HOUSE BILL NO. 1950 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE BOSLEY.
4878H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal section 192.990, RSMo, and to enact in lieu thereof three new sections relating to maternal care.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 192.990, RSMo, is repealed and three new sections enacted in lieu 2 thereof, to be known as sections 192.258, 192.990, and 192.1030, to read as follows: 192.258. 1. For purposes of this section, the following terms mean: 2 (1) "Local public health agency", a county health center board established 3 under chapter 205, a county health department, a city health department or agency, a 4 combined city and county health department or agency, a multicounty health 5 department or agency, or any other county or city health authority; 6 (2) "Term infants", infants who are at thirty-six weeks or more of gestation. 7 2. (1) Each county shall annually report infant deaths to the local public health 8 agency or agencies with jurisdiction over the county or any part of the county. 9 (2) The data shall be aggregated to ensure data reflects how regionalized care 10 systems are, or should be, collaborating to improve fetal and infant health outcomes 11 based on standard statistical methods for accurate dissemination of public health data 12 without risking a confidentiality or other disclosure breach. 13 (3) The data shall be disaggregated by racial and ethnic identity. 14 3. Subject to appropriation, a local public health agency shall establish a fetal 15 and infant mortality review committee to investigate infant deaths to prevent fetal and 16 infant death if both of the following apply with respect to the local public health 17 agency's jurisdiction:
EXPLANATION — 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. HB 1950 2
18 (1) The jurisdiction has five or more infant deaths in a single year; and 19 (2) The jurisdiction has an infant death rate that is higher than the state's infant 20 death rate for two consecutive years. 21 4. The department of health and senior services shall establish a fetal and infant 22 mortality review process in which all local public health agencies may voluntarily 23 participate. A local public health agency that participates in the fetal and infant 24 mortality review process established by the department of health and senior services 25 shall do all of the following: 26 (1) Annually investigate, track, and review a minimum amount of twenty 27 percent of the jurisdiction's cases of term infants who were born following labor with 28 the outcome of intrapartum stillbirth, early neonatal death, or postneonatal death, 29 focusing on demographic groups that are disproportionately impacted by infant death. 30 A jurisdiction that has fewer than five infant deaths in a year shall investigate at least 31 one infant death; 32 (2) Establish a committee for fetal and infant mortality reviews led by local 33 public health agencies. The committee shall include members of the community but 34 shall not include anyone employed by a law enforcement agency. In jurisdictions in 35 which the coroner, medical examiner, or other medical professional is employed by law 36 enforcement, these individuals can share information with the committee in their 37 medical professional capacity only. The committee shall be subject to the following 38 provisions: 39 (a) All data and records obtained, prepared, created, and maintained in 40 anticipation of a review meeting shall be confidential. Data and records prepared, 41 created, and maintained in anticipation of a review meeting shall not be subject to 42 public records requests, subpoena, or civil processes and shall not be admissible in 43 evidence in connection with any administrative, judicial, executive, legislative, or other 44 proceeding; 45 (b) All participants engaged in and associated with the review process shall sign 46 a confidentiality agreement that states such participants will not discuss or share 47 information about individual cases and the proceedings of the review meeting outside 48 the meeting. This shall not preclude the committee from publishing, or from otherwise 49 making available for public inspection, statistical compilations or reports that are based 50 on confidential information, provided that those compilations or reports shall not 51 contain personally identifying information or other information that could be used to 52 ultimately identify the individuals concerned and shall utilize standard public health 53 reporting practices for accurate dissemination of these data elements, especially with HB 1950 3
54 regard to the reporting of small numbers so as not to inadvertently risk a breach of 55 confidentiality or other disclosure; and 56 (c) To the extent prescribed by section 537.035, members of the committee, 57 persons attending a committee meeting, and persons who present information to a 58 committee shall not be questioned in any administrative, civil, or criminal proceeding 59 regarding information presented in, or opinions formed as a result of, a meeting. This 60 paragraph shall not prohibit a person from testifying to information obtained 61 independently of the committee or that is public information. A health care provider, 62 health care facility, or pharmacy providing access to medical records under this section 63 shall not be held liable for civil damages or be subject to any criminal or disciplinary 64 action for good faith efforts in providing the records; 65 (3) Conduct voluntary interviews with individuals who have experienced child 66 loss or surviving family members of maternal or infant death who have knowledge of 67 the event. The interview shall include questions to determine if the pregnant person had 68 concerns about perinatal care during any point in the person's pregnancy or 69 postpartum care, whether there were disagreements about care offered and received, 70 and whether the pregnant person had asked for certain care that was denied or not 71 received; 72 (4) Conduct a report or investigation, to the degree practicable, with all medical 73 staff involved with a maternal or infant death; and 74 (5) Offer grief counseling to surviving family members. 