Texas 2023 - 88th Regular

Texas House Bill HB1958 Compare Versions

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1	1	88R7534 LRM-D
2	2	By: Thierry H.B. No. 1958
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to maternal mortality and morbidity in this state and
8	8	Medicaid eligibility of and coverage for certain services provided
9	9	to pregnant women.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 34.001, Health and Safety Code, is
12	12	amended by adding Subdivision (11-a) and amending Subdivision (12)
13	13	to read as follows:
14	14	(11-a) "Pregnancy-associated death" means the death
15	15	of a woman from any cause that occurs during or within one year of
16	16	delivery or end of pregnancy, regardless of the outcome or location
17	17	of the pregnancy.
18	18	(12) "Pregnancy-related death" means the death of a
19	19	woman while pregnant or within one year of delivery or end of
20	20	pregnancy, regardless of the outcome, duration, or location [and
21	21	site] of the pregnancy, from any cause related to or aggravated by
22	22	the pregnancy or its management, but not from accidental or
23	23	incidental causes.
24	24	SECTION 2. The heading to Section 34.002, Health and Safety
25	25	Code, is amended to read as follows:
26	26	Sec. 34.002. TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW
27	27	COMMITTEE; REFERENCE IN LAW.
28	28	SECTION 3. Section 34.002, Health and Safety Code, is
29	29	amended by adding Subsection (a-1) and amending Subsections (b) and
30	30	(e) to read as follows:
31	31	(a-1) Notwithstanding any other law, a reference in this
32	32	chapter or other law to the Maternal Mortality and Morbidity Task
33	33	Force means the Texas Maternal Mortality and Morbidity Review
34	34	Committee.
35	35	(b) The review committee is a multidisciplinary advisory
36	36	committee within the department and is composed of the following 23
37	37	[17] members:
38	38	(1) 21 [15] members appointed by the commissioner as
39	39	follows:
40	40	(A) four physicians specializing in obstetrics,
41	41	at least one of whom is a maternal fetal medicine specialist;
42	42	(B) one certified nurse-midwife;
43	43	(C) one registered nurse;
44	44	(D) one nurse specializing in labor and delivery;
45	45	(E) one physician specializing in family
46	46	practice;
47	47	(F) one physician specializing in psychiatry;
48	48	(G) one physician specializing in pathology;
49	49	(H) one epidemiologist, biostatistician, or
50	50	researcher of pregnancy-related deaths;
51	51	(I) one social worker or social service provider;
52	52	(J) two [one] community advocates [advocate] in a
53	53	relevant field;
54	54	(K) one medical examiner or coroner responsible
55	55	for recording deaths; [and]
56	56	(L) one physician specializing in critical care;
57	57	(M) one physician specializing in emergency
58	58	care;
59	59	(N) one physician specializing in cardiology;
60	60	(O) one physician specializing in
61	61	anesthesiology;
62	62	(P) one physician specializing in oncology; and
63	63	(Q) one representative of a managed care
64	64	organization;
65	65	(2) a representative of the department's family and
66	66	community health programs; and
67	67	(3) the state epidemiologist for the department or the
68	68	epidemiologist's designee.
69	69	(e) A member of the review committee appointed under
70	70	Subsection (b)(1) is not entitled to compensation for service on
71	71	the review committee but, subject to Section 34.014(b), may be
72	72	reimbursed [or reimbursement] for travel or other expenses incurred
73	73	by the member while conducting the business of the review
74	74	committee.
75	75	SECTION 4. Section 34.003(a), Health and Safety Code, is
76	76	amended to read as follows:
77	77	(a) Review committee members appointed by the commissioner
78	78	serve staggered six-year terms, with one-third or as near as
79	79	possible to one-third of the members' terms [of four or five
80	80	members, as appropriate,] expiring February 1 of each odd-numbered
81	81	year.
