115TH CONGRESS 
2D SESSION 
H. R. 1318 
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 mater-
nal health outcomes for pregnancy-related and preg-
nancy-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 Representa-
tives 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 2018’’. 
SEC. 2. SAFE MOTHERHOOD. 
Section 317K of the Public Health Service Act (42 
U.S.C. 247b–12) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘purpose of this sub-
section is to develop’’ and inserting ‘‘pur-
poses of this subsection are to establish or 
continue a Federal initiative to support 
State and tribal maternal mortality review 
committees, to improve data collection and 
reporting around maternal mortality, and 
to develop or support’’; 
(ii) by striking ‘‘population at risk of 
death and’’ and inserting ‘‘populations at 
risk of death and severe’’; and 
(B) in paragraph (2)— 
(i) by amending subparagraph (A) to 
read as follows:
‘‘(A) The Secretary may continue and im-
prove activities related to a national maternal 
mortality data collection and surveillance pro-
gram to identify and support the review of 
pregnancy-associated deaths and pregnancy-re-
lated deaths that occur during, or within 1 year 
following, pregnancy.’’; and 
(ii) by inserting after subparagraph 
(C) the following: 
‘‘(D) The Secretary may, in cooperation 
with States, Indian tribes, and tribal organiza-
tions, develop a program to support States, In-
dian tribes, and tribal organizations in estab-
lishing or operating maternal mortality review 
committees, in accordance with subsection 
(d).’’; 
(2) in subsection (b)(2)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘encouraging pre-
conception’’ and inserting ‘‘prepregnancy’’; 
and 
(ii) by striking ‘‘diabetics’’ and insert-
ing ‘‘women with diabetes and women with 
substance use disorder’’ before the semi-
colon;
(B) in subparagraph (H)— 
(i) by inserting ‘‘the identification of 
the determinants of disparities in maternal 
care, health risks, and health outcomes, in-
cluding’’ before ‘‘an examination’’; and 
(ii) by inserting ‘‘and other groups of 
women with disproportionately high rates 
of maternal mortality’’ before the semi-
colon; 
(C) in subparagraph (I), by striking ‘‘do-
mestic’’ and inserting ‘‘interpersonal’’; 
(D) by redesignating subparagraphs (I) 
through (L) as subparagraphs (J) through (M), 
respectively; 
(E) by inserting after subparagraph (H) 
the following: 
‘‘(I) activities to reduce disparities in ma-
ternity services and outcomes;’’; and 
(F) in subparagraph (K), as so redesig-
nated, by striking ‘‘, alcohol and illegal drug 
use’’ and inserting ‘‘and substance abuse and 
misuse’’; 
(3) in subsection (c)— 
(A) by striking ‘‘(1) IN
GENERAL—The 
Secretary’’ and inserting ‘‘The Secretary’’;
(B) by redesignating subparagraphs (A) 
through (C) as paragraphs (1) through (3), re-
spectively, and adjusting the margins accord-
ingly; 
(C) in paragraph (1), as so redesignated, 
by striking ‘‘and the building of partnerships 
with outside organizations concerned about safe 
motherhood’’; 
(D) in paragraph (2), as so redesignated, 
by striking ‘‘; and’’ and inserting a semicolon; 
(E) in paragraph (3), as so redesignated, 
by striking the period and inserting ‘‘; and’’; 
and 
(F) by adding at the end the following: 
‘‘(4) activities to promote physical, mental, and 
behavioral health during, and up to 1 year following, 
pregnancy, with an emphasis on prevention of, and 
treatment for, mental health disorders and sub-
stance use disorder.’’; 
(4) by redesignating subsection (d) as sub-
section (f); 
(5) by inserting after subsection (c) the fol-
lowing: 
‘‘(d) MATERNAL
MORTALITY
REVIEW
COMMIT-
TEES.—
‘‘(1) IN GENERAL.—In order to participate in 
the program under subsection (a)(2)(D), the applica-
ble maternal mortality review committee of the 
State, Indian tribe, or tribal organization shall— 
‘‘(A) include multidisciplinary and diverse 
membership that represents a variety of clinical 
specialties, State, tribal, or local public health 
officials, epidemiologists, statisticians, commu-
nity organizations, geographic regions within 
the area covered by such committee, and indi-
viduals or organizations that represent the pop-
ulations in the area covered by such committee 
that are most affected by pregnancy-related 
deaths or pregnancy-associated deaths and lack 
of access to maternal health care services; and 
‘‘(B) demonstrate to the Centers for Dis-
ease Control and Prevention that such maternal 
mortality review committee’s methods and proc-
esses for data collection and review, as required 
under paragraph (3), use best practices to reli-
ably determine and include all pregnancy-asso-
ciated deaths and pregnancy-related deaths, re-
gardless of the outcome of the pregnancy. 
