and other individuals on possible pregnancy-re-
lated and pregnancy-associated deaths. Such 
process shall include— 
(i) making publicly available on the 
website of the State department of health 
a telephone number, Internet web link, and 
email address for such reporting; and 
(ii) publicizing to local professional or-
ganizations, community organizations, and 
social services agencies the availability of 
the telephone number, Internet web link, 
and email address made available under 
clause (i). 
(C) IDENTIFICATION
OF
PREGNANCY-RE-
LATED
AND
PREGNANCY-ASSOCIATED
DEATHS 
BY STATE VITAL STATISTICS UNIT.—The State, 
through the vital statistics unit of the State, 
shall annually identify pregnancy-related and 
pregnancy-associated deaths occurring in such 
State in the year involved by— 
(i) matching each death record of a 
woman in such year to a live birth certifi-
cate or an infant death record for the pur-
pose of identifying deaths of women that 
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occurred during pregnancy and within one 
year after the end of a pregnancy; 
(ii) identifying each death of a woman 
reported during such year as having an un-
derlying or contributing cause of death re-
lated 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) using any other method the State 
may devise to identify maternal deaths 
such as reviewing a random sample of re-
ported deaths of women to ascertain cases 
of pregnancy-related and pregnancy-associ-
ated deaths that are not discernable from 
a review of death records alone. 
For purposes of effectively collecting and ob-
taining data on pregnancy-related and preg-
nancy-associated deaths, the State shall adopt 
the most recent standardized birth and death 
records, as issued by the National Center for 
Vital Health Statistics, including the rec-
ommended checkbox section for pregnancy on 
each death record. 
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(D) CASE INVESTIGATION AND DEVELOP-
MENT OF CASE SUMMARIES.— 
(i) IN
GENERAL.—Following the re-
ceipt of reports by the State department of 
health pursuant to subparagraph (A) or 
(B) and the collection of cases of preg-
nancy-related 
and 
pregnancy-associated 
deaths by the vital statistics unit of the 
State under subparagraph (C), the State, 
through the State maternal mortality re-
view committee established under sub-
section (a)(1), shall investigate each case, 
using the case abstraction form described 
in subsection (c), and prepare a de-identi-
fied case summary for each case, which 
shall be reviewed by the committee and in-
cluded in applicable reports. The State de-
partment of health or vital statistics unit 
of the State, as the case may be, shall pro-
vide the State maternal mortality review 
committee with access to the information 
collected pursuant to subparagraph (A) or 
(B), or under subparagraph (C), as nec-
essary to carry out this subparagraph. 
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(ii) MANDATORY DATA AND INFORMA-
TION.—Each case investigation under this 
subparagraph shall, subject to availability, 
include data and information obtained 
through— 
(I) medical examiner and autopsy 
reports of the woman involved; 
(II) 
medical 
records 
of 
the 
woman, including such records related 
to health care prior to pregnancy, pre-
natal and postnatal care, labor and 
delivery care, emergency room care, 
hospital discharge records, and any 
care delivered up until the time of 
death of the woman; 
(III) oral and written interviews 
of individuals directly involved in the 
maternal care of the woman during 
and immediately following the preg-
nancy of the woman, including health 
care, mental health, and social service 
providers, as applicable; 
(IV) socioeconomic and other rel-
evant background information about 
the woman; 
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(V) any information collected 
under subparagraph (C)(i); and 
(VI) any other information on 
the cause of death of the woman, such 
as social services and child welfare re-
ports. 
(iii) DISCRETIONARY
DATA
AND
IN-
FORMATION.—Each 
case 
investigation 
under this subparagraph may include data 
and information obtained through oral or 
written interviews of the family of the 
woman. 
(2) STATE
MATERNAL
MORTALITY
REVIEW 
COMMITTEES.— 
(A) MANDATORY
ACTIVITIES.—A State 
maternal mortality review committee established 
under subsection (a)(1) shall carry out the fol-
lowing activities: 
(i) Develop the processes described in 
subparagraphs (A) and (B) of paragraph 
(1). 
(ii) Review the data and information 
collected by the vital statistics unit of the 
State under paragraph (1)(C) regarding 
pregnancy-related and pregnancy-associ-
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ated deaths to identify trends, patterns, 
and disparities in adverse outcomes and 
address medical, non-medical, and system- 
related factors that may have contributed 
to such pregnancy-related and pregnancy- 
associated deaths and disparities. 
(iii) Carry out the activities described 
in paragraph (1)(D). 
(iv) Develop recommendations, based 
on the case summaries prepared under 
paragraph (1)(D) and the data and infor-
mation collected under paragraph (1)(C), 
to improve maternal care, social and health 
services, and public health policy and insti-
tutions, including improving access to ma-
ternal care and social and health services 
and identifying disparities in maternal care 
and outcomes. 
