[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6165 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 6165
To amend the Public Health Service Act to improve data collection with
respect to maternal mortality and severe maternal morbidity, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 10, 2020
Ms. Davids of Kansas (for herself, Ms. Underwood, Ms. Adams, Mr. Clay,
Ms. Scanlon, Ms. Norton, Ms. Sewell of Alabama, Mr. Khanna, Ms. Moore,
Mr. Lawson of Florida, Ms. Pressley, and Ms. Haaland) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Natural Resources, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to improve data collection with
respect to maternal mortality and severe maternal morbidity, 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 ``Data to Save Moms Act of 2020''.
SEC. 2. FUNDING FOR MATERNAL MORTALITY REVIEW COMMITTEES TO PROMOTE
REPRESENTATIVE COMMUNITY ENGAGEMENT.
(a) In General.--Section 317K(d) of the Public Health Service Act
(42 U.S.C. 247b-12(d)) is amended by adding at the end the following:
``(9) Grants to promote representative community engagement
in maternal mortality review committees.--
``(A) In general.--The Secretary may, using funds
made available pursuant to subparagraph (C), provide
assistance to an applicable maternal mortality review
committee of a State, Indian tribe, tribal
organization, or urban Indian organization (as such
term is defined in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603))--
``(i) to select for inclusion in the
membership of such a committee community
members from the State, Indian tribe, tribal
organization, or urban Indian organization by--
``(I) prioritizing community
members who can increase the diversity
of the committee's membership with
respect to race and ethnicity,
location, and professional background,
including members with non-clinical
experiences; and
``(II) to the extent applicable,
using funds reserved under subsection
(f) to address barriers to maternal
mortality review committee
participation for community members,
including required training,
transportation barriers, compensation,
and other supports as may be necessary;
``(ii) to establish initiatives to conduct
outreach and community engagement efforts
within communities throughout the State or
Tribe to seek input from community members on
the work of such maternal mortality review
committee, with a particular focus on outreach
to minority women; and
``(iii) to release public reports
assessing--
``(I) the pregnancy-related death
and pregnancy-associated death review
processes of the maternal mortality
review committee, with a particular
focus on the maternal mortality review
committee's sensitivity to the unique
circumstances of minority women who
have suffered pregnancy-related deaths;
and
``(II) the impact of the use of
funds made available pursuant to
paragraph (C) on increasing the
diversity of the maternal mortality
review committee membership and
promoting community engagement efforts
throughout the State or Tribe.
``(B) Technical assistance.--The Secretary shall
provide (either directly through the Department of
Health and Human Services or by contract) technical
assistance to any maternal mortality review committee
receiving a grant under this paragraph on best
practices for increasing the diversity of the maternal
mortality review committee's membership and for
conducting effective community engagement throughout
the State or Tribe.
``(C) Authorization of appropriations.--In addition
to any funds made available under subsection (f), there
are authorized to be appropriated to carry out this
paragraph $10,000,000 for each of fiscal years 2021
through 2025.''.
(b) Reservation of Funds.--Section 317K(f) of the Public Health
Service Act (42 U.S.C. 247b-12(f)) is amended by adding at the end the
following: ``Of the amount made available under the preceding sentence
for a fiscal year, not less than $1,500,000 shall be reserved for
grants to Indian tribes, tribal organizations, or urban Indian
organizations (as such term is defined in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603))''.
SEC. 3. DATA COLLECTION AND REVIEW.
(a) In General.--Section 317K(d)(3)(A)(i) of the Public Health
Service Act (42 U.S.C. 247b-12(d)(3)(A)(i)) is amended--
(1) by redesignating subclauses (II) and (III) as
subclauses (V) and (VI), respectively; and
(2) by inserting after subclause (I) the following:
``(II) to the extent practicable,
reviewing cases of severe maternal
morbidity in which the patient received
a transfusion of four or more units of
blood and was admitted to an intensive
care unit;
``(III) to the extent practicable,
consulting with local community-based
organizations representing women from
demographic groups disproportionately
impacted by poor maternal health
outcomes to ensure that, in addition to
clinical factors, non-clinical factors
that might have contributed to a
pregnancy-related death are
appropriately considered;''.
