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--- version:4285S.01I - Introduced
+++ version:Senate Committee Substitute - Committee Version
@@ -1,228 +1,246 @@
-EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
-and is intended to be omitted in the law.
-SECOND REGULAR SESSION
+4285S.02C
+ 1
+SENATE COMMITTEE SUBSTITUTE
+FOR
 SENATE BILL NO. 871
-103RD GENERAL ASSEMBLY
-INTRODUCED BY SENATOR WASHINGTON.
-4285S.01I KRISTINA MARTIN, Secretary
 AN ACT
-To repeal section 192.990, RSMo, and to enact in lieu thereof one new section relating to maternal
+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-     Section A.  Section 192.990, RSMo, is repealed and one new 1
-section enacted in lieu thereof, to be known as section 192.990, 2
-to read as follows:3
-     192.990.  1.  There is hereby established within the  1
-department of health and senior services the "Pregnancy- 2
-Associated Mortality Review Board" to improve data  3
-collection and reporting with respect to maternal deaths.   4
-The department may collaborate with localities and with  5
-other states to meet the goals of the initiative. 6
-     2.  For purposes of this section, the following terms  7
-shall mean: 8
-     (1)  "Department", the Missouri department of health  9
-and senior services; 10
-     (2)  "Maternal death", the death of a woman while  11
-pregnant or during the one-year period following the date of  12
-the end of pregnancy, regardless of the cause of death and  13
-regardless of whether a delivery, miscarriage, or death  14
-occurs inside or outside of a hospital. 15
-     3.  The board shall be composed of no more than  16
-[eighteen] twenty-two members, with a chair elected from  17
- SB 871 2
-among its membership.  The board shall meet at least twice  18
-per year and shall approve the strategic priorities, funding  19
-allocations, work processes, and products of the board.   20
-Members of the board shall be appointed by the director of  21
-the department.  Members shall serve four-year terms, except  22
-that the initial terms shall be staggered so that  23
-approximately one-third serve three-, four-, and five-year  24
-terms. 25
-     4.  The board shall have a multidisciplinary and  26
-diverse membership that represents a variety of medical and  27
-nursing specialties, including, but not limited to,  28
-obstetrics and maternal-fetal care, as well as state or  29
-local public health officials, epidemiologists,  30
-statisticians, community organizations, geographic regions,  31
-and other individuals or organizations that are most  32
-affected by maternal deaths and lack of access to maternal  33
-health care services.  At least one member from each  34
-congressional district shall be selected to serve on the  35
-board and membership shall be demographically diverse,  36
-including by race, ethnicity, sex, age, and rural and urban  37
-populations. 38
-     5.  The duties of the board shall include, but not be  39
-limited to: 40
-     (1)  Conducting ongoing comprehensive,  41
-multidisciplinary reviews of all maternal deaths; 42
-     (2)  Identifying factors associated with maternal  43
-deaths; 44
-     (3)  Reviewing medical records and other relevant data,  45
-which shall include, to the extent available: 46
-     (a)  A description of the maternal deaths determined by  47
-matching each death record of a maternal death to a birth  48
-certificate of an infant or fetal death record, as  49
- SB 871 3
-applicable, and an indication of whether the delivery,  50
-miscarriage, or death occurred inside or outside of a  51
-hospital; 52
-     (b)  Data collected from medical examiner and coroner  53
-reports, as appropriate; [and] 54
-     (c)  The level and timing of prenatal and postnatal  55
-medical care; and 56
-     (d)  Using other appropriate methods or information to  57
-identify maternal deaths, including deaths from pregnancy  58
-outcomes not identified under paragraph (a) of this  59
-subdivision; 60
-     (4)  Consulting with relevant experts, as needed; 61
-     (5)  Analyzing cases to produce recommendations for  62
-reducing maternal mortality; 63
-     (6)  Disseminating recommendations to policy makers,  64
-health care providers and facilities, and the general public; 65
-     (7)  Recommending and promoting preventative strategies  66
-and making recommendations for systems changes; 67
-     (8)  Protecting the confidentiality of the hospitals  68
-and individuals involved in any maternal deaths; 69
-     (9)  Examining racial and social disparities in  70
-maternal deaths; 71
-     (10)  Investigating and developing recommendations  72
-regarding approaches taken in other states or other  73
-organizations to reduce or eliminate racial inequities in  74
-maternal deaths, including community-driven strategies,  75
-health care accessibility, insurance availability, and other  76
-barriers to access and delivery of prenatal and postpartum  77
-care; 78
-     (11)  Subject to appropriation, providing for voluntary  79
-and confidential case reporting of maternal deaths to the  80
-appropriate state health agency by family members of the  81
- SB 871 4
-deceased, and other appropriate individuals, for purposes of  82
-review by the board; 83
-     [(11)] (12)  Making publicly available the contact  84
-information of the board for use in such reporting; 85
-     [(12)] (13)  Conducting outreach to local professional  86
-organizations, community organizations, and social services  87
-agencies regarding the availability of the review board; 88
-[and] 89
-     (14)  Examining and developing recommendations on the  90
-adequacy of data collected under this section and if  91
-additional categories of data would be informative in the  92
-study of maternal deaths in Missouri; and 93
-     [(13)] (15)  Ensuring that data collected under this  94
-section is made available, as appropriate and practicable,  95
-for research purposes, in a manner that protects  96
-individually identifiable or potentially identifiable  97
-information and that is consistent with state and federal  98
-privacy laws. 99
-     6.  The board may contract with other entities  100
-consistent with the duties of the board. 101
-     7.  (1)  Before June 30, 2020, and annually thereafter,  102
-the board shall submit to the Director of the Centers for  103
-Disease Control and Prevention, the director of the  104
-department, the governor, and the general assembly a report  105
-on maternal mortality in the state based on data collected  106
-through ongoing comprehensive, multidisciplinary reviews of  107
