SB 871

4285S.02C
  SENATE COMMITTEE SUBSTITUTE
  FOR
  SENATE BILL NO. 871
  AN ACT
  To 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  Section A.       Section 192.990, RSMo, is repealed and one new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 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 services the "Pregnancy-
   Associated Mortality Review Board" to improve data
   collection and reporting with respect to maternal deaths.
   The department may collaborate with localities and with
   other states to meet the goals of the initiative.
  2. For purposes of this section, the following terms
   shall mean:
  (1) "Department", the Missouri department of health
   and senior services;
  (2) "Maternal death", the death of a woman while
   pregnant or during the one-year period following the date of
   the end of pregnancy, regardless of the cause of death and
   regardless of whether a delivery, miscarriage, or death
   occurs inside or outside of a hospital;
  (3) "Maternity care deserts", counties in which access
   to maternity care services is limited or absent, either
   through a lack of services or through barriers to a woman's
   ability to access care within a county.  A "maternity care
   desert" shall include, but not be limited to, any county
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without a hospital or birth center offering obstetric care
and without any obstetric clinicians.
    3. The board shall be composed of no more than
[eighteen] twenty-two members, with a chair elected from
among its membership.   The board shall meet at least twice
per year and shall approve the strategic priorities, funding
allocations, work processes, and products of the board.
Members of the board shall be appointed by the director of
the department.   Members shall serve four-year terms, except
that the initial terms shall be staggered so that
approximately one-third serve three-, four-, and five-year
terms.
    4. The board shall have a multidisciplinary and
diverse membership that represents a variety of medical and
nursing specialties, including, but not limited to,
obstetrics and maternal-fetal care, as well as state or
local public health officials, epidemiologists,
statisticians, community organizations, geographic regions,
and other individuals or organizations that are most
affected by maternal deaths and lack of access to maternal
health care services.   At least one member from each
congressional district shall be selected to serve on the
board and membership shall be demographically diverse,
including by race, ethnicity, sex, age, and rural and urban
populations.
    5. The duties of the board shall include, but not be
limited to:
    (1) Conducting ongoing comprehensive,
multidisciplinary reviews of all maternal deaths;
    (2) Identifying factors associated with maternal
deaths;
    (3) Identifying maternity care deserts throughout the
state;
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    (4) Reviewing medical records and other relevant data,
which shall include, to the extent available:
    (a) A description of the maternal deaths determined by
matching each death record of a maternal death to a birth
certificate of an infant or fetal death record, as
applicable, and an indication of whether the delivery,
miscarriage, or death occurred inside or outside of a
hospital;
    (b) Data collected from medical examiner and coroner
reports, as appropriate; [and]
    (c) The level and timing of prenatal and postnatal
medical care; and
    (d) Using other appropriate methods or information to
identify maternal deaths, including deaths from pregnancy
outcomes not identified under paragraph (a) of this
subdivision;
    [(4)] (5)     Consulting with relevant experts, as needed;
    [(5)] (6)     Analyzing cases to produce recommendations
for reducing maternal mortality;
    [(6)] (7)     Disseminating recommendations to policy
makers, health care providers and facilities, and the
general public;
    [(7)] (8)     Recommending and promoting preventative
strategies and making recommendations for systems changes;
    [(8)] (9)     Protecting the confidentiality of the
hospitals and individuals involved in any maternal deaths;
    [(9)] (10)     Examining racial and social disparities in
maternal deaths;
    (11) Investigating and developing recommendations
regarding approaches taken in other states or other
organizations to reduce or eliminate racial inequities in
maternal deaths, including community-driven strategies,
health care accessibility, insurance availability, and other
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barriers to access and delivery of prenatal and postpartum
care;
     [(10)] (12)   Subject to appropriation, providing for
voluntary and confidential case reporting of maternal deaths
to the appropriate state health agency by family members of
the deceased, and other appropriate individuals, for
purposes of review by the board;
     [(11)] (13)   Making publicly available the contact
information of the board for use in such reporting;
     [(12)] (14)   Conducting outreach to local professional
organizations, community organizations, and social services
agencies regarding the availability of the review board;
[and]
     (15) Examining and developing recommendations on the
adequacy of data collected under this section and if
additional categories of data would be informative in the
study of maternal deaths in Missouri; and
     [(13)] (16)   Ensuring that data collected under this
section is made available, as appropriate and practicable,
for research purposes, in a manner that protects
individually identifiable or potentially identifiable
information and that is consistent with state and federal
privacy laws.
