Hawaii 2022 Regular Session

Hawaii House Bill HB698 Compare Versions

Only one version of the bill is available at this time.

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1	1	HOUSE OF REPRESENTATIVES H.B. NO. 698 THIRTY-FIRST LEGISLATURE, 2021 STATE OF HAWAII A BILL FOR AN ACT relating to maternal HEALTH. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	HOUSE OF REPRESENTATIVES H.B. NO. 698
4	4	THIRTY-FIRST LEGISLATURE, 2021
5	5	STATE OF HAWAII
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7	7	HOUSE OF REPRESENTATIVES
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9	9	H.B. NO.
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11	11	698
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13	13	THIRTY-FIRST LEGISLATURE, 2021
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	relating to maternal HEALTH.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that maternal morbidity rates in the United States are among the highest in the developed world. Each year, more than fifty thousand women suffer from complications in pregnancy or childbirth that have serious consequences for the women's short- or long-term health. Although Hawaii currently collects data on incidents of severe maternal morbidity, the data is not disaggregated by race or ethnic background, making it difficult for the State to assess and meet the specific needs of women who are Black, Native Hawaiian, Samoan, and other women of color. Adequate and disaggregated data would allow the State to create tailored health care policies and culturally appropriate preventative care programs to ensure that all women in the State have the best possible maternal health outcomes. The legislature also finds that there are disparities in national maternal health outcomes that are not fully explained by differences in prenatal care access, socioeconomic status, or general physical health. A growing body of evidence indicates that women of color are often treated unequally and unfairly in the health care system. Studies show that implicit bias is often a key factor driving unequal treatment and poorer health outcomes for patients of color. At present, the State does not require health care professionals to undergo implicit bias training. Accordingly, the purpose of this Act is to: (1) Require the department of human services to collect and report severe maternal morbidity data, disaggregated by race and ethnic background; (2) Establish a maternal disparity and health equity task force to review existing policies and provide recommendations on improving maternal health outcomes, particularly health outcomes for women of color; and (3) Require the department of health to develop and the Hawaii state commission on the status of women to administer an implicit bias training program for health care professionals in the State's perinatal facilities. SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows: "Part . MATERNAL HEALTH §346-A Definitions. As used in this part, unless the context otherwise requires: "Health care professional" means a physician or other health care practitioner licensed, accredited, or certified to perform specified physical, mental, or behavioral health care services consistent with the professional's scope of practice under the laws of this state. "Implicit bias" means a bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudices and stereotypes that operate at a level below conscious awareness and intentional control. "Implicit prejudice" means negative and prejudicial feelings or beliefs about a group that a person holds without being aware of the feelings or beliefs. "Implicit stereotypes" means the unconscious attribution, as influenced by experience and based on learned associations, of particular qualities to a member of a certain social group, including members of a particular gender or race. "Perinatal care" means the provision of health care during pregnancy, labor, delivery, and the postpartum and neonatal periods. "Perinatal facility" means a hospital, clinic, or birthing center that provides perinatal care. "Severe maternal morbidity" means any health condition attributed to or aggravated by pregnancy or childbirth that results in significant short- or long-term consequences to a woman's health. §346-B Severe maternal morbidity data. (a) The department shall collect and track data on incidents of severe maternal morbidity in the State, including, but not limited to, the following health conditions or treatments for the health conditions: (1) Obstetric hemorrhage; (2) Hypertension; (3) Preeclampsia; (4) Eclampsia; (5) Venous thromboembolism; (6) Sepsis; (7) Cerebrovascular accident; (8) Amniotic fluid embolism; (9) Cardiac arrest; (10) Pulmonary edema; (11) Uterine rupture; (12) Emergency hysterectomy; and (13) Blood transfusion. (b) Beginning on June 30, 2022, and no later than June 30 of each year thereafter, the department shall publish a public report, in accordance with this section, containing data on all incidents of severe maternal morbidity for the previous year, disaggregated by county and by racial and ethnic identity. All reported data shall comply with the Health Insurance Portability and Accountability Act of 1996. §346-C Maternal disparity and health equity task force; reports. (a) There is established within the department a maternal disparity and health equity task force, which shall be an advisory body exempt from section 26-34. The task force shall comprise the following members or their designees: (1) The director; (2) The director of health; (3) The chair of the Hawaii sexual and gender minority workgroup of the department of health; (4) The chair of the office of Hawaiian affairs; and (5) The executive director of the Hawaii state commission on the status of women. The director of human services shall serve as the chair of the task force. (b) The following shall be invited to become members of the task force by the governor: (1) A licensed obstetrician-gynecologist; (2) A license midwife; (3) A licensed nurse; (4) A representative of the Healthy Mothers Healthy Babies Coalition of Hawaii; (5) A representative of March of Dimes; (6) A representative of Planned Parenthood; (7) A representative of Papa Ola Lokahi; (8) A representative of We Are Oceania; (9) A representative of the Popolo Project; (10) A representative of the Micronesia Women's Task Force; (11) A representative of the Healthcare Association of Hawaii; (12) A