By: Thierry, Oliverson, Harris of Williamson, H.B. No. 663
      Collier, Howard, et al.
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the confidentiality and reporting of certain maternal
  mortality information to the Department of State Health Services
  and to a work group establishing a maternal mortality and morbidity
  data registry.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 34.001, Health and Safety Code, is
  amended by adding Subdivision (11-a) and amending Subdivision (12)
  to read as follows:
               (11-a)  "Pregnancy-associated death" means the death
  of a woman from any cause that occurs during or within one year of
  delivery or end of pregnancy, regardless of the outcome or location
  of the pregnancy.
               (12)  "Pregnancy-related death" means the death of a
  woman while pregnant or within one year of delivery or end of
  pregnancy, regardless of the outcome, duration, or location [and
  site] of the pregnancy, from any cause related to or aggravated by
  the pregnancy or its management, but not from accidental or
  incidental causes.
         SECTION 2.  The heading to Section 34.002, Health and Safety
  Code, is amended to read as follows:
         Sec. 34.002.  TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW
  COMMITTEE; REFERENCE IN LAW.
         SECTION 3.  Section 34.002, Health and Safety Code, is
  amended by adding Subsection (a-1) and amending Subsection (e) to
  read as follows:
         (a-1)  Notwithstanding any other law, a reference in this
  chapter or other law to the Maternal Mortality and Morbidity Task
  Force means the Texas Maternal Mortality and Morbidity Review
  Committee.
         (e)  A member of the review committee appointed under
  Subsection (b)(1) is not entitled to compensation for service on
  the review committee, but may receive [or] reimbursement from the
  department as provided by Section 2110.004, Government Code, for
  travel [or other] expenses incurred by the member while conducting
  the business of the review committee.
         SECTION 4.  Section 34.008, Health and Safety Code, is
  amended by adding Subsection (e) to read as follows:
         (e)  Notwithstanding any other law and for purposes of this
  chapter, a health care provider, including a nurse, who during the
  review of information relevant to a case of pregnancy-associated
  death, pregnancy-related death, or severe maternal morbidity
  obtained under this chapter learns of conduct related to the
  provider's profession that is subject to a reporting requirement is
  exempt from that reporting requirement for the reviewed
  information.
         SECTION 5.  Section 34.009(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Any information pertaining to a pregnancy-associated
  death, a pregnancy-related death, or severe maternal morbidity is
  confidential for purposes of this chapter.
         SECTION 6.  Section 34.014, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.014.  FUNDING. (a) The department may accept gifts
  and grants from any source to fund the duties of the department and
  the review committee under this chapter.
         (b)  The department may use only gifts, grants, or federal
  funds to reimburse travel or other expenses incurred by a member of
  the review committee in accordance with Section 34.002(e).
         SECTION 7.  Section 34.017, Health and Safety Code, is
  amended by adding Subsections (c), (d), and (e) to read as follows:
         (c)  The department may allow voluntary and confidential
  reporting to the department of pregnancy-associated deaths and
  pregnancy-related deaths by health care professionals, health care
  facilities, and persons who complete the medical certification for
  a death certificate for deaths reviewed or analyzed by the review
  committee.
         (d)  The department shall allow voluntary and confidential
  reporting to the department of pregnancy-associated deaths and
  pregnancy-related deaths by family members of or other appropriate
  individuals associated with a deceased patient. The department
  shall:
               (1)  post on the department's Internet website the
  contact information of the person to whom a report may be submitted
  under this subsection; and
               (2)  conduct outreach to local health organizations on
  the availability of the review committee to review and analyze the
  deaths described by this subsection.
         (e)  Information reported to the department under this
  section is confidential in accordance with Section 34.009.
         SECTION 8.  Chapter 34, Health and Safety Code, is amended by
  adding Section 34.022 to read as follows:
         Sec. 34.022.  DEVELOPMENT OF WORK GROUP ON ESTABLISHMENT OF
  MATERNAL MORTALITY AND MORBIDITY DATA REGISTRY. (a) In this
  section, "maternal mortality and morbidity data registry" means an
  Internet website or database established to collect individualized
  patient information and aggregate statistical reports on the health
  status, health behaviors, and service delivery needs of maternal
  patients.
