1 SB320
2 219002-3
3 By Senator Weaver
4 RFD: Healthcare
5 First Read: 17-MAR-22
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8 SYNOPSIS: Existing law requires abortion providers, 48
9 hours before performing an abortion on a woman, to
10 provide the woman with a state-produced pamphlet of
11 pregnancy-related services in this state.
12 This bill would require a physician, before
13 performing an abortion on a woman, to confirm that
14 the woman has received a free resource access
15 assistance offer. This offer would be provided
16 through a phone call to a toll-free number that is
17 staffed by support professionals who would explain
18 available pregnancy-related services to the woman,
19 help her learn about and connect to those
20 resources, and make available additional direct
21 support related to her pregnancy.
22 This bill would make available substantive
23 services to help pregnant women and parents of
24 young children navigate existing private and public
25 resources to support their pregnancy and parenting,
26 and would establish a process to ensure every woman
Page 1 1 seeking to obtain an abortion in Alabama learns
2 about those services prior to an abortion.
3 This bill would also support follow-up
4 services for women after the birth of their
5 children, including referrals to resources in their
6 community and public assistance programs.
7
8 A BILL
9 TO BE ENTITLED
10 AN ACT
11
12 Relating to pregnancy, parenting, and abortion; to
13 create the Every Mother Matters Act; to support certain
14 services for women before and after childbirth; to require a
15 physician, prior to the performance of an abortion, to confirm
16 that a woman upon whom an abortion is to be performed has
17 received a free resource access assistance offer; and to
18 provide for the provision and contents of the offer.
19 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
20 Section 1. This act shall be known and may be cited
21 as the Every Mother Matters Act.
22 Section 2. For the purposes of this act, the
23 following terms have the following meanings:
24 (1) ABORTION. The same meaning as in Section
25 26-23H-3, Code of Alabama 1975.
26 (2) ABORTION PROVIDER. Any individual or entity that
27 offers or advertises the provision of abortions or that
Page 2 1 operates a facility at which abortions are performed or
2 induced, excluding general and specialized hospitals as
3 described in Section 22-21-20, Code of Alabama 1975.
4 (3) ABUSE. The same meaning as in Section 30-5-2,
5 Code of Alabama 1975.
6 (4) ASSAULT. The acts or offenses described in
7 Sections 13A-6-20, 13A-6-21, and 13A-6-22, Code of Alabama
8 1975.
9 (5) CARE AGENT. An individual employed by an
10 organization to perform the services required by this act.
11 (6) COERCION. The acts or offenses described in
12 Section 13A-6-25, Code of Alabama 1975.
13 (7) DEPARTMENT. The Alabama Department of Public
14 Health.
15 (8) ECTOPIC PREGNANCY. The same meaning as in
16 Section 26-23H-3, Code of Alabama 1975.
17 (9) HUMAN TRAFFICKING. The acts or offenses
18 described in Sections 13A-6-152 and 13A-6-153, Code of Alabama
19 1975.
20 (10) MEDICAL EMERGENCY. A condition that, based on
21 the good faith clinical judgment of a physician, has
22 complicated the medical condition of a pregnant woman so as to
23 necessitate the immediate termination of the woman's pregnancy
24 to avert her death or for which a delay will create a serious
25 risk of substantial and irreversible impairment of a major
26 bodily function.
Page 3 1 (11) NEGLECT. The same meaning as in Section
2 26-16-2, Code of Alabama 1975.
3 (12) ORGANIZATION. A non-governmental entity
4 contracting with the department to provide health pregnancy
5 program services, care plan coordination, and resource access
6 assistance offers as required by this act.
7 (13) PARTICIPANT. An individual receiving Pregnancy
8 Launch Program Services as provided in this act.
9 (14) SEXUAL ABUSE. The acts or offenses described in
10 Sections 13A-6-66 and 13A-6-67, Code of Alabama 1975.
11 Section 3. The department shall establish the
12 Pregnancy Launch Program by contracting with one or more
13 organizations to provide direct services, support, social
14 services case management, and program referrals statewide to
15 biological parents of unborn children, biological or adoptive
16 parents of children under two years of age, and parents and
17 legal guardians of pregnant minors.
