) the chief medical exam15 iners or designees; 

16 ‘‘(VII) facility representatives, 

17 such as from hospitals or free-stand18 ing birth centers; and 

19 ‘‘(VIII) community or patient ad20 vocates who represent those commu21 nities within the State that are the 

22 most affected by maternal mortality. 

23 ‘‘(iii) ADDITIONAL MEMBERS.—Each 

24 such review committee may also include 

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1 demic, health, social service, or policy pro2 fessions, or community organizations, on 

3 an ongoing basis, or as needed, as deter4 mined beneficial by the review committee, 

5 including— 

6 ‘‘(I) anesthesiologists; 

7 ‘‘(II) emergency physicians; 

8 ‘‘(III) pathologists; 

9 ‘‘(IV) epidemiologists or biostat10 isticians; 

11 ‘‘(V) intensivists; 

12 ‘‘(VI) vital statistics officers; 

13 ‘‘(VII) nutritionists; 

14 ‘‘(VIII) mental health profes15 sionals; 

16 ‘‘(IX) substance abuse treatment 

17 specialists; 

18 ‘‘(X) representatives of relevant 

19 advocacy groups; 

20 ‘‘(XI) academics; 

21 ‘‘(XII) representatives of bene22 ficiaries of the State plan under the 

23 Medicaid program under title XIX; 

24 ‘‘(XIII) paramedics; 

25 ‘‘(XIV) lawyers; 


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1 ‘‘(XV) risk management special2 ists; 

3 ‘‘(XVI) representatives of the de4 partments of health or public health 

5 of major cities in the State involved; 

6 and 

7 ‘‘(XVII) policy makers. 

8 ‘‘(iv) DIVERSE COMMUNITY MEMBER9 SHIP.—The composition of such a com10 mittee, with respect to a State, shall in11 clude— 

12 ‘‘(I) representatives from diverse 

13 communities, particularly those com14 munities within such State most se15 verely affected by pregnancy-related 

16 deaths or pregnancy-associated deaths 

17 and by a lack of access to relevant 

18 maternal care services, from commu19 nity maternal child health organiza20 tions, and from minority advocacy 

21 groups; 

22 ‘‘(II) members, including health 

23 care providers, from different geo24 graphic regions in the State, including 


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1 any rural, urban, and tribal areas; 

2 and 

3 ‘‘(III) health care and social serv4 ice providers who work in commu5 nities that are diverse with regard to 

6 race, ethnicity, immigration status, 

7 Indigenous status, and English pro8 ficiency. 

9 ‘‘(v) MATERNAL MORTALITY REVIEW

10 STAFF.—Staff of each such review com11 mittee shall include— 

12 ‘‘(I) vital health statisticians, ma13 ternal child health statisticians, or 

14 epidemiologists; 

15 ‘‘(II) a coordinator of the State 

16 maternal mortality review committee, 

17 to be designated by the State; and 

18 ‘‘(III) administrative staff. 

19 ‘‘(C) OPTION FOR STATES TO FORM RE20 GIONAL MATERNAL MORTALITY REVIEWS.— 

21 States with a low rate of occurrence of preg22 nancy-associated or pregnancy-related deaths 

23 may choose to partner with one or more neigh24 boring States to fulfill the activities described in 

25 paragraph (1)(C). In such a case, with respect 


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1 to States in such a partnership, any require2 ment under this section relating to the report3 ing of information related to such activities 

4 shall be deemed to be fulfilled by each such 

5 State if a single such report is submitted for 

6 the partnership. 

7 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI8 TIES.—For purposes of subsection (a), a State de9 partment of health of a State receiving a grant 

10 under such subsection shall— 

11 ‘‘(A) in consultation with the maternal 

12 mortality review committee of the State and in 

13 conjunction with relevant professional organiza14 tions, develop a plan for ongoing health care 

15 provider education, based on the findings and 

16 recommendations of the committee, in order to 

17 improve the quality of maternal care; and 

18 ‘‘(B) take steps to widely disseminate the 

19 findings and recommendations of the State ma20 ternal mortality review committees of the State 

21 and to implement the recommendations of such 

22 committee. 

23 ‘‘(c) CASE ABSTRACTION FORM.— 

24 ‘‘(1) DEVELOPMENT.—The Director of the Cen25 ters for Disease Control and Prevention shall deVerDate Mar 15 2010 03:49 Mar 15, 2014 Jkt 039200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H4216.IH H4216

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1 velop a uniform, comprehensive case abstraction 

2 form and make such form available to States for 

3 State maternal mortality review committees for use 

4 by such committees in order to— 

5 ‘‘(A) ensure that the cases and information 

6 collected and reviewed by such committees can 

7 be pooled for review by the Department of 

8 Health and Human Services and its agencies; 

9 and 

10 ‘‘(B) preserve the uniformity of the infor11 mation and its use for Federal public health 

12 purposes. 

13 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 

14 Each State may modify the form developed under 

15 paragraph (1) for implementation and use by such 

16 State or by the State maternal mortality review com17 mittee of such State by including on such form addi18 tional information to be collected, but may not alter 

19 the standard questions on such form, in order to en20 sure that the information can be collected and re21 viewed centrally at the Federal level. 