82	82	SECTION 5. Section 34.008, Health and Safety Code, is
83	83	amended by adding Subsection (e) to read as follows:
84	84	(e) For purposes of this chapter, a health care provider,
85	85	including a nurse, who is involved in obtaining information
86	86	relevant to a case of pregnancy-associated death,
87	87	pregnancy-related death, or severe maternal morbidity under this
88	88	chapter and who is required under other law to report a violation
89	89	related to the provider's profession is exempt from that reporting
90	90	requirement for the information obtained under this chapter.
91	91	SECTION 6. Section 34.009(a), Health and Safety Code, is
92	92	amended to read as follows:
93	93	(a) Any information pertaining to a pregnancy-associated
94	94	death, a pregnancy-related death, or severe maternal morbidity is
95	95	confidential for purposes of this chapter.
96	96	SECTION 7. Section 34.014, Health and Safety Code, is
97	97	amended to read as follows:
98	98	Sec. 34.014. FUNDING. (a) The department may accept gifts
99	99	and grants from any source to fund the duties of the department and
100	100	the review committee under this chapter.
101	101	(b) The department may use only gifts, grants, or federal
102	102	funds to reimburse travel or other expenses incurred by a member of
103	103	the review committee in accordance with Section 34.002(e).
104	104	SECTION 8. Section 34.017, Health and Safety Code, is
105	105	amended by adding Subsections (c), (d), and (e) to read as follows:
106	106	(c) The department may allow voluntary and confidential
107	107	reporting to the department of pregnancy-associated deaths and
108	108	pregnancy-related deaths by health care providers and persons who
109	109	complete the medical certification for a death certificate for
110	110	deaths reviewed or analyzed by the review committee.
111	111	(d) The department shall allow voluntary and confidential
112	112	reporting to the department of pregnancy-associated deaths and
113	113	pregnancy-related deaths by family members of or other appropriate
114	114	individuals associated with a deceased patient. The department
115	115	shall:
116	116	(1) post on the department's Internet website the
117	117	contact information of the person to whom a report may be submitted
118	118	under this subsection; and
119	119	(2) conduct outreach to local health organizations on
120	120	the availability of the review committee to review and analyze the
121	121	deaths described by this subsection.
122	122	(e) Information reported to the department under this
123	123	section is confidential in accordance with Section 34.009.
124	124	SECTION 9. Chapter 34, Health and Safety Code, is amended by
125	125	adding Section 34.022 to read as follows:
126	126	Sec. 34.022. DEVELOPMENT OF WORK GROUP ON ESTABLISHMENT OF
127	127	MATERNAL MORTALITY AND MORBIDITY DATA REGISTRY. (a) In this
128	128	section, "maternal mortality and morbidity data registry" means an
129	129	Internet website or database established to collect individualized
130	130	patient information and aggregate statistical reports on the health
131	131	status, health behaviors, and service delivery needs of maternal
132	132	patients.
133	133	(b) The department shall establish a work group to advise
134	134	the department on the report and recommendations required by
135	135	Subsection (e). The work group consists of the following members
136	136	appointed by the commissioner unless otherwise provided:
137	137	(1) one member with appropriate expertise appointed by
138	138	the governor;
139	139	(2) two members with appropriate expertise appointed
140	140	by the lieutenant governor;
141	141	(3) two members with appropriate expertise appointed
142	142	by the speaker of the house of representatives;
143	143	(4) the chair of the Texas Hospital Association or the
144	144	chair's designee;
145	145	(5) the president of the Texas Medical Association or
146	146	the president's designee;
147	147	(6) the president of the Texas Nurses Association or
148	148	the president's designee;
149	149	(7) one member who is a physician specializing in
150	150	obstetrics and gynecology;
151	151	(8) one member who is a physician specializing in
152	152	maternal and fetal medicine;
153	153	(9) one member who is a registered nurse specializing
154	154	in labor and delivery;
155	155	(10) one member who is a representative of a hospital
156	156	located in a rural area of this state;
157	157	(11) one member who is a representative of a hospital
158	158	located in a county with a population of four million or more;
159	159	(12) one member who is a representative of a hospital
160	160	located in an urban area of this state in a county with a population
161	161	of less than four million;
162	162	(13) one member who is a representative of a public
163	163	hospital;
164	164	(14) one member who is a representative of a private
165	165	hospital;
166	166	(15) one member who is an epidemiologist;
167	167	(16) one member who is a statistician;
168	168	(17) one member who is a public health expert; and
169	169	(18) any other member with appropriate expertise as
170	170	the commissioner determines necessary.
