I 
115TH CONGRESS 
2D SESSION 
H. R. 5977 
To improve Federal efforts with respect to the prevention of maternal 
mortality, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 25, 2018 
Ms. KELLY of Illinois introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To improve Federal efforts with respect to the prevention 
of maternal mortality, 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 ‘‘Mothers and Offspring 
Mortality and Morbidity Awareness Act’’ or the 
‘‘MOMMA’s Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Every year, across the United States, four 
million women give birth, about 700 women suffer 
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fatal complications during pregnancy, while giving 
birth, or during the postpartum period, and 65,000 
women suffer near-fatal, partum-related complica-
tions. 
(2) The maternal mortality rate is often used as 
a proxy to measure the overall health of a popu-
lation. While the infant mortality rate in the United 
States has reached its lowest point, the risk of death 
for women in the United States during pregnancy, 
childbirth, or the postpartum period is higher than 
such risk in any all other developed nations. The es-
timated maternal mortality rate (per 100,000 live 
births) for the 48 contiguous States and Washington 
DC increased from 18.8 percent in 2000 to 23.8 
percent in 2014 to 26.6 percent in 2018. This esti-
mated rate is on par with such rate for under-
developed nations such as Iraq and Afghanistan. 
(3) International studies estimate the 2015 
U.S. maternal mortality rate as 26.4 per 100,000 
live births, which is almost twice the 2015 World 
Health Organization (WHO) estimation of 14 per 
100,000 live births. 
(4) It is estimated that almost half of all mater-
nal mortalities in the United States are preventable. 
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(5) African-American women experience mater-
nal-related deaths at three to four times the rate of 
non-Hispanic White women. 
(6) The findings described in paragraphs (1) 
through (5) are of major concern to researchers, 
academicians, and epidemiologists at the Centers for 
Disease Control and Prevention (CDC); providers 
across the obstetrical continuum represented by or-
ganizations such as the Preeclampsia Foundation; 
the American College of Obstetricians and Gyne-
cologists; the Association of Women’s Health, Ob-
stetric, and Neonatal Nurses; the California Mater-
nal Quality Care Collaborative; Black Women’s 
Health Imperative; the National Birth Equity Col-
laborative; Black Mamas Matter Alliance; the Na-
tional Association of Certified Professional Midwives; 
and the American College of Nurse Midwives. 
(7) According to the CDC, the maternal mor-
tality rate varies drastically for women by race and 
ethnicity. There are 12.7 deaths per 100,000 live 
births for White women, 43.5 deaths per 100,000 
live births for African-American women, and 14.4 
deaths per 100,000 live births for women of other 
ethnicities. While maternal mortality disparately im-
pacts African-American women, the phenomenon 
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traverses race, ethnicity, socioeconomic status, edu-
cational background, and geography. 
(8) Hemorrhage, cardiovascular and coronary 
conditions, cardiomyopathy, infection, embolism, 
mental health conditions, preeclampsia and eclamp-
sia, infection or sepsis, and anesthesia complications 
are the predominant causes of maternal-related 
deaths and complications. Such conditions are large-
ly preventable or manageable. 
(9) The United States has not been able to sub-
mit a formal maternal mortality rate to international 
data repositories since 2007. Thus, no official ma-
ternal mortality rate exists for the Nation. There 
can be no maternal mortality rate without stream-
lining maternal mortality-related data from the 
State level and extrapolating such data to the Fed-
eral level. 
(10) In the United States, death reporting and 
analysis is a State function rather than a Federal 
process. States report all deaths—including mater-
nal deaths—on a semi-voluntary basis, without 
standardization across States. While the CDC has 
the capacity and system for collecting death-related 
data based on death certificates, these data are not 
sufficiently reported by States in an organized and 
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standard format across States such that the CDC is 
able to identify causes of maternal death and best 
practices for the prevention of such death. 
(11) Vital registration systems often underesti-
mate maternal mortality and are insufficient data 
sources from which to derive a full scope of medical 
and social determinant factors contributing to ma-
ternal deaths. While the addition of pregnancy 
checkboxes on death certificates since 2003 have 
likely improved States’ abilities to identify preg-
nancy-related deaths, they are not generally com-
pleted by obstetrical providers or persons trained to 
recognize pregnancy-related mortality. Thus, these 
vital forms may be missing information or may cap-
ture inconsistent data. Due to varying maternal 
mortality-related analyses, lack of reliability, and 
granularity in data, current maternal mortality 
informatics do not fully encapsulate the myriad med-
ical and socially determinant factors that contribute 
to such high maternal mortality rates within the 
United States compared to other developed nations. 
