Texas 2025 - 89th Regular

Texas House Bill HB3121 Compare Versions

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

Old	New	Differences
1	1	89R13726 LRM-D
2	2	By: Collier H.B. No. 3121
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to maternal mortality and morbidity in this state and
10	10	Medicaid eligibility of and coverage for certain services provided
11	11	to pregnant women.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Section 34.001, Health and Safety Code, is
14	14	amended by adding Subdivision (11-a) and amending Subdivision (12)
15	15	to read as follows:
16	16	(11-a) "Pregnancy-associated death" means the death
17	17	of a woman from any cause that occurs during or within one year of
18	18	delivery or end of pregnancy, regardless of the outcome or location
19	19	of the pregnancy.
20	20	(12) "Pregnancy-related death" means the death of a
21	21	woman while pregnant or within one year of delivery or end of
22	22	pregnancy, regardless of the outcome, duration, or location [and
23	23	site] of the pregnancy, from any cause related to or aggravated by
24	24	the pregnancy or its management, but not from accidental or
25	25	incidental causes.
26	26	SECTION 2. The heading to Section 34.002, Health and Safety
27	27	Code, is amended to read as follows:
28	28	Sec. 34.002. TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW
29	29	COMMITTEE; REFERENCE IN LAW.
30	30	SECTION 3. Section 34.002, Health and Safety Code, is
31	31	amended by adding Subsection (a-1) and amending Subsection (e) to
32	32	read as follows:
33	33	(a-1) Notwithstanding any other law, a reference in this
34	34	chapter or other law to the Maternal Mortality and Morbidity Task
35	35	Force means the Texas Maternal Mortality and Morbidity Review
36	36	Committee.
37	37	(e) A member of the review committee appointed under
38	38	Subsection (b)(1) is not entitled to compensation for service on
39	39	the review committee but, subject to Section 34.014(b), may be
40	40	reimbursed [or reimbursement] for travel or other expenses incurred
41	41	by the member while conducting the business of the review
42	42	committee.
43	43	SECTION 4. Section 34.008, Health and Safety Code, is
44	44	amended by adding Subsection (e) to read as follows:
45	45	(e) For purposes of this chapter, a health care provider,
46	46	including a nurse, who is involved in obtaining information
47	47	relevant to a case of pregnancy-associated death,
48	48	pregnancy-related death, or severe maternal morbidity under this
49	49	chapter and who is required under other law to report a violation
50	50	related to the provider's profession is exempt from that reporting
51	51	requirement for the information obtained under this chapter.
52	52	SECTION 5. Section 34.009(a), Health and Safety Code, is
53	53	amended to read as follows:
54	54	(a) Any information pertaining to a pregnancy-associated
55	55	death, a pregnancy-related death, or severe maternal morbidity is
56	56	confidential for purposes of this chapter.
57	57	SECTION 6. Section 34.014, Health and Safety Code, is
58	58	amended to read as follows:
59	59	Sec. 34.014. FUNDING. (a) The department may accept gifts
60	60	and grants from any source to fund the duties of the department and
61	61	the review committee under this chapter.
62	62	(b) The department may use only gifts, grants, or federal
63	63	funds to reimburse travel or other expenses incurred by a member of
64	64	the review committee in accordance with Section 34.002(e).
65	65	SECTION 7. Section 34.017, Health and Safety Code, is
66	66	amended by adding Subsections (c), (d), and (e) to read as follows:
67	67	(c) The department may allow voluntary and confidential
68	68	reporting to the department of pregnancy-associated deaths and
69	69	pregnancy-related deaths by health care providers and persons who
70	70	complete the medical certification for a death certificate for
71	71	deaths reviewed or analyzed by the review committee.
72	72	(d) The department shall allow voluntary and confidential
73	73	reporting to the department of pregnancy-associated deaths and
74	74	pregnancy-related deaths by family members of or other appropriate
75	75	individuals associated with a deceased patient. The department
76	76	shall:
77	77	(1) post on the department's Internet website the
78	78	contact information of the person to whom a report may be submitted
79	79	under this subsection; and
80	80	(2) conduct outreach to local health organizations on
81	81	the availability of the review committee to review and analyze the
82	82	deaths described by this subsection.
83	83	(e) Information reported to the department under this
84	84	section is confidential in accordance with Section 34.009.
85	85	SECTION 8. Chapter 34, Health and Safety Code, is amended by
86	86	adding Section 34.022 to read as follows:
87	87	Sec. 34.022. DEVELOPMENT OF WORK GROUP ON ESTABLISHMENT OF
88	88	MATERNAL MORTALITY AND MORBIDITY DATA REGISTRY. (a) In this
89	89	section, "maternal mortality and morbidity data registry" means an
90	90	Internet website or database established to collect individualized
91	91	patient information and aggregate statistical reports on the health
92	92	status, health behaviors, and service delivery needs of maternal
93	93	patients.