75 5. Counties, hospitals, birthing centers, and state entities shall provide to local 76 public health agencies death records, medical records, autopsy reports, toxicology 77 reports, hospital discharge records, birth records, and any other information that will 78 help the local public health agency conduct the fetal and infant mortality review within 79 thirty days of a request made in writing by a local public health agency. The local public 80 health agency shall not request, and health care providers shall not provide, reports, 81 testimony, or other information produced as a result of activities undertaken by a peer 82 review committee, as defined in section 537.035, that has the responsibility to evaluate or 83 improve the quality of care rendered in a hospital. 84 6. (1) There is hereby created in the state treasury the "Fetal and Infant 85 Mortality Review Fund", which shall consist of moneys appropriated to it by the general 86 assembly and any gifts, contributions, grants, or bequests received from federal, private, 87 or other sources. The state treasurer shall be custodian of the fund. In accordance with 88 sections 30.170 and 30.180, the state treasurer may approve disbursements. The fund 89 shall be a dedicated fund and, upon appropriation, moneys in this fund shall be used 90 solely as provided in this section. HB 1950 4
91 (2) Notwithstanding the provisions of section 33.080 to the contrary, any moneys 92 remaining in the fund at the end of the biennium shall not revert to the credit of the 93 general revenue fund. 94 (3) The state treasurer shall invest moneys in the fund in the same manner as 95 other funds are invested. Any interest and moneys earned on such investments shall be 96 credited to the fund. 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" or "maternal mortality", the death of a woman while pregnant 8 or during the one-year period following the date of the end of pregnancy, regardless of the 9 cause of death and regardless of whether a delivery, miscarriage, or death occurs inside or 10 outside of a hospital; 11 (3) "Severe maternal morbidity", unexpected outcomes of pregnancy, labor, or 12 delivery that result in significant short-term or long-term consequences to the pregnant 13 person's mental or physical health. 14 3. The board shall be composed of no more than eighteen members, with a chair 15 elected from among its membership. The board shall meet at least twice per year and shall 16 approve the strategic priorities, funding allocations, work processes, and products of the 17 board. Members of the board shall be appointed by the director of the department. Members 18 shall serve four-year terms, except that the initial terms shall be staggered so that 19 approximately one-third serve three-, four-, and five-year terms. 20 4. The board shall have a multidisciplinary and diverse membership that represents a 21 variety of medical and nursing specialties, including, but not limited to, obstetrics and 22 maternal-fetal care, as well as state or local public health officials, epidemiologists, 23 statisticians, community organizations, geographic regions, and other individuals or 24 organizations that are most affected by maternal deaths and lack of access to maternal 25 health care services. 26 5. The duties of the board shall include, but not be limited to: 27 (1) Conducting ongoing comprehensive, multidisciplinary reviews of all maternal 28 deaths; 29 (2) Identifying factors associated with maternal deaths; 30 (3) Reviewing medical records and other relevant data, which shall include, to the 31 extent available: HB 1950 5
32 (a) A description of the maternal deaths determined by matching each death record of 33 a maternal death to a birth certificate of an infant or fetal death record, as applicable, and an 34 indication of whether the delivery, miscarriage, or death occurred inside or outside of a 35 hospital; 36 (b) Data collected from medical examiner and coroner reports, as appropriate; and 37 (c) Using other appropriate methods or information to identify maternal deaths, 38 including deaths from pregnancy outcomes not identified under paragraph (a) of this 39 subdivision; 40 (4) Consulting with relevant experts, as needed; 41 (5) Analyzing cases to produce recommendations for reducing maternal mortality; 42 (6) Analyzing common indicators of severe maternal morbidity to identify 43 prevention opportunities and reduce near-miss experiences; 44 (7) Disseminating recommendations to policy makers, health care providers and 45 facilities, and the general public on best practices to prevent maternal mortality and 46 morbidity including, but not limited to, addressing socioeconomic and environmental 47 impacts, including global warming, on pregnancy outcomes; 48 [(7)] (8) Recommending and promoting preventative strategies and making 49 recommendations for systems changes, including changes in data collection and 50 investigatory processes; 51 [(8)] (9) Protecting the confidentiality of the hospitals and individuals involved in any 52 maternal deaths; 53 [(9)] (10) Examining racial and social disparities in maternal deaths and making 54 recommendations on the prevention of racial and social disparities; 55 [(10)] (11) Tracking and examining disparities experienced by lesbian, bisexual, 56 transgender, intersex, and gender-nonconforming individuals and reporting findings, to 57 the extent practicable; 58 (12) Subject to appropriation, providing for voluntary and confidential case reporting 59 of maternal deaths to the appropriate state health agency by family members of the deceased, 60 and other appropriate individuals, for purposes of review by the board; 61 [(11)] (13) Making publicly available the contact information of the board for use in 62 such reporting; 63 [(12)] (14) Conducting outreach to local professional organizations, community 64 organizations, and social services agencies regarding the availability of the review board; and 65 [(13)] (15) Ensuring that data collected under this section is made available, as 66 appropriate and practicable, for research purposes, in a manner that protects individually 67 identifiable or potentially identifiable information and that is consistent with state and federal 68 privacy laws. HB 1950 6
