Sec. 505. Preventing maternal deaths

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The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall establish a grant program under which the Secretary may make grants to States for the purpose of— carrying out the activities described in subsection (b)(1); establishing and sustaining a State maternal mortality review committee, in accordance with subsection (b)(2); ensuring that the State department of health carries out the activities described in subsection (b)(3); disseminating the case abstraction form developed under subsection (c); and providing for the public disclosure of information, in accordance with subsection (d).

The Secretary shall establish criteria for determining eligibility for, and the amount of a grant awarded to, a State under paragraph (1). Such criteria shall provide that in the case of a State that receives a grant under paragraph

(1)for a fiscal year and is determined by the Secretary to have not used such grant in accordance with this section, such State may not be eligible for such a grant for any subsequent fiscal year. With respect to a State that receives a grant under subsection (a)(1), the following shall apply: The State, through the State maternal mortality review committee established under subsection (a)(1), shall develop a process that provides for mandatory and confidential case reporting to the State department of health by individuals and entities described in clause

(ii)with respect to pregnancy-related and pregnancy-associated deaths. Individuals and entities described in this clause include each of the following: Health care professionals. Medical examiners. Medical coroners. Hospitals. Birth centers. Other health care facilities. Other individuals responsible for completing death records. Other appropriate individuals or entities specified by the Secretary. The State, through the State maternal mortality review committee established under subsection (a)(1), shall develop a process that provides for voluntary and confidential case reporting to the State department of health by family members of the deceased and other individuals on possible pregnancy-related and pregnancy-associated deaths. Such process shall include— 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 publicizing to local professional organizations, community organizations, and social services agencies the availability of the telephone number, Internet web link, and email address made available under clause (i). 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— matching each death record of a person in such year to a live birth certificate or an infant death record for the purpose of identifying deaths of persons that occurred during pregnancy and within one year after the end of a pregnancy; identifying each death of a person reported during such year as having an underlying or contributing cause of death related to pregnancy, regardless of the time that has passed between the end of the pregnancy and the death; collecting data from medical examiner and coroner reports; and using any other method the State may devise to identify maternal deaths such as reviewing a random sample of reported deaths of persons who could have been pregnant to ascertain cases of pregnancy-related and pregnancy-associated deaths that are not discernable from a review of death records alone. For purposes of effectively collecting and obtaining data on pregnancy-related and pregnancy-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 recommended checkbox section for pregnancy on each death record. Following the receipt of reports by the State department of health pursuant to subparagraph

(A)or

(B)and the collection of cases of pregnancy-related and pregnancy-associated deaths by the vital statistics unit of the State under subparagraph (C), the State, through the State maternal mortality review committee established under subsection (a)(1), shall investigate each case, using the case abstraction form described in subsection (c), and prepare a de-identified case summary for each case, which shall be reviewed by the committee and included in applicable reports. The State department of health or vital statistics unit of the State, as the case may be, shall provide the State maternal mortality review committee with access to the information collected pursuant to subparagraph

(A)or (B), or under subparagraph (C), as necessary to carry out this subparagraph. Each case investigation under this subparagraph shall, subject to availability, include data and information obtained through— medical examiner and autopsy reports of the person involved; medical records of the person, including such records related to health care prior to pregnancy, prenatal 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 person; oral and written interviews of individuals directly involved in the maternal care of the person during and immediately following the pregnancy of the person, including health care, mental health, and social service providers, as applicable; socioeconomic and other relevant background information about the person; any information collected under subparagraph (C)(i); and any other information on the cause of death of the person, such as social services and child welfare reports. Each case investigation under this subparagraph may include data and information obtained through oral or written interviews of the family of the person. A State maternal mortality review committee established under subsection (a)(1) shall carry out the following activities: Develop the processes described in subparagraphs