94	94	(b) The department shall establish a work group to advise
95	95	the department on the report and recommendations required by
96	96	Subsection (e). The work group consists of the following members
97	97	appointed by the commissioner unless otherwise provided:
98	98	(1) one member with appropriate expertise appointed by
99	99	the governor;
100	100	(2) two members with appropriate expertise appointed
101	101	by the lieutenant governor;
102	102	(3) two members with appropriate expertise appointed
103	103	by the speaker of the house of representatives;
104	104	(4) the chair of the Texas Hospital Association or the
105	105	chair's designee;
106	106	(5) the president of the Texas Medical Association or
107	107	the president's designee;
108	108	(6) the president of the Texas Nurses Association or
109	109	the president's designee;
110	110	(7) one member who is a physician specializing in
111	111	obstetrics and gynecology;
112	112	(8) one member who is a physician specializing in
113	113	maternal and fetal medicine;
114	114	(9) one member who is a registered nurse specializing
115	115	in labor and delivery;
116	116	(10) one member who is a representative of a hospital
117	117	located in a rural area of this state;
118	118	(11) one member who is a representative of a hospital
119	119	located in a county with a population of four million or more;
120	120	(12) one member who is a representative of a hospital
121	121	located in an urban area of this state in a county with a population
122	122	of less than four million;
123	123	(13) one member who is a representative of a public
124	124	hospital;
125	125	(14) one member who is a representative of a private
126	126	hospital;
127	127	(15) one member who is an epidemiologist;
128	128	(16) one member who is a statistician;
129	129	(17) one member who is a public health expert; and
130	130	(18) any other member with appropriate expertise as
131	131	the commissioner determines necessary.
132	132	(c) The work group shall elect from among the membership a
133	133	presiding officer.
134	134	(d) The work group shall meet periodically and at the call
135	135	of the presiding officer.
136	136	(e) With the goals of improving the quality of maternal care
137	137	and combating maternal mortality and morbidity and with the advice
138	138	of the work group, the department shall assess and prepare a report
139	139	and recommendations on the establishment of a secure maternal
140	140	mortality and morbidity data registry to record information
141	141	submitted by participating health care providers on the health
142	142	status of maternal patients over varying periods, including the
143	143	frequency and characteristics of maternal mortality and morbidity
144	144	during pregnancy and the postpartum period.
145	145	(f) In developing the report and recommendations required
146	146	by Subsection (e), the department shall:
147	147	(1) consider individual maternal patient information
148	148	related to health status and health care received over varying
149	149	periods that should be submitted to the registry;
150	150	(2) review existing and developing registries used
151	151	within and outside this state that serve the same or a similar
152	152	purpose as a maternal mortality and morbidity data registry;
153	153	(3) review ongoing health data collection efforts and
154	154	initiatives in this state to avoid duplication and ensure
155	155	efficiency;
156	156	(4) review and consider existing laws that govern data
157	157	submission and sharing, including laws governing the
158	158	confidentiality and security of individually identifiable health
159	159	information; and
160	160	(5) evaluate the clinical period during which a health
161	161	care provider should submit to a maternal mortality and morbidity
162	162	data registry known and available information, including
163	163	information:
164	164	(A) from a maternal patient's first appointment
165	165	with an obstetrician and each subsequent appointment until the date
166	166	of delivery;
167	167	(B) for the 42 days following a patient's
168	168	delivery; and
169	169	(C) until the 364th day following a patient's
170	170	delivery.
171	171	(g) If the department recommends the establishment of a
172	172	maternal mortality and morbidity data registry, the report under
173	173	Subsection (e) must include specific recommendations on the
174	174	relevant individual patient information and categories of
175	175	information to be submitted to the registry and on the intervals for
176	176	submission of information. The categories must include:
177	177	(1) notifiable maternal deaths, including
178	178	individualized patient data on:
179	179	(A) patients who die during pregnancy; and
180	180	(B) patients who were pregnant at any point in
181	181	the 12 months preceding their death;
182	182	(2) individualized patient information on each
183	183	pregnancy and birth;
184	184	(3) individualized patient data on the most common
185	185	high-risk conditions for maternal patients and severe cases of
186	186	maternal morbidity;
187	187	(4) nonidentifying demographic data from the
188	188	provider's patient admissions records, including age, race, and
189	189	patient health benefit coverage status; and
190	190	(5) a statistical summary based on an aggregate of
191	191	individualized patient data that includes the following:
192	192	(A) total live births;
193	193	(B) maternal age distributions;
194	194	(C) maternal race and ethnicity distributions;
195	195	(D) health benefit plan issuer distributions;
196	196	(E) incidence of diabetes, hypertension, and
197	197	hemorrhage among patients;
198	198	(F) gestational age distributions;
199	199	(G) birth weight distributions;
200	200	(H) total preterm birth rate;
201	201	(I) rate of vaginal deliveries; and
202	202	(J) rate of cesarean sections.
