Modifies the pregnancy-associated mortality review board

SECOND REGULAR SESSION
HOUSE BILL NO. 3269
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE BYRNES.
71 10H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o repeal section 192.990, RSMo, and to enact in lieu thereof one new section relating to
maternal mortality .
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 192.990, RSMo, is repealed and one new section enacted in lieu
2 thereof, to be known as section 192.990, to read as follows:
192.990. 1. There is hereby established within the department of health and senior
2 services the "Pregnancy-Associated Mortality Review Board" to improve data collection and
3 reporting with respect to maternal deaths. The department may collaborate with localities and
4 with other states to meet the goals of the initiative.
5 2. For purposes of this section, the following terms shall mean:
6 (1) "Department", the Missouri department of health and senior services;
7 (2) "Maternal death", the death of a woman while pregnant or during the one-year
8 period following the date of the end of pregnancy , regardless of the cause of death and
9 regardless of whether a delivery , miscarriage, or death occurs inside or outside of a hospital ;
10 (3) "Maternity car e deserts", counties in which access to maternity care services
11 is limited or absent, either thr ough a lack of services or thr ough barriers to a woman's
12 ability to access car e within a county . A "maternity care desert" shall include, but not
13 be limited to, any county without a hospital or birth center offering obstetric care and
14 without any obstetric clinicians .
15 3. The board shall be composed of no more than [ eighteen ] twenty-two members,
16 with a chair elected from among its membership. The board shall meet at least twice per year
17 and shall approve the strategic priorities, funding allocations, work processes, and products of
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
18 the board. Members of the board shall be appointed by the director of the department.
19 Members shall serve four- year terms, except that the initial terms shall be staggered so that
20 approximately one-third serve three-, four- , and five-year terms.
21 4. The board shall have a multidisciplinary and diverse membership that represents a
22 variety of medical and nursing specialties, including, but not limited to, obstetrics and
23 maternal-fetal care, as well as state or local public health of ficials, epidemiologists,
24 statisticians, community org anizations, geographic regions, and other individuals or
25 or ganizations that are most affected by maternal deaths and lack of access to maternal
26 health care services. At least one member fr om each congr essional district shall be
27 selected to serve on the board and membership shall be demographically diverse,
28 including by race, ethnicity , sex, age, and rural and urban populations.
29 5. The duties of the board shall include, but not be limited to:
30 (1) Conducting ongoing comprehensive, multidisciplinary reviews of all maternal
31 deaths;
32 (2) Identifying factors associated with maternal deaths;
33 (3) Identifying maternity car e deserts thr oughout the state;
34 (4) Reviewing medical records and other relevant data, which shall include, to the
35 extent available:
36 (a) A description of the maternal deaths determined by matching each death record of
37 a maternal death to a birth certificate of an infant or fetal death record, as applicable, and an
38 indication of whether the delivery , miscarriage, or death occurred inside or outside of a
39 hospital;
40 (b) Data collected from medical examiner and coroner reports, as appropriate; [ and ]
41 (c) The level and timing of pr enatal and postnatal medical care ; and
42 (d) Using other appropriate methods or information to identify maternal deaths,
43 including deaths from pregnancy outcomes not identified under paragraph (a) of this
44 subdivision;
45 [ (4) ] (5) Consulting with relevant experts, as needed;
46 [ (5) ] (6) Analyzing cases to produce recommendations for reducing maternal
47 mortality;
48 [ (6) ] (7) Disseminating recommendations to policy makers, health care providers and
49 facilities, and the general public;
50 [ (7) ] (8) Recommending and promoting preventative strategies and making
51 recommendations for systems changes;
52 [ (8) ] (9) Protecting the confidentiality of the hospitals and individuals involved in any
53 maternal deaths;
54 [ (9) ] (10) Examining racial and social disparities in maternal deaths;
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55 (1 1) Investigating and developing re commendations rega rding appr oaches taken
56 in other states or other organizations to redu ce or eliminate racial inequities in maternal
57 deaths, including community-driven strategies, health care accessibility , insurance
58 availability , and other barriers to access and delivery of prena tal and postpartum care;
59 [ (10) ] (12) Subject to appropriation, providing for voluntary and confidential case
60 reporting of maternal deaths to the appropriate state health agency by family members of the
61 deceased, and other appropriate individuals, for purposes of review by the board;
62 [ (1 1) ] (13) Making publicly available the contact information of the board for use in
63 such reporting;
64 [ (12) ] (14) Conducting outreach to local professional or ganizations, community
65 or ganizations, and social services agencies regarding the availability of the review board;
66 [ and ]
67 (15) Examining and developing recomm endations on the adequacy of data
68 collected under this section and if additional categories of data would be informative in
69 the study of maternal deaths in Missouri; and
70 [ (13) ] (16) Ensuring that data collected under this section is made available, as
71 appropriate and practicable, for research purposes, in a manner that protects individually
72 identifiable or potentially identifiable information and that is consistent with state and federal
73 privacy laws.
