rate from any reporting process established 
by the State department of health prior to 
the date of the enactment of this section, 
voluntary and confidential case reporting 
by individuals described in clause (ii) of 
pregnancy-associated deaths to the State 
department of health. 
‘‘(ii) The State shall, through the 
State maternal mortality review committee, 
develop a process for voluntary and con-
fidential reporting by family members of 
the deceased and by other individuals on 
possible pregnancy-related and pregnancy- 
associated deaths to the State department 
of health. Such process shall include— 
‘‘(I) making publicly available on 
the Internet Web site of the State de-
partment of health a telephone num-
ber, Internet Web link, and email ad-
dress for such reporting; and 
‘‘(II) publicizing to local profes-
sional organizations, community orga-
nizations, and social services agencies 
the availability of the telephone num-
ber, Internet Web link, and email ad-
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dress made available under subclause 
(I). 
‘‘(C) DEVELOPMENT OF CASE-FINDING.— 
The State, through the vital statistics unit of 
the State, shall annually identify pregnancy-re-
lated and pregnancy-associated deaths occur-
ring in such State during the year involved 
by— 
‘‘(i) matching all death records, with 
respect to such year, for women of child-
bearing age to live birth certificates and in-
fant death certificates to identify deaths of 
women that occurred during pregnancy 
and within one year after the end of a 
pregnancy; 
‘‘(ii) identifying deaths reported dur-
ing 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 ex-
aminer and coroner reports; and 
‘‘(iv) any other methods the States 
may devise to identify maternal deaths, 
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such as through review of a random sam-
ple of reported deaths of women of child-
bearing age to ascertain cases of preg-
nancy-related 
and 
pregnancy-associated 
deaths that are not discernable from a re-
view of death certificates alone. 
When feasible and for purposes of effectively 
collecting and obtaining data on pregnancy-re-
lated and pregnancy-associated deaths, the 
State shall adopt the most recent standardized 
birth and death certificates, as issued by the 
National Center for Vital Health Statistics, in-
cluding the recommended checkbox section for 
pregnancy on the death certificates. 
‘‘(D) CASE INVESTIGATION AND DEVELOP-
MENT OF CASE SUMMARIES.—Following receipt 
of reports by the State department of health 
pursuant to subparagraph (A) or (B) and col-
lection by the vital statistics unit of the State 
of possible cases of pregnancy-related and preg-
nancy-associated deaths pursuant to subpara-
graph (C), the State, through the State mater-
nal mortality review committee established 
under subsection (a), shall investigate each 
case, utilizing the case abstraction form de-
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scribed in subsection (c), and prepare de-identi-
fied case summaries, which shall be reviewed by 
the committee and included in applicable re-
ports. For purposes of subsection (a), under the 
processes established under subparagraphs (A), 
(B), and (C), a State department of health or 
vital statistics unit of a State shall provide to 
the State maternal mortality review committee 
access to information collected pursuant to such 
subparagraphs as necessary to carry out this 
subparagraph. Data and information collected 
for the case summary and review are for pur-
poses of public health activities, in accordance 
with HIPAA privacy and security law (as de-
fined in section 3009(a)(2) of the Public Health 
Service Act). Such case investigations shall in-
clude data and information obtained through— 
‘‘(i) medical examiner and autopsy re-
ports of the woman involved; 
‘‘(ii) medical records of the woman, 
including such records related to health 
care prior to pregnancy, prenatal and post-
natal care, labor and delivery care, emer-
gency 
room 
care, 
hospital 
discharge 
records, and any care delivered up until 
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the time of death of the woman for pur-
poses of public health activities, in accord-
ance with HIPAA privacy and security law 
(as defined in section 3009(a)(2) of the 
Public Health Service Act); 
‘‘(iii) oral and written interviews of in-
dividuals directly involved in the maternal 
care of the woman during and immediately 
following the pregnancy of the woman, in-
cluding health care, mental health, and so-
cial service providers, as applicable; 
‘‘(iv) optional oral or written inter-
views of the family of the woman; 
‘‘(v) socioeconomic and other relevant 
background information about the woman; 
‘‘(vi) information collected in subpara-
graph (C)(i); and 
‘‘(vii) other information on the cause 
of death of the woman, such as social serv-
ices and child welfare reports. 