     6. The board may contract with other entities
consistent with the duties of the board.
     7. (1) Before June 30, 2020, and annually thereafter,
the board shall submit to the Director of the Centers for
Disease Control and Prevention, the director of the
department, the governor, and the general assembly a report
on maternal mortality in the state based on data collected
through ongoing comprehensive, multidisciplinary reviews of
all maternal deaths, and any other projects or efforts
funded by the board.   The data shall be collected using best
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practices to reliably determine and include all maternal
deaths, regardless of the outcome of the pregnancy and shall
include data, findings, and recommendations of the
committee, and, as applicable, information on the
implementation during such year of any recommendations
submitted by the board in a previous year.   Data reported by
the board shall be disaggregated by race, ethnicity,
language, nationality, age, zip code, the presence or
absence of maternity care deserts, and level and timing of
prenatal and postnatal care in a manner that protects
individually identifiable or potentially identifiable
information and that is consistent with state and federal
privacy laws.
    (2) The report shall be made available to the public
on the department's website and the director shall
disseminate the report to all health care providers and
facilities that provide women's health services in the state.
    8. The director of the department, or his or her
designee, shall provide the board with the copy of the death
certificate and any linked birth or fetal death certificate
for any maternal death occurring within the state.
    9. Upon request by the department, health care
providers, health care facilities, clinics, laboratories,
medical examiners, coroners, law enforcement agencies,
driver's license bureaus, other state agencies, and
facilities licensed by the department shall provide to the
department data related to maternal deaths from sources such
as medical records, autopsy reports, medical examiner's
reports, coroner's reports, law enforcement reports, motor
vehicle records, social services records, and other sources
as appropriate.   Such data requests shall be limited to
maternal deaths which have occurred within the previous
twenty-four months.   No entity shall be held liable for
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civil damages or be subject to any criminal or disciplinary
action when complying in good faith with a request from the
department for information under the provisions of this
subsection.
    10. (1)   The board shall protect the privacy and
confidentiality of all patients, decedents, providers,
hospitals, or any other participants involved in any
maternal deaths.   In no case shall any individually
identifiable health information be provided to the public or
submitted to an information clearinghouse.
    (2) Nothing in this subsection shall prohibit the
board or department from publishing statistical compilations
and research reports that:
    (a) Are based on confidential information relating to
mortality reviews under this section; and
    (b) Do not contain identifying information or any
other information that could be used to ultimately identify
the individuals concerned.
    (3) Information, records, reports, statements, notes,
memoranda, or other data collected under this section shall
not be admissible as evidence in any action of any kind in
any court or before any other tribunal, board, agency, or
person. Such information, records, reports, notes,
memoranda, data obtained by the department or any other
person, statements, notes, memoranda, or other data shall
not be exhibited nor their contents disclosed in any way, in
whole or in part, by any officer or representative of the
department or any other person.       No person participating in
such review shall disclose, in any manner, the information
so obtained except in strict conformity with such review
project. Such information shall not be subject to
disclosure under chapter 610.
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    (4) All information, records of interviews, written
reports, statements, notes, memoranda, or other data
obtained by the department, the board, and other persons,
agencies, or organizations so authorized by the department
under this section shall be confidential.
    (5) All proceedings and activities of the board,
opinions of members of such board formed as a result of such
proceedings and activities, and records obtained, created,
or maintained under this section, including records of
interviews, written reports, statements, notes, memoranda,
or other data obtained by the department or any other
person, agency, or organization acting jointly or under
contract with the department in connection with the
requirements of this section, shall be confidential and
shall not be subject to subpoena, discovery, or introduction
into evidence in any civil or criminal proceeding; provided,
however, that nothing in this section shall be construed to
limit or restrict the right to discover or use in any civil
or criminal proceeding anything that is available from
another source and entirely independent of the board's
proceedings.
    (6) Members of the board shall not be questioned in
any civil or criminal proceeding regarding the information
presented in or opinions formed as a result of a meeting or
communication of the board; provided, however, that nothing
in this section shall be construed to prevent a member of
the board from testifying to information obtained
independently of the board or which is public information.
    11. The department may use grant program funds to
support the efforts of the board and may apply for
additional federal government and private foundation grants
as needed. The department may also accept private,
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foundation, city, county, or federal moneys to implement the
provisions of this section.
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