representative of the Hawaii Primary Care Association; and (13) Any additional members that the governor deems necessary. The terms of the members invited pursuant to paragraphs (1), (2), and (3) shall be for four years. The governor may remove or suspend any member for cause after due notice and public hearing. (c) The task force shall: (1) Provide recommendations on reducing the frequency and improving the outcomes of severe maternal morbidity incidents in the State; (2) Provide recommendations on addressing maternal health disparities based on race or economic status, with a special emphasis on improving health outcomes for women of color; and (3) Submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of each regular session of the legislature. (d) No later than twenty days prior to the convening of the regular session of 2022, the task force shall submit to the legislature an initial report containing the findings and recommendations pursuant to subsection (c) and the evaluations pursuant to this subsection. The task force shall update the initial report if it determines that revisions are necessary or upon request by the governor or legislature. The initial report and updated reports shall comprise: (1) An evaluation of existing State practices for collecting and disseminating severe maternal morbidity data, including discussions of: (A) The adequacy of maternal health data currently collected in electronic health records, including the adequacy of data collected on race and ethnicity; (B) Any barriers preventing the State from correlating data on maternal health outcomes with data on race and ethnicity; (C) The extent to which the State's consideration of and proposed solutions to the maternal morbidity crisis are informed by the subjective experiences and reported stories of pregnant and postpartum women and their families; (D) The social determinates of health as they relate to pregnancy-associated and pregnancy-related deaths; (E) Any legal barriers that would prevent the State from collecting and reporting maternity care data; (F) The advisability of separating pregnancy-associated deaths from pregnancy-related deaths in the data collection and reporting processes; and (G) Any funding available from federal, state, local, or other sources to support efforts to address severe maternal morbidity; and (2) An evaluation of existing standards of care for maternal health, including prenatal care, labor and delivery practices, and postpartum care for up to one year postpartum. The evaluation shall comprise discussions of: (A) The efficacy of the existing standards of care for maternal health used by hospitals, health systems, birth centers, health plans, and other relevant entities in the State; (B) The adequacy of the outcome measures currently used to evaluate maternity care for testing purposes and to validate new maternal health care payment and service delivery models; (C) The standards of care for maternal health that are considered effective in other countries; (D) Existing maternal care measures that may be eliminated because they are not achieving their intended effects; (E) Any barriers that are preventing health care professionals from implementing standards of care for maternal health that are aligned with best practices; (F) The frequency with which standards of care for maternal health are currently reviewed and revised; (G) The strengths and weaknesses of the prenatal and postpartum care measures discussed in the health plan employer data and information set, established by the National Committee for Quality Assurance; (H) The strengths and weaknesses of the maternal care measures established by the medicaid program in title XIX of the Social Security Act, title 42 United States Code section 1396 et seq.; and title XXI of the Children's Health Insurance Program, title 42 United States Code section 1397aa et seq.; (I) The extent to which standards of care in maternal health are informed by women's subjective experiences of care, as reported by patients; (J) The extent to which standards of care in maternal health are informed by and take into consideration the unique experiences of women of color and their families; as reported by patients of color; (K) The adequacy of existing processes for collecting stratified data on the race and ethnicity of pregnant and postpartum women in hospitals, health systems, and birth centers and for incorporating racially and ethnically stratified data in standards of care for maternal health; and (L) The extent to which hospitals, health systems, and birth centers in the State are implementing existing state and national standards of care for maternal health. §346-D Implicit bias training for perinatal facilities. (a) The department shall develop and the Hawaii state commission on the status of women shall administer an evidence-based implicit bias training program. (b) All health care professionals employed at a perinatal facility and engaged in direct patient care shall complete implicit bias training within sixty days of the enactment of this Act or sixty days of the start of employment and an implicit bias refresher course every two years thereafter, or more frequently if deemed necessary by the Hawaii state commission on the status of women. (c) The implicit bias training program developed pursuant to this section shall include: (1) Methods of identifying the attendee's previous or current implicit biases, implicit prejudices, or implicit stereotypes; (2) Discussions of personal, interpersonal, institutional, structural, and cultural barriers to inclusion; (3) Discussions of the corrective measures available to decrease implicit bias at the interpersonal and institutional levels, including discussions of existing policies and practices for this purpose; (4) Information on the effects of historical and contemporary exclusion and oppression on minorities and minority communities; (5) Discussions of cultural identity across racial or ethnic groups; (6) Methods of communicating more effectively across identity groups, including identity groups based on race, ethnicity, religion, and other factors; (7) Discussions of any concerns about implicit bias in the perinatal facility's power dynamics or organizational decision-making processes; (8) Discussions of health inequities within the perinatal care field, including information on the effects of implicit bias on maternal and infant health outcomes; and (9) Perspectives from diverse, local constituency groups and experts on community-specific topics related to identity, race, culture, and provider-community relations. (d) The Hawaii state commission on the status of women may offer implicit bias training to a health care professional not employed by a perinatal facility; provided that the health care professional works in the perinatal field and is involved in direct patient care. (e) Upon completion of the training and upon the health care professional's request, the Hawaii state commission on the status of women shall provide to the health care professional a certificate of implicit bias training completion." SECTION 3. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act. SECTION 4. This Act shall take effect on July 1, 2021. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that maternal morbidity rates in the United States are among the highest in the developed world. Each year, more than fifty thousand women suffer from complications in pregnancy or childbirth that have serious consequences for the women's short- or long-term health. Although Hawaii currently collects data on incidents of severe maternal morbidity, the data is not disaggregated by race or ethnic background, making it difficult for the State to assess and meet the specific needs of women who are Black, Native Hawaiian, Samoan, and other women of color. Adequate and disaggregated data would allow the State to create tailored health care policies and culturally appropriate preventative care programs to ensure that all women in the State have the best possible maternal health outcomes.
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51	51	The legislature also finds that there are disparities in national maternal health outcomes that are not fully explained by differences in prenatal care access, socioeconomic status, or general physical health. A growing body of evidence indicates that women of color are often treated unequally and unfairly in the health care system. Studies show that implicit bias is often a key factor driving unequal treatment and poorer health outcomes for patients of color. At present, the State does not require health care professionals to undergo implicit bias training.
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53	53	Accordingly, the purpose of this Act is to:
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55	55	(1) Require the department of human services to collect and report severe maternal morbidity data, disaggregated by race and ethnic background;
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57	57	(2) Establish a maternal disparity and health equity task force to review existing policies and provide recommendations on improving maternal health outcomes, particularly health outcomes for women of color; and
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59	59	(3) Require the department of health to develop and the Hawaii state commission on the status of women to administer an implicit bias training program for health care professionals in the State's perinatal facilities.
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61	61	SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:
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63	63	"Part . MATERNAL HEALTH
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65	65	§346-A Definitions. As used in this part, unless the context otherwise requires:
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67	67	"Health care professional" means a physician or other health care practitioner licensed, accredited, or certified to perform specified physical, mental, or behavioral health care services consistent with the professional's scope of practice under the laws of this state.
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69	69	"Implicit bias" means a bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudices and stereotypes that operate at a level below conscious awareness and intentional control.
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71	71	"Implicit prejudice" means negative and prejudicial feelings or beliefs about a group that a person holds without being aware of the feelings or beliefs.
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73	73	"Implicit stereotypes" means the unconscious attribution, as influenced by experience and based on learned associations, of particular qualities to a member of a certain social group, including members of a particular gender or race.
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75	75	"Perinatal care" means the provision of health care during pregnancy, labor, delivery, and the postpartum and neonatal periods.
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77	77	"Perinatal facility" means a hospital, clinic, or birthing center that provides perinatal care.
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79	79	"Severe maternal morbidity" means any health condition attributed to or aggravated by pregnancy or childbirth that results in significant short- or long-term consequences to a woman's health.
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81	81	§346-B Severe maternal morbidity data. (a) The department shall collect and track data on incidents of severe maternal morbidity in the State, including, but not limited to, the following health conditions or treatments for the health conditions:
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83	83	(1) Obstetric hemorrhage;
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85	85	(2) Hypertension;
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87	87	(3) Preeclampsia;
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89	89	(4) Eclampsia;
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91	91	(5) Venous thromboembolism;
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93	93	(6) Sepsis;
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95	95	(7) Cerebrovascular accident;
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97	97	(8) Amniotic fluid embolism;
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99	99	(9) Cardiac arrest;
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101	101	(10) Pulmonary edema;
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103	103	(11) Uterine rupture;
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105	105	(12) Emergency hysterectomy; and
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107	107	(13) Blood transfusion.
