H. R. 1318—2 
(i) by striking ‘‘encouraging preconception’’ and 
inserting ‘‘prepregnancy’’; and 
(ii) by striking ‘‘diabetics’’ and inserting ‘‘women 
with diabetes and women with substance use disorder’’ 
before the semicolon; 
(B) in subparagraph (H)— 
(i) by inserting ‘‘the identification of the deter-
minants of disparities in maternal care, health risks, 
and health outcomes, including’’ before ‘‘an examina-
tion’’; and 
(ii) by inserting ‘‘and other groups of women with 
disproportionately high rates of maternal mortality’’ 
before the semicolon; 
(C) in subparagraph (I), by striking ‘‘domestic’’ 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 maternity services 
and outcomes;’’; and 
(F) in subparagraph (K), as so redesignated, 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), respectively, and adjusting 
the margins accordingly; 
(C) in paragraph (1), as so redesignated, by striking 
‘‘and the building of partnerships with outside organiza-
tions 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 substance use disorder.’’; 
(4) by redesignating subsection (d) as subsection (f); 
(5) by inserting after subsection (c) the following: 
‘‘(d) MATERNAL MORTALITY REVIEW COMMITTEES.— 
‘‘(1) IN GENERAL.—In order to participate in the program 
under subsection (a)(2)(D), the applicable maternal mortality 
review committee of the State, Indian tribe, or tribal organiza-
tion shall— 
‘‘(A) include multidisciplinary and diverse membership 
that represents a variety of clinical specialties, State, tribal, 
or local public health officials, epidemiologists, statisticians, 
community organizations, geographic regions within the 
area covered by such committee, and individuals or 
organizations that represent the populations in the area 
covered by such committee that are most affected by preg-
nancy-related deaths or pregnancy-associated deaths and 
lack of access to maternal health care services; and
H. R. 1318—3 
‘‘(B) demonstrate to the Centers for Disease Control 
and Prevention that such maternal mortality review 
committee’s methods and processes for data collection and 
review, as required under paragraph (3), use best practices 
to reliably determine and include all pregnancy-associated 
deaths and pregnancy-related deaths, regardless of the out-
come of the pregnancy. 
‘‘(2) 
PROCESS
FOR
CONFIDENTIAL
REPORTING.—States, 
Indian tribes, and tribal organizations that participate in the 
program described in this subsection shall, through the State 
maternal mortality review committee, develop a process that— 
‘‘(A) provides for confidential case reporting of preg-
nancy-associated and pregnancy-related 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 medical examiners and med-
ical coroners; and 
‘‘(iv) other appropriate individuals or entities; and 
‘‘(B) provides for voluntary and confidential case 
reporting of pregnancy-associated deaths and pregnancy- 
related deaths to the appropriate State or tribal health 
agency by family members of the deceased, and other 
appropriate 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 professional 
organizations, community organizations, and social 
services agencies regarding the availability of the 
review committee. 
‘‘(3) DATA COLLECTION AND REVIEW.—States, Indian tribes, 
and tribal organizations that participate in the program 
described in this subsection shall— 
‘‘(A) annually identify pregnancy-associated deaths and 
pregnancy-related deaths— 
‘‘(i) through the appropriate vital statistics 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 applicable 
year to a birth certificate of an infant or fetal 
death record, as applicable; 
‘‘(II) to the extent practicable, identifying an 
underlying or contributing cause of each preg-
nancy-associated 
death 
and 
each 
pregnancy- 
related death in the State or tribal area in the 
applicable year; and 
‘‘(III) collecting data from medical examiner 
and coroner reports, as appropriate; 
‘‘(ii) using other appropriate methods or informa-
tion to identify pregnancy-associated deaths and preg-
nancy-related deaths, including deaths from pregnancy 
outcomes not identified through clause (i)(I);
H. R. 1318—4 
‘‘(B) through the maternal mortality review 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 organization to make recommenda-
tions to individuals and entities described in paragraph 
(2)(A), as appropriate, to improve maternal care and reduce 
pregnancy-associated death and pregnancy-related death; 
‘‘(C) identify training available to the individuals and 
entities described in paragraph (2)(A) for accurate identi-
fication and reporting of pregnancy-associated and preg-
nancy-related deaths; 
‘‘(D) ensure that, to the extent practicable, the data 
collected and reported under this paragraph 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 preg-
nancy-associated deaths and pregnancy-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 confidentiality protections to ensure, 
at a minimum, that— 
‘‘(A) there is no disclosure by the maternal mortality 
review committee, including any individual members of 
the committee, to any person, including any government 
official, of any identifying information about any specific 
maternal mortality case; and 
‘‘(B) no information from committee proceedings, 
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 subse-
quent fiscal year, each maternal mortality review committee 
participating in the program described in this subsection shall 
submit to the Director of the Centers for Disease Control and 
Prevention a report that includes— 
‘‘(A) data, findings, and any recommendations of such 
committee; and 
‘‘(B) as applicable, information on the implementation 
during such year of any recommendations submitted by 
the committee in a previous year. 
‘‘(6) STATE PARTNERSHIPS.—States may partner with one 
or more neighboring States to carry out the activities under 
this subparagraph. With respect to the States in such a partner-
ship, 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 Secretary, in consultation with 
Indian tribes, shall identify and establish appropriate mecha-
nisms for Indian tribes and tribal organizations to demonstrate, 
report data, and conduct the activities as required for participa-
tion in the program described in this subsection. Such mecha-
nisms may include technical assistance with respect to grant
H. R. 1318—5 
application and submission procedures, and award management 
activities. 
‘‘(8) RESEARCH AVAILABILITY.—The Secretary shall develop 
a process to ensure that data collected under paragraph (5) 
is made available, as appropriate and practicable, for research 
purposes, in a manner that protects individually identifiable 
or potentially identifiable information and that is consistent 
with State and Federal privacy law. 
‘‘(e) DEFINITIONS.—In this section— 
‘‘(1) the terms ‘Indian tribe’ and ‘tribal organization’ have 
the meanings given such terms in section 4 of the Indian 
Self-Determination and Education Assistance Act; 
‘‘(2) the term ‘pregnancy-associated death’ means a death 
of a woman, by any cause, that occurs during, or within 1 
year following, her pregnancy, regardless of the outcome, dura-
tion, 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 outcome, duration, or site of the 
pregnancy— 
‘‘(A) from any cause related to, or aggravated 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’’. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.