,i #aacth ,,congress #b;d ,session ,h4 ,r4 #dbaf ,,in ,,the ,,house ,,of ,,representatives ,march #ab1 #bjad ,mr4 ,conyers 7for himself and ,ms4 ,de,gette7 introduced the following bill2 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 ,states2 to develop definitions of severe maternal morbidity and data collection protocols2 and to eliminate disparities in maternal health outcomes4 #a4 ,short title ,this ,act may be cited as the ,maternal ,health ,accountability ,act of #bjad4 #b4 ,findings2 purposes 7a7 ,findings ,congress finds the following3 7#a7 ,the aggregate pregnancy-related mortality ratio in the ,united ,states as measured by the ,centers for ,disease ,control and ,prevention ,pregnancy ,mortality ,surveillance ,system was #ad4e for the #h-year period #aiih through #bjje1 higher than any other period in the previous #bj years4 ,although this increase may reflect changes in data collection methods by the ,states1 this reported increase1 along with no improvement in previous years remains a source of great concern for the ,centers for ,disease ,control and ,prevention1 and registered nurses1 health care providers1 and patient advocates such as the ,joint ,commission1 the ,american ,college of ,obstetricians and ,gynecologists1 and ,amnesty ,international4 7#b7 ,the ,centers for ,disease ,control and ,prevention has found that maternal deaths should be investigated through ,state-based maternal death reviews and maternal quality collaboratives1 as these entities are well-situated to identify deaths1 review the factors associated with them1 and take action with the findings in order to institute the systemic changes needed to decrease pregnancy-related and pregnancy-associated mortality4 7#c7 ,women of color and low-income women face added risks in terms of death1 complications1 and access to quality health care4 ,african-,american women are three to four times more likely to die of pregnancy-related complications than ,white women4 ,in #bjjf the ,centers for ,disease ,control and ,prevention reported that the maternal mortality ratio for non-,hispanic ,white women was #i4a deaths per #ajj1jjj births compared with #cd4h deaths per #ajj1jjj births for non-,hispanic ,black women4 ,these rates and disparities have not improved in more than #bj years4 7#d7 ,healthy ,people #bjaj1 a comprehensive1 nationwide health promotion and disease prevention agenda launched by the ,department of ,health and ,human ,services1 set a target goal of reducing maternal mortality in the ,united ,states to #d4c deaths per #ajj1jjj live births by #bjaj4 ,in #bjjg1 the national maternal mortality ratio was #ab4g deaths per #ajj1jjj live births4 7#e7 ,severe complications that result in women nearly dying1 known as a near miss or severe maternal morbidity has increased by #ge percent for delivery 7based on data comparing #aiih through #aiii7 and #aad percent for postpartum hospitalizations 7based on data comparing #bjjh through #bjji74 ,such data also estimates that severe morbidity affects #eb1jjj women a year and is expected to continue to increase4 ,moreover1 there is no scientific consensus on uniform definitions of severe maternal morbidity and best practices for data collection1 making it difficult to measure the full extent of severe morbidity and developing evidence-based interventions4 7b7 ,purposes ,the purposes of this ,act are the following3 7#a7 ,to establish governmental accountability and a shared responsibility between ,states and the ,federal ,government to identify opportunities for improvement in quality of care and system changes1 and to educate and inform health institutions and professionals1 women1 and families about preventing pregnancy-related deaths and complications and reducing disparities4 7#b7 ,to develop a model for ,states to operate maternal mortality reviews and assess the various factors that may have contributed to maternal mortality1 including quality of care1 racial disparities1 and systemic problems in the delivery of health care1 and to develop appropriate interventions to reduce and prevent such deaths4 #c4 ,uniform ,state maternal mortality review committees on pregnancy-related deaths 7a7 ,condition of receipt of payments from allotment under ,maternal and ,child ,health ,service ,block ,grant ,title ,v of the ,social ,security ,act 7#db ,u4,s4,c4 #gja et seq47 is amended by adding at the end the following new section3 #ead4 ,uniform ,state maternal mortality review committees on pregnancy-related deaths 7a7 ,grants 7#a7 ,in general ,notwithstanding any other provision of this title1 for each of fiscal years #bjae through #bjba1 in addition to payments from allotments for ,states under section #ejb for such year1 the ,secretary shall1 subject to paragraph 7#c7 and in accordance with the criteria established under paragraph 7#b71 award grants to ,states to-- 7,a7 carry out the activities described in subsection 7b77#a72 7,b7 establish a ,state maternal mortality review committee1 in accordance with subsection 7b77#b71 to carry out the activities described in subsection 