[115th Congress Public Law 344]
[From the U.S. Government Publishing Office]
[[Page 132 STAT. 5047]]
Public Law 115-344
115th Congress
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 maternal health outcomes for pregnancy-related
and pregnancy-associated deaths, to identify solutions to improve health
care quality and health outcomes for mothers, and for other
purposes. <<NOTE: Dec. 21, 2018 - [H.R. 1318]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Preventing
Maternal Deaths Act of 2018. 42 USC 201 note.>>
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 subsection
is to develop'' and inserting ``purposes 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) <<NOTE: Time period.>> The Secretary may
continue and improve activities related to a national
maternal mortality data collection and surveillance
program to identify and support the review of pregnancy-
associated deaths and pregnancy-related deaths that
occur during, or within 1 year following, pregnancy.'';
and
(ii) by inserting after subparagraph (C) the
following:
``(D) <<NOTE: Cooperation.>> The Secretary may, in
cooperation with States, Indian tribes, and tribal
organizations, develop a program to support States,
Indian tribes, and tribal organizations in establishing
or operating maternal mortality review committees, in
accordance with subsection (d).'';
(2) in subsection (b)(2)--
(A) in subparagraph (A)--
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(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
determinants of disparities in maternal care,
health risks, and health outcomes, including''
before ``an examination''; 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
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) <<NOTE: Time period.>> 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
organization 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
pregnancy-related deaths or pregnancy-associated deaths
and lack of access to maternal health care services; and
[[Page 132 STAT. 5049]]
``(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 outcome 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
pregnancy-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 medical 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) <<NOTE: Public information.>> 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 pregnancy-
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
information to identify pregnancy-associated
deaths and pregnancy-related deaths, including
deaths from pregnancy outcomes not identified
through clause (i)(I);
[[Page 132 STAT. 5050]]
``(B) <<NOTE: Recommenda- tions.>> 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
recommendations 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
identification and reporting of pregnancy-associated and
pregnancy-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) <<NOTE: Public information.>> publicly
identify the methods used to identify pregnancy-
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
subsequent 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) <<NOTE: Recommenda- tions.>> 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 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 Secretary, <<NOTE: Consultation.>> in
consultation with Indian tribes, shall identify and establish
appropriate mechanisms for Indian tribes and tribal
organizations to demonstrate, report data, and conduct the
activities as required for participation in the program
described in this subsection. Such mechanisms may include
technical assistance with respect to grant
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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, 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 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''.
Approved December 21, 2018.
LEGISLATIVE HISTORY--H.R. 1318:
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CONGRESSIONAL RECORD, Vol. 164 (2018):
Dec. 11, considered and passed House.
Dec. 13, considered and passed Senate.
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