Non-standardization of data and lack of data shar-
ing across States and between Federal entities, 
health networks, and research institutions keep the 
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Nation in the dark about ways to prevent maternal 
deaths. 
(12) Having reliable and valid State data ag-
gregated at the Federal level are critical to the Na-
tion’s ability to quell surges in maternal death and 
imperative for researchers to identify long-lasting 
interventions. 
(13) Leaders in maternal wellness highly rec-
ommend that maternal deaths be investigated at the 
State level first. Then, have data regarding maternal 
deaths be standardized across States, streamlined, 
de-identified, and sent once a year to a federally su-
pervised database, managed by a Federal agency at 
the discretion of the Secretary of Health and 
Human Services. Such data standardization and col-
lection would be similar in operation and effect to 
the National Program of Cancer Registries housed 
at the CDC and akin to the Confidential Enquiry in 
Maternal Deaths Programme in the United King-
dom. Such a maternal mortality and morbidities reg-
istry and surveillance would help providers, academi-
cians, lawmakers, and the public to address ques-
tions concerning the types of, causes of, and best 
practices to thwart, pregnancy-related or pregnancy- 
associated mortalities and morbidities. 
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(14) The United Nations’ Millennium Develop-
ment Goal 5a aimed to reduce by three quarters, be-
tween 1990 and 2015, the maternal mortality rate, 
yet this metric has not been achieved. In fact, the 
maternal mortality rate in the United States has 
been estimated to have more than doubled between 
2000 and 2014. Yet, because national data are not 
fully available, the United States does not have an 
official maternal mortality rate. 
(15) Many States have struggled to establish or 
maintain Maternal Mortality Review Committees 
(MMRC). On the State level, MMRCs have lagged 
because States have not had the resources to mount 
local reviews. State-level reviews are necessary as 
only the State departments of health have the au-
thority to request medical records, autopsy reports, 
and police reports critical to the function of the 
MMRC. 
(16) The United Kingdom regards maternal 
deaths as a health systems failure and a national 
committee of obstetrics experts review each maternal 
death or near-fatal childbirth complication. Such 
committee also establishes the predominant course of 
maternal-related deaths from conditions such as 
preeclampsia. Consequently, the United Kingdom 
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has been able to reduce their incidences of 
preeclampsia to less than one in 10,000 women—its 
lowest rate since 1952. 
(17) The United States has no comparable, co-
ordinated Federal process by which to review cases 
of maternal mortality, systems failures, or best prac-
tices. Many States have active MMRCs and leverage 
their work to impact maternal wellness. For exam-
ple, the State of California has worked extensively 
with their State health departments, health and hos-
pital systems, and research collaborative organiza-
tions, including the California Maternal Quality Care 
Collaborative and the Alliance for Innovation on Ma-
ternal Health, to establish MMRCs, wherein they 
have determined the most prevalent causes of mater-
nal mortality and recorded and shared data with 
providers and researchers, who have developed and 
implemented safety bundles and care protocols re-
lated to preeclampsia, maternal hemorrhage, and the 
like. In this way, the State of California has been 
able to leverage its maternal mortality review board 
system, generate data, and apply those data to effect 
changes in maternal care-related protocol. To date, 
the State of California has stymied its maternal 
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mortality rate, which is now comparable to the low 
rates of the United Kingdom. 
(18) Hospitals and health systems across the 
United States lack standardization of emergency ob-
stetrical protocols before, during, and after delivery. 
Consequently, many providers are delayed in recog-
nizing critical signs indicating maternal distress that 
quickly escalate into fatal or near-fatal incidences. 
Moreover, any attempt to address an obstetrical 
emergency that does not take into account both clin-
ical and public health approaches falls woefully 
under the mark of excellent care delivery. State- 
based maternal quality collaborative organizations, 
including the Alliance for Innovation on Maternal 
Health (AIMs) and California Maternal Quality 
Care Collaborative, have formed obstetrical proto-
cols, tool kits, and other resources to improve system 
care and response as they relate to maternal com-
plications and warning signs for such conditions as 
maternal 
hemorrhage, 
hypertension, 
and 
preeclampsia. State perinatal quality collaboratives 
are working to identify health care processes that 
need to be improved and use the best available meth-
ods to make those changes as quickly as possible, 
while the Alliance for Innovation on Maternal 
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Health is working with States and health systems to 
align national, State, and hospital level quality im-
provement efforts through the creation and dissemi-
nation of maternal safety bundles to improve overall 
maternal health outcomes. 
