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.