7b77#b77;,a71 and to establish the processes described in subsection 7b77#a72 7,c7 ensure the ,state department of health carries out the applicable activities described in subsection 7b77#c71 with respect to pregnancy-related deaths occurring within the ,state during such fiscal year2 7,d7 implement and use the comprehensive case abstraction form developed under subsection 7c71 in accordance with such subsection2 7,e7 provide for public disclosure of information1 in accordance with subsection 7e72 and 7,f7 collect1 analyze1 and report to the ,secretary cases of maternal morbidity1 including reports of maternal morbidity data on admissions to an intensive care unit or the transfusion of more than three units of blood products4 7#b7 ,criteria ,the ,secretary shall establish criteria for determining eligibility for and the amount of a grant awarded to a ,state under paragraph 7#a74 ,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 used such grant in accordance with this section1 such ,state shall not be eligible for such a grant for any subsequent fiscal year4 7#c7 ,authorization of appropriations ,for purposes of carrying out the grant program under this section1 including for administrative purposes1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjae through #bjba4 7b7 ,pregnancy-,related death review 7#a7 ,review of pregnancy-related death and pregnancy-associated death cases ,for purposes of subsection 7a71 with respect to a ,state that receives a grant under subsection 7a71 the following shall apply3 7,a7 ,mandatory reporting of pregnancy-related deaths 7i7 ,in general ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process1 separate from any reporting process established by the ,state department of health prior to the date of the enactment of this section1 that provides for mandatory and confidential case reporting by individuals and entities described in clause 7ii7 of pregnancy-related deaths to the ,state department of health4 7ii7 ,individuals and ,entities described ,individuals and entities described in this clause include each of the following3 7,i7 ,health care providers4 7,,ii7 ,medical examiners4 7,,iii7 ,medical coroners4 7,,iv7 ,hospitals4 7,v7 ,free-standing birth centers4 7,,vi7 ,other health care facilities4 7,,vii7 ,any other individuals responsible for completing death certificates4 7,,viii7 ,any other appropriate individuals or entities specified by the ,secretary4 7,b7 ,voluntary reporting of pregnancy-related and pregnancy-associated deaths 7i7 ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process for and encourage1 separate from any reporting process established by the ,state department of health prior to the date of the enactment of this section1 voluntary and confidential case reporting by individuals described in clause 7ii7 of pregnancy-associated deaths to the ,state department of health4 7ii7 ,the ,state shall1 through the ,state maternal mortality review committee1 develop a process for voluntary and confidential reporting by family members of the deceased and by other individuals on possible pregnancy-related and pregnancy-associated deaths to the ,state department of health4 ,such process shall include-- 7,i7 making publicly available on the ,internet ,web site of the ,state department of health a telephone number1 ,internet ,web link1 and email address for such reporting2 and 7,,ii7 publicizing to local professional organizations1 community organizations1 and social services agencies the availability of the telephone number1 ,internet ,web link1 and email address made available under subclause 7,i74 7,c7 ,development of case-finding ,the ,state1 through the vital statistics unit of the ,state1 shall annually identify pregnancy-related and pregnancy-associated deaths occurring in such ,state during the year involved by-- 7i7 matching all death records1 with respect to such year1 for women of childbearing age to live birth certificates and infant death certificates to identify deaths of women that occurred during pregnancy and within one year after the end of a pregnancy2 7ii7 identifying deaths reported during such year as having an underlying or contributing cause of death related to pregnancy1 regardless of the time that has passed between the end of the pregnancy and the death2 7iii7 collecting data from medical examiner and coroner reports2 and 7iv7 any other methods the ,states may devise to identify maternal deaths1 such as through review of a random sample of reported deaths of women of childbearing age to ascertain cases of pregnancy-related and pregnancy-associated deaths that are not discernable from a review of death certificates alone4 ,when feasible and for purposes of effectively collecting and obtaining data on pregnancy-related and pregnancy-associated deaths1 the ,state shall adopt the most recent standardized birth and death certificates1 as issued by the ,national ,center for ,vital ,health ,statistics1 including the recommended checkbox section for pregnancy on the death certificates4 7,d7 ,case investigation and development of