(19) The CDC reports that more than half of 
all maternal deaths occur in the immediate 
postpartum period—between 42 days up to a full 
year—whereas more than one-third of pregnancy-re-
lated or pregnancy-associated deaths occur while a 
person is still pregnant. Yet, for pregnant women, 
Medicaid coverage lapses at the end of the month on 
which the 60th postpartum day lands. 
(20) A growing body of evidence-based research 
has shown the correlation between the stress associ-
ated with one’s race—the stress of racism—and 
one’s birthing outcomes. The stress of sex and race 
discrimination and institutional racism has been 
demonstrated to contribute to a higher risk of ma-
ternal mortality, irrespective of one’s gestational 
age, maternal age, socioeconomic status, or indi-
vidual-level health risk factors, including poverty, 
limited access to prenatal care, and poor physical 
and mental health (although these are not nominal 
factors). African-American women remain the most 
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at risk for pregnancy-associated or pregnancy-re-
lated 
causes 
of 
death. 
When 
it 
comes 
to 
preeclampsia, for example—which is related to obe-
sity—African-American women of normal weight re-
main the most at risk of dying during the perinatal 
period compared to non-African-American obese 
women. 
(21) The rising U.S. maternal mortality rate is 
predominantly driven by the disproportionately high 
rates of African-American maternal mortality. 
(22) African-American women are three to four 
times more likely to die from pregnancy or maternal- 
related distress than are White women, yielding one 
of the greatest and most disconcerting racial dispari-
ties in public health. 
(23) Compared to women from other racial and 
ethnic 
demographics, 
African-American 
women 
across the socioeconomic spectrum experience pro-
longed, unrelenting stress related to racial and gen-
der discrimination, contributing to higher rates of 
maternal mortality, giving birth to low-weight ba-
bies, and experiencing pre-term birth. Racism is a 
risk-factor for these aforementioned experiences. 
This cumulative stress often extends across the life 
course and is situated in everyday spaces where Afri-
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can-American women establish livelihood. Structural 
barriers, lack of access to care, and genetic pre-
dispositions to health vulnerabilities exacerbate Afri-
can-American women’s likelihood to experience poor 
or fatal birthing outcomes, but do not fully account 
for the great disparity. 
(24) African-American women are twice as like-
ly to experience postpartum depression, and dis-
proportionately higher rates of preeclampsia com-
pared to White women. 
(25) Racism is deeply ingrained in United 
States systems, including in health care delivery sys-
tems between patients and providers, often resulting 
in disparate treatment for pain, irreverence for cul-
tural 
norms 
with 
respect 
to 
health, 
and 
dismissiveness. Research has demonstrated that pa-
tients respond more warmly and adhere to medical 
treatment plans at a higher degree with providers of 
the same race or ethnicity or with providers with 
great ability to exercise empathy. However, the pro-
vider pool is not primed with many people of color, 
nor are providers (whether student-doctors in train-
ing or licensed practitioners) consistently required to 
undergo implicit bias, cultural competency, or empa-
thy training on a consistent, on-going basis. 
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SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO 
PREVENTION OF MATERNAL MORTALITY. 
(a) TECHNICAL ASSISTANCE FOR STATES WITH RE-
SPECT
TO REPORTING MATERNAL MORTALITY.—Not 
later than one year after the date of enactment of this 
Act, the Director of the Centers for Disease Control and 
Prevention (referred to in this section as the ‘‘Director’’) 
shall provide technical assistance to States that elect to 
report on maternal mortality for the purpose of encour-
aging uniformity in the reporting of such data and to en-
courage the sharing of such data among the respective 
States. 
(b) BEST PRACTICES RELATING TO PREVENTION OF 
MATERNAL MORTALITY.—Not later than one year after 
the date of enactment of this Act, the Director shall issue 
best practices to State maternal mortality review commit-
tees on how best to identify, review, and prevent maternal 
mortality. In issuing such best practices, the Director shall 
take into account any data made available by States relat-
ing to maternal mortality. 
