‘‘(I) Health care providers. 
‘‘(II) Medical examiners. 
‘‘(III) Medical coroners. 
‘‘(IV) Hospitals. 
‘‘(V) Free-standing birth centers. 
‘‘(VI) Other health care facilities. 
‘‘(VII) Any other individuals re-
sponsible for completing death certifi-
cates. 
‘‘(VIII) Any other appropriate in-
dividuals or entities specified by the 
Secretary. 
‘‘(B) VOLUNTARY
REPORTING
OF
PREG-
NANCY-RELATED AND PREGNANCY-ASSOCIATED 
DEATHS.— 
‘‘(i) The State shall, through the 
State maternal mortality review committee, 
develop a process for and encourage, sepa-
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. 
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‘‘(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-
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-
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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, 
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. 
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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-
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 
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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 
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); 
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‘‘(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 
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-
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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 
pregnancy-associated deaths and dis-
parities. 
‘‘(III) Develop recommendations, 
based on the review of the case sum-
maries under paragraph (1)(D) and 
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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-
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 
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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 
obstetricians 
(including 
generalists 
and maternal fetal medicine special-
ists), and family practice physicians; 
‘‘(II) certified nurse midwives, 
certified midwives, and advanced prac-
tice nurses; 
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‘‘(III) hospital-based 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-
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; 
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‘‘(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; 
‘‘(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. 
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‘‘(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 
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. 
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