,i #aafth ,,congress #b;d ,session ,h4 ,r4 #fafe ,,in ,,the ,,house ,,of ,,representatives ,march #aj1 #bjbj,ms4 ,davids of ,kansas 7for herself1 ,ms4 ,underwood1 ,ms4 ,adams1 ,mr4 ,clay1 ,ms4 ,scanlon1 ,ms4 ,norton1 ,ms4 ,sewell of ,alabama1 ,mr4 ,khanna1 ,ms4 ,moore1 ,mr4 ,lawson of ,florida1 ,ms4 ,pressley1 and ,ms4 ,haaland7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,natural ,resources1 for a period to be subsequently determined by the ,speaker1 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 morbidity1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,data to ,save ,moms ,act of #bjbj4 #b4 ,funding for maternal mortality review committees to promote representative community engagement 7a7 ,in general ,section #cag,k7d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77 is amended by adding at the end the following3 7#i7 ,grants to promote representative community engagement in maternal mortality review committees 7,a7 ,in general ,the ,secretary may1 using funds made available pursuant to subparagraph 7,c71 provide assistance to an applicable maternal mortality review committee of a ,state1 ,indian tribe1 tribal organization1 or urban ,indian organization 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77-- 7i7 to select for inclusion in the membership of such a committee community members from the ,state1 ,indian tribe1 tribal organization1 or urban ,indian organization by-- 7,i7 prioritizing community members who can increase the diversity of the committee's membership with respect to race and ethnicity1 location1 and professional background1 including members with non-clinical experiences2 and 7,,ii7 to the extent applicable1 using funds reserved under subsection 7f7 to address barriers to maternal mortality review committee participation for community members1 including required training1 transportation barriers1 compensation1 and other supports as may be necessary2 7ii7 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 committee1 with a particular focus on outreach to minority women2 and 7iii7 to release public reports assessing-- 7,i7 the pregnancy-related death and pregnancy-associated death review processes of the maternal mortality review committee1 with a particular focus on the maternal mortality review committee's sensitivity to the unique circumstances of minority women who have suffered pregnancy-related deaths2 and 7,,ii7 the impact of the use of funds made available pursuant to paragraph 7,c7 on increasing the diversity of the maternal mortality review committee membership and promoting community engagement efforts throughout the ,state or ,tribe4 7,b7 ,technical assistance ,the ,secretary shall provide 7either directly through the ,department of ,health and ,human ,services or by contract7 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 ,tribe4 7,c7 ,authorization of appropriations ,in addition to any funds made available under subsection 7f71 there are authorized to be appropriated to carry out this paragraph #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 7b7 ,reservation of funds ,section #cag,k7f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;f77 is amended by adding at the end the following3 ,of the amount made available under the preceding sentence for a fiscal year1 not less than #a1ejj1jjj shall be reserved for grants to ,indian tribes1 tribal organizations1 or urban ,indian organizations 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 #c4 ,data collection and review 7a7 ,in general ,section #cag,k7d77#c77;,a77i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#c77;,a77i77 is amended-- 7#a7 by redesignating subclauses 7,,ii7 and 7,,iii7 as subclauses 7,v7 and 7,,vi71 respectively2 and 7#b7 by inserting after subclause 7,i7 the following3 7,,ii7 to the extent practicable1 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 unit2 7,,iii7 to the extent practicable1 consulting with local community-based organizations representing women from demographic groups disproportionately impacted by poor maternal health outcomes to ensure that1 in addition to clinical factors1 non-clinical factors that might have contributed to a pregnancy-related death are appropriately considered2 4 7b7 ,severe maternal morbidity defined ,section #cag,k7e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;e77 is amended-- 7#a7 in paragraph 7#b71 by striking and at the end2 7#b7 in paragraph 7#c71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#d7 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 health4 4 #d4 ,task force on maternal health data and quality measures 7a7 ,establishment ,not later than #ahj days after the date of enactment of this ,act1 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 7in this section referred to as the ,task ,force74 7b7 ,duties of task force 7#a7 ,in general ,the ,task ,force shall use all available relevant information1 including information from ,state-level sources1 to prepare and submit a report containing the following3 7,a7 ,an evaluation of current ,state and ,tribal practices for maternal health1 maternal mortality1 and severe maternal morbidity data collection and dissemination1 including consideration of-- 7i7 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 death2 7ii7 maternal health data collected with electronic health records1 including data on race and ethnicity2 7iii7 the barriers preventing ,states from correlating maternal outcome data with race and ethnicity data2 7iv7 processes for determining the cause of a