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109	109	(b) Beginning on June 30, 2022, and no later than June 30 of each year thereafter, the department shall publish a public report, in accordance with this section, containing data on all incidents of severe maternal morbidity for the previous year, disaggregated by county and by racial and ethnic identity. All reported data shall comply with the Health Insurance Portability and Accountability Act of 1996.
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111	111	§346-C Maternal disparity and health equity task force; reports. (a) There is established within the department a maternal disparity and health equity task force, which shall be an advisory body exempt from section 26-34. The task force shall comprise the following members or their designees:
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113	113	(1) The director;
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115	115	(2) The director of health;
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117	117	(3) The chair of the Hawaii sexual and gender minority workgroup of the department of health;
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119	119	(4) The chair of the office of Hawaiian affairs; and
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121	121	(5) The executive director of the Hawaii state commission on the status of women.
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123	123	The director of human services shall serve as the chair of the task force.
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125	125	(b) The following shall be invited to become members of the task force by the governor:
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127	127	(1) A licensed obstetrician-gynecologist;
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129	129	(2) A license midwife;
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131	131	(3) A licensed nurse;
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133	133	(4) A representative of the Healthy Mothers Healthy Babies Coalition of Hawaii;
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135	135	(5) A representative of March of Dimes;
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137	137	(6) A representative of Planned Parenthood;
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139	139	(7) A representative of Papa Ola Lokahi;
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141	141	(8) A representative of We Are Oceania;
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143	143	(9) A representative of the Popolo Project;
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145	145	(10) A representative of the Micronesia Women's Task Force;
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147	147	(11) A representative of the Healthcare Association of Hawaii;
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149	149	(12) A representative of the Hawaii Primary Care Association; and
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151	151	(13) Any additional members that the governor deems necessary.
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153	153	The terms of the members invited pursuant to paragraphs (1), (2), and (3) shall be for four years. The governor may remove or suspend any member for cause after due notice and public hearing.
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155	155	(c) The task force shall:
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157	157	(1) Provide recommendations on reducing the frequency and improving the outcomes of severe maternal morbidity incidents in the State;
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159	159	(2) Provide recommendations on addressing maternal health disparities based on race or economic status, with a special emphasis on improving health outcomes for women of color; and
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161	161	(3) Submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of each regular session of the legislature.
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163	163	(d) No later than twenty days prior to the convening of the regular session of 2022, the task force shall submit to the legislature an initial report containing the findings and recommendations pursuant to subsection (c) and the evaluations pursuant to this subsection. The task force shall update the initial report if it determines that revisions are necessary or upon request by the governor or legislature. The initial report and updated reports shall comprise:
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165	165	(1) An evaluation of existing State practices for collecting and disseminating severe maternal morbidity data, including discussions of:
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167	167	(A) The adequacy of maternal health data currently collected in electronic health records, including the adequacy of data collected on race and ethnicity;
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169	169	(B) Any barriers preventing the State from correlating data on maternal health outcomes with data on race and ethnicity;
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171	171	(C) The extent to which the State's consideration of and proposed solutions to the maternal morbidity crisis are informed by the subjective experiences and reported stories of pregnant and postpartum women and their families;
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173	173	(D) The social determinates of health as they relate to pregnancy-associated and pregnancy-related deaths;
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175	175	(E) Any legal barriers that would prevent the State from collecting and reporting maternity care data;
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177	177	(F) The advisability of separating pregnancy-associated deaths from pregnancy-related deaths in the data collection and reporting processes; and
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179	179	(G) Any funding available from federal, state, local, or other sources to support efforts to address severe maternal morbidity; and
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181	181	(2) An evaluation of existing standards of care for maternal health, including prenatal care, labor and delivery practices, and postpartum care for up to one year postpartum. The evaluation shall comprise discussions of:
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183	183	(A) The efficacy of the existing standards of care for maternal health used by hospitals, health systems, birth centers, health plans, and other relevant entities in the State;
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185	185	(B) The adequacy of the outcome measures currently used to evaluate maternity care for testing purposes and to validate new maternal health care payment and service delivery models;
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187	187	(C) The standards of care for maternal health that are considered effective in other countries;
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189	189	(D) Existing maternal care measures that may be eliminated because they are not achieving their intended effects;
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191	191	(E) Any barriers that are preventing health care professionals from implementing standards of care for maternal health that are aligned with best practices;
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193	193	(F) The frequency with which standards of care for maternal health are currently reviewed and revised;
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195	195	(G) The strengths and weaknesses of the prenatal and postpartum care measures discussed in the health plan employer data and information set, established by the National Committee for Quality Assurance;
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197	197	(H) The strengths and weaknesses of the maternal care measures established by the medicaid program in title XIX of the Social Security Act, title 42 United States Code section 1396 et seq.; and title XXI of the Children's Health Insurance Program, title 42 United States Code section 1397aa et seq.;
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199	199	(I) The extent to which standards of care in maternal health are informed by women's subjective experiences of care, as reported by patients;
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201	201	(J) The extent to which standards of care in maternal health are informed by and take into consideration the unique experiences of women of color and their families; as reported by patients of color;
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203	203	(K) The adequacy of existing processes for collecting stratified data on the race and ethnicity of pregnant and postpartum women in hospitals, health systems, and birth centers and for incorporating racially and ethnically stratified data in standards of care for maternal health; and
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205	205	(L) The extent to which hospitals, health systems, and birth centers in the State are implementing existing state and national standards of care for maternal health.
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207	207	§346-D Implicit bias training for perinatal facilities. (a) The department shall develop and the Hawaii state commission on the status of women shall administer an evidence-based implicit bias training program.
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209	209	(b) All health care professionals employed at a perinatal facility and engaged in direct patient care shall complete implicit bias training within sixty days of the enactment of this Act or sixty days of the start of employment and an implicit bias refresher course every two years thereafter, or more frequently if deemed necessary by the Hawaii state commission on the status of women.
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211	211	(c) The implicit bias training program developed pursuant to this section shall include:
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213	213	(1) Methods of identifying the attendee's previous or current implicit biases, implicit prejudices, or implicit stereotypes;
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215	215	(2) Discussions of personal, interpersonal, institutional, structural, and cultural barriers to inclusion;
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217	217	(3) Discussions of the corrective measures available to decrease implicit bias at the interpersonal and institutional levels, including discussions of existing policies and practices for this purpose;
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219	219	(4) Information on the effects of historical and contemporary exclusion and oppression on minorities and minority communities;
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221	221	(5) Discussions of cultural identity across racial or ethnic groups;
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223	223	(6) Methods of communicating more effectively across identity groups, including identity groups based on race, ethnicity, religion, and other factors;
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225	225	(7) Discussions of any concerns about implicit bias in the perinatal facility's power dynamics or organizational decision-making processes;
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227	227	(8) Discussions of health inequities within the perinatal care field, including information on the effects of implicit bias on maternal and infant health outcomes; and
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229	229	(9) Perspectives from diverse, local constituency groups and experts on community-specific topics related to identity, race, culture, and provider-community relations.
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231	231	(d) The Hawaii state commission on the status of women may offer implicit bias training to a health care professional not employed by a perinatal facility; provided that the health care professional works in the perinatal field and is involved in direct patient care.
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233	233	(e) Upon completion of the training and upon the health care professional's request, the Hawaii state commission on the status of women shall provide to the health care professional a certificate of implicit bias training completion."
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235	235	SECTION 3. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.
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237	237	SECTION 4. This Act shall take effect on July 1, 2021.
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241	241	INTRODUCED BY: _____________________________
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243	243	INTRODUCED BY:
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245	245	_____________________________
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251	251	Report Title: DHS; HSCSW; Maternal Health Equity; Standards of Care; Implicit Bias Training Description: Requires the department of human services to collect and report data on severe maternal morbidity incidents, disaggregated by county, race, and ethnicity. Establishes a maternal disparity and health equity task force to make recommendations on reducing maternal morbidity and improving maternal health outcomes for women, particularly women of color. Requires the task force to submit an initial report to the legislature no later than 6/30/2022 and an annual report prior to each regular session. Requires the department of human services to develop and the Hawaii state commission on the status of women to administer implicit bias training for health care professionals in perinatal facilities. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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257	257	Report Title:
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259	259	DHS; HSCSW; Maternal Health Equity; Standards of Care; Implicit Bias Training
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263	263	Description:
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265	265	Requires the department of human services to collect and report data on severe maternal morbidity incidents, disaggregated by county, race, and ethnicity. Establishes a maternal disparity and health equity task force to make recommendations on reducing maternal morbidity and improving maternal health outcomes for women, particularly women of color. Requires the task force to submit an initial report to the legislature no later than 6/30/2022 and an annual report prior to each regular session. Requires the department of human services to develop and the Hawaii state commission on the status of women to administer implicit bias training for health care professionals in perinatal facilities.
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273	273	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.