18 Section 4. The Pregnancy Launch Program shall do all
19 of the following:
20 (1) Encourage healthy childbirth.
21 (2) Support childbirth as an alternative to
22 abortion.
23 (3) Promote family formation.
24 (4) Aid successful parenting.
25 (5) Increase families' economic self-sufficiency.
26 (6) Improve maternal health, mortality, and
27 postpartum outcomes.
Page 4 1 Section 5. (a) The Pregnancy Launch Program shall
2 consist of at least the following components:
3 (1) The use of licensed nurses, community health
4 workers, or other individuals of equivalent expertise to offer
5 healthy pregnancy program services to participants in the
6 Pregnancy Launch Program, including all of the following:
7 a. Assistance assessing and evaluating needs related
8 to pregnancy or parenting.
9 b. Medically accurate pregnancy-related medical
10 information.
11 c. Assistance obtaining obstetric care, primary
12 care, mental health or behavioral health counseling, and
13 postpartum care.
14 d. Support for factors affecting a pregnant woman's
15 pregnancy, including her or her family's well-being and
16 available support services.
17 e. Information on adoption.
18 (2) The use of licensed social workers, certified
19 life coaches, nurses, community health workers, licensed
20 professional counselors, or other individuals of equivalent
21 experience to offer care plan coordination services to
22 participants in the Pregnancy Launch Program, including all of
23 the following:
24 a. Assistance in identifying needs related to the
25 pregnancy or parent's ability to care for his or her unborn
26 child.
Page 5 1 b. Development of a care plan of resources and
2 support to address the needs identified.
3 c. Referrals to appropriate local resources,
4 including state and federal benefits programs and local
5 charitable organizations.
6 d. Assistance in applying for state and federal
7 benefits programs.
8 e. Assistance in accomplishing elements of the care
9 plan.
10 f. Services related to postpartum depression and
11 related referrals.
12 g. Assistance obtaining pediatric care and
13 postpartum care.
14 h. Assistance obtaining substance abuse treatment
15 and alcohol abuse treatment.
16 i. Education on available public and private
17 resources to address the pregnant woman's or biological
18 father's socioeconomic needs.
19 j. Social services or assistance in obtaining social
20 services related to education, professional certification,
21 housing, employment, resume development, childcare, adoption
22 services, financial needs, substance abuse, and health
23 benefits plan coverage.
24 k. Assistance for abuse, assault, sexual assault,
25 neglect, coercion, and human trafficking.
26 l. Assistance obtaining mental health or behavioral
27 counseling.
Page 6 1 (3) Administrative support and other expenses
2 necessary for the development or ongoing provision of
3 services.
4 (b)(1) The Pregnancy Launch Program shall be
5 available to residents of all counties of the state, including
6 residents in rural areas that may currently lack access to
7 similar services.
8 (2) Notwithstanding any law to the contrary, healthy
9 pregnancy program services and care plan coordination services
10 of the Pregnancy Launch Program may be provided in person
11 through existing facilities or remotely through a telephonic
12 system or other comparable, synchronous direct audio or video
13 technologies.
14 (c) To be eligible to be a participant, an
15 individual shall, at the time of initial contact with the
16 Pregnancy Launch Program, be one of the following:
17 (1) A resident of this state who is the biological
18 parent of an unborn child or a biological or adoptive parent
19 of a child under two years of age.
20 (2) A pregnant woman seeking to obtain an abortion
21 in this state.
22 (3) A parent or legal guardian of a minor residing
23 in this state who is pregnant or has a child under the age of
24 two years.
25 (d) Existing participants of the Pregnancy Launch
26 Program whose pregnancies are terminated are eligible to
Page 7 1 continue to receive services for six months after the date of
2 termination.
3 Section 6. Each organization providing Pregnancy
4 Launch Program services shall record and report monthly to the
5 department the following information pertaining to care plan
6 coordination and healthy pregnancy services:
7 (1) The number of pregnant women, biological
8 fathers, or parents or guardians of a pregnant minor
9 requesting assistance in developing a personalized care plan.