(B) DISCRETIONARY ACTIVITIES.— 
(i) IN GENERAL.—A State maternal 
mortality review committee established 
under subsection (a)(1) may, while subject 
to confidentiality requirements, present 
findings and recommendations based on 
the case summaries prepared under para-
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under subsection (a)(1) shall be multidisci-
plinary and diverse. Membership on the 
State maternal mortality review committee 
shall be reviewed annually by the State de-
partment of health to ensure that member-
ship representation requirements are being 
fulfilled in accordance with this subpara-
graph. 
(ii) REQUIRED
MEMBERSHIP.—Each 
State maternal mortality review committee 
shall include— 
(I) representatives from medical 
specialties 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, cer-
tified midwives, and advanced practice 
nurses; 
(III) 
hospital-based 
registered 
nurses; 
(IV) representatives of the ma-
ternal and child health department of 
the State department of health; 
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(V) social service providers or so-
cial workers, including those with ex-
perience working with communities di-
verse with respect to race, ethnicity, 
and limited English proficiency; 
(VI) chief medical examiners or 
designees; 
(VII) 
facility 
representatives, 
such as from hospitals or birth cen-
ters; 
(VIII) patient advocates, commu-
nity maternal health organizations, 
and minority advocacy groups that 
represent those diverse racial and eth-
nic communities within the State that 
are the most affected by pregnancy- 
related or pregnancy-associated deaths 
and by a lack of access to maternal 
health care services; and 
(IX) representatives of the de-
partments of health or public health 
of major cities in the State. 
(iii) DISCRETIONARY MEMBERSHIP.— 
Each State maternal mortality review com-
mittee may also include representatives 
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from other relevant academic, health, so-
cial service, or policy professions or com-
munity organizations on an ongoing basis, 
or as needed, as determined beneficial by 
the committee, including— 
(I) anesthesiologists; 
(II) emergency physicians; 
(III) pathologists; 
(IV) epidemiologists; 
(V) intensivists; 
(VI) nutritionists; 
(VII) mental health professionals; 
(VIII) substance use disorder 
treatment specialists; 
(IX) representatives of relevant 
patient and provider advocacy groups; 
(X) academics; 
(XI) paramedics; and 
(XII) risk management special-
ists. 
(iv) STAFF.—Staff of each State ma-
ternal mortality review committee shall in-
clude— 
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(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. 
(D) OPTION FOR STATES TO ESTABLISH 
REGIONAL MATERNAL MORTALITY REVIEW COM-
MITTEES.—States may choose to partner with 
one or more neighboring States to carry out the 
activities required of a State maternal mortality 
review committee under this section. In such a 
case, with respect to the States in such a part-
nership, any requirement under this section re-
lating 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 sub-
mitted for the partnership. 
(E) TREATMENT AS PUBLIC HEALTH AU-
THORITY FOR PURPOSES OF HIPAA.—For pur-
poses of applying HIPAA privacy and security 
law (as defined in section 3009(a)(2) of the 
Public Health Service Act (42 U.S.C. 300jj– 
19)), each State maternal mortality review com-
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mittee and regional maternal mortality review 
committee established under subsection (a)(1) 
or subsection (b)(2)(D), as the case may be, 
shall be deemed to be a public health authority 
described in section 164.501 (and referenced in 
section 164.512(b)(1)(i)) of title 45, Code of 
Federal Regulations (or any successor regula-
tion), carrying out public health activities and 
purposes 
described 
in 
such 
section 
164.512(b)(1)(i) (or any such successor regula-
tion). 
(3) STATE DEPARTMENT OF HEALTH ACTIVI-
TIES.—With respect to a State that receives a grant 
under subsection (a)(1), the State department of 
health shall— 
(A) in consultation with the State maternal 
mortality review committee and in conjunction 
with relevant professional organizations and pa-
tient advocacy organizations, 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-
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ternal mortality review committee and imple-
ment the recommendations of the committee. 
(c) CASE ABSTRACTION FORM.— 
(1) DISSEMINATION.—The Director of the Cen-
ters for Disease Control and Prevention shall dis-
seminate a uniform case abstraction form to States 
and State maternal mortality review committees for 
the purpose of— 
(A) ensuring that the data 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) preserving the uniformity of the infor-
mation collected for Federal public health pur-
poses. 
(2) PERMISSIBLE STATE MODIFICATION.—Each 
State may modify the form developed under para-
graph (1) for implementation and use by such State 
or by the State maternal mortality review committee 
of such State by including on such form additional 
information to be collected, but may not alter the 
standard questions on such form, in order to ensure 
that the information can be collected and reviewed 
centrally at the Federal level. 
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(d) PUBLIC DISCLOSURE OF INFORMATION.— 
(1) IN GENERAL.—For fiscal year 2018, 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 subsection 
(f)(1) for such year. 
(2) INFORMATION CLEARINGHOUSE.—The Sec-
retary shall establish an information clearinghouse, 
to be administered by the Director of the Centers for 
Disease Control and Prevention, that will maintain 
findings and recommendations submitted pursuant 
to paragraph (1) and provide such findings and rec-
ommendations for public review and research pur-
poses by State departments of health, State mater-
nal mortality review committees, health providers 
and institutions, and national patient and provider 
advocacy groups. 