case summaries ,following receipt of reports by the ,state department of health pursuant to subparagraph 7,a7 or 7,b7 and collection by the vital statistics unit of the ,state of possible cases of pregnancy-related and pregnancy-associated deaths pursuant to subparagraph 7,c71 the ,state1 through the ,state maternal mortality review committee established under subsection 7a71 shall investigate each case1 utilizing the case abstraction form described in subsection 7c71 and prepare de-identified case summaries1 which shall be reviewed by the committee and included in applicable reports4 ,for purposes of subsection 7a71 under the processes established under subparagraphs 7,a71 7,b71 and 7,c71 a ,state department of health or vital statistics unit of a ,state shall provide to the ,state maternal mortality review committee access to information collected pursuant to such subparagraphs as necessary to carry out this subparagraph4 ,data and information collected for the case summary and review are for purposes of public health activities1 in accordance with ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act74 ,such case investigations shall include data and information obtained through-- 7i7 medical examiner and autopsy reports of the woman involved2 7ii7 medical records of the woman1 including such records related to health care prior to pregnancy1 prenatal and postnatal care1 labor and delivery care1 emergency room care1 hospital discharge records1 and any care delivered up until the time of death of the woman for purposes of public health activities1 in accordance with ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act72 7iii7 oral and written interviews of individuals directly involved in the maternal care of the woman during and immediately following the pregnancy of the woman1 including health care1 mental health1 and social service providers1 as applicable2 7iv7 optional oral or written interviews of the family of the woman2 7v7 socioeconomic and other relevant background information about the woman2 7vi7 information collected in subparagraph 7,c77i72 and 7vii7 other information on the cause of death of the woman1 such as social services and child welfare reports4 7#b7 ,state maternal mortality review committees 7,a7 ,duties 7i7 ,required committee activities ,for purposes of subsection 7a71 a maternal mortality review committee established by a ,state pursuant to a grant under such subsection shall carry out the following pregnancy-related death and pregnancy-associated death review activities and shall include all information relevant to the death involved on the case abstraction form developed under subsection 7d73 7,i7 ,with respect to a case of pregnancy-related or pregnancy-associated death of a woman1 review the case summaries prepared under subparagraphs 7,a71 7,b71 7,c71 and 7,d7 of paragraph 7#a74 7,,ii7 ,review aggregate statistical reports developed by the vital statistics unit of the ,state under paragraph 7#a77;,c7 regarding pregnancy-related and pregnancy-associated deaths to identify trends1 patterns1 and disparities in adverse outcomes and address medical1 non-medical1 and system-related factors that may have contributed to such pregnancy-related and pregnancy-associated deaths and disparities4 7,,iii7 ,develop recommendations1 based on the review of the case summaries under paragraph 7#a77;,d7 and aggregate statistical reports under subclause 7,,ii71 to improve maternal care1 social and health services1 and public health policy and institutions1 including with respect to improving access to maternal care1 improving the availability of social services1 and eliminating disparities in maternal care and outcomes4 7ii7 ,optional committee activities ,for purposes of subsection 7a71 a maternal mortality review committee established by a ,state under such subsection may present findings and recommendations regarding a specific case or set of circumstances directly to a health care facility or its local or ,state professional organization for the purpose of instituting policy changes1 educational activities1 or otherwise improving the quality of care provided by the facilities4 7,b7 ,composition of maternal mortality review committees 7i7 ,in ,general ,each ,state maternal mortality review committee established pursuant to a grant under subsection 7a7 shall be multi-disciplinary1 consisting of health care and social service providers1 public health officials1 other persons with professional expertise on maternal health and mortality1 and patient and community advocates who represent those communities within such ,state that are the most affected by maternal mortality4 ,membership on such a committee of a ,state shall be reviewed annually by the ,state department of health to ensure that membership representation requirements are being fulfilled in accordance with this paragraph4 7ii7 ,required membership ,each such review committee shall include-- 7,i7 representatives from medical specialities providing care to pregnant and postpartum patients1 including obstetricians 7including