10 (2) The number of unique pregnant women, biological
11 fathers, or parents or guardians of a pregnant minor receiving
12 support in the following categories:
13 a. Education.
14 b. Training for a professional certification.
15 c. Housing.
16 d. Employment.
17 e. Resume development.
18 f. Child care.
19 g. Adoption services.
20 h. Financial needs.
21 i. Substance abuse.
22 j. Health benefit coverage.
23 (3) The number of pregnant women needing assistance
24 for abuse, assault, sexual assault, neglect, coercion, and
25 human trafficking.
26 (4) The number of women needing assistance for
27 postpartum depression and related referrals.
Page 8 1 (5) The number of pregnant women needing assistance
2 obtaining obstetric care, pediatric care, postpartum care, or
3 mental health or behavioral counseling.
4 (6) The number of pregnant women receiving
5 assistance or education for issues related to their health,
6 unborn children's health, pregnancy, abortion, fetal
7 development, or birth.
8 Section 7. (a) An individual shall not perform or
9 induce an abortion unless the individual verifies, in
10 accordance with Section 12, that the woman upon whom the
11 abortion is to be performed or induced has received a resource
12 access assistance offer.
13 (b) A resource access assistance offer under
14 subsection (a) shall consist of a care agent doing all of the
15 following:
16 (1) Informing the pregnant woman of and making
17 available the following:
18 a. Free healthy pregnancy program services offered
19 under Section 5.
20 b. Free care plan coordination services offered
21 under Section 5.
22 (2) Providing education on other public and private
23 resources available to address the socioeconomic needs of the
24 pregnant woman or the biological father of the unborn child.
25 (3) Offering screening and assistance for abuse,
26 assault, sexual assault, neglect, coercion, and human
27 trafficking.
Page 9 1 (c)(1) The pregnant woman is not required to do
2 either of the following in order to obtain an abortion:
3 a. Provide any personally identifiable information
4 to the department, care agent, or contracting organization.
5 b. Initiate, accept, or complete any services
6 offered pursuant to this section in order to obtain an
7 abortion.
8 (2) The pregnant woman may decline services offered
9 pursuant to Section 5 at any time.
10 (d) The resource access assistance offer shall be
11 provided at the expense of the state at no cost to the woman.
12 (e) This section does not apply in the case of a
13 medical emergency necessitating the performance of an
14 abortion. An individual who performs or induces an abortion in
15 a medical emergency shall do both of the following:
16 (1) Include in the woman's medical records a
17 statement signed by the physician certifying the nature of the
18 medical emergency.
19 (2) Not later than the 30th day after the
20 performance of the abortion, certify to the department the
21 specific medical condition that constituted the emergency.
22 (f) This section shall become operative 20 months
23 following the effective date of this act.
24 Section 8. (a) The department shall, not later than
25 10 months following the effective date of this act, contract
26 with one or more organizations sufficient to ensure that every
27 woman seeking an abortion in Alabama receives a resource
Page 10 1 access assistance offer as well as the opportunity to receive
2 free care plan coordination and free healthy pregnancy program
3 services.
4 (b) The department shall only contract with
5 organizations that are capable of offering resource access
6 assistance offers, care plan coordination, and healthy
7 pregnancy program services by telephonic means or other
8 comparable, synchronous direct audio or video technologies.
9 Section 9. An organization and any of its
10 subcontractors or agents who provide services under Sections 3
11 through 8 shall not do any of the following:
12 (1) Be an abortion provider that directly or
13 indirectly promotes, refers for, or assists women in obtaining
14 an abortion.
15 (2) Own, operate, or be affiliated with an abortion
16 provider that directly or indirectly promotes, refers for, or
17 assists women in obtaining an abortion.
18 (3) Employ an individual who has performed or
19 induced an abortion in the last two years.
20 (4) Have as a director, board member, officer,
21 volunteer, or employee an individual who has performed or
22 induced an abortion in the last two years or who serves in any
23 of these roles for an entity described in subdivision (1).
24 (5) Refer women to an abortion provider, recommend
25 abortion, or take any other action that directly or indirectly
26 assists a woman in obtaining an abortion.