‘‘(2) PROCESS
FOR
CONFIDENTIAL
REPORT-
ING.—States, Indian tribes, and tribal organizations
that participate in the program described in this 
subsection shall, through the State maternal mor-
tality review committee, develop a process that— 
‘‘(A) provides for confidential case report-
ing of pregnancy-associated and pregnancy-re-
lated deaths to the appropriate State or tribal 
health agency, including such reporting by— 
‘‘(i) health care professionals; 
‘‘(ii) health care facilities; 
‘‘(iii) any individual responsible for 
completing death records, including med-
ical examiners and medical coroners; and 
‘‘(iv) other appropriate individuals or 
entities; and 
‘‘(B) provides for voluntary and confiden-
tial case reporting of pregnancy-associated 
deaths and pregnancy-related deaths to the ap-
propriate State or tribal health agency by fam-
ily members of the deceased, and other appro-
priate individuals, for purposes of review by the 
applicable maternal mortality review committee; 
and 
‘‘(C) shall include—
‘‘(i) making publicly available contact 
information of the committee for use in 
such reporting; and 
‘‘(ii) conducting outreach to local pro-
fessional organizations, community organi-
zations, and social services agencies re-
garding the availability of the review com-
mittee. 
‘‘(3) DATA COLLECTION AND REVIEW.—States, 
Indian tribes, and tribal organizations that partici-
pate in the program described in this subsection 
shall— 
‘‘(A) annually identify pregnancy-associ-
ated deaths and pregnancy-related deaths— 
‘‘(i) through the appropriate vital sta-
tistics unit by— 
‘‘(I) matching each death record 
related 
to 
a 
pregnancy-associated 
death or pregnancy-related death in 
the State or tribal area in the applica-
ble year to a birth certificate of an in-
fant or fetal death record, as applica-
ble; 
‘‘(II) to the extent practicable, 
identifying an underlying or contrib-
uting cause of each pregnancy-associ-
ated death and each pregnancy-related 
death in the State or tribal area in 
the applicable year; and 
‘‘(III) collecting data from med-
ical examiner and coroner reports, as 
appropriate; 
‘‘(ii) using other appropriate methods 
or information to identify pregnancy-asso-
ciated 
deaths 
and 
pregnancy-related 
deaths, including deaths from pregnancy 
outcomes not identified through clause 
(i)(I); 
‘‘(B) through the maternal mortality re-
view committee, review data and information to 
identify adverse outcomes that may contribute 
to pregnancy-associated death and pregnancy- 
related death, and to identify trends, patterns, 
and disparities in such adverse outcomes to 
allow the State, Indian tribe, or tribal organiza-
tion to make recommendations to individuals 
and entities described in paragraph (2)(A), as 
appropriate, to improve maternal care and re-
duce pregnancy-associated death and preg-
nancy-related death;
‘‘(C) identify training available to the indi-
viduals and entities described in paragraph 
(2)(A) for accurate identification and reporting 
of pregnancy-associated and pregnancy-related 
deaths; 
‘‘(D) ensure that, to the extent practicable, 
the data collected and reported under this para-
graph is in a format that allows for analysis by 
the Centers for Disease Control and Prevention; 
and 
‘‘(E) publicly identify the methods used to 
identify pregnancy-associated deaths and preg-
nancy-related deaths in accordance with this 
section. 