‘‘(2) STATE
MATERNAL
MORTALITY
REVIEW 
COMMITTEES.— 
‘‘(A) DUTIES.— 
‘‘(i) REQUIRED
COMMITTEE
ACTIVI-
TIES.—For purposes of subsection (a), a 
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maternal mortality review committee estab-
lished by a State pursuant to a grant 
under such subsection shall carry out the 
following 
pregnancy-related 
death 
and 
pregnancy-associated death review activi-
ties and shall include all information rel-
evant to the death involved on the case ab-
straction form developed under subsection 
(d): 
‘‘(I) With respect to a case of 
pregnancy-related or pregnancy-asso-
ciated death of a woman, review the 
case summaries prepared under sub-
paragraphs (A), (B), (C), and (D) of 
paragraph (1). 
‘‘(II) Review aggregate statistical 
reports developed by the vital statis-
tics unit of the State under paragraph 
(1)(C) 
regarding 
pregnancy-related 
and pregnancy-associated deaths to 
identify trends, patterns, and dispari-
ties in adverse outcomes and address 
medical, non-medical, and system-re-
lated factors that may have contrib-
uted to such pregnancy-related and 
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pregnancy-associated deaths and dis-
parities. 
‘‘(III) Develop recommendations, 
based on the review of the case sum-
maries under paragraph (1)(D) and 
aggregate statistical reports under 
subclause (II), to improve maternal 
care, social and health services, and 
public health policy and institutions, 
including with respect to improving 
access to maternal care, improving the 
availability of social services, and 
eliminating disparities in maternal 
care and outcomes. 
‘‘(ii) OPTIONAL
COMMITTEE
ACTIVI-
TIES.—For purposes of subsection (a), a 
maternal mortality review committee estab-
lished by a State under such subsection 
may present findings and recommendations 
regarding a specific case or set of cir-
cumstances directly to a health care facil-
ity or its local or State professional organi-
zation for the purpose of instituting policy 
changes, educational activities, or other-
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wise improving the quality of care provided 
by the facilities. 
‘‘(B) COMPOSITION
OF
MATERNAL
MOR-
TALITY REVIEW COMMITTEES.— 
‘‘(i) IN GENERAL.—Each State mater-
nal mortality review committee established 
pursuant to a grant under subsection (a) 
shall be multi-disciplinary, consisting of 
health care and social service providers, 
public health officials, other persons with 
professional expertise on maternal health 
and mortality, and patient and community 
advocates who represent those communities 
within such State that are the most af-
fected by maternal mortality. Membership 
on such a committee of a State shall be re-
viewed annually by the State department 
of health to ensure that membership rep-
resentation requirements are being fulfilled 
in accordance with this paragraph. 
‘‘(ii) REQUIRED MEMBERSHIP.—Each 
such review committee shall include— 
‘‘(I) representatives from medical 
specialities providing care to pregnant 
and postpartum patients, including 
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obstetricians 
(including 
generalists 
and maternal fetal medicine special-
ists), and family practice physicians; 
‘‘(II) certified nurse midwives, 
certified midwives, and advanced prac-
tice nurses; 
‘‘(III) hospital-based registered 
nurses; 
‘‘(IV) representatives of the State 
department of health maternal and 
child health department; 
‘‘(V) social service providers or 
social workers; 
‘‘(VI) the chief medical exam-
iners or designees; 
‘‘(VII) 
facility 
representatives, 
such as from hospitals or free-stand-
ing birth centers; and 
‘‘(VIII) community or patient ad-
vocates who represent those commu-
nities within the State that are the 
most affected by maternal mortality. 