generalists and maternal fetal medicine specialists71 and family practice physicians2 7,,ii7 certified nurse midwives1 certified midwives1 and advanced practice nurses2 7,,iii7 hospital-based registered nurses2 7,,iv7 representatives of the ,state department of health maternal and child health department2 7,v7 social service providers or social workers2 7,,vi7 the chief medical examiners or designees2 7,,vii7 facility representatives1 such as from hospitals or free-standing birth centers2 and 7,,viii7 community or patient advocates who represent those communities within the ,state that are the most affected by maternal mortality4 7iii7 ,additional members ,each such review committee may also include representatives from other relevant academic1 health1 social service1 or policy professions1 or community organizations1 on an ongoing basis1 or as needed1 as determined beneficial by the review committee1 including-- 7,i7 anesthesiologists2 7,,ii7 emergency physicians2 7,,iii7 pathologists2 7,,iv7 epidemiologists or biostatisticians2 7,v7 intensivists2 7,,vi7 vital statistics officers2 7,,vii7 nutritionists2 7,,viii7 mental health professionals2 7,,ix7 substance abuse treatment specialists2 7,x7 representatives of relevant advocacy groups2 7,,xi7 academics2 7,,xii7 representatives of beneficiaries of the ,state plan under the ,medicaid program under title ,,xix2 7,,xiii7 paramedics2 7,,xiv7 lawyers2 7,,xv7 risk management specialists2 7,,xvi7 representatives of the departments of health or public health of major cities in the ,state involved2 and 7,,xvii7 policy makers4 7iv7 ,diverse community membership ,the composition of such a committee1 with respect to a ,state1 shall include-- 7,i7 representatives from diverse communities1 particularly those communities within such ,state most severely affected by pregnancy-related deaths or pregnancy-associated deaths and by a lack of access to relevant maternal care services1 from community maternal child health organizations1 and from minority advocacy groups2 7,,ii7 members1 including health care providers1 from different geographic regions in the ,state1 including any rural1 urban1 and tribal areas2 and 7,,iii7 health care and social service providers who work in communities that are diverse with regard to race1 ethnicity1 immigration status1 ,indigenous status1 and ,english proficiency4 7v7 ,maternal mortality review staff ,staff of each such review committee shall include-- 7,i7 vital health statisticians1 maternal child health statisticians1 or epidemiologists2 7,,ii7 a coordinator of the ,state maternal mortality review committee1 to be designated by the ,state2 and 7,,iii7 administrative staff4 7,c7 ,option for ,states to form regional maternal mortality reviews ,states with a low rate of occurrence of pregnancy-associated or pregnancy-related deaths may choose to partner with one or more neighboring ,states to fulfill the activities described in paragraph 7#a77;,c74 ,in such a case1 with respect to ,states in such a partnership1 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 partnership4 7#c7 ,state ,department of ,health ,activities ,for purposes of subsection 7a71 a ,state department of health of a ,state receiving a grant under such subsection shall-- 7,a7 in consultation with the maternal mortality review committee of the ,state and in conjunction with relevant professional organizations1 develop a plan for ongoing health care provider education1 based on the findings and recommendations of the committee1 in order to improve the quality of maternal care2 and 7,b7 take steps to widely disseminate the findings and recommendations of the ,state maternal mortality review committees of the ,state and to implement the recommendations of such committee4 7c7 ,case abstraction form 7#a7 ,development ,the ,director of the ,centers for ,disease ,control and ,prevention shall develop a uniform1 comprehensive case abstraction form and make such form available to ,states for ,state maternal mortality review committees for use by such committees in order to-- 7,a7 ensure that the cases and information collected and reviewed by such committees can be pooled for review by the ,department of ,health and ,human ,services and its agencies2 and 7,b7 preserve the uniformity of the information and its use for ,federal public health purposes4 7#b7 ,permissible ,state modification ,each ,state may modify the form developed under paragraph 7#a7 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 collected1 but may not alter the standard questions on such form1 in order to ensure that the information can be collected and reviewed centrally at the ,federal level4 7d7 ,treatment as public health authority for purposes of ,,hipaa ,for purposes of applying ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act71 a ,state maternal mortality review committee of a ,state established pursuant to this section to carry out activities described in subsection 7b77#b77;,a7 shall be deemed to be a public health authority described in section #afd4eja 7and referenced in section #afd4eab7;b77#a77;i77 of title #de1 ,code of ,federal ,regulations 7or any successor regulation71 carrying out public health activities and purposes described in such section #afd4eab7;b77#a77;i7 7or any such successor regulation74 7e7 ,public disclosure of information 7#a7 ,in general ,for fiscal year #bjae or a subsequent fiscal year1 each ,state receiving a grant under this section for such year shall1 subject to paragraph 7#c71 provide for the public disclosure1 and submission to the information clearinghouse established under paragraph 7#b71 of the information included in the report of the ,state under section #ejf7;a77#b77;,f7 for such year 7relating to the findings for such year of the ,state maternal mortality review committee established by the ,state under this section74 7#b7 ,information clearinghouse ,the ,secretary of ,health and ,human ,services shall establish an information clearinghouse1 that shall be administered by the ,director of the ,centers for ,disease ,control and ,prevention1 that will maintain findings and recommendations submitted pursuant to paragraph 7#a7 and provide such findings and recommendations for public review and research purposes by ,state health departments1 maternal mortality review committees1 and health providers and institutions4 7#c7 ,confidentiality of information ,in no case shall any individually identifiable health information be provided to the public1 or submitted to the information clearinghouse1 under paragraph 7#a74 7f7 ,confidentiality of review committee proceedings 7#a7 ,in general ,all proceedings and activities of a ,state maternal mortality review committee under this section1 opinions of members of such a committee formed as a result of such proceedings and activities1 and records obtained1 created1 or maintained pursuant to this section1 including records of interviews1 written reports1 and statements procured by the ,department of ,health and ,human ,services or by any other person1 agency1 or organization acting jointly with the ,department1 in connection with morbidity and mortality reviews under this section1 shall be confidential1 and not subject to discovery1 subpoena1 or introduction into evidence in any civil1 criminal1 legislative1 or other proceeding4 ,such records shall not be open to public inspection4 7#b7 ,testimony of members of committee 7,a7 ,in general ,members of a ,state maternal mortality review committee under this section may not be questioned in any civil1 criminal1 legislative1 or other proceeding regarding information presented in1 or opinions formed as a result of1 a meeting or communication of the committee4 7,b7 ,clarification ,nothing in this subsection shall be construed to prevent a member of such a committee from testifying regarding information that was obtained independent of such member's participation on the committee1 or that is public information4 7#c7 ,availability of information for research purposes ,nothing in this subsection shall prohibit the publishing by such a committee or the ,department of ,health and ,human ,services of statistical compilations and research reports that-- 7,a7 are based on confidential information1 relating to morbidity and mortality review2 and 7,b7 do not contain identifying information or any other information that could be used to ultimately identify the individuals concerned4 7g7 ,definitions ,for purposes of this section3 7#a7 ,the term pregnancy-associated death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy1 irrespective of the cause of such death4 7#b7 ,the term pregnancy-related death means the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy1 irrespective of the duration or site of the pregnancy1 from any cause related to or aggravated by the pregnancy or its management1 but not from any accidental or incidental cause4 7#c7 ,the term woman of childbearing age means a woman who is at least #aj years of age and not more than #ed years of age4 4 7b7 ,inclusion of findings of review committees in required reports 7#a7 ,state triennial reports ,paragraph 7#b7 of section #ejf7;a7 of such ,act 7#db ,u4,s4,c4 #gjf7;a77 is amended by inserting after subparagraph 7,e7 the following new subparagraph3 7,f7 ,in the case of a ,state receiving a grant under section #ead1 beginning for the first fiscal year beginning after #c years after the date of establishment of the ,state maternal mortality review committee established by the ,state pursuant to such grant and once every #c years thereafter1 information containing the findings and recommendations of such committee and information on the implementation of such recommendations during the period involved4 4 7#b7 ,annual reports to ,congress ,paragraph 7#c7 of such section is amended-- 7,a7 in subparagraph 7,d71 at the end1 by striking and2 7,b7 in subparagraph 7,e71 at the end1 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 ,for fiscal year #bjae and each subsequent fiscal year1 taking into account the findings1 recommendations1 and implementation information submitted by ,states pursuant to paragraph 