171	171	(c) The work group shall elect from among the membership a
172	172	presiding officer.
173	173	(d) The work group shall meet periodically and at the call
174	174	of the presiding officer.
175	175	(e) With the goals of improving the quality of maternal care
176	176	and combating maternal mortality and morbidity and with the advice
177	177	of the work group, the department shall assess and prepare a report
178	178	and recommendations on the establishment of a secure maternal
179	179	mortality and morbidity data registry to record information
180	180	submitted by participating health care providers on the health
181	181	status of maternal patients over varying periods, including the
182	182	frequency and characteristics of maternal mortality and morbidity
183	183	during pregnancy and the postpartum period.
184	184	(f) In developing the report and recommendations required
185	185	by Subsection (e), the department shall:
186	186	(1) consider individual maternal patient information
187	187	related to health status and health care received over varying
188	188	periods that should be submitted to the registry;
189	189	(2) review existing and developing registries used
190	190	within and outside this state that serve the same or a similar
191	191	purpose as a maternal mortality and morbidity data registry;
192	192	(3) review ongoing health data collection efforts and
193	193	initiatives in this state to avoid duplication and ensure
194	194	efficiency;
195	195	(4) review and consider existing laws that govern data
196	196	submission and sharing, including laws governing the
197	197	confidentiality and security of individually identifiable health
198	198	information; and
199	199	(5) evaluate the clinical period during which a health
200	200	care provider should submit to a maternal mortality and morbidity
201	201	data registry known and available information, including
202	202	information:
203	203	(A) from a maternal patient's first appointment
204	204	with an obstetrician and each subsequent appointment until the date
205	205	of delivery;
206	206	(B) for the 42 days following a patient's
207	207	delivery; and
208	208	(C) until the 364th day following a patient's
209	209	delivery.
210	210	(g) If the department recommends the establishment of a
211	211	maternal mortality and morbidity data registry, the report under
212	212	Subsection (e) must include specific recommendations on the
213	213	relevant individual patient information and categories of
214	214	information to be submitted to the registry and on the intervals for
215	215	submission of information. The categories must include:
216	216	(1) notifiable maternal deaths, including
217	217	individualized patient data on:
218	218	(A) patients who die during pregnancy; and
219	219	(B) patients who were pregnant at any point in
220	220	the 12 months preceding their death;
221	221	(2) individualized patient information on each
222	222	pregnancy and birth;
223	223	(3) individualized patient data on the most common
224	224	high-risk conditions for maternal patients and severe cases of
225	225	maternal morbidity;
226	226	(4) nonidentifying demographic data from the
227	227	provider's patient admissions records, including age, race, and
228	228	patient health benefit coverage status; and
229	229	(5) a statistical summary based on an aggregate of
230	230	individualized patient data that includes the following:
231	231	(A) total live births;
232	232	(B) maternal age distributions;
233	233	(C) maternal race and ethnicity distributions;
234	234	(D) health benefit plan issuer distributions;
235	235	(E) incidence of diabetes, hypertension, and
236	236	hemorrhage among patients;
237	237	(F) gestational age distributions;
238	238	(G) birth weight distributions;
239	239	(H) total preterm birth rate;
240	240	(I) rate of vaginal deliveries; and
241	241	(J) rate of cesarean sections.
242	242	(h) If the department establishes a maternal mortality and
243	243	morbidity data registry, a health care provider submitting
244	244	information to the registry shall comply with all applicable
245	245	federal and state laws relating to patient confidentiality and
246	246	quality of health care information.