(b) Severe Maternal Morbidity Defined.--Section 317K(e) of the
Public Health Service Act (42 U.S.C. 247b-12(e)) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(4) the term `severe maternal morbidity' means one or
more unexpected outcomes of labor and delivery that result in
significant short-term or long-term consequences to a woman's
health.''.
SEC. 4. TASK FORCE ON MATERNAL HEALTH DATA AND QUALITY MEASURES.
(a) Establishment.--Not later than 180 days after the date of
enactment of this Act, the Secretary of Health and Human Services shall
establish a task force to be known as the ``Task Force on Maternal
Health Data and Quality Measures'' (in this section referred to as the
``Task Force'').
(b) Duties of Task Force.--
(1) In general.--The Task Force shall use all available
relevant information, including information from State-level
sources, to prepare and submit a report containing the
following:
(A) An evaluation of current State and Tribal
practices for maternal health, maternal mortality, and
severe maternal morbidity data collection and
dissemination, including consideration of--
(i) the timeliness of processes for
amending a death certificate when new
information pertaining to the death becomes
available to reflect whether the death was a
pregnancy-related death;
(ii) maternal health data collected with
electronic health records, including data on
race and ethnicity;
(iii) the barriers preventing States from
correlating maternal outcome data with race and
ethnicity data;
(iv) processes for determining the cause of
a pregnancy-associated death in States that do
not have a maternal mortality review committee;
(v) whether maternal mortality review
committees include multidisciplinary and
diverse membership (as described in section
317K(d)(1)(A) of the Public Health Service Act
(42 U.S.C. 247b-12(d)(1)(A));
(vi) whether members of maternal mortality
review committees participate in trainings on
bias, racism, or discrimination, and the
quality of such trainings;
(vii) the extent to which States have
implemented systematic processes of listening
to the stories of pregnant and postpartum women
and their family members, with a particular
focus on minority women and their family
members, to fully understand the causes of, and
inform potential solutions to, the maternal
mortality and severe maternal morbidity crisis
within their respective States;
(viii) the consideration of social
determinants of health by maternal mortality
review committees when examining the causes of
pregnancy-associated and pregnancy-related
deaths;
(ix) the legal barriers preventing the
collation of State maternity care data;
(x) the effectiveness of data collection
and reporting processes in separating
pregnancy-associated deaths from pregnancy-
related deaths; and
(xi) the current Federal, State, local, and
Tribal funding support for the activities
referred to in clauses (i) through (x).
(B) An assessment of whether the funding referred
to in subparagraph (A)(xi) is adequate for States to
carry out optimal data collection and dissemination
processes with respect to maternal health, maternal
mortality, and severe maternal morbidity.
(C) An evaluation of current quality measures for
maternity care, including prenatal measures, labor and
delivery measures, and postpartum measures up to one
year postpartum. Such evaluation shall be conducted in
consultation with the National Quality Forum and shall
include consideration of--
(i) effective quality measures for
maternity care used by hospitals, health
systems, birth centers, health plans, and other
relevant entities;
(ii) the sufficiency of current outcome
measures used to evaluate maternity care for
testing and validating new maternal health care
payment and service delivery models;
(iii) quality measures for the childbirth
experiences of women that other countries
effectively use;
(iv) current maternity care quality
measures that may be eliminated because they
are not achieving their intended effect;
(v) barriers preventing maternity care
providers from implementing quality measures
that are aligned from best practices;
(vi) the frequency with which maternity
care quality measures are reviewed and revised;
(vii) the strengths and weaknesses of the
Prenatal and Postpartum Care measures of the
Health Plan Employer Data and Information Set
measures established by the National Committee
for Quality Assurance;
(viii) the strengths and weaknesses of
maternity care quality measures under the
Medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) and the
Children's Health Insurance Program under title
XXI of such Act (42 U.S.C. 1397 et seq.),
including the extent to which States
voluntarily report relevant measures;
(ix) the extent to which maternity care
quality measures are informed by patient
experiences that include subjective measures of
patient-reported experience of care;
(x) the current processes for collecting
stratified data on the race and ethnicity of
pregnant and postpartum women in hospitals,
health systems, and birth centers, and for
incorporating such racially and ethnically
stratified data in maternity care quality
measures;
(xi) the extent to which maternity care
quality measures account for the unique
experiences of minority women and their
families; and
(xii) the extent to which hospitals, health
systems, and birth centers are implementing
existing maternity care quality measures.