(A)and

(B)of paragraph (1). Review the data and information collected by the vital statistics unit of the State under paragraph (1)(C) regarding pregnancy-related and pregnancy-associated 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. Carry out the activities described in paragraph (1)(D). Develop recommendations, based on the case summaries prepared under paragraph (1)(D) and the data and information collected under paragraph (1)(C), to improve maternal care, social and health services, and public health policy and institutions, including improving access to maternal care and social and health services and identifying disparities in maternal care and outcomes. 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 paragraph (1)(D) directly to a health care facility or its local or State professional organization for the purpose of— instituting policy changes, educational activities, and improvements in the quality of care provided by the facility; and exploring and forming regional collaborations. A State maternal mortality review committee may investigate cases of severe maternal morbidity and any such investigation may include data and information obtained through— identified patient registries; or oral or written interviews of the person concerned and the family of such person. A State maternal mortality review committee established under subsection (a)(1) shall be multidisciplinary and diverse. Membership on the State maternal mortality review committee shall be reviewed annually by the State department of health to ensure that membership representation requirements are being fulfilled in accordance with this subparagraph. Each State maternal mortality review committee shall include— representatives from medical specialties providing care to pregnant and postpartum patients, including obstetricians (including generalists and maternal fetal medicine specialists) and family practice physicians; certified nurse midwives, certified midwives, and advanced practice nurses; hospital-based registered nurses; representatives of the maternal and child health department of the State department of health; social service providers or social workers, including those with experience working with communities diverse with respect to race, ethnicity, and limited-English proficiency; chief medical examiners or designees; facility representatives, such as from hospitals or birth centers; patient advocates, community maternal health organizations, and minority advocacy groups that represent those diverse racial and ethnic 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 representatives of the departments of health or public health of major cities in the State. Each State maternal mortality review committee may also include representatives from other relevant academic, health, social service, or policy professions or community organizations on an ongoing basis, or as needed, as determined beneficial by the committee, including— anesthesiologists; emergency physicians; pathologists; epidemiologists; intensivists; nutritionists; mental health professionals; substance use disorder treatment specialists; representatives of relevant patient and provider advocacy groups; academics; paramedics; and risk management specialists. Staff of each State maternal mortality review committee shall include— vital health statisticians, maternal child health statisticians, or epidemiologists; a coordinator of the State maternal mortality review committee, to be designated by the State; and administrative staff. 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 partnership, any requirement under this section 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. For purposes 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 committee 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 regulation), carrying out public health activities and purposes described in such section 164.512(b)(1)(i) (or any such successor regulation). With respect to a State that receives a grant under subsection (a)(1), the State department of health shall— in consultation with the State maternal mortality review committee and in conjunction with relevant professional organizations and patient 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 take steps to widely disseminate the findings and recommendations of the State maternal mortality review committee and implement the recommendations of the committee. The Director of the Centers for Disease Control and Prevention shall disseminate a uniform case abstraction form to States and State maternal mortality review committees for the purpose of— 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 preserving the uniformity of the information collected for Federal public health purposes. Each State may modify the form developed under paragraph

(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. For fiscal year 2019, 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 established under paragraph (2), of the information included in the report of the State under subsection (f)(1) for such year. The Secretary 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 recommendations for public review and research purposes by State departments of health, State maternal mortality review committees, health providers and institutions, and national patient and provider advocacy groups. In no case may any individually identifiable health information be provided to the public, or submitted to the information clearinghouse, under this subsection. All proceedings and activities 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 obtained, created, or maintained pursuant to this section, 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 Department, in connection with morbidity and mortality reviews under this section, shall be confidential and may not be subject to discovery, subpoena, or introduction into evidence in any civil, criminal, legislative, or other proceeding. Such records shall not be open to public inspection. Members of a State maternal mortality review committee established under subsection (a)(1) may not be questioned in any civil, criminal, legislative, or other proceeding regarding information presented in, or opinions formed as a result of, a meeting or communication of the committee. Nothing in this subsection may be construed to prevent a member of a State maternal mortality review committee established under subsection (a)(1) from testifying regarding information that was obtained independent of such member’s participation on the committee, or public information. Nothing in this subsection may prohibit a State maternal mortality review committee established under subsection (a)(1) or the Department of Health and Human Services from publishing statistical compilations and research reports that— are based on confidential information, relating to morbidity and mortality reviews under this section; and do not contain identifying information or any other information that could be used to ultimately identify the individuals concerned. Not later than one year after the end of fiscal year 2019, and each subsequent fiscal year, each State maternal mortality review 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 findings and recommendations of such committee and information on the implementation of such recommendations during such year. Not later than 60 days after the deadline for State reports under paragraph

(1)for fiscal year 2019, and each subsequent fiscal year, the Secretary of Health and Human Services shall submit to Congress a report on— the findings, recommendations, and implementation information submitted by any State pursuant to paragraph (1); and 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. In this section: The term pregnancy-associated death means the death of a person while pregnant or during the one-year period following the date of the end of pregnancy, irrespective of the cause of such death. The term pregnancy-related death means the death of a person while pregnant or during the one-year period following the date of the end of pregnancy, irrespective of the duration of the pregnancy, from any cause related to, or aggravated by, the pregnancy or its management, excluding any accidental or incidental cause. 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 person. The term State means each of the 50 States, the District of Columbia, and each of the territories. 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. There is authorized to be appropriated to carry out this section $7,000,000 for each of fiscal years 2019 through 2023.

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42 USC 300jj–19

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Sec. 505

Preventing maternal deaths

Cite42 USC 300jj–19

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