Page 11 1 Section 10. Each care agent providing services under
2 this act, and any individual providing program services
3 through a subcontract or through an organization on a
4 volunteer basis, shall:
5 (1) Meet the qualifications established by the
6 department.
7 (2) Have not performed or induced an abortion in the
8 last two years.
9 (3) Have not, within the last two years, served as a
10 director, board member, officer, volunteer, or employee for an
11 entity that is an abortion provider or an entity that directly
12 or indirectly promotes abortion or assists women in obtaining
13 an abortion.
14 (4) Maintain the confidentiality of information the
15 care agent obtains while performing services under this act.
16 (5) Complete a training program regarding
17 recognizing signs that an individual may have been a victim of
18 human trafficking and provide appropriate assistance to that
19 individual.
20 (6) Not refer women to an abortion provider,
21 recommend abortion, or take any other action that directly or
22 indirectly assists a woman in obtaining an abortion.
23 Section 11. The department shall do all of the
24 following:
25 (1) Annually designate the proportion of resource
26 access assistance offers to be provided by each organization
27 based on the organization's share of participants initiating
Page 12 1 care plan coordination services or healthy pregnancy program
2 services.
3 (2) Establish a single toll-free number by which all
4 pregnant women seeking an abortion in Alabama may immediately
5 receive resource access assistance offers by automatically
6 connecting the pregnant woman to an organization based on this
7 proportion.
8 (3)a. Develop and maintain a secure process for
9 completing the verification requirements of this section and
10 Section 12 and enforcing the auditing requirements of Section
11 13.
12 b. The process shall not transmit any information to
13 either of the following:
14 1. The organization or care agent concerning the
15 identity or location of the individual who may perform or
16 induce the abortion or the facility at which the abortion may
17 occur.
18 2. The individual performing or inducing the
19 abortion or the individual's agent regarding the identity of
20 the organization or care agent providing the resource access
21 assistance offer.
22 (4) Provide a monthly report to each organization
23 regarding the percentage of pregnant women who were provided
24 resource access assistance offers by the organization who
25 subsequently obtained an abortion in this state.
26 (5) Provide a monthly report to the chairs of the
27 House and Senate health committees regarding its plans for
Page 13 1 implementing this act, its progress towards that
2 implementation, and the anticipated timeline for the
3 completion of key milestones.
4 (6) Adopt rules for the implementation of this act.
5 Section 12. (a) The individual who is to perform or
6 induce an abortion, or the individual's agent, shall do each
7 of the following before accepting any payment for
8 abortion-related services, before an abortion is performed or
9 induced, and before any sedative or anesthesia is
10 administered:
11 (1) Verify through the department's secure
12 verification process that the woman received a resource access
13 assistance offer from an organization.
14 (2) Record the verification in the woman's medical
15 record.
16 (3) Take any other steps required by department rule
17 to complete the secure verification process.
18 (b) The individual who performs or induces an
19 abortion, or the individual's agent, shall, within two
20 business days of the completion of an abortion, report to the
21 department confirmation for each abortion performed or induced
22 and the date and time of the performance or induction of the
23 abortion.
24 (c) Care agents shall do both of the following:
25 (1) Provide the resource access assistance offer,
26 care coordination, and healthy pregnancy program services.
27 (2) Record the information required by Section 6.
Page 14 1 (d) An organization shall record and report at least
2 monthly to the department the following information pertaining
3 to resource access assistance offers:
4 (1) The number of pregnant women needing assistance
5 for violence, abuse, assault, sexual assault, coercion,
6 neglect, or human trafficking.
7 (2) The number of women receiving a resource access
8 assistance offer who initiate care plan coordination.
9 (3) The number of women receiving a resource access
10 assistance offer who initiate healthy pregnancy program
11 services.
12 (e) This section shall become operative 20 months
13 following the effective date of this act.
14 Section 13. (a) The department, in order to enforce
15 compliance with this act, shall audit the medical records kept
16 by every individual who performs or induces an abortion and
17 every abortion provider according to the following process:
18 (1) At least once a year, the department shall audit
19 10 percent of the abortion medical records at random,
20 unannounced, and reasonable times.