74 6. The board may contract with other entities consistent with the duties of the board.
75 7. (1) Before June 30, 2020, and annually thereafter , the board shall submit to the
76 Director of the Centers for Disease Control and Prevention, the director of the department, the
77 governor , and the general assembly a report on maternal mortality in the state based on data
78 collected through ongoing comprehensive, multidisciplinary reviews of all maternal deaths,
79 and any other projects or ef forts funded by the board. The data shall be collected using best
80 practices to reliably determine and include all maternal deaths, regardless of the outcome of
81 the pregnancy and shall include data, findings, and recommendations of the committee, and,
82 as applicable, information on the implementation during such year of any recommendations
83 submitted by the board in a previous year . Data r eported by the board shall be
84 disaggr egated by race, ethnicity , language, nationality , age, zip code, the pr esence or
85 absence of maternity care deserts, and level and timing of pr enatal and postnatal car e in
86 a manner that pr otects individually identifiable or potentially identifiable information
87 and that is consistent with state and federal privacy laws.
88 (2) The report shall be made available to the public on the department's website and
89 the director shall disseminate the report to all health care providers and facilities that provide
90 women's health services in the state.
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91 8. The director of the department, or his or her designee, shall provide the board with
92 the copy of the death certificate and any linked birth or fetal death certificate for any maternal
93 death occurring within the state.
94 9. Upon request by the department, health care providers, health care facilities,
95 clinics, laboratories, medical examiners, coroners, law enforcement agencies, driver's license
96 bureaus, other state agencies, and facilities licensed by the department shall provide to the
97 department data related to maternal deaths from sources such as medical records, autopsy
98 reports, medical examiner's reports, coroner's reports, law enforcement reports, motor vehicle
99 records, social services records, and other sources as appropriate. Such data requests shall be
100 limited to maternal deaths which have occurred within the previous twenty-four months. No
101 entity shall be held liable for civil damages or be subject to any criminal or disciplinary action
102 when complying in good faith with a request from the department for information under the
103 provisions of this subsection.
104 10. (1) The board shall protect the privacy and confidentiality of all patients,
105 decedents, providers, hospitals, or any other participants involved in any maternal deaths. In
106 no case shall any individually identifiable health information be provided to the public or
107 submitted to an information clearinghouse.
108 (2) Nothing in this subsection shall prohibit the board or department from publishing
109 statistical compilations and research reports that:
110 (a) Are based on confidential information relating to mortality reviews under this
111 section; and
112 (b) Do not contain identifying information or any other information that could be
113 used to ultimately identify the individuals concerned.
114 (3) Information, records, reports, statements, notes, memoranda, or other data
115 collected under this section shall not be admissible as evidence in any action of any kind in
116 any court or before any other tribunal, board, agency , or person. Such information, records,
117 reports, notes, memoranda, data obtained by the department or any other person, statements,
118 notes, memoranda, or other data shall not be exhibited nor their contents disclosed in any
119 way , in whole or in part, by any of ficer or representative of the department or any other
120 person. No person participating in such review shall disclose, in any manner , the information
121 so obtained except in strict conformity with such review project. Such information shall not
122 be subject to disclosure under chapter 610.
123 (4) All information, records of interviews, written reports, statements, notes,
124 memoranda, or other data obtained by the department, the board, and other persons, agencies,
125 or or ganizations so authorized by the department under this section shall be confidential.
126 (5) All proceedings and activities of the board, opinions of members of such board
127 formed as a result of such proceedings and activities, and records obtained, created, or
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128 maintained under this section, including records of interviews, written reports, statements,
129 notes, memoranda, or other data obtained by the department or any other person, agency , or
130 or ganization acting jointly or under contract with the department in connection with the
131 requirements of this section, shall be confidential and shall not be subject to subpoena,
132 discovery , or introduction into evidence in any civil or criminal proceeding; provided,
133 however , that nothing in this section shall be construed to limit or restrict the right to discover
134 or use in any civil or criminal proceeding anything that is available from another source and
135 entirely independent of the board's proceedings.
136 (6) Members of the board shall not be questioned in any civil or criminal proceeding
137 regarding the information presented in or opinions formed as a result of a meeting or
138 communication of the board; provided, however , that nothing in this section shall be
139 construed to prevent a member of the board from testifying to information obtained
140 independently of the board or which is public information.
141 1 1. The department may use grant program funds to support the ef forts of the board
142 and may apply for additional federal government and private foundation grants as needed.
143 The department may also accept private, foundation, city , county , or federal moneys to
144 implement the provisions of this section.
✔
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