(D) Recommendations on authorizing additional funds
to improve maternal mortality review committees and
relevant maternal health initiatives by the agencies
and organizations within the Department of Health and
Human Services.
(E) Recommendations for new authorities that may be
granted to maternal mortality review committees to be
able to--
(i) access records from other Federal and
State agencies and departments that may be
necessary to identify causes of pregnancy-
associated deaths that are unique to women from
specific populations, such as women veterans
and women who are incarcerated; and
(ii) work with relevant experts who are not
members of the maternal mortality review
committee to assist in the review of pregnancy-
associated deaths of women from specific
populations, such as women veterans and women
who are incarcerated.
(F) Recommendations to improve current quality
measures for maternity care, including recommendations
on updating the Pregnancy & Delivery Care measures on
the Hospital Compare website of the Centers for
Medicare & Medicaid Services or any successor website,
with a particular focus on racial and ethnic
disparities in maternal health outcomes.
(G) Recommendations to improve the coordination by
the Department of Health and Human Services of the
efforts undertaken by the agencies and organizations
within the Department related to maternal health data
and quality measures.
(2) Public comment.--Not later than 60 days after the date
on which a majority of the members of the Task Force have been
appointed, the Task Force shall publish in the Federal Register
a notice for public comment period of 90 days, beginning on the
date of publication, on the duties and activities of the Task
Force.
(c) Membership.--
(1) In general.--The Task Force shall be composed of 18
members appointed by the Secretary of Health and Human
Services. The Secretary shall give special consideration to
individuals who are representative of populations most affected
by maternal mortality and severe maternal morbidity.
(2) Member criteria.--To be eligible to be appointed as a
member of the Task Force, an individual shall be--
(A) a woman who has experienced severe maternal
morbidity;
(B) a family member of a woman who had a pregnancy-
related death;
(C) an individual who provides non-clinical support
to women from pregnancy through the postpartum period,
such as a doula, community health worker, peer
supporter, certified lactation consultant, nutritionist
or dietitian, social worker, home visitor, or a patient
navigator;
(D) a leader of a community-based organization that
addresses adverse maternal health outcomes with a
specific focus on racial and ethnic disparities;
(E) an academic researcher in a field or policy
area related to the duties of the Task Force;
(F) a maternal health care provider;
(G) an elected or duly appointed leader from an
Indian Tribe;
(H) an expert in a field or policy area related to
the duties of the Task Force; or
(I) an individual who has experience with Federal
or State government programs related to the duties of
the Task Force.
(3) Appointment timing.--Appointments to the Task Force
shall be made not later than 180 days after the date of
enactment of this Act.
(4) Duration.--Each member shall be appointed for the life
of the Task Force.
(5) Co-chair selection.--Not later than 30 days after the
date on which a majority of the members of the Task Force have
been appointed, the Secretary shall select 2 of the members of
the Task Force to serve as co-chairs of the Task Force.
(6) Vacancies.--
(A) In general.--A vacancy in the Task Force--
(i) shall not affect the powers of the Task
Force; and
(ii) shall be filled in the same manner as
the original appointment.
(B) Co-chair vacancy.--In the event of a vacancy of
a co-chair of the Task Force, a replacement co-chair
shall be selected in the same manner as the original
selection.
(7) Compensation.--Except as provided in paragraph (8),
members of the Task Force shall serve without pay.
(8) Travel expenses.--Members of the Task Force shall be
allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of service for the Task Force.
(d) Meetings.--
(1) In general.--The Task Force shall meet at the call of
the co-chairs of the Task Force.
(2) Quorum.--A majority of the members of the Task Force
shall constitute a quorum.
(3) Initial meeting.--The Task Force shall meet not later
than 60 days after the date on which a majority of the members
of the Task Force have been appointed.
(e) Staff of Task Force.--
(1) Additional staff.--The co-chairs of the Task Force may
appoint and fix the pay of additional staff to the Task Force
as the co-chairs consider appropriate.