21 (2) The department shall determine for each audited
22 medical record whether the individual who performed or induced
23 the abortion fully complied with subsections (a) and (b) of
24 Section 12.
25 (3) If the department finds that for five percent or
26 more of the audited medical records, the individual who
27 performed or induced the abortion failed to comply with
Page 15 1 subsections (a) and (b) of Section 12, the department shall
2 audit all abortion medical records from that individual since
3 the last inspection performed pursuant to this section.
4 (b) The results of the department's audit shall be a
5 public writing for the purpose of the Alabama Open Records
6 Law, Section 36-12-40, Code of Alabama 1975, and the
7 department shall publicly post the results of each audit on
8 its website, provided that the audit results shall not contain
9 any personally identifying information on any woman who
10 obtained an abortion.
11 (c) Any individual performing or inducing an
12 abortion who fails to comply with subsections (a) and (b) of
13 Section 12 shall be subject to a civil penalty of five
14 thousand dollars ($5,000) for each abortion he or she performs
15 or induces in violation of subsections (a) and (b) of Section
16 12.
17 (d) An abortion provider shall be jointly and
18 severally liable for each fine associated with an abortion
19 performed or induced at that facility.
20 (e) The Attorney General or the district attorney of
21 the county in which the abortion was performed or induced may
22 file an action to recover the civil penalty assessed under
23 this section.
24 (f) The civil penalty imposed by this section is in
25 addition to the criminal liability established by the Woman's
26 Right to Know Act, Chapter 23A of Title 26, Code of Alabama
27 1975.
Page 16 1 (g)(1) The Board of Medical Examiners shall revoke
2 the license of an abortion provider if greater than five
3 percent of medical records audited at that facility do not
4 comply with subsections (a) and (b) of Section 12.
5 (2) The department shall revoke the health center
6 facility license of an abortion provider if greater than five
7 percent of medical records audited at that facility do not
8 comply with subsections (a) and (b) of Section 12.
9 (h) This section shall become operative 20 months
10 following the effective date of this act.
11 Section 14. Records that identify an individual care
12 agent, pregnant woman, or biological or adoptive parent held
13 by the department pursuant to this act are not open records
14 for the purposes of Article 3 of Chapter 12 of Title 36, Code
15 of Alabama 1975. Those records may be released or made public
16 as follows:
17 (1) For statistical purposes, but only if a care
18 agent, pregnant woman, or biological or adoptive parent is not
19 identified.
20 (2) With the consent of each individual identified
21 in the information released.
22 (3) To individuals performing or inducing abortions
23 and to organizations, to the extent necessary to fulfill their
24 obligations pursuant to this act.
25 (4) To appropriate state agencies or county and
26 district courts to enforce this chapter.
Page 17 1 (5) To appropriate state licensing boards to enforce
2 state licensing laws.
3 (6) To licensed medical or health care personnel
4 currently treating the pregnant woman.
5 (7) Pursuant to a subpoena issued by a court of
6 competent jurisdiction, provided the release is made subject
7 to a confidentiality requirement as determined by that court.
8 Section 15. This act does not:
9 (1) Create or recognize a right to abortion.
10 (2) Create or recognize a right to a particular
11 method of abortion.
12 (3) Make lawful an abortion that is currently
13 unlawful under any law of this state.
14 Section 16. Nothing in this act shall be interpreted
15 to violate any speech or conduct rights protected by the First
16 Amendment of the Constitution of the United States, as made
17 applicable to the states through interpretations by the
18 Supreme Court of the United States of the Fourteenth Amendment
19 of the Constitution of the United States, or by the
20 Constitution of Alabama of 1901, including the Alabama
21 Religious Freedom Amendment, Article 1, Section 3.01.
22 Section 17. The provisions of this act are
23 severable. If any part of this act is declared invalid or
24 unconstitutional, that declaration shall not affect the part
25 which remains.
Page 18 1 Section 18. This act shall become effective on the
2 first day of the first month following its passage and
3 approval by the Governor, or its otherwise becoming law.
Page 19