247	247	(i) The report and recommendations required under
248	248	Subsection (e) must outline potential uses of a maternal mortality
249	249	and morbidity data registry, including:
250	250	(1) periodic department analysis of information
251	251	submitted to the registry; and
252	252	(2) the feasibility of preparing and issuing reports,
253	253	using aggregated information, to each health care provider
254	254	participating in the registry to improve the quality of maternal
255	255	care.
256	256	(j) Not later than September 1, 2024, the department shall
257	257	prepare and submit to the governor, the lieutenant governor, the
258	258	speaker of the house of representatives, the Legislative Budget
259	259	Board, and each standing committee of the legislature having
260	260	primary jurisdiction over the department and post on the
261	261	department's Internet website the report and recommendations
262	262	required under Subsection (e).
263	263	(k) This section expires September 1, 2025.
264	264	SECTION 10. Section 32.024(l-1), Human Resources Code, is
265	265	amended to read as follows:
266	266	(l-1) The commission shall continue to provide medical
267	267	assistance to a woman who is eligible for medical assistance for
268	268	pregnant women for a period of not less than 12 [six] months
269	269	following the last month of the woman's pregnancy [date the woman
270	270	delivers or experiences an involuntary miscarriage].
271	271	SECTION 11. Subchapter B, Chapter 32, Human Resources Code,
272	272	is amended by adding Section 32.02481 to read as follows:
273	273	Sec. 32.02481. MEDICAL ASSISTANCE PILOT PROGRAM FOR DOULA
274	274	SERVICES. (a) In this section:
275	275	(1) "Doula" means a nonmedical birthing coach who
276	276	provides doula services and meets the qualifications for a doula as
277	277	determined by commission rule.
278	278	(2) "Doula services" means nonmedical childbirth
279	279	education, coaching, and support services, including emotional and
280	280	physical support provided during pregnancy, labor, delivery, and
281	281	the postpartum period, or provided intermittently during pregnancy
282	282	and the postpartum period.
283	283	(b) The commission shall establish a pilot program to
284	284	provide medical assistance reimbursement for doula services
285	285	provided by a doula. The executive commissioner, in consultation
286	286	with the Perinatal Advisory Council established under Section
287	287	241.187, Health and Safety Code, by rule shall determine the
288	288	qualifications necessary for an individual to be considered a doula
289	289	and the doula services to be covered under the pilot program.
290	290	(c) Not later than September 1, 2024, the commission shall
291	291	implement the pilot program in:
292	292	(1) the most populous county in this state; and
293	293	(2) the county with the greatest maternal health
294	294	support needs, as determined by the county's maternal and infant
295	295	mortality rates and the number of births in the county by Medicaid
296	296	recipients.
297	297	(d) The commission shall prescribe eligibility requirements
298	298	for participation in the pilot program.
299	299	(e) Not later than September 1 of each year during the
300	300	operation of the pilot program, the commission shall prepare and
301	301	publish on the commission's Internet website a report evaluating:
302	302	(1) the total costs during the preceding year of
303	303	providing medical assistance reimbursement for doula services
304	304	under the pilot program; and
305	305	(2) the impact on birth outcomes for women who receive
306	306	doula services under the pilot program.
307	307	(f) Not later than September 1, 2028, the commission shall
308	308	prepare and submit to the legislature a written report that:
309	309	(1) summarizes the results of the pilot program,
310	310	including the effectiveness of the pilot program in reducing
311	311	maternal mortality rates and racial disparities in health outcomes
312	312	in the geographic areas of this state in which the pilot program
313	313	operates;
314	314	(2) includes feedback from participating doulas and
315	315	recipients who received doula services under the pilot program; and
316	316	(3) includes a recommendation on whether the pilot
317	317	program should be continued, expanded, or terminated.
318	318	(g) The pilot program terminates and this section expires
319	319	September 1, 2029.
