Preventing Maternal Deaths Act

H. R. 1318

One Hundred Fifteenth Congress
of the
United States of America
AT T H E S E C O N D S E S S I O N
Begun and held at the City of Washington on Wednesday,
the third day of January, two thousand and eighteen

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.

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
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) 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 pregnancyrelated deaths that occur during, or within 1 year following,
pregnancy.’’; and
(ii) by inserting after subparagraph (C) the following:
‘‘(D) 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) 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

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‘‘(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 pregnancyrelated 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) 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 pregnancyrelated 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);

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‘‘(B) 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) 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) 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, 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’’.

Speaker of the House of Representatives.

Vice President of the United States and
President of the Senate.