‘‘(iii) ADDITIONAL
MEMBERS.—Each 
such review committee may also include 
representatives from other relevant aca-
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demic, health, social service, or policy pro-
fessions, or community organizations, on 
an ongoing basis, or as needed, as deter-
mined beneficial by the review committee, 
including— 
‘‘(I) anesthesiologists; 
‘‘(II) emergency physicians; 
‘‘(III) pathologists; 
‘‘(IV) epidemiologists or biostat-
isticians; 
‘‘(V) intensivists; 
‘‘(VI) vital statistics officers; 
‘‘(VII) nutritionists; 
‘‘(VIII) mental health profes-
sionals; 
‘‘(IX) substance abuse treatment 
specialists; 
‘‘(X) representatives of relevant 
advocacy groups; 
‘‘(XI) academics; 
‘‘(XII) representatives of bene-
ficiaries of the State plan under the 
Medicaid program under title XIX; 
‘‘(XIII) paramedics; 
‘‘(XIV) lawyers; 
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‘‘(XV) risk management special-
ists; 
‘‘(XVI) representatives of the de-
partments of health or public health 
of major cities in the State involved; 
and 
‘‘(XVII) policy makers. 
‘‘(iv) DIVERSE COMMUNITY MEMBER-
SHIP.—The composition of such a com-
mittee, with respect to a State, shall in-
clude— 
‘‘(I) representatives from diverse 
communities, particularly those com-
munities within such State most se-
verely affected by pregnancy-related 
deaths or pregnancy-associated deaths 
and by a lack of access to relevant 
maternal care services, from commu-
nity maternal child health organiza-
tions, and from minority advocacy 
groups; 
‘‘(II) members, including health 
care providers, from different geo-
graphic regions in the State, including 
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any rural, urban, and tribal areas; 
and 
‘‘(III) health care and social serv-
ice providers who work in commu-
nities that are diverse with regard to 
race, ethnicity, immigration status, 
Indigenous status, and English pro-
ficiency. 
‘‘(v) MATERNAL MORTALITY REVIEW 
STAFF.—Staff of each such review com-
mittee shall include— 
‘‘(I) vital health statisticians, ma-
ternal 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. 
‘‘(C) OPTION FOR STATES TO FORM RE-
GIONAL
MATERNAL
MORTALITY
REVIEWS.— 
States with a low rate of occurrence of preg-
nancy-associated or pregnancy-related deaths 
may choose to partner with one or more neigh-
boring States to fulfill the activities described in 
paragraph (1)(C). In such a case, with respect 
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to States in such a partnership, any require-
ment under this section relating to the report-
ing 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. 
‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI-
TIES.—For purposes of subsection (a), a State de-
partment of health of a State receiving a grant 
under such subsection shall— 
‘‘(A) in consultation with the maternal 
mortality review committee of the State and in 
conjunction with relevant professional organiza-
tions, 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 ma-
ternal mortality review committees of the State 
and to implement the recommendations of such 
committee. 
‘‘(c) CASE ABSTRACTION FORM.— 
‘‘(1) DEVELOPMENT.—The Director of the Cen-
ters for Disease Control and Prevention shall de-
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velop a uniform, comprehensive case abstraction 
form and make such form available to States for 
State maternal mortality review committees for use 
by such committees in order to— 
‘‘(A) ensure that the cases 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) preserve the uniformity of the infor-
mation and its use 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 com-
mittee of such State by including on such form addi-
tional information to be collected, but may not alter 
the standard questions on such form, in order to en-
sure that the information can be collected and re-
viewed centrally at the Federal level. 