pregnancy-associated death in ,states that do not have a maternal mortality review committee2 7v7 whether maternal mortality review committees include multidisciplinary and diverse membership 7as described in section #cag,k7d77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#a77;,a772 7vi7 whether members of maternal mortality review committees participate in trainings on bias1 racism1 or discrimination1 and the quality of such trainings2 7vii7 the extent to which ,states have implemented systematic processes of listening to the stories of pregnant and postpartum women and their family members1 with a particular focus on minority women and their family members1 to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective ,states2 7viii7 the consideration of social determinants of health by maternal mortality review committees when examining the causes of pregnancy-associated and pregnancy-related deaths2 7ix7 the legal barriers preventing the collation of ,state maternity care data2 7x7 the effectiveness of data collection and reporting processes in separating pregnancy-associated deaths from pregnancy-related deaths2 and 7xi7 the current ,federal1 ,state1 local1 and ,tribal funding support for the activities referred to in clauses 7i7 through 7x74 7,b7 ,an assessment of whether the funding referred to in subparagraph 7,a77xi7 is adequate for ,states to carry out optimal data collection and dissemination processes with respect to maternal health1 maternal mortality1 and severe maternal morbidity4 7,c7 ,an evaluation of current quality measures for maternity care1 including prenatal measures1 labor and delivery measures1 and postpartum measures up to one year postpartum4 ,such evaluation shall be conducted in consultation with the ,national ,quality ,forum and shall include consideration of-- 7i7 effective quality measures for maternity care used by hospitals1 health systems1 birth centers1 health plans1 and other relevant entities2 7ii7 the sufficiency of current outcome measures used to evaluate maternity care for testing and validating new maternal health care payment and service delivery models2 7iii7 quality measures for the childbirth experiences of women that other countries effectively use2 7iv7 current maternity care quality measures that may be eliminated because they are not achieving their intended effect2 7v7 barriers preventing maternity care providers from implementing quality measures that are aligned from best practices2 7vi7 the frequency with which maternity care quality measures are reviewed and revised2 7vii7 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 ,assurance2 7viii7 the strengths and weaknesses of maternity care quality measures under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig et seq471 including the extent to which ,states voluntarily report relevant measures2 7ix7 the extent to which maternity care quality measures are informed by patient experiences that include subjective measures of patient-reported experience of care2 7x7 the current processes for collecting stratified data on the race and ethnicity of pregnant and postpartum women in hospitals1 health systems1 and birth centers1 and for incorporating such racially and ethnically stratified data in maternity care quality measures2 7xi7 the extent to which maternity care quality measures account for the unique experiences of minority women and their families2 and 7xii7 the extent to which hospitals1 health systems1 and birth centers are implementing existing maternity care quality measures4 7,d7 ,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 ,services4 7,e7 ,recommendations for new authorities that may be granted to maternal mortality review committees to be able to-- 7i7 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 populations1 such as women veterans and women who are incarcerated2 and 7ii7 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 populations1 such as women veterans and women who are incarcerated4 7,f7 ,recommendations to improve current quality measures for maternity care1 including recommendations on updating the ,pregnancy ,delivery ,care measures on the ,hospital ,compare website of the ,centers for ,medicare ,medicaid ,services or any successor website1 with a particular focus on racial and ethnic disparities in maternal health outcomes4 7,g7 ,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 measures4 7#b7 ,public comment ,not later than #fj days after the date on which a majority of the members of the ,task ,force have been appointed1 the ,task ,force shall publish in the ,federal ,register a notice for public comment period of #ij days1 beginning on the date of publication1 on the duties and activities of the ,task ,force4 7c7 ,membership 7#a7 ,in general ,the ,task ,force shall be composed of #ah members appointed by the ,secretary of ,health and ,human ,services4 ,the ,secretary shall give special consideration to individuals who are representative of populations most affected by maternal mortality and severe maternal morbidity4 7#b7 ,member criteria ,to be eligible to be appointed as a member of the ,task ,force1 an individual shall be-- 7,a7 a woman who has experienced severe maternal morbidity2 7,b7 a family member of a woman who had a pregnancy-related death2 7,c7 an individual who provides non-clinical support to women from pregnancy through the postpartum period1 such as a doula1 community health worker1 peer supporter1 certified lactation consultant1 nutritionist or dietitian1 social worker1 home visitor1 