320	320	SECTION 12. (a) In this section:
321	321	(1) "Department" means the Department of State Health
322	322	Services.
323	323	(2) "Review committee" means the Texas Maternal
324	324	Mortality and Morbidity Review Committee established under Chapter
325	325	34, Health and Safety Code.
326	326	(b) The review committee and the department shall jointly
327	327	conduct a study to evaluate maternal mortality and morbidity among
328	328	Black women in this state. In conducting the study, the review
329	329	committee and department shall:
330	330	(1) compare maternal mortality and morbidity rates
331	331	among Black women in this state in relation to maternal mortality
332	332	and morbidity rates among each other race and ethnicity;
333	333	(2) compare maternal mortality and morbidity rates
334	334	among Black women in this state in relation to socioeconomic status
335	335	and education level;
336	336	(3) assess the impact of social determinants of
337	337	health, including an evaluation of data on pregnancy-related
338	338	deaths, pregnancy-related complications that almost resulted in
339	339	death, and morbidities, to identify any correlation in that data to
340	340	women who are uninsured, women who receive health care coverage
341	341	under Medicaid, and women who receive health care coverage through
342	342	a private insurer;
343	343	(4) evaluate the impact of the following health
344	344	conditions on maternal mortality and morbidity:
345	345	(A) cardiac health conditions;
346	346	(B) preeclampsia, eclampsia, and other
347	347	hypertensive disorders;
348	348	(C) hemorrhage;
349	349	(D) obesity; and
350	350	(E) stress-related health conditions; and
351	351	(5) assess the extent to which implicit biases held by
352	352	health care providers against Black individuals affect maternal
353	353	mortality and morbidity among Black women.
354	354	(c) Based on the results of the study conducted under this
355	355	section, the review committee and department shall develop
356	356	recommendations to address disparities in maternal mortality and
357	357	morbidity among Black women, including recommendations on:
358	358	(1) strategies to reduce the incidence of
359	359	pregnancy-related deaths and severe maternal morbidity;
360	360	(2) patient outreach and education;
361	361	(3) health care provider training, including a
362	362	recommendation on the potential benefit of training on cultural
363	363	competency and implicit biases against Black individuals;
364	364	(4) best practices identified as successful in
365	365	reducing maternal mortality and morbidity; and
366	366	(5) the implementation in this state of programs
367	367	operating in other states that have reduced maternal mortality and
368	368	morbidity rates.
369	369	(d) Not later than September 1, 2024, the review committee
370	370	and department shall prepare and submit to the governor, lieutenant
371	371	governor, speaker of the house of representatives, and appropriate
372	372	committees of the legislature a written report that summarizes the
373	373	results of the study and includes the recommendations developed
374	374	under this section. The report may be consolidated with the
375	375	biennial report required under Section 34.015, Health and Safety
376	376	Code.
377	377	(e) This section expires December 31, 2024.
378	378	SECTION 13. The executive commissioner of the Health and
379	379	Human Services Commission shall adopt rules as necessary to
380	380	implement Section 34.022, Health and Safety Code, as added by this
381	381	Act, not later than December 1, 2023.
382	382	SECTION 14. Notwithstanding Section 32.02481(e), Human
383	383	Resources Code, as added by this Act, the Health and Human Services
384	384	Commission shall prepare and publish the first report required by
385	385	that section not later than September 1, 2025.
386	386	SECTION 15. If before implementing any provision of this
387	387	Act a state agency determines that a waiver or authorization from a
388	388	federal agency is necessary for implementation of that provision,
389	389	the agency affected by the provision shall request the waiver or
390	390	authorization and may delay implementing that provision until the
391	391	waiver or authorization is granted.
392	392	SECTION 16. This Act takes effect immediately if it
393	393	receives a vote of two-thirds of all the members elected to each
394	394	house, as provided by Section 39, Article III, Texas Constitution.
395	395	If this Act does not receive the vote necessary for immediate
396	396	effect, this Act takes effect September 1, 2023.