(3) CONFIDENTIALITY
OF
INFORMATION.—In 
no case may any individually identifiable health in-
formation be provided to the public, or submitted to 
the information clearinghouse, under this subsection. 
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(e) CONFIDENTIALITY OF PROCEEDINGS OF STATE 
MATERNAL MORTALITY REVIEW COMMITTEES.— 
(1) IN GENERAL.—All proceedings and activi-
ties of a State maternal mortality review committee 
established under subsection (a)(1), opinions of 
members of such a committee formed as a result of 
such proceedings and activities, and records ob-
tained, created, or maintained pursuant to this sec-
tion, including records of interviews, written reports, 
and statements procured by the Department of 
Health and Human Services or by any other person, 
agency, or organization acting jointly with the De-
partment, in connection with morbidity and mor-
tality reviews under this section, shall be confidential 
and may not be subject to discovery, subpoena, or 
introduction into evidence in any civil, criminal, leg-
islative, or other proceeding. Such records shall not 
be open to public inspection. 
(2) 
TESTIMONY
OF
MEMBERS
OF
COM-
MITTEE.— 
(A) IN
GENERAL.—Members of a State 
maternal mortality review committee established 
under subsection (a)(1) may not be questioned 
in any civil, criminal, legislative, or other pro-
ceeding regarding information presented in, or 
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opinions formed as a result of, a meeting or 
communication of the committee. 
(B) CLARIFICATION.—Nothing in this sub-
section may be construed to prevent a member 
of a State maternal mortality review committee 
established under subsection (a)(1) from testi-
fying regarding information that was obtained 
independent of such member’s participation on 
the committee, or public information. 
(3) AVAILABILITY OF INFORMATION FOR RE-
SEARCH PURPOSES.—Nothing in this subsection may 
prohibit a State maternal mortality review com-
mittee established under subsection (a)(1) or the De-
partment of Health and Human Services from pub-
lishing statistical compilations and research reports 
that— 
(A) are based on confidential information, 
relating to morbidity and mortality reviews 
under this section; and 
(B) do not contain identifying information 
or any other information that could be used to 
ultimately identify the individuals concerned. 
(f) REPORTS.— 
(1) STATE REPORTS.—Not later than one year 
after the end of fiscal year 2018, and each subse-
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quent fiscal year, each State maternal mortality re-
view committee established under subsection (a)(1) 
and receiving a grant under this section for such 
year, shall submit to the Director of the Centers for 
Disease Control and Prevention a report on the find-
ings and recommendations of such committee and 
information on the implementation of such rec-
ommendations during such year. 
(2) ANNUAL
REPORTS
TO
CONGRESS.—Not 
later than 60 days after the deadline for State re-
ports under paragraph (1) for fiscal year 2018, and 
each subsequent fiscal year, the Secretary of Health 
and Human Services shall submit to Congress a re-
port on— 
(A) the findings, recommendations, and 
implementation information submitted by any 
State pursuant to paragraph (1); and 
(B) the status of pregnancy-related and 
pregnancy-associated deaths in the United 
States, including recommendations on methods 
to prevent such deaths in the United States. 
(g) DEFINITIONS.—In this section: 
(1) The term ‘‘pregnancy-associated death’’ 
means the death of a woman while pregnant or dur-
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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 of the preg-
nancy, from any cause related to, or aggravated by, 
the pregnancy or its management, excluding any ac-
cidental or incidental cause. 
(3) The term ‘‘severe maternal morbidity’’ 
means the physical and psychological conditions that 
result from, or are aggravated by, pregnancy and 
have an adverse effect on the health of a woman. 
(4) The term ‘‘State’’ means each of the 50 
States, the District of Columbia, and each of the 
territories. 
(5) The term ‘‘vital statistics unit’’ means the 
entity that is responsible for maintaining vital 
records for a State, including official records of live 
births, deaths, fetal deaths, marriages, divorces, and 
annulments. 
(h) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$7,000,000 for each of fiscal years 2018 through 2022. 
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SEC. 4. 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 MATERNAL 
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, national patient advo-
cacy organizations, and national health disparity organiza-
tions, carry out the following activities to eliminate dis-
parities in maternal health outcomes: 
‘‘(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 health care services, re-
sources, and information that have been dem-
onstrated 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-
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parities in maternity services and outcomes and to 
implement and assess 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; 
‘‘(3) criteria designed by the Secretary to en-
sure that a variety 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 en-
sure that the demonstration projects and models will 
be carried out in consultation with local and regional 
provider organizations, such as community health 
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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, 2018, and end on December 31, 
2021. 
‘‘(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 
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 
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bundled payment made by the State under the 
project. 
‘‘(2) FINAL REPORT.—Not later than December 
31, 2022, the Secretary shall submit to Congress a 
report on the results of the demonstration project 
under subsection (a)(3).’’. 
Æ 
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