or a patient navigator2 7,d7 a leader of a community-based organization that addresses adverse maternal health outcomes with a specific focus on racial and ethnic disparities2 7,e7 an academic researcher in a field or policy area related to the duties of the ,task ,force2 7,f7 a maternal health care provider2 7,g7 an elected or duly appointed leader from an ,indian ,tribe2 7,h7 an expert in a field or policy area related to the duties of the ,task ,force2 or 7,i7 an individual who has experience with ,federal or ,state government programs related to the duties of the ,task ,force4 7#c7 ,appointment timing ,appointments to the ,task ,force shall be made not later than #ahj days after the date of enactment of this ,act4 7#d7 ,duration ,each member shall be appointed for the life of the ,task ,force4 7#e7 ,co-chair selection ,not later than #cj days after the date on which a majority of the members of the ,task ,force have been appointed1 the ,secretary shall select #b of the members of the ,task ,force to serve as co-chairs of the ,task ,force4 7#f7 ,vacancies 7,a7 ,in general ,a vacancy in the ,task ,force-- 7i7 shall not affect the powers of the ,task ,force2 and 7ii7 shall be filled in the same manner as the original appointment4 7,b7 ,co-chair vacancy ,in the event of a vacancy of a co-chair of the ,task ,force1 a replacement co-chair shall be selected in the same manner as the original selection4 7#g7 ,compensation ,except as provided in paragraph 7#h71 members of the ,task ,force shall serve without pay4 7#h7 ,travel expenses ,members of the ,task ,force shall be allowed travel expenses1 including per diem in lieu of subsistence1 at rates authorized for employees of agencies under subchapter ,i of chapter #eg of title #e1 ,united ,states ,code1 while away from their homes or regular places of business in the performance of service for the ,task ,force4 7d7 ,meetings 7#a7 ,in general ,the ,task ,force shall meet at the call of the co-chairs of the ,task ,force4 7#b7 ,quorum ,a majority of the members of the ,task ,force shall constitute a quorum4 7#c7 ,initial meeting ,the ,task ,force shall meet not later than #fj days after the date on which a majority of the members of the ,task ,force have been appointed4 7e7 ,staff of task force 7#a7 ,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 appropriate4 7#b7 ,applicability of certain civil service laws ,the staff of the ,task ,force may be appointed without regard to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and may be paid without regard to the provisions of chapter #ea and subchapter ,,iii of chapter #ec of that title relating to classification and ,general ,schedule pay rates4 7#c7 ,detailees ,any ,federal ,government employee may be detailed to the ,task ,force without reimbursement from the ,task ,force1 and the detailee shall retain the rights1 status1 and privileges of his or her regular employment without interruption4 7f7 ,powers of task force 7#a7 ,testimony and evidence ,the ,task ,force may take such testimony and receive such evidence as the ,task ,force considers advisable to carry out this section4 7#b7 ,obtaining official data ,the ,task ,force may secure directly from any ,federal department or agency information necessary to carry out its duties under this section4 ,on request of the co-chairs of the ,task ,force1 the head of that department or agency shall furnish such information to the ,task ,force4 7#c7 ,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 agencies4 7g7 ,report ,not later than #b years after the date on which the initial #ah members of the ,task ,force are appointed under subsection 7c77#a71 the ,task ,force shall submit to the ,committee on ,energy and ,commerce1 the ,committee on ,education and ,labor1 and the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance and the ,committee on ,health1 ,education1 ,labor and ,pensions of the ,senate1 and make publicly available1 a report that-- 7#a7 contains the information1 evaluations1 and recommendations described in subsection 7b72 and 7#b7 is signed by more than half of the members of the ,task ,force4 7h7 ,termination ,section #ad of the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the ,task ,force4 7i7 ,definitions ,in this section3 7#a7 ,maternal health care provider ,the term maternal health care provider means an individual who is an obstetrician-gynecologist1 family physician1 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 ,midwives1 nurse practitioner1 or clinical nurse specialist4 7#b7 ,maternal mortality ,the term maternal mortality means deaths occurring during1 or within #ab months after1 pregnancy from complications of pregnancy or childbirth4 7#c7 ,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 #cagk7a77#b77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77#b77;,d774 7#d7 ,pregnancy-associated death ,the term pregnancy-associated death means a death of a woman1 by any cause1 that occurs during1 or within #a year following1 her pregnancy1 regardless of the outcome1 duration1 or site of the pregnancy4 7#e7 ,pregnancy-related death ,the term pregnancy-related death means a death of a woman that occurs during1 or within #a year following1 her pregnancy1 regardless of the outcome1 duration1 or site of the pregnancy-- 7,a7 from any cause related to1 or aggravated by1 the pregnancy or its management2 and 7,b7 not from accidental or incidental causes4 7#f7 ,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 woman4 7j7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section