(c) ALLIANCE
FOR
INNOVATION
ON
MATERNAL 
HEALTH GRANT PROGRAM.— 
(1) IN
GENERAL.—Not later than one year 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services, acting 
through the Associate Administrator of the Maternal 
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and Child Health Bureau of the Health Resources 
and Services Administration, shall establish a grant 
program to be known as the Alliance for Innovation 
on Maternal Health Grant Program (referred to in 
this subsection as ‘‘AIM’’) under which the Sec-
retary shall award grants to eligible entities for the 
purpose of directing widespread adoption and imple-
mentation of maternal safety bundles through col-
laborative State-based teams and collecting and ana-
lyzing process, structure, and outcome data to drive 
continuous improvement in the implementation of 
such safety bundles by such State-based teams with 
the ultimate goal of eliminating preventable mater-
nal mortality and severe maternal morbidity in the 
United States. 
(2) ELIGIBLE ENTITIES.—In order to be eligi-
ble for a grant under paragraph (1), an entity 
shall— 
(A) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require; 
and 
(B) demonstrate in such application that 
the entity is an interdisciplinary, multi-stake-
holder national organization with a national 
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data-driven maternal safety and quality im-
provement initiative based on implementation 
approaches that have been proven to improve 
maternal safety and outcomes in the United 
States. 
(3) USE OF FUNDS.—An eligible entity that re-
ceives a grant under paragraph (1) shall use such 
grant funds— 
(A) to develop and implement, through a 
robust, multi-stakeholder process, maternal 
safety bundles to assist States and health care 
systems in aligning national, State, and hos-
pital-level quality improvement efforts to im-
prove maternal health outcomes, specifically the 
reduction of maternal mortality and severe ma-
ternal morbidity; 
(B) to ensure, in developing and imple-
menting maternal safety bundles under sub-
paragraph (A), that such maternal safety bun-
dles— 
(i) satisfy the quality improvement 
needs of a State or health care system by 
factoring in the results and findings of rel-
evant data reviews, such as reviews con-
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ducted by a State maternal mortality re-
view committee; and 
(ii) address topics such as— 
(I) obstetric hemorrhage; 
(II) maternal mental health; 
(III) the maternal venous system; 
(IV) obstetric care for women 
with opioid use disorder; 
(V) postpartum care basics for 
maternal safety; 
(VI) reduction of peripartum ra-
cial and ethnic disparities; 
(VII) reduction of primary cae-
sarean birth; 
(VIII) severe hypertension in 
pregnancy; 
(IX) severe maternal morbidity 
reviews; 
(X) support after a several ma-
ternal morbidity event; and 
(XI) thromboembolism; and 
(C) to provide ongoing technical assistance 
at the national and State levels to support im-
plementation of maternal safety bundles under 
subparagraph (A). 
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(4) MATERNAL
SAFETY
BUNDLE
DEFINED.— 
For purposes of this subsection, the term ‘‘maternal 
safety bundle’’ means standardized, evidence-in-
formed processes to improve variation in response to 
maternal care. 
(5) AUTHORIZATION OF APPROPRIATIONS.—For 
purposes of carrying out this subsection, there is au-
thorized to be appropriated $5,000,000 for each of 
fiscal years 2019 through 2023. 
(d) EXPANSION OF MEDICAID AND CHIP COVERAGE 
FOR PREGNANT AND POSTPARTUM WOMEN.— 
(1) EXTENDING
MEDICAID
COVERAGE
FOR 
PREGNANT
AND
POSTPARTUM
WOMEN.—Section 
1902 of the Social Security Act (42 U.S.C. 1396a) 
is amended— 
(A) in subsection (e)— 
(i) in paragraph (5), by striking ‘‘60- 
day’’ and inserting ‘‘one-year’’; and 
(ii) in paragraph (6), by striking ‘‘60- 
day’’ and inserting ‘‘one-year’’; and 
(B) in subsection (l)(1)(A), by striking 
‘‘60-day’’ and inserting ‘‘one-year’’. 
(2) EXTENDING
MEDICAID
COVERAGE
FOR 
LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of the 
Social Security Act (42 U.S.C. 1396b(v)(4)(A)) is 
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amended by striking ‘‘60-day’’ and inserting ‘‘one- 
year’’. 