22 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY

23 FOR PURPOSES OF HIPAA.—For purposes of applying 

24 HIPAA privacy and security law (as defined in section 

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1 ternal mortality review committee of a State established 

2 pursuant to this section to carry out activities described 

3 in subsection (b)(2)(A) shall be deemed to be a public 

4 health authority described in section 164.501 (and ref5 erenced in section 164.512(b)(1)(i)) of title 45, Code of 

6 Federal Regulations (or any successor regulation), car7 rying out public health activities and purposes described 

8 in such section 164.512(b)(1)(i) (or any such successor 

9 regulation). 

10 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 

11 ‘‘(1) IN GENERAL.—For fiscal year 2015 or a 

12 subsequent fiscal year, each State receiving a grant 

13 under this section for such year shall, subject to 

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

15 submission to the information clearinghouse estab16 lished under paragraph (2), of the information in17 cluded in the report of the State under section 

18 506(a)(2)(F) for such year (relating to the findings 

19 for such year of the State maternal mortality review 

20 committee established by the State under this sec21 tion). 

22 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 

23 Secretary of Health and Human Services shall es24 tablish an information clearinghouse, that shall be 

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1 ease Control and Prevention, that will maintain find2 ings and recommendations submitted pursuant to 

3 paragraph (1) and provide such findings and rec4 ommendations for public review and research pur5 poses by State health departments, maternal mor6 tality review committees, and health providers and 

7 institutions. 

8 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 

9 no case shall any individually identifiable health in10 formation be provided to the public, or submitted to 

11 the information clearinghouse, under paragraph (1). 

12 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE

13 PROCEEDINGS.— 

14 ‘‘(1) IN GENERAL.—All proceedings and activi15 ties of a State maternal mortality review committee 

16 under this section, opinions of members of such a 

17 committee formed as a result of such proceedings 

18 and activities, and records obtained, created, or 

19 maintained pursuant to this section, including 

20 records of interviews, written reports, and state21 ments procured by the Department of Health and 

22 Human Services or by any other person, agency, or 

23 organization acting jointly with the Department, in 

24 connection with morbidity and mortality reviews 

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1 ject to discovery, subpoena, or introduction into evi2 dence in any civil, criminal, legislative, or other pro3 ceeding. Such records shall not be open to public in4 spection. 

5 ‘‘(2) TESTIMONY OF MEMBERS OF COM6 MITTEE.— 

7 ‘‘(A) IN GENERAL.—Members of a State 

8 maternal mortality review committee under this 

9 section may not be questioned in any civil, 

10 criminal, legislative, or other proceeding regard11 ing information presented in, or opinions 

12 formed as a result of, a meeting or communica13 tion of the committee. 

14 ‘‘(B) CLARIFICATION.—Nothing in this 

15 subsection shall be construed to prevent a mem16 ber of such a committee from testifying regard17 ing information that was obtained independent 

18 of such member’s participation on the com19 mittee, or that is public information. 

20 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE21 SEARCH PURPOSES.—Nothing in this subsection 

22 shall prohibit the publishing by such a committee or 

23 the Department of Health and Human Services of 

24 statistical compilations and research reports that— 


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1 ‘‘(A) are based on confidential information, 

2 relating to morbidity and mortality review; and 

3 ‘‘(B) do not contain identifying informa4 tion or any other information that could be 

5 used to ultimately identify the individuals con6 cerned. 

7 ‘‘(g) DEFINITIONS.—For purposes of this section: 

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

9 means the death of a woman while pregnant or dur10 ing the one-year period following the date of the end 

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

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

13 the death of a woman while pregnant or during the 

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

15 pregnancy, irrespective of the duration or site of the 

16 pregnancy, from any cause related to or aggravated 

17 by the pregnancy or its management, but not from 

18 any accidental or incidental cause. 

19 ‘‘(3) The term ‘woman of childbearing age’ 

20 means a woman who is at least 10 years of age and 

21 not more than 54 years of age.’’. 

22 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT23 TEES IN REQUIRED REPORTS.— 

24 (1) STATE TRIENNIAL REPORTS.—Paragraph 

25 (2) of section 506(a) of such Act (42 U.S.C. 706(a)) 


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1 is amended by inserting after subparagraph (E) the 

2 following new subparagraph: 

3 ‘‘(F) In the case of a State receiving a 

4 grant under section 514, beginning for the first 

5 fiscal year beginning after 3 years after the 

6 date of establishment of the State maternal 

7 mortality review committee established by the 

8 State pursuant to such grant and once every 3 

9 years thereafter, information containing the 

10 findings and recommendations of such com11 mittee and information on the implementation 

12 of such recommendations during the period in13 volved.’’. 