for fiscal years #bjba through #bjbd4 #e4 ,indian ,health ,service study on maternal mortality 7a7 ,in general ,the ,director of the ,indian ,health ,service 7referred to in this section as the ,director7 shall1 in coordination with entities described in subsection 7b7-- 7#a7 not later than #ij days after the enactment of this ,act1 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 women2 and 7#b7 not later than #c years after the date of the enactment of this ,act1 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 women4 7b7 ,participating entities ,the entities described in this subsection shall consist of #ab members1 selected by the ,director from among individuals nominated by ,indian tribes and tribal organizations 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 and urban ,indian organizations 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 ,in selecting such members1 the ,director shall ensure that each of the #ab service areas of the ,indian ,health ,service is represented4 7c7 ,contents of study ,the study conducted pursuant to subsection 7a7 shall-- 7#a7 examine the causes of maternal mortality and severe maternal morbidity that are unique to ,american ,indian and ,alaska ,native women2 7#b7 include a systematic process of listening to the stories of ,american ,indian and ,alaska ,native women to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective communities2 7#c7 distinguish between the causes of1 landscape of maternity care at1 and recommendations to improve maternal health outcomes within1 the different settings in which ,american ,indian and ,alaska ,native women receive maternity care1 such as-- 7,a7 facilities operated by the ,indian ,health ,service2 7,b7 an ,indian health program operated by an ,indian tribe or tribal organization pursuant to a contract1 grant1 cooperative agreement1 or compact with the ,indian ,health ,service pursuant to the ,indian ,self-,determination ,act2 and 7,c7 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 ,act2 7#d7 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 7other than the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act71 including coordination with the efforts of the ,task ,force established under section #c2 7#e7 review current data collection and quality measurement processes and practices2 7#f7 consider social determinants of health1 including poverty1 lack of health insurance1 unemployment1 sexual violence1 and environmental conditions in ,tribal areas2 7#g7 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 morbidity2 7#h7 consider how current funding of the ,indian ,health ,service affects the ability of the ,service to deliver quality maternity care2 7#i7 consider the extent to which the delivery of maternity care services is culturally appropriate for ,american ,indian and ,alaska ,native women2 7#aj7 make recommendations to reduce misclassification of ,american ,indian and ,alaska ,native women1 including consideration of best practices in training for maternal mortality review committee members to be able to correctly classify ,american ,indian and ,alaska ,native women2 and 7#aa7 make recommendations informed by the stories shared by ,american ,indian and ,alaska ,native women in paragraph 7#b7 to improve maternal health outcomes for such women4 7d7 ,report ,the agreement entered into under subsection 7a7 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 #cf months after the date of the enactment of this ,act4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjba through #bjbc4 #f4 ,grants to minority-serving institutions to study maternal mortality1 severe maternal morbidity1 and other adverse maternal health outcomes 7a7 ,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 women4 ,such research may-- 7#a7 include the development and implementation of systematic processes of listening to the stories of minority women to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective communities2 and 7#b7 assess the potential causes of low rates of maternal mortality among ,hispanic women1 including potential racial misclassification and other data collection and reporting issues that might be misrepresenting maternal mortality rates among ,hispanic women in the ,united ,states4 7b7 ,application ,to be eligible to receive a grant under subsection 7a71 an entity described in such subsection shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,technical assistance ,the ,secretary may use not more than #aj percent of the funds made available under subsection 7f7-- 7#a7 to conduct outreach to ,minority-,serving ,institutions to raise awareness of the availability of grants under this subsection 7a72 7#b7 to provide technical assistance in the application process for such a grant2 and 7#c7 to promote capacity building as needed to enable entities described in such subsection to submit such an application4 7d7 ,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 grant4 7e7 ,evaluation ,beginning one year after the date on which the first grant is awarded under this section1 the ,secretary shall submit to ,congress an annual report summarizing the findings of research conducted using funds made available under this section4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #aj1jjj1jjj for each of fiscal years #bjba through #bjbe4 7g7 ,minority-,serving institutions defined ,in this section1 the term minority-serving institution has the meaning given the term in section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a774