(2) Applicability of certain civil service laws.--The staff
of the Task Force may be appointed without regard to the
provisions of title 5, United States Code, governing
appointments in the competitive service, and may be paid
without regard to the provisions of chapter 51 and subchapter
III of chapter 53 of that title relating to classification and
General Schedule pay rates.
(3) Detailees.--Any Federal Government employee may be
detailed to the Task Force without reimbursement from the Task
Force, and the detailee shall retain the rights, status, and
privileges of his or her regular employment without
interruption.
(f) Powers of Task Force.--
(1) Testimony and evidence.--The Task Force may take such
testimony and receive such evidence as the Task Force considers
advisable to carry out this section.
(2) Obtaining official data.--The Task Force may secure
directly from any Federal department or agency information
necessary to carry out its duties under this section. On
request of the co-chairs of the Task Force, the head of that
department or agency shall furnish such information to the Task
Force.
(3) Postal services.--The Task Force may use the United
States mails in the same manner and under the same conditions
as other Federal departments and agencies.
(g) Report.--Not later than 2 years after the date on which the
initial 18 members of the Task Force are appointed under subsection
(c)(1), the Task Force shall submit to the Committee on Energy and
Commerce, the Committee on Education and Labor, and the Committee on
Ways and Means of the House of Representatives and the Committee on
Finance and the Committee on Health, Education, Labor and Pensions of
the Senate, and make publicly available, a report that--
(1) contains the information, evaluations, and
recommendations described in subsection (b); and
(2) is signed by more than half of the members of the Task
Force.
(h) Termination.--Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Task Force.
(i) Definitions.--In this section:
(1) Maternal health care provider.--The term ``maternal
health care provider'' means an individual who is an
obstetrician-gynecologist, family physician, midwife who meets
at a minimum the international definition of the midwife and
global standards for midwifery education as established by the
International Confederation of Midwives, nurse practitioner, or
clinical nurse specialist.
(2) Maternal mortality.--The term ``maternal mortality''
means deaths occurring during, or within 12 months after,
pregnancy from complications of pregnancy or childbirth.
(3) Maternal mortality review committee.--The term
``maternal mortality review committee'' means a maternal
mortality review committee duly authorized by a State and
receiving funding under section 317k(a)(2)(D) of the Public
Health Service Act (42 U.S.C. 247b-12(a)(2)(D)).
(4) Pregnancy-associated death.--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.
(5) Pregnancy-related death.--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.
(6) Severe maternal morbidity.--The term ``severe maternal
morbidity'' means unexpected outcomes of labor and delivery
resulting in significant short-term or long-term consequences
to the health of a woman.
(j) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section
for fiscal years 2021 through 2024.
SEC. 5. INDIAN HEALTH SERVICE STUDY ON MATERNAL MORTALITY.
(a) In General.--The Director of the Indian Health Service
(referred to in this section as the ``Director'') shall, in
coordination with entities described in subsection (b)--
(1) not later than 90 days after the enactment of this Act,
enter into a contract with an independent research organization
or Tribal Epidemiology Center to conduct a comprehensive study
on maternal mortality and severe maternal morbidity in the
populations of American Indian and Alaska Native women; and
(2) not later than 3 years after the date of the enactment
of this Act, submit to Congress a report on such study that
contains recommendations for policies and practices that can be
adopted to improve maternal health outcomes for such women.
(b) Participating Entities.--The entities described in this
subsection shall consist of 12 members, selected by the Director from
among individuals nominated by Indian tribes and tribal organizations
(as such terms are defined in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 5304)), and urban
Indian organizations (as such term is defined in section 4 of the
Indian Health Care Improvement Act (25 U.S.C. 1603)). In selecting such
members, the Director shall ensure that each of the 12 service areas of
the Indian Health Service is represented.