‘‘(d) 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), a State ma-
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ternal mortality review committee of a State established 
pursuant to this section to carry out activities described 
in subsection (b)(2)(A) shall be deemed to be a public 
health authority described in section 164.501 (and ref-
erenced in section 164.512(b)(1)(i)) of title 45, Code of 
Federal Regulations (or any successor regulation), car-
rying out public health activities and purposes described 
in such section 164.512(b)(1)(i) (or any such successor 
regulation). 
‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 
‘‘(1) IN GENERAL.—For fiscal year 2015 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 estab-
lished under paragraph (2), of the information in-
cluded in the report of the State under section 
506(a)(2)(F) for such year (relating to the findings 
for such year of the State maternal mortality review 
committee established by the State under this sec-
tion). 
‘‘(2) 
INFORMATION
CLEARINGHOUSE.—The 
Secretary of Health and Human Services shall es-
tablish an information clearinghouse, that shall be 
administered by the Director of the Centers for Dis-
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ease Control and Prevention, that will maintain find-
ings and recommendations submitted pursuant to 
paragraph (1) and provide such findings and rec-
ommendations for public review and research pur-
poses by State health departments, maternal mor-
tality review committees, and health providers and 
institutions. 
‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 
no case shall any individually identifiable health in-
formation be provided to the public, or submitted to 
the information clearinghouse, under paragraph (1). 
‘‘(f) CONFIDENTIALITY
OF
REVIEW
COMMITTEE 
PROCEEDINGS.— 
‘‘(1) IN GENERAL.—All proceedings and activi-
ties of a State maternal mortality review committee 
under this section, 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 state-
ments 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 not sub-
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ject to discovery, subpoena, or introduction into evi-
dence in any civil, criminal, legislative, or other pro-
ceeding. Such records shall not be open to public in-
spection. 
‘‘(2) TESTIMONY
OF
MEMBERS
OF
COM-
MITTEE.— 
‘‘(A) IN GENERAL.—Members of a State 
maternal mortality review committee under this 
section may not be questioned in any civil, 
criminal, legislative, or other proceeding regard-
ing information presented in, or opinions 
formed as a result of, a meeting or communica-
tion of the committee. 
‘‘(B) CLARIFICATION.—Nothing in this 
subsection shall be construed to prevent a mem-
ber of such a committee from testifying regard-
ing information that was obtained independent 
of such member’s participation on the com-
mittee, or that is public information. 
‘‘(3) AVAILABILITY OF INFORMATION FOR RE-
SEARCH
PURPOSES.—Nothing in this subsection 
shall prohibit the publishing by such a committee or 
the Department of Health and Human Services of 
statistical compilations and research reports that— 
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‘‘(A) are based on confidential information, 
relating to morbidity and mortality review; and 
‘‘(B) do not contain identifying informa-
tion or any other information that could be 
used to ultimately identify the individuals con-
cerned. 
‘‘(g) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘pregnancy-associated death’ 
means the death of a woman while pregnant or dur-
ing 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 or site of the 
pregnancy, from any cause related to or aggravated 
by the pregnancy or its management, but not from 
any accidental or incidental cause. 
‘‘(3) The term ‘woman of childbearing age’ 
means a woman who is at least 10 years of age and 
not more than 54 years of age.’’. 
(b) INCLUSION OF FINDINGS OF REVIEW COMMIT-
TEES IN REQUIRED REPORTS.— 
(1) STATE
TRIENNIAL
REPORTS.—Paragraph 
(2) of section 506(a) of such Act (42 U.S.C. 706(a)) 
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is amended by inserting after subparagraph (E) the 
following new subparagraph: 
‘‘(F) In the case of a State receiving a 
grant under section 514, beginning for the first 
fiscal year beginning after 3 years after the 
date of establishment of the State maternal 
mortality review committee established by the 
State pursuant to such grant and once every 3 
years thereafter, information containing the 
findings and recommendations of such com-
mittee and information on the implementation 
of such recommendations during the period in-
volved.’’. 
