88R7534 LRM-D
By: Thierry H.B. No. 1958
A BILL TO BE ENTITLED
AN ACT
relating to maternal mortality and morbidity in this state and
Medicaid eligibility of and coverage for certain services provided
to pregnant women.
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 Subsections (b) and
(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.
(b) The review committee is a multidisciplinary advisory
committee within the department and is composed of the following 23
[17] members:
(1) 21 [15] members appointed by the commissioner as
follows:
(A) four physicians specializing in obstetrics,
at least one of whom is a maternal fetal medicine specialist;
(B) one certified nurse-midwife;
(C) one registered nurse;
(D) one nurse specializing in labor and delivery;
(E) one physician specializing in family
practice;
(F) one physician specializing in psychiatry;
(G) one physician specializing in pathology;
(H) one epidemiologist, biostatistician, or
researcher of pregnancy-related deaths;
(I) one social worker or social service provider;
(J) two [one] community advocates [advocate] in a
relevant field;
(K) one medical examiner or coroner responsible
for recording deaths; [and]
(L) one physician specializing in critical care;
(M) one physician specializing in emergency
care;
(N) one physician specializing in cardiology;
(O) one physician specializing in
anesthesiology;
(P) one physician specializing in oncology; and
(Q) one representative of a managed care
organization;
(2) a representative of the department's family and
community health programs; and
(3) the state epidemiologist for the department or the
epidemiologist's designee.
(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 34.003(a), Health and Safety Code, is
amended to read as follows:
(a) Review committee members appointed by the commissioner
serve staggered six-year terms, with one-third or as near as
possible to one-third of the members' terms [of four or five
members, as appropriate,] expiring February 1 of each odd-numbered
year.
SECTION 5. 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 6. 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 7. 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 8. 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
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 9. 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 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
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, 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 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
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 10. Section 32.024(l-1), Human Resources Code, is
amended to read as follows:
(l-1) The commission shall continue to provide medical
assistance to a woman who is eligible for medical assistance for
pregnant women for a period of not less than 12 [six] months
following the last month of the woman's pregnancy [date the woman
delivers or experiences an involuntary miscarriage].
SECTION 11. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.02481 to read as follows:
Sec. 32.02481. MEDICAL ASSISTANCE PILOT 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
determined by commission rule.
(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
and the postpartum period.
(b) The commission shall establish a pilot 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 pilot program.
(c) Not later than September 1, 2024, the commission shall
implement the pilot program in:
(1) the most populous county in this state; and
(2) the county with the greatest maternal health
support needs, as determined by the county's maternal and infant
mortality rates and the number of births in the county by Medicaid
recipients.
(d) The commission shall prescribe eligibility requirements
for participation in the pilot program.
(e) Not later than September 1 of each year during the
operation of the pilot 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
under the pilot program; and
(2) the impact on birth outcomes for women who receive
doula services under the pilot program.
(f) Not later than September 1, 2028, the commission shall
prepare and submit to the legislature a written report that:
(1) summarizes the results of the pilot program,
including the effectiveness of the pilot program in reducing
maternal mortality rates and racial disparities in health outcomes
in the geographic areas of this state in which the pilot program
operates;
(2) includes feedback from participating doulas and
recipients who received doula services under the pilot program; and
(3) includes a recommendation on whether the pilot
program should be continued, expanded, or terminated.
(g) The pilot program terminates and this section expires
September 1, 2029.
SECTION 12. (a) In this section:
(1) "Department" means the Department of State Health
Services.
(2) "Review committee" means the Texas Maternal
Mortality and Morbidity Review Committee established under Chapter
34, Health and Safety Code.
(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
and education level;
(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
a private insurer;
(4) evaluate the impact of the following health
conditions on maternal mortality and morbidity:
(A) cardiac health conditions;
(B) preeclampsia, eclampsia, and other
hypertensive disorders;
(C) hemorrhage;
(D) obesity; and
(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
morbidity rates.
(d) Not later than September 1, 2024, 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
Code.
(e) This section expires December 31, 2024.
SECTION 13. 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 14. Notwithstanding Section 32.02481(e), Human
Resources Code, as added by this Act, the Health and Human Services
Commission shall prepare and publish the first report required by
that section not later than September 1, 2025.
SECTION 15. 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 16. 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, 2023.