(c) Contents of Study.--The study conducted pursuant to subsection
(a) shall--
(1) examine the causes of maternal mortality and severe
maternal morbidity that are unique to American Indian and
Alaska Native women;
(2) include a systematic process of listening to the
stories of American Indian and Alaska Native women to fully
understand the causes of, and inform potential solutions to,
the maternal mortality and severe maternal morbidity crisis
within their respective communities;
(3) distinguish between the causes of, landscape of
maternity care at, and recommendations to improve maternal
health outcomes within, the different settings in which
American Indian and Alaska Native women receive maternity care,
such as--
(A) facilities operated by the Indian Health
Service;
(B) an Indian health program operated by an Indian
tribe or tribal organization pursuant to a contract,
grant, cooperative agreement, or compact with the
Indian Health Service pursuant to the Indian Self-
Determination Act; and
(C) an urban Indian health program operated by an
urban Indian organization pursuant to a grant or
contract with the Indian Health Service pursuant to
title V of the Indian Health Care Improvement Act;
(4) review processes for coordinating programs of the
Indian Health Service with social services provided through
other programs administered by the Secretary of Health and
Human Services (other than the Medicare program under title
XVIII of the Social Security Act, the Medicaid program under
title XIX of such Act, and the Children's Health Insurance
Program under title XXI of such Act), including coordination
with the efforts of the Task Force established under section 3;
(5) review current data collection and quality measurement
processes and practices;
(6) consider social determinants of health, including
poverty, lack of health insurance, unemployment, sexual
violence, and environmental conditions in Tribal areas;
(7) consider the role that historical mistreatment of
American Indian and Alaska Native women has played in causing
currently high rates of maternal mortality and severe maternal
morbidity;
(8) consider how current funding of the Indian Health
Service affects the ability of the Service to deliver quality
maternity care;
(9) consider the extent to which the delivery of maternity
care services is culturally appropriate for American Indian and
Alaska Native women;
(10) make recommendations to reduce misclassification of
American Indian and Alaska Native women, including
consideration of best practices in training for maternal
mortality review committee members to be able to correctly
classify American Indian and Alaska Native women; and
(11) make recommendations informed by the stories shared by
American Indian and Alaska Native women in paragraph (2) to
improve maternal health outcomes for such women.
(d) Report.--The agreement entered into under subsection (a) with
an independent research organization or Tribal Epidemiology Center
shall require that the organization or center transmit to Congress a
report on the results of the study conducted pursuant to that agreement
not later than 36 months after the date of the enactment of this Act.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2021 through 2023.
SEC. 6. GRANTS TO MINORITY-SERVING INSTITUTIONS TO STUDY MATERNAL
MORTALITY, SEVERE MATERNAL MORBIDITY, AND OTHER ADVERSE
MATERNAL HEALTH OUTCOMES.
(a) In General.--The Secretary of Health and Human Services shall
establish a program under which the Secretary shall award grants to
research centers and other entities at minority-serving institutions to
study specific aspects of the maternal health crisis among minority
women. Such research may--
(1) include the development and implementation of
systematic processes of listening to the stories of minority
women to fully understand the causes of, and inform potential
solutions to, the maternal mortality and severe maternal
morbidity crisis within their respective communities; and
(2) assess the potential causes of low rates of maternal
mortality among Hispanic women, including potential racial
misclassification and other data collection and reporting
issues that might be misrepresenting maternal mortality rates
among Hispanic women in the United States.
(b) Application.--To be eligible to receive a grant under
subsection (a), an entity described in such subsection shall submit to
the Secretary an application at such time, in such manner, and
containing such information as the Secretary may require.
(c) Technical Assistance.--The Secretary may use not more than 10
percent of the funds made available under subsection (f)--
(1) to conduct outreach to Minority-Serving Institutions to
raise awareness of the availability of grants under this
subsection (a);
(2) to provide technical assistance in the application
process for such a grant; and
(3) to promote capacity building as needed to enable
entities described in such subsection to submit such an
application.
(d) Reporting Requirement.--Each entity awarded a grant under this
section shall periodically submit to the Secretary a report on the
status of activities conducted using the grant.
(e) Evaluation.--Beginning one year after the date on which the
first grant is awarded under this section, the Secretary shall submit
to Congress an annual report summarizing the findings of research
conducted using funds made available under this section.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $10,000,000 for each of fiscal
years 2021 through 2025.
(g) Minority-Serving Institutions Defined.--In this section, the
term ``minority-serving institution'' has the meaning given the term in
section 371(a) of the Higher Education Act of 1965 (20 U.S.C.
1067q(a)).
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