14 (2) ANNUAL REPORTS TO CONGRESS.—Para15 graph (3) of such section is amended— 

16 (A) in subparagraph (D), at the end, by 

17 striking ‘‘and’’; 

18 (B) in subparagraph (E), at the end, by 

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

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(F) For fiscal year 2015 and each subse23 quent fiscal year, taking into account the find24 ings, recommendations, and implementation in25 formation submitted by States pursuant to 


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1 paragraph (2)(F), on the status of pregnancy2 related deaths and pregnancy-associated deaths 

3 in the United States and including rec4 ommendations on methods to prevent such 

5 deaths in the United States.’’. 

6 SEC. 4. NIH WORKSHOP AND RESEARCH PLAN DEVELOP7 MENT ON SEVERE MATERNAL MORBIDITY. 

8 (a) WORKSHOP.—The Secretary of Health and 

9 Human Services, acting through the Director of NIH and 

10 in consultation with the Administrator of the Health Re11 sources and Services Administration, the Director of the 

12 Centers for Disease Control and Prevention, the heads of 

13 other Federal agencies that administer Federal health pro14 grams, and relevant national professional organizations 

15 dealing with maternal morbidity, shall organize a national 

16 workshop to identify definitions for severe maternal mor17 bidity and make recommendations for a research plan to 

18 identify and monitor severe maternal morbidity in the 

19 United States. 

20 (b) RESEARCH PLAN AND DATA COLLECTION PRO21 TOCOLS.—The Secretary, taking into account the findings 

22 of the workshop under paragraph (1), shall develop uni23 form definitions of severe maternal morbidity, a research 

24 plan on severe maternal morbidity, and possible data col25 lection protocols to assist States in identifying and moniVerDate Mar 15 2010 03:49 Mar 15, 2014 Jkt 039200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H4216.IH H4216

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1 toring cases of severe maternal morbidity and to develop 

2 recommendations on addressing such cases. 

3 (c) REPORT.—Not later than 2 years after the date 

4 of enactment of this Act, the Secretary shall prepare and 

5 submit to the appropriate committees of Congress a report 

6 concerning the definitions and research plan developed 

7 under this section. 

8 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated for fiscal year 2015— 

10 (1) $50,000 to carry out subsection (a); and 

11 (2) $100,000 to carry out subsection (b). 

12 SEC. 5. ELIMINATING DISPARITIES IN MATERNITY HEALTH 

13 OUTCOMES. 

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

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

16 (42 U.S.C. 247b–22) the following new section: 

17 ‘‘SEC. 317U. ELIMINATING DISPARITIES IN MATERNITY 

18 HEALTH OUTCOMES. 

19 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta20 tion with relevant national stakeholder organizations, such 

21 as national medical specialty organizations, national ma22 ternal child health organizations, and national health dis23 parity organizations, carry out the following activities to 

24 eliminate disparities in maternal health outcomes: 


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1 ‘‘(1) Conduct research into the determinants 

2 and the distribution of disparities in maternal care, 

3 health risks, and health outcomes, and improve the 

4 capacity of the performance measurement infrastruc5 ture to measure such disparities. 

6 ‘‘(2) Expand access to services that have been 

7 demonstrated to improve the quality and outcomes 

8 of maternity care for vulnerable populations. 

9 ‘‘(3) Establish a demonstration project to com10 pare the effectiveness of interventions to reduce dis11 parities in maternity services and outcomes, and im12 plement and assessing effective interventions. 

13 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM14 ONSTRATION PROJECT.—The demonstration project 

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

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

17 based on— 

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

19 specify which regions and populations the State in20 volved will serve under the demonstration project; 

21 ‘‘(2) criteria designed by the Secretary to en22 sure that, as a whole, the demonstration project is, 

23 to the greatest extent possible, representative of the 

24 demographic and geographic composition of commu25 nities most affected by disparities; 


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1 ‘‘(3) criteria designed by the Secretary to en2 sure that a variety of type of models are tested 

3 through the demonstration project and that such 

4 models include interventions that have an existing 

5 evidence base for effectiveness; and 

6 ‘‘(4) criteria designed by the Secretary to as7 sure that the demonstration projects and models will 

8 be carried out in consultation with local and regional 

9 provider organizations, such as community health 

10 centers, hospital systems, and medical societies rep11 resenting providers of maternity services. 

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

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

14 begin on January 1, 2015, and end on December 31, 

15 2019. 

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

17 The Secretary may make grants to States and health care 

18 providers participating in the demonstration project under 

19 subsection (a)(3) for the purpose of collecting data nec20 essary for the evaluation and monitoring of such project. 

21 ‘‘(e) REPORTS.— 

22 ‘‘(1) STATE REPORTS.—Each State that par23 ticipates in the demonstration project under sub24 section (a)(3) shall report to the Secretary, in a 


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

2 the data necessary to— 

3 ‘‘(A) monitor the— 

4 ‘‘(i) outcomes of the project; 

5 ‘‘(ii) costs of the project; and 

6 ‘‘(iii) quality of maternity care pro7 vided under the project; and 

8 ‘‘(B) evaluate the rationale for the selec9 tion of the items and services included in any 

10 bundled payment made by the State under the 

11 project. 

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

13 31, 2020, the Secretary shall submit to Congress a 

14 report on the results of the demonstration project 

15 under subsection (a)(3).’’. 

Æ 


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