(2) ANNUAL
REPORTS
TO
CONGRESS.—Para-
graph (3) of such section is amended— 
(A) in subparagraph (D), at the end, by 
striking ‘‘and’’; 
(B) in subparagraph (E), at the end, by 
striking the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) For fiscal year 2015 and each subse-
quent fiscal year, taking into account the find-
ings, recommendations, and implementation in-
formation submitted by States pursuant to 
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paragraph (2)(F), on the status of pregnancy- 
related deaths and pregnancy-associated deaths 
in the United States and including rec-
ommendations on methods to prevent such 
deaths in the United States.’’. 
SEC. 4. NIH WORKSHOP AND RESEARCH PLAN DEVELOP-
MENT ON SEVERE MATERNAL MORBIDITY. 
(a) WORKSHOP.—The Secretary of Health and 
Human Services, acting through the Director of NIH and 
in consultation with the Administrator of the Health Re-
sources and Services Administration, the Director of the 
Centers for Disease Control and Prevention, the heads of 
other Federal agencies that administer Federal health pro-
grams, and relevant national professional organizations 
dealing with maternal morbidity, shall organize a national 
workshop to identify definitions for severe maternal mor-
bidity and make recommendations for a research plan to 
identify and monitor severe maternal morbidity in the 
United States. 
(b) RESEARCH PLAN AND DATA COLLECTION PRO-
TOCOLS.—The Secretary, taking into account the findings 
of the workshop under paragraph (1), shall develop uni-
form definitions of severe maternal morbidity, a research 
plan on severe maternal morbidity, and possible data col-
lection protocols to assist States in identifying and moni-
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toring cases of severe maternal morbidity and to develop 
recommendations on addressing such cases. 
(c) REPORT.—Not later than 2 years after the date 
of enactment of this Act, the Secretary shall prepare and 
submit to the appropriate committees of Congress a report 
concerning the definitions and research plan developed 
under this section. 
(d) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated for fiscal year 2015— 
(1) $50,000 to carry out subsection (a); and 
(2) $100,000 to carry out subsection (b). 
SEC. 5. 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 MATERNITY 
HEALTH OUTCOMES. 
‘‘(a) IN GENERAL.—The Secretary shall, in consulta-
tion with relevant national stakeholder organizations, such 
as national medical specialty organizations, national ma-
ternal child health organizations, and national health dis-
parity organizations, carry out the following activities to 
eliminate disparities in maternal health outcomes: 
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‘‘(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 infrastruc-
ture to measure such disparities. 
‘‘(2) Expand access to services that have been 
demonstrated to improve the quality and outcomes 
of maternity care for vulnerable populations. 
‘‘(3) Establish a demonstration project to com-
pare the effectiveness of interventions to reduce dis-
parities in maternity services and outcomes, and im-
plement and assessing effective interventions. 
‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM-
ONSTRATION
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 in-
volved will serve under the demonstration project; 
‘‘(2) criteria designed by the Secretary to en-
sure that, as a whole, the demonstration project is, 
to the greatest extent possible, representative of the 
demographic and geographic composition of commu-
nities most affected by disparities; 
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‘‘(3) criteria designed by the Secretary to en-
sure that a variety of type 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 as-
sure 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 rep-
resenting providers of maternity services. 
‘‘(c) DURATION
OF DEMONSTRATION PROJECT.— 
The demonstration project under subsection (a)(3) shall 
begin on January 1, 2015, and end on December 31, 
2019. 
‘‘(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 nec-
essary for the evaluation and monitoring of such project. 
‘‘(e) REPORTS.— 
‘‘(1) STATE REPORTS.—Each State that par-
ticipates in the demonstration project under sub-
section (a)(3) shall report to the Secretary, in a 
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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 pro-
vided under the project; and 
‘‘(B) evaluate the rationale for the selec-
tion 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, 2020, the Secretary shall submit to Congress a 
report on the results of the demonstration project 
under subsection (a)(3).’’. 
Æ 
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