-all maternal deaths, and any other projects or efforts  108
-funded by the board.  The data shall be collected using best  109
-practices to reliably determine and include all maternal  110
-deaths, regardless of the outcome of the pregnancy and shall  111
-include data, findings, and recommendations of the  112
-committee, and, as applicable, information on the  113
- SB 871 5
-implementation during such year of any recommendations  114
-submitted by the board in a previous year.  Data reported by  115
-the board shall be disaggregated by race, ethnicity,  116
-language, nationality, age, zip code, and level and timing  117
-of prenatal and postnatal care in a manner that protects  118
-individually identifiable or potentially identifiable  119
-information and that is consistent with state and federal  120
-privacy laws. 121
-     (2)  The report shall be made available to the public  122
-on the department's website and the director shall  123
-disseminate the report to all health care providers and  124
-facilities that provide women's health services in the state. 125
-     8.  The director of the department, or his or her  126
-designee, shall provide the board with the copy of the death  127
-certificate and any linked birth or fetal death certificate  128
-for any maternal death occurring within the state. 129
-     9.  Upon request by the department, health care  130
-providers, health care facilities, clinics, laboratories,  131
-medical examiners, coroners, law enforcement agencies,  132
-driver's license bureaus, other state agencies, and  133
-facilities licensed by the department shall provide to the  134
-department data related to maternal deaths from sources such  135
-as medical records, autopsy reports, medical examiner's  136
-reports, coroner's reports, law enforcement reports, motor  137
-vehicle records, social services records, and other sources  138
-as appropriate.  Such data requests shall be limited to  139
-maternal deaths which have occurred within the previous  140
-twenty-four months.  No entity shall be held liable for  141
-civil damages or be subject to any criminal or disciplinary  142
-action when complying in good faith with a request from the  143
-department for information under the provisions of this  144
-subsection. 145
- SB 871 6
-     10.  (1)  The board shall protect the privacy and  146
-confidentiality of all patients, decedents, providers,  147
-hospitals, or any other participants involved in any  148
-maternal deaths.  In no case shall any individually  149
-identifiable health information be provided to the public or  150
-submitted to an information clearinghouse. 151
-     (2)  Nothing in this subsection shall prohibit the  152
-board or department from publishing statistical compilations  153
-and research reports that: 154
-     (a)  Are based on confidential information relating to  155
-mortality reviews under this section; and 156
-     (b)  Do not contain identifying information or any  157
-other information that could be used to ultimately identify  158
-the individuals concerned. 159
-     (3)  Information, records, reports, statements, notes,  160
-memoranda, or other data collected under this section shall  161
-not be admissible as evidence in any action of any kind in  162
-any court or before any other tribunal, board, agency, or  163
-person.  Such information, records, reports, notes,  164
-memoranda, data obtained by the department or any other  165
-person, statements, notes, memoranda, or other data shall  166
-not be exhibited nor their contents disclosed in any way, in  167
-whole or in part, by any officer or representative of the  168
-department or any other person.  No person participating in  169
-such review shall disclose, in any manner, the information  170
-so obtained except in strict conformity with such review  171
-project.  Such information shall not be subject to  172
-disclosure under chapter 610. 173
-     (4)  All information, records of interviews, written  174
-reports, statements, notes, memoranda, or other data  175
-obtained by the department, the board, and other persons,  176
- SB 871 7
-agencies, or organizations so authorized by the department  177
-under this section shall be confidential. 178
-     (5)  All proceedings and activities of the board,  179
-opinions of members of such board formed as a result of such  180
-proceedings and activities, and records obtained, created,  181
-or maintained under this section, including records of  182
-interviews, written reports, statements, notes, memoranda,  183
-or other data obtained by the department or any other  184
-person, agency, or organization acting jointly or under  185
-contract with the department in connection with the  186
-requirements of this section, shall be confidential and  187
-shall not be subject to subpoena, discovery, or introduction  188
-into evidence in any civil or criminal proceeding; provided,  189
-however, that nothing in this section shall be construed to  190
-limit or restrict the right to discover or use in any civil  191
-or criminal proceeding anything that is available from  192
-another source and entirely independent of the board's  193
-proceedings. 194
-     (6)  Members of the board shall not be questioned in  195
-any civil or criminal proceeding regarding the information  196
-presented in or opinions formed as a result of a meeting or  197
-communication of the board; provided, however, that nothing  198
-in this section shall be construed to prevent a member of  199
-the board from testifying to information obtained  200
-independently of the board or which is public information. 201
-     11.  The department may use grant program funds to  202
-support the efforts of the board and may apply for  203
-additional federal government and private foundation grants  204
-as needed.  The department may also accept private,  205
-foundation, city, county, or federal moneys to implement the  206
-provisions of this section. 207
-✓
+     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
+
+ 2
+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;
+
+ 3
+     (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
+
+ 4
+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
+
+ 5
+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
+
+ 6
+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.
+
+ 7
+     (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,
+
+ 8
+foundation, city, county, or federal moneys to implement the
+provisions of this section.