69 6. (1) The board's review of cases of maternal mortality and morbidity shall 70 include, to the degree practicable, for populations experiencing disparity, voluntary 71 interviews with the following individuals: 72 (a) Pertinent surviving family members or support people present with direct 73 knowledge of, or involvement in, the event, including the patient in cases of severe 74 maternal morbidity. The board shall transcribe or summarize in writing any oral 75 statements received in accordance with this paragraph; and 76 (b) Members of the medical team who were present or involved in the deceased 77 individual's direct care. 78 (2) In determining the practicability of the interviews under subdivision (1) of 79 this subsection, the board may prioritize interviews with populations that have a 80 documented higher rate of maternal death. 81 7. The board may contract with other entities consistent with the duties of the board. 82 [7.] 8. (1) Before June 30, 2020, and annually thereafter, the board shall submit to the 83 Director of the Centers for Disease Control and Prevention, the director of the department, the 84 governor, and the general assembly a report on maternal mortality in the state based on data 85 collected through ongoing comprehensive, multidisciplinary reviews of all maternal deaths, 86 and any other projects or efforts funded by the board. The data shall be collected using best 87 practices to reliably determine and include all maternal deaths, regardless of the outcome of 88 the pregnancy and shall include data, findings, and recommendations of the committee, and, 89 as applicable, information on the implementation during such year of any recommendations 90 submitted by the board in a previous year. 91 (2) The report shall be made available to the public on the department's website and 92 the director shall disseminate the report to all health care providers and facilities that provide 93 women's health services in the state. 94 [8.] 9. The director of the department, or his or her designee, shall provide the board 95 with the copy of the death certificate and any linked birth or fetal death certificate for any 96 maternal death occurring within the state. 97 [9.] 10. Upon request by the department, health care providers, health care facilities, 98 clinics, laboratories, medical examiners, coroners, law enforcement agencies, driver's license 99 bureaus, other state agencies, and facilities licensed by the department shall provide to the 100 department data related to maternal deaths from sources such as medical records, autopsy 101 reports, medical examiner's reports, coroner's reports, law enforcement reports, motor vehicle 102 records, social services records, and other sources as appropriate. Such data requests shall be 103 limited to maternal deaths which have occurred within the previous twenty-four months. No 104 entity shall be held liable for civil damages or be subject to any criminal or disciplinary action HB 1950 7
105 when complying in good faith with a request from the department for information under the 106 provisions of this subsection. 107 [10.] 11. (1) The board shall protect the privacy and confidentiality of all patients, 108 decedents, providers, hospitals, or any other participants involved in any maternal deaths or 109 any cases of severe maternal morbidity. In no case shall any individually identifiable 110 health information be provided to the public or submitted to an information clearinghouse. 111 (2) Nothing in this subsection shall prohibit the board or department from publishing 112 statistical compilations and research reports that: 113 (a) Are based on confidential information relating to mortality reviews under this 114 section; and 115 (b) Do not contain identifying information or any other information that could be 116 used to ultimately identify the individuals concerned. 117 (3) Information, records, reports, statements, notes, memoranda, or other data 118 collected under this section shall not be admissible as evidence in any action of any kind in 119 any court or before any other tribunal, board, agency, or person. Such information, records, 120 reports, notes, memoranda, data obtained by the department or any other person, statements, 121 notes, memoranda, or other data shall not be exhibited nor their contents disclosed in any 122 way, in whole or in part, by any officer or representative of the department or any other 123 person. No person participating in such review shall disclose, in any manner, the information 124 so obtained except in strict conformity with such review project. Such information shall not 125 be subject to disclosure under chapter 610. 126 (4) All information, records of interviews, written reports, statements, notes, 127 memoranda, or other data obtained by the department, the board, and other persons, agencies, 128 or organizations so authorized by the department under this section shall be confidential. 129 (5) All proceedings and activities of the board, opinions of members of such board 130 formed as a result of such proceedings and activities, and records obtained, created, or 131