88R2858 EAS-F     By: Thierry H.B. No. 663       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, subject to Section 34.014(b), may be   reimbursed [or reimbursement] 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)  For purposes of this chapter, a licensed health care   provider, including a nurse, who is involved in obtaining   information relevant to a case of pregnancy-associated death,   pregnancy-related death, or severe maternal morbidity under this   chapter and who is required under other law to report a violation   related to the provider's profession is exempt from that reporting   requirement for the information obtained under this chapter.          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.