I 
113TH CONGRESS 
2D SESSION 
H. R. 4216 
To amend title V of the Social Security Act to provide grants to States 
to establish State maternal mortality review committees on pregnancy- 
related deaths occurring within such States; to develop definitions of 
severe maternal morbidity and data collection protocols; and to eliminate 
disparities in maternal health outcomes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 12, 2014 
Mr. CONYERS (for himself and Ms. DEGETTE) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title V of the Social Security Act to provide 
grants to States to establish State maternal mortality 
review committees on pregnancy-related deaths occurring 
within such States; to develop definitions of severe mater-
nal morbidity and data collection protocols; and to elimi-
nate disparities in maternal health outcomes. 
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 ‘‘Maternal Health Ac-
countability Act of 2014’’. 
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SEC. 2. FINDINGS; PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
(1) The aggregate pregnancy-related mortality 
ratio in the United States as measured by the Cen-
ters for Disease Control and Prevention Pregnancy 
Mortality Surveillance System was 14.5 for the 8- 
year period 1998 through 2005, higher than any 
other period in the previous 20 years. Although this 
increase may reflect changes in data collection meth-
ods by the States, this reported increase, along with 
no improvement in previous years remains a source 
of great concern for the Centers for Disease Control 
and Prevention, and registered nurses, health care 
providers, and patient advocates such as the Joint 
Commission, the American College of Obstetricians 
and Gynecologists, and Amnesty International. 
(2) The Centers for Disease Control and Pre-
vention has found that maternal deaths should be 
investigated through State-based maternal death re-
views and maternal quality collaboratives, as these 
entities are well-situated to identify deaths, review 
the factors associated with them, and take action 
with the findings in order to institute the systemic 
changes needed to decrease pregnancy-related and 
pregnancy-associated mortality. 
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(3) Women of color and low-income women face 
added risks in terms of death, complications, and ac-
cess to quality health care. African-American women 
are three to four times more likely to die of preg-
nancy-related complications than White women. In 
2006 the Centers for Disease Control and Preven-
tion reported that the maternal mortality ratio for 
non-Hispanic White women was 9.1 deaths per 
100,000 births compared with 34.8 deaths per 
100,000 births for non-Hispanic Black women. 
These rates and disparities have not improved in 
more than 20 years. 
(4) Healthy People 2010, a comprehensive, na-
tionwide health promotion and disease prevention 
agenda launched by the Department of Health and 
Human Services, set a target goal of reducing ma-
ternal mortality in the United States to 4.3 deaths 
per 100,000 live births by 2010. In 2007, the na-
tional maternal mortality ratio was 12.7 deaths per 
100,000 live births. 
(5) Severe complications that result in women 
nearly dying, known as a ‘‘near miss’’ or severe ma-
ternal morbidity has increased by 75 percent for de-
livery (based on data comparing 1998 through 1999) 
and 114 percent for postpartum hospitalizations 
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(based on data comparing 2008 through 2009). 
Such data also estimates that severe morbidity af-
fects 52,000 women a year and is expected to con-
tinue to increase. Moreover, there is no scientific 
consensus on uniform definitions of severe maternal 
morbidity and best practices for data collection, 
making it difficult to measure the full extent of se-
vere morbidity and developing evidence-based inter-
ventions. 
(b) PURPOSES.—The purposes of this Act are the fol-
lowing: 
(1) To establish governmental accountability 
and a shared responsibility between States and the 
Federal Government to identify opportunities for im-
provement in quality of care and system changes, 
and to educate and inform health institutions and 
professionals, women, and families about preventing 
pregnancy-related deaths and complications and re-
ducing disparities. 
(2) To develop a model for States to operate 
maternal mortality reviews and assess the various 
factors that may have contributed to maternal mor-
tality, including quality of care, racial disparities, 
and systemic problems in the delivery of health care, 
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and to develop appropriate interventions to reduce 
and prevent such deaths. 
SEC. 3. UNIFORM STATE MATERNAL MORTALITY REVIEW 
COMMITTEES 
ON 
PREGNANCY-RELATED 
DEATHS. 
(a) CONDITION OF RECEIPT OF PAYMENTS FROM 
ALLOTMENT UNDER MATERNAL
AND CHILD HEALTH 
SERVICE BLOCK GRANT.—Title V of the Social Security 
Act (42 U.S.C. 701 et seq.) is amended by adding at the 
end the following new section: 
‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE-
VIEW 
COMMITTEES 
ON 
PREGNANCY-RE-
LATED DEATHS. 
‘‘(a) GRANTS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this title, for each of fiscal years 2015 
through 2021, in addition to payments from allot-
ments for States under section 502 for such year, 
the Secretary shall, subject to paragraph (3) and in 
accordance with the criteria established under para-
graph (2), award grants to States to— 
‘‘(A) carry out the activities described in 
subsection (b)(1); 
‘‘(B) establish a State maternal mortality 
review committee, in accordance with subsection 
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(b)(2), to carry out the activities described in 
subsection (b)(2)(A), and to establish the proc-
esses described in subsection (b)(1); 
‘‘(C) ensure the State department of 
health carries out the applicable activities de-
scribed in subsection (b)(3), with respect to 
pregnancy-related deaths occurring within the 
State during such fiscal year; 
‘‘(D) implement and use the comprehensive 
case abstraction form developed under sub-
section (c), in accordance with such subsection; 
‘‘(E) provide for public disclosure of infor-
mation, in accordance with subsection (e); and 
‘‘(F) collect, analyze, and report to the 
Secretary cases of maternal morbidity, includ-
ing reports of maternal morbidity data on ad-
missions to an intensive care unit or the trans-
fusion of more than three units of blood prod-
ucts. 
‘‘(2) CRITERIA.—The Secretary shall establish 
criteria for determining eligibility for and the 
amount of a grant awarded to a State under para-
graph (1). Such criteria shall provide that in the 
case of a State that receives such a grant for a fiscal 
year and is determined by the Secretary to have not 
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used such grant in accordance with this section, 
such State shall not be eligible for such a grant for 
any subsequent fiscal year. 
‘‘(3) AUTHORIZATION
OF
APPROPRIATIONS.— 
For purposes of carrying out the grant program 
under this section, including for administrative pur-
poses, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2015 through 
2021. 
‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 
‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 
AND PREGNANCY-ASSOCIATED DEATH CASES.—For 
purposes of subsection (a), with respect to a State 
that receives a grant under subsection (a), the fol-
lowing shall apply: 
‘‘(A) MANDATORY
REPORTING
OF
PREG-
NANCY-RELATED DEATHS.— 
‘‘(i) IN GENERAL.—The State shall, 
through the State maternal mortality re-
view committee, develop a process, sepa-
rate from any reporting process established 
by the State department of health prior to 
the date of the enactment of this section, 
that provides for mandatory and confiden-
tial case reporting by individuals and enti-
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ties described in clause (ii) of pregnancy- 
related deaths to the State department of 
health. 
‘‘(ii) INDIVIDUALS AND ENTITIES DE-
SCRIBED.—Individuals and entities de-
scribed in this clause include each of the 
following: 
‘‘(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-
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