7#b77;,f71 on the status of pregnancy-related deaths and pregnancy-associated deaths in the ,united ,states and including recommendations on methods to prevent such deaths in the ,united ,states4 4 #d4 ,,nih workshop and research plan development on severe maternal morbidity 7a7 ,workshop ,the ,secretary of ,health and ,human ,services1 acting through the ,director of ,,nih and in consultation with the ,administrator of the ,health ,resources and ,services ,administration1 the ,director of the ,centers for ,disease ,control and ,prevention1 the heads of other ,federal agencies that administer ,federal health programs1 and relevant national professional organizations dealing with maternal morbidity1 shall organize a national workshop to identify definitions for severe maternal morbidity and make recommendations for a research plan to identify and monitor severe maternal morbidity in the ,united ,states4 7b7 ,research plan and data collection protocols ,the ,secretary1 taking into account the findings of the workshop under paragraph 7#a71 shall develop uniform definitions of severe maternal morbidity1 a research plan on severe maternal morbidity1 and possible data collection protocols to assist ,states in identifying and monitoring cases of severe maternal morbidity and to develop recommendations on addressing such cases4 7c7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report concerning the definitions and research plan developed under this section4 7d7 ,authorization of appropriations ,there is authorized to be appropriated for fiscal year #bjae-- 7#a7 #ej1jjj to carry out subsection 7a72 and 7#b7 #ajj1jjj to carry out subsection 7b74 #e4 ,eliminating disparities in maternity health outcomes ,part ,b of title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #cag,t of such ,act 7#db ,u4,s4,c4 #bdg;b-#bb7 the following new section3 #cag,u4 ,eliminating disparities in maternity health outcomes 7a7 ,in general ,the ,secretary shall1 in consultation with relevant national stakeholder organizations1 such as national medical specialty organizations1 national maternal child health organizations1 and national health disparity organizations1 carry out the following activities to eliminate disparities in maternal health outcomes3 7#a7 ,conduct research into the determinants and the distribution of disparities in maternal care1 health risks1 and health outcomes1 and improve the capacity of the performance measurement infrastructure to measure such disparities4 7#b7 ,expand access to services that have been demonstrated to improve the quality and outcomes of maternity care for vulnerable populations4 7#c7 ,establish a demonstration project to compare the effectiveness of interventions to reduce disparities in maternity services and outcomes1 and implement and assessing effective interventions4 7b7 ,scope and selection of ,states for demonstration project ,the demonstration project under subsection 7a77#c7 shall be conducted in no more than #h ,states1 which shall be selected by the ,secretary based on-- 7#a7 applications submitted by ,states1 which specify which regions and populations the ,state involved will serve under the demonstration project2 7#b7 criteria designed by the ,secretary to ensure that1 as a whole1 the demonstration project is1 to the greatest extent possible1 representative of the demographic and geographic composition of communities most affected by disparities2 7#c7 criteria designed by the ,secretary to ensure that a variety of type of models are tested through the demonstration project and that such models include interventions that have an existing evidence base for effectiveness2 and 7#d7 criteria designed by the ,secretary to assure that the demonstration projects and models will be carried out in consultation with local and regional provider organizations1 such as community health centers1 hospital systems1 and medical societies representing providers of maternity services4 7c7 ,duration of demonstration project ,the demonstration project under subsection 7a77#c7 shall begin on ,january #a1 #bjae1 and end on ,december #ca1 #bjai4 7d7 ,grants for evaluation and monitoring ,the ,secretary may make grants to ,states and health care providers participating in the demonstration project under subsection 7a77#c7 for the purpose of collecting data necessary for the evaluation and monitoring of such project4 7e7 ,reports 7#a7 ,state reports ,each ,state that participates in the demonstration project under subsection 7a77#c7 shall report to the ,secretary1 in a time1 form1 and manner specified by the ,secretary1 the data necessary to-- 7,a7 monitor the-- 7i7 outcomes of the project2 7ii7 costs of the project2 and 7iii7 quality of maternity care provided under the project2 and 7,b7 evaluate the rationale for the selection of the items and services included in any bundled payment made by the ,state under the project4 7#b7 ,final report ,not later than ,december #ca1 #bjbj1 the ,secretary shall submit to ,congress a report on the results of the demonstration project under subsection 7a77#c74 4