(3) EXTENDING
CHIP
COVERAGE
FOR
PREG-
NANT
AND
POSTPARTUM
WOMEN.—Section 
2112(d)(2)(A) of the Social Security Act (42 U.S.C. 
1397ll(d)(2)(A)) is amended by striking ‘‘60-day’’ 
and inserting ‘‘one-year’’. 
(4) MAINTENANCE OF EFFORT.— 
(A) MEDICAID.—Section 1902(l) of the So-
cial Security Act (42 U.S.C. 1396a(l)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(5)(A) Subject to subparagraph (B), during the pe-
riod that begins on the date of enactment of this para-
graph and ends on the date that is five years after such 
date of enactment, as a condition for receiving any Federal 
payments under section 1903(a) for calendar quarters oc-
curring during such period, a State, including a State de-
scribed in paragraph (4)(B) that elects to meet the re-
quirement of subsection (a)(10)(A)(i)(IV), shall not have 
in effect, with respect to women who are eligible for med-
ical 
assistance 
because 
of 
such 
subsection 
(a)(10)(A)(i)(IV) or section 1903(v)(4)(A)(i), eligibility 
standards, methodologies, or procedures under the State 
plan (or a waiver of such plan) that are more restrictive 
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than the eligibility standards, methodologies, or proce-
dures, respectively, under such plan (or waiver) that are 
in effect on the date of enactment of this paragraph. 
‘‘(B) A State’s determination of income in accordance 
with subsection (e)(14) shall not be considered to be eligi-
bility standards, methodologies, or procedures that are 
more restrictive than the standards, methodologies, or pro-
cedures in effect under the State plan (or a waiver of such 
plan) on the date of enactment of this paragraph for pur-
poses of determining compliance with the requirement of 
subparagraph (A).’’. 
(B) CHIP.—Section 2105(d) of the Social 
Security Act (42 U.S.C. 1397ee(d)) is amended 
by adding at the end the following new para-
graph: 
‘‘(4) IN
ELIGIBILITY
STANDARDS
FOR
TAR-
GETED
LOW-INCOME
PREGNANT
WOMEN.—During 
the period that begins on the date of enactment of 
this paragraph and ends on the date that is five 
years after such date of enactment, as a condition 
of receiving payments under subsection (a) and sec-
tion 1903(a), a State that elects to provide preg-
nancy-related assistance to targeted low-income 
pregnant women (as defined in section 2112(d)), or 
women who are eligible for such assistance through 
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the application of section 1903(v)(4)(A)(i) under 
section 2107(e)(1), shall not have in effect, with re-
spect to such women, eligibility standards, meth-
odologies, or procedures under the State child health 
plan (or a waiver of such plan) that are more re-
strictive than the eligibility standards, methodolo-
gies, or procedures, respectively, under such plan (or 
waiver) that are in effect on the date of enactment 
of this paragraph.’’. 
(5) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Except as otherwise 
provided and subject to subparagraph (B), the 
amendments made by this subsection shall take 
effect with respect to eligibility determinations 
made with respect to a State plan under title 
XIX of the Social Security Act or a State child 
health plan under title XXI of such Act on or 
after the date that is one year after the date of 
enactment of this Act. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act or a State child 
health plan under title XXI of such Act that 
the Secretary of Health and Human Services 
determines requires State legislation in order 
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for the respective plan to meet any requirement 
imposed by amendments made by this sub-
section, the respective plan shall not be re-
garded as failing to comply with the require-
ments of such title solely on the basis of its fail-
ure to meet such an additional requirement be-
fore the first day of the first calendar quarter 
beginning after the close of the first regular 
session of the State legislature that begins after 
the date of enactment of this Act. For purposes 
of the previous sentence, in the case of a State 
that has a 2-year legislative session, each year 
of the session shall be considered to be a sepa-
rate regular session of the State legislature. 
(e) REGIONAL CENTERS OF EXCELLENCE.—Part P 
of title III of the Public Health Service Act is amended 
by adding at the end the following new section: 
‘‘SEC. 399V–7. REGIONAL CENTERS OF EXCELLENCE AD-
DRESSING IMPLICIT BIAS AND CULTURAL 
COMPETENCY IN PATIENT-PROVIDER INTER-
ACTIONS EDUCATION. 
‘‘(a) IN GENERAL.—Not later than one year after the 
date of enactment of this section, the Secretary, in con-
sultation with such other agency heads as the Secretary 
determines appropriate, shall, subject to the availability of 
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