‘‘(4) CONFIDENTIALITY.—States, Indian tribes, 
and tribal organizations participating in the program 
described in this subsection shall establish confiden-
tiality protections to ensure, at a minimum, that— 
‘‘(A) there is no disclosure by the maternal 
mortality review committee, including any indi-
vidual members of the committee, to any per-
son, including any government official, of any 
identifying information about any specific ma-
ternal mortality case; and
‘‘(B) no information from committee pro-
ceedings, including deliberation or records, is 
made public unless specifically authorized under 
State and Federal law. 
‘‘(5) REPORTS TO CDC.—For fiscal year 2019, 
and each subsequent fiscal year, each maternal mor-
tality review committee participating in the program 
described in this subsection shall submit to the Di-
rector of the Centers for Disease Control and Pre-
vention a report that includes— 
‘‘(A) data, findings, and any recommenda-
tions of such committee; and 
‘‘(B) as applicable, information on the im-
plementation during such year of any rec-
ommendations submitted by the committee in a 
previous year. 
‘‘(6) STATE PARTNERSHIPS.—States may part-
ner with one or more neighboring States to carry out 
the activities under this subparagraph. With respect 
to the States in such a partnership, any requirement 
under this subparagraph 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.
‘‘(7) APPROPRIATE
MECHANISMS
FOR
INDIAN 
TRIBES
AND
TRIBAL
ORGANIZATIONS.—The Sec-
retary, in consultation with Indian tribes, shall iden-
tify and establish appropriate mechanisms for Indian 
tribes and tribal organizations to demonstrate, re-
port data, and conduct the activities as required for 
participation in the program described in this sub-
section. Such mechanisms may include technical as-
sistance with respect to grant application and sub-
mission procedures, and award management activi-
ties. 
‘‘(8) RESEARCH AVAILABILITY.—The Secretary 
shall develop a process to ensure that data collected 
under paragraph (5) is made available, as appro-
priate and practicable, for research purposes, in a 
manner that protects individually identifiable or po-
tentially identifiable information and that is con-
sistent with State and Federal privacy law. 
‘‘(e) DEFINITIONS.—In this section— 
‘‘(1) the terms ‘Indian tribe’ and ‘tribal organi-
zation’ have the meanings given such terms in sec-
tion 4 of the Indian Self-Determination and Edu-
cation Assistance Act; 
‘‘(2) the term ‘pregnancy-associated death’ 
means a death of a woman, by any cause, that oc-
curs during, or within 1 year following, her preg-
nancy, regardless of the outcome, duration, or site of 
the pregnancy; and 
‘‘(3) the term ‘pregnancy-related death’ means 
a death of a woman that occurs during, or within 1 
year following, her pregnancy, regardless of the out-
come, duration, or site of the pregnancy— 
‘‘(A) from any cause related to, or aggra-
vated by, the pregnancy or its management; 
and 
‘‘(B) not from accidental or incidental 
causes.’’; and 
(6) in subsection (f), as so redesignated, by 
striking ‘‘such sums as may be necessary for each of 
the fiscal years 2001 through 2005’’ and inserting 
‘‘$58,000,000 for each of fiscal years 2019 through 
2023’’. 
Passed the House of Representatives December 11, 
2018. 
Attest: 
Clerk.
115TH CONGRESS 
2D SESSION 
H. R. 1318 
AN ACT 
To support States in their work to save and sustain 
the health of mothers during pregnancy, child-
birth, and in the postpartum period, to eliminate 
disparities in maternal health outcomes for preg-
nancy-related and pregnancy-associated deaths, 
to identify solutions to improve health care qual-
ity and health outcomes for mothers, and for 
other purposes.