HOUSE BILL NO. 3269 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE BYRNES.
7110H.01I JOSEPH ENGLER, Chief Clerk
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Section A. Section 192.990, RSMo, is repealed and one new section enacted in lieu 2 thereof, to be known as section 192.990, to read as follows: 192.990. 1.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 care deserts", counties in which access to maternity care services 11 is limited or absent, either through a lack of services or through barriers to a woman's 12 ability to access care 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
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 3269 2
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 officials, epidemiologists, 24 statisticians, community organizations, geographic regions, and other individuals or 25 organizations that are most affected by maternal deaths and lack of access to maternal 26 health care services. At least one member from each congressional 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 care deserts throughout 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 prenatal 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; HB 3269 3
55 (11) Investigating and developing recommendations regarding approaches taken 56 in other states or other organizations to reduce 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 prenatal 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 [(11)] (13) Making publicly available the contact information of the board for use in 63 such reporting; 64 [(12)] (14) Conducting outreach to local professional organizations, community 65 organizations, and social services agencies regarding the availability of the review board; 66 [and] 67 (15) Examining and developing recommendations 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 efforts 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 reported by the board shall be 84 disaggregated by race, ethnicity, language, nationality, age, zip code, the presence or 85 absence of maternity care deserts, and level and timing of prenatal and postnatal care in 86 a manner that protects 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. HB 3269 4
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 officer 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 organizations 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 HB 3269 5
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 organization 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 11. The department may use grant program funds to support the efforts 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. ✔
Statutes affected: