HLS 21RS-169 REENGROSSED
2021 Regular Session
HOUSE BILL NO. 190
BY REPRESENTATIVES WILLARD, GARY CARTER, COX, DUBUISSON,
DUPLESSIS, EDMONSTON, EMERSON, GAINES, GREEN, HILFERTY,
HUGHES, JAMES, JONES, JORDAN, LANDRY, LARVADAIN, LYONS,
MARCELLE, DUSTIN MILLER, NEWELL, PIERRE, AND SELDERS
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Provides relative to maternity services of midwives and doulas
1 AN ACT
2To enact R.S. 22:1059 and 1059.1, relative to health insurance coverage for midwifery and
3 doula services; to provide relative to health insurance coverage for maternity services
4 provided by midwives and doulas; to provide for legislative findings; to create the
5 Louisiana Doula Registry Board and provide for its purpose, composition, and
6 duties; to authorize rulemaking; to provide for definitions; to provide for
7 applicability; to provide for an effective date; and to provide for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 22:1059 and 1059.1 are hereby enacted to read as follows:
10 §1059. Required coverage for services provided by midwives; reimbursement
11 discrimination prohibited; definitions
12 A. The legislature hereby finds and affirms all of the following:
13 (1) Midwives are community-based practitioners who provide
14 comprehensive, holistic, individualized maternity care and alternative birthing
15 services to low-risk clients.
16 (2) Midwifery care is family-centered and individualized to consider the
17 unique cultural, ethnic, psychosocial, nutritional, and educational needs of the client
18 and supports healthy lifestyle habits that benefit the whole family.
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1 (3) Midwives have made a tremendous contribution to the health and welfare
2 of mothers and the practice of midwifery continues to advance as a profession as
3 these providers comprise an increasing part of mainstream health care.
4 B.(1) Any health coverage plan delivered or issued for delivery in this state
5 that provides benefits for maternity services shall include coverage for healthcare
6 services provided by a midwife.
7 (2) The coverage provided for in this Section may be subject to annual
8 deductibles, coinsurance, and copayments. A health coverage plan shall not
9 differentiate between services performed by a midwife within his lawful scope of
10 practice and services by a physician with respect to copayment or annual deductible
11 amounts or coinsurance percentages.
12 C.(1) Whenever any health coverage plan delivered or issued for delivery in
13 this state provides for reimbursement of any services which are within the lawful
14 scope of practice of certified nurse midwives and certified professional midwives as
15 defined in R.S. 37:3241, the insured or other person entitled to benefits under the
16 health coverage plan shall be entitled to reimbursement for the services, whether the
17 services are performed by a physician or a midwife.
18 (2) Terminology in any health coverage plan policy or contract deemed
19 discriminatory against certified nurse midwives, certified professional midwives, or
20 midwifery or that inhibits reimbursement for services at the in-network rate is void
21 and unenforceable.
22 D. For purposes of this Section, the following definitions apply:
23 (1) "Health coverage plan" means any hospital, health, or medical expense
24 insurance policy, hospital or medical service contract, employee welfare benefit plan,
25 contract, or other agreement with a health maintenance organization or a preferred
26 provider organization, health and accident insurance policy, or any other insurance
27 contract of this type in this state, including a group insurance plan, a self-insurance
28 plan, and the Office of Group Benefits programs. "Health coverage plan" does not
29 include a plan providing coverage for excepted benefits as defined in R.S. 22:1061,
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1 limited benefit health insurance plans, and short-term policies that have a term of
2 less than twelve months.
3 (2) "Midwife" means a certified nurse midwife licensed by the Louisiana
4 State Board of Nursing in accordance with the provisions of R.S. 37:911 et seq. or
5 a certified professional midwife licensed pursuant to the Midwife Practitioners Act,
6 R.S. 37:3240 et seq.
7 §1059.1. Legislative findings; Louisiana Doula Registry Board; purpose;
8 composition; duties of the board; rulemaking authority
9 A.(1) The legislature hereby finds and declares that research indicates
10 maternal mortality, severe maternal morbidity, infant mortality, preterm birth, and
11 unexpected outcomes of pregnancy and birth resulting in significant health
12 consequences are rising in the United States, and that these outcomes occur more
13 frequently in Louisiana than in other states. Louisiana has the highest maternal death
14 rate in the nation and the second highest infant death rate in the nation.
15 (2) The benefits of doula care have been documented in numerous studies
16 including the 2017 Cochrane Review of twenty-six trials of continuous labor support
17 and doula care involving over fifteen thousand women in seventeen different
18 countries. The numerous benefits of doula care include decreased cesarean sections,
19 increased spontaneous vaginal births, shortened duration of birth, increased maternal
20 satisfaction postpartum, improved breastfeeding rates, and lower rates of preterm
21 labor and low birth weight.
22 B.(1) The legislature hereby creates within the Louisiana Department of
23 Health the Louisiana Doula Registry Board, hereafter referred to in this Section as
24 the "doula registry board", for the purpose of reviewing and approving doula
25 registration to allow for health insurance reimbursement of doula services.
26 (2) The doula registry board shall create the criteria for the registration
27 application, review submitted doula registration applications, and grant registration
28 status to doulas seeking health insurance reimbursement to promote safe and
29 equitable care for every mother and every birth in this state.
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1 C. The doula registry board shall perform all of the following tasks:
2 (1) Review applications for doulas to register to receive health insurance
3 reimbursement in Louisiana.
4 (2) Approve applications to designate registered doula status.
5 (3) Notify applicants of approval or denial of doula registration status.
6 (4) Maintain a statewide registry of doulas approved for health insurance
7 reimbursement in Louisiana.
8 D.(1) The doula registry board shall be composed of the following members:
9 (a) One representative of an organization providing doula services for people
10 giving birth in Louisiana in Region 1 appointed by the medical director of the
11 Louisiana Perinatal Quality Collaborative.
12 (b) One representative of an organization providing doula services for people
13 giving birth in Louisiana in Region 2 appointed by the medical director of the
14 Louisiana Perinatal Quality Collaborative.
15 (c) One representative of an organization providing doula services for people
16 giving birth in Region 3 appointed by the medical director of the Louisiana Perinatal
17 Quality Collaborative.
18 (d) One representative of an organization providing doula services for people
19 giving birth in Louisiana in Region 4 appointed by the medical director of the
20 Louisiana Perinatal Quality Collaborative.
21 (e) One representative of an organization providing doula services for people
22 giving birth in Louisiana in Region 5 appointed by the medical director of the
23 Louisiana Perinatal Quality Collaborative.
24 (f) One representative of an organization providing doula services for people
25 giving birth in Louisiana in Region 6 appointed by the medical director of the
26 Louisiana Perinatal Quality Collaborative.
27 (g) One representative of an organization providing doula services for people
28 giving birth in Louisiana in Region 7 appointed by the medical director of the
29 Louisiana Perinatal Quality Collaborative.
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1 (h) One representative of an organization providing doula services for people
2 giving birth in Louisiana in Region 8 appointed by the medical director of the
3 Louisiana Perinatal Quality Collaborative.
4 (i) One representative of an organization providing doula services for people
5 giving birth in Louisiana in Region 9 appointed by the medical director of the
6 Louisiana Perinatal Quality Collaborative.
7 (j) One person with lived experience having used doula services for at least
8 two births.
9 (k) One doula with lactation training.
10 (l) One representative from Sista Midwife Productions.
11 (m) One representative from Community Birth Companion.
12 (n) One representative from Birthmark Doula Collective.
13 (o) One representative from H.E.R. Institute.
14 (2) The doula registry board shall elect from among its members a practicing
15 doula as chairperson.
16 (3) Members of the doula registry board shall serve without compensation
17 for up to two years with the option for reappointment.
18 (4) The doula registry board shall hold quarterly public meetings unless
19 otherwise provided by vote of the doula registry board or by order of the chairperson.
20 (5) The doula registry board may establish subcommittees and appoint
21 persons to those subcommittees, including persons who are not board members, nor
22 voting members, as it deems necessary and appropriate to accomplish its goals.
23 E. Members of the nonvoting subcommittee shall include and are not limited
24 to all of the following:
25 (1) One representative of New Orleans Breastfeeding Center.
26 (2) One representative of March of Dimes.
27 (3) One representative of National Birth Equity Collaborative.
28 (4) One representative of Institute of Women & Ethnic Studies.
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1 (5) One obstetrician with demonstrated work rooted in community, health
2 equity, and training in equitable practices.
3 (6) One certified professional midwife.
4 (7) One certified nurse midwife.
5 (8) One community nurse practitioner.
6 (9) One representative from Louisiana Medicaid.
7 (10) One representative from Louisiana Hospital Association.
8 (11) One representative from each private health insurer in Louisiana as
9 determined by the doula registry board.
10 F. The regional representatives described in Paragraph (D)(1) of this Section
11 shall be appointed from the regions specified on the Administrative Regions and
12 Districts map of the Louisiana Department of Health, hereinafter the "department".
13 G. The department shall promulgate all such rules in accordance with the
14 Administrative Procedure Act as are necessary to implement the provisions of this
15 Section.
16 H. The department shall provide staff support to the doula registry board.
17 I. Nothing in this Section prohibits any person from practicing as a doula in
18 this state, regardless of whether such person is registered in accordance with the
19 provisions of this Section.
20 Section 2. This Act shall become effective on January 1, 2022.
21 (B) The provisions of this Act apply to any new policy, contract, program, or health
22coverage plan issued on and after January 1, 2022. Any policy, contract, or health coverage
23plan in effect prior to January 1, 2022, shall convert to conform to the provisions of this Act
24on or before the renewal date, but no later than January 1, 2023.
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DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 190 Reengrossed 2021 Regular Session Willard
Abstract: Provides for health insurance coverage for maternity services provided by
certified nurse midwives, certified professional midwives, and doulas.
Proposed law requires any health coverage plan delivered or issued for delivery in this state
that provides benefits for maternity services to include coverage for healthcare services
provided by a certified midwife, subject to annual deductibles, coinsurance, and copayment
provisions as are consistent with those established under the health coverage plan.
Proposed law entitles the insured or other beneficiary of benefits under the health coverage
plan to reimbursement for services within the lawful scope of practice of a midwife as
defined in law.
Proposed law prohibits a health coverage plan from differentiating between services
performed by midwives and physicians with respect to copayments, annual deductible
amounts, or coinsurance percentages.
Proposed law prohibits terminology in any health coverage plan policy or contract deemed
discriminatory against certified nurse midwives, certified professional midwives, and the
practice of midwifery. Further prohibits terminology that inhibits reimbursement for
midwifery services at the in-network rate.
Proposed law defines "health coverage plan" and "midwife".
Proposed law creates the Louisiana Doula Registry board (doula registry board), outlines
legislative findings, and details the board’s purpose, composition, and duties. Requires
board membership to include certain members who represent all areas of the state, and
members who are part of organizations relative to doula practice or who demonstrate work
rooted in community, health equity, and training practices. Further authorizes the doula
registry board to create subcommittees composed of certain persons who may not be board
members or voting members.
Proposed law requires the doula registry board to review applications for doulas registering
to receive health insurance reimbursement in the state of La., approve or deny such
applications, notify applicants of approval or denial of doula registration status, and maintain
a statewide registry of doulas approved for health insurance reimbursement in this state.
Proposed law requires regional representatives of the board to be appointed from the regions
specified on a certain map provided by LDH. Requires LDH to promulgate administrative
rules in accordance with the APA to implement the provisions necessary for the doula
registry board. Further requires LDH to provide support staff to the doula registry board.
Proposed law authorizes a doula to practice in this state, regardless of whether the doula is
registered with the board.
Proposed law requires a policy, contract, or health coverage plan to convert to the
provisions of proposed law by Jan. 1, 2023.
Effective Jan. 1, 2022.
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HB NO. 190
(Adds R.S. 22:1059 and 1059.1)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
original bill:
1. Prohibit a health coverage plan from differentiating between services performed
by midwives and physicians with respect to copayments, annual deductible
amounts, or coinsurance percentages.
2. Remove certain language regarding discrimination of services between midwives
and physicians.
3. Create the Louisiana Doula Registry board, outline legislative findings, and
detail the board’s purpose, composition, and duties. Authorize a doula to
practice in this state, regardless of whether the doula is registered with the board.
Further require the La. Department of Health to provide support staff to the doula
registry board.
4. Change the effective date for when a policy, contract, or health coverage plan
shall convert to the provisions of proposed law from Jan. 1, 2022 to Jan. 1, 2023.
5. Make technical changes.
The House Floor Amendments to the engrossed bill:
1. Remove language relative to provider rates.
2. Specify for certain regional representatives of the doula registry board to be
appointed from the regions specified on the Administrative Regions and District
Map supplied by LDH.
3. Require LDH to promulgate all such administrative rules in accordance with the
APA to implement the provisions necessary for the doula registry board.
4. Make technical changes.
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