         (b)  The department shall establish a work group to provide
  advice and consultation services to the department on the report
  and recommendations required by Subsection (e). The work group
  consists of the following members appointed by the commissioner
  unless otherwise provided:
               (1)  one member with appropriate expertise appointed by
  the governor;
               (2)  two members with appropriate expertise appointed
  by the lieutenant governor;
               (3)  two members with appropriate expertise appointed
  by the speaker of the house of representatives;
               (4)  the chair of the Texas Hospital Association or the
  chair's designee;
               (5)  the president of the Texas Medical Association or
  the president's designee;
               (6)  the president of the Texas Nurses Association or
  the president's designee;
               (7)  one member who is a physician specializing in
  obstetrics and gynecology;
               (8)  one member who is a physician specializing in
  maternal and fetal medicine;
               (9)  one member who is a registered nurse specializing
  in labor and delivery;
               (10)  one member who is a representative of a hospital
  located in a rural area of this state;
               (11)  one member who is a representative of a hospital
  located in a county with a population of four million or more;
               (12)  one member who is a representative of a hospital
  located in an urban area of this state in a county with a population
  of less than four million;
               (13)  one member who is a representative of a public
  hospital;
               (14)  one member who is a representative of a private
  hospital;
               (15)  one member who is an epidemiologist;
               (16)  one member who is a statistician;
               (17)  one member who is a public health expert; and
               (18)  any other member with appropriate expertise as
  the commissioner determines necessary.
         (c)  The work group shall elect from among the membership a
  presiding officer.
         (d)  The work group shall meet periodically and at the call
  of the presiding officer.
         (e)  With the goals of improving the quality of maternal care
  and combating maternal mortality and morbidity and with the advice
  of the work group established under this section, the department
  shall assess and prepare a report and recommendations on the
  establishment of a secure maternal mortality and morbidity data
  registry to record information submitted by participating health
  care providers on the health status of maternal patients over
  varying periods, including the frequency and characteristics of
  maternal mortality and morbidity during pregnancy and the
  postpartum period.
         (f)  In developing the report and recommendations required
  by Subsection (e), the department shall:
               (1)  consider individual maternal patient information
  related to health status and health care received over varying
  periods that should be submitted to the registry;
               (2)  review existing and developing registries used
  within and outside this state that serve the same or a similar
  purpose as a maternal mortality and morbidity data registry;
               (3)  review ongoing health data collection efforts and
  initiatives in this state to avoid duplication and ensure
  efficiency;
               (4)  review and consider existing laws that govern data
  submission and sharing, including laws governing the
  confidentiality and security of individually identifiable health
  information; and
               (5)  evaluate the clinical period during which a health
  care provider should submit to a maternal mortality and morbidity
  data registry known and available information, including
  information:
                     (A)  from a maternal patient's first appointment
  with an obstetrician and each subsequent appointment until the date
  of delivery;
                     (B)  for the 42 days following a patient's
  delivery; and
                     (C)  until the 364th day following a patient's
  delivery.
         (g)  If the department recommends the establishment of a
  maternal mortality and morbidity data registry, the report under
  Subsection (e) must include specific recommendations on the
  relevant individual patient information and categories of
  information to be submitted to the registry, including
  recommendations on the intervals for submission of information.
  The categories must include:
               (1)  notifiable maternal deaths, including
  individualized patient data on:
                     (A)  patients who die during pregnancy; and
                     (B)  patients who were pregnant at any point in
  the 12 months preceding their death;
               (2)  individualized patient information on each
  pregnancy and birth;
               (3)  individualized patient data on the most common
  high-risk conditions for maternal patients and severe cases of
  maternal morbidity;
               (4)  nonidentifying demographic data from the
  provider's patient admissions records, including age, race, and
  patient health benefit coverage status; and
               (5)  a statistical summary based on an aggregate of
  individualized patient data that includes the following:
                     (A)  total live births;
                     (B)  maternal age distributions;
                     (C)  maternal race and ethnicity distributions;
                     (D)  health benefit plan issuer distributions;
                     (E)  incidence of diabetes, hypertension, and
  hemorrhage among patients;
                     (F)  gestational age distributions;
                     (G)  birth weight distributions;
                     (H)  total preterm birth rate;
                     (I)  rate of vaginal deliveries; and
                     (J)  rate of cesarean sections.
         (h)  If the department establishes a maternal mortality and
  morbidity data registry, a health care provider submitting
  information to the registry shall comply with all applicable
  federal and state laws relating to patient confidentiality and
  quality of health care information.
         (i)  The report and recommendations required under
  Subsection (e) must outline potential uses of a maternal mortality
  and morbidity data registry, including:
               (1)  periodic department analysis of information
  submitted to the registry; and
               (2)  the feasibility of preparing and issuing reports,
  using aggregated information, to each health care provider
  participating in the registry to improve the quality of maternal
  care.
         (j)  Not later than September 1, 2024, the department shall
  prepare and submit to the governor, the lieutenant governor, the
  speaker of the house of representatives, the Legislative Budget
  Board, and each standing committee of the legislature having
  primary jurisdiction over the department and post on the
  department's Internet website the report and recommendations
  required under Subsection (e).
         (k)  This section expires September 1, 2025.
         SECTION 9.  The executive commissioner of the Health and
  Human Services Commission shall adopt rules as necessary to
  implement Section 34.022, Health and Safety Code, as added by this
  Act, not later than December 1, 2023.
         SECTION 10.  This Act takes effect September 1, 2023.