HB 3121

relating to maternal mortality and morbidity in this state and
Medicaid eligibility of and coverage for certain services provided
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)
(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
(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
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
SECTION 3.  Section 34.002, Health and Safety Code, is
amended by adding Subsection (a-1) and amending Subsection (e) to
(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
(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
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 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
(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
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 providers 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
(1)  post on the department's Internet website the
contact information of the person to whom a report may be submitted
(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
(b)  The department shall establish a work group to advise
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
(2)  two members with appropriate expertise appointed
(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
(5)  the president of the Texas Medical Association or
(6)  the president of the Texas Nurses Association or
(7)  one member who is a physician specializing in
(8)  one member who is a physician specializing in
(9)  one member who is a registered nurse specializing
(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
(13)  one member who is a representative of a public
(14)  one member who is a representative of a private
(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
(d)  The work group shall meet periodically and at the call
(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, 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
(4)  review and consider existing laws that govern data
submission and sharing, including laws governing the
confidentiality and security of individually identifiable health
(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
(A)  from a maternal patient's first appointment
with an obstetrician and each subsequent appointment until the date
(B)  for the 42 days following a patient's
(C)  until the 364th day following a patient's
(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 and 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
(3)  individualized patient data on the most common
high-risk conditions for maternal patients and severe cases of
(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:
(B)  maternal age distributions;
(C)  maternal race and ethnicity distributions;
(D)  health benefit plan issuer distributions;
(E)  incidence of diabetes, hypertension, and
(F)  gestational age distributions;
(G)  birth weight distributions;
(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
(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
(j)  Not later than September 1, 2026, 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
(k)  This section expires September 1, 2027.
SECTION 9.  Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.02481 to read as follows:
Sec. 32.02481.  MEDICAL ASSISTANCE PROGRAM FOR DOULA
SERVICES.  (a)  In this section:
(1)  "Doula" means a nonmedical birthing coach who
provides doula services and meets the qualifications for a doula as
(2)  "Doula services" means nonmedical childbirth
education, coaching, and support services, including emotional and
physical support provided during pregnancy, labor, delivery, and
the postpartum period, or provided intermittently during pregnancy
(b)  The commission shall establish a program to provide
medical assistance reimbursement for doula services provided by a
doula.  The executive commissioner, in consultation with the
Perinatal Advisory Council established under Section 241.187,
Health and Safety Code, by rule shall determine the qualifications
necessary for an individual to be considered a doula and the doula
services to be covered under the program.
(c)  The commission shall prescribe eligibility requirements
for participation in the program.
(d)  Not later than September 1 of each year during the
operation of the program, the commission shall prepare and publish
on the commission's Internet website a report evaluating:
(1)  the total costs during the preceding year of
providing medical assistance reimbursement for doula services
(2)  the impact on birth outcomes for women who receive
doula services under the program.
(e)  Not later than September 1, 2030, the commission shall
prepare and submit to the legislature a written report that:
(1)  summarizes the results of the program, including
the effectiveness of the program in reducing maternal mortality
rates and racial disparities in health outcomes in the geographic
areas of this state in which the program operates;
(2)  includes feedback from participating doulas and
recipients who received doula services under the program; and
(3)  includes a recommendation on whether the program
should be continued, expanded, or terminated.
(f)  The program terminates and this section expires
SECTION 10.  (a)  In this section:
(1)  "Department" means the Department of State Health
(2)  "Review committee" means the Texas Maternal
Mortality and Morbidity Review Committee established under Chapter
(b)  The review committee and the department shall jointly
conduct a study to evaluate maternal mortality and morbidity among
Black women in this state.  In conducting the study, the review
committee and department shall:
(1)  compare maternal mortality and morbidity rates
among Black women in this state in relation to maternal mortality
and morbidity rates among each other race and ethnicity;
(2)  compare maternal mortality and morbidity rates
among Black women in this state in relation to socioeconomic status
(3)  assess the impact of social determinants of
health, including an evaluation of data on pregnancy-related
deaths, pregnancy-related complications that almost resulted in
death, and morbidities, to identify any correlation in that data to
women who are uninsured, women who receive health care coverage
under Medicaid, and women who receive health care coverage through
(4)  evaluate the impact of the following health
conditions on maternal mortality and morbidity:
(A)  cardiac health conditions;
(B)  preeclampsia, eclampsia, and other
(E)  stress-related health conditions; and
(5)  assess the extent to which implicit biases held by
health care providers against Black individuals affect maternal
mortality and morbidity among Black women.
(c)  Based on the results of the study conducted under this
section, the review committee and department shall develop
recommendations to address disparities in maternal mortality and
morbidity among Black women, including recommendations on:
(1)  strategies to reduce the incidence of
pregnancy-related deaths and severe maternal morbidity;
(2)  patient outreach and education;
(3)  health care provider training, including a
recommendation on the potential benefit of training on cultural
competency and implicit biases against Black individuals;
(4)  best practices identified as successful in
reducing maternal mortality and morbidity; and
(5)  the implementation in this state of programs
operating in other states that have reduced maternal mortality and
(d)  Not later than September 1, 2026, the review committee
and department shall prepare and submit to the governor, lieutenant
governor, speaker of the house of representatives, and appropriate
committees of the legislature a written report that summarizes the
results of the study and includes the recommendations developed
under this section.  The report may be consolidated with the
biennial report required under Section 34.015, Health and Safety
(e)  This section expires December 31, 2026.
SECTION 11.  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, 2025.
SECTION 12.  If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 13.  This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2025.