203	203	(h) If the department establishes a maternal mortality and
204	204	morbidity data registry, a health care provider submitting
205	205	information to the registry shall comply with all applicable
206	206	federal and state laws relating to patient confidentiality and
207	207	quality of health care information.
208	208	(i) The report and recommendations required under
209	209	Subsection (e) must outline potential uses of a maternal mortality
210	210	and morbidity data registry, including:
211	211	(1) periodic department analysis of information
212	212	submitted to the registry; and
213	213	(2) the feasibility of preparing and issuing reports,
214	214	using aggregated information, to each health care provider
215	215	participating in the registry to improve the quality of maternal
216	216	care.
217	217	(j) Not later than September 1, 2026, the department shall
218	218	prepare and submit to the governor, the lieutenant governor, the
219	219	speaker of the house of representatives, the Legislative Budget
220	220	Board, and each standing committee of the legislature having
221	221	primary jurisdiction over the department and post on the
222	222	department's Internet website the report and recommendations
223	223	required under Subsection (e).
224	224	(k) This section expires September 1, 2027.
225	225	SECTION 9. Subchapter B, Chapter 32, Human Resources Code,
226	226	is amended by adding Section 32.02481 to read as follows:
227	227	Sec. 32.02481. MEDICAL ASSISTANCE PROGRAM FOR DOULA
228	228	SERVICES. (a) In this section:
229	229	(1) "Doula" means a nonmedical birthing coach who
230	230	provides doula services and meets the qualifications for a doula as
231	231	determined by commission rule.
232	232	(2) "Doula services" means nonmedical childbirth
233	233	education, coaching, and support services, including emotional and
234	234	physical support provided during pregnancy, labor, delivery, and
235	235	the postpartum period, or provided intermittently during pregnancy
236	236	and the postpartum period.
237	237	(b) The commission shall establish a program to provide
238	238	medical assistance reimbursement for doula services provided by a
239	239	doula. The executive commissioner, in consultation with the
240	240	Perinatal Advisory Council established under Section 241.187,
241	241	Health and Safety Code, by rule shall determine the qualifications
242	242	necessary for an individual to be considered a doula and the doula
243	243	services to be covered under the program.
244	244	(c) The commission shall prescribe eligibility requirements
245	245	for participation in the program.
246	246	(d) Not later than September 1 of each year during the
247	247	operation of the program, the commission shall prepare and publish
248	248	on the commission's Internet website a report evaluating:
249	249	(1) the total costs during the preceding year of
250	250	providing medical assistance reimbursement for doula services
251	251	under the program; and
252	252	(2) the impact on birth outcomes for women who receive
253	253	doula services under the program.
254	254	(e) Not later than September 1, 2030, the commission shall
255	255	prepare and submit to the legislature a written report that:
256	256	(1) summarizes the results of the program, including
257	257	the effectiveness of the program in reducing maternal mortality
258	258	rates and racial disparities in health outcomes in the geographic
259	259	areas of this state in which the program operates;
260	260	(2) includes feedback from participating doulas and
261	261	recipients who received doula services under the program; and
262	262	(3) includes a recommendation on whether the program
263	263	should be continued, expanded, or terminated.
264	264	(f) The program terminates and this section expires
265	265	September 1, 2031.
266	266	SECTION 10. (a) In this section:
267	267	(1) "Department" means the Department of State Health
268	268	Services.
269	269	(2) "Review committee" means the Texas Maternal
270	270	Mortality and Morbidity Review Committee established under Chapter
271	271	34, Health and Safety Code.
272	272	(b) The review committee and the department shall jointly
273	273	conduct a study to evaluate maternal mortality and morbidity among
274	274	Black women in this state. In conducting the study, the review
275	275	committee and department shall:
276	276	(1) compare maternal mortality and morbidity rates
277	277	among Black women in this state in relation to maternal mortality
278	278	and morbidity rates among each other race and ethnicity;
279	279	(2) compare maternal mortality and morbidity rates
280	280	among Black women in this state in relation to socioeconomic status
281	281	and education level;
282	282	(3) assess the impact of social determinants of
283	283	health, including an evaluation of data on pregnancy-related
284	284	deaths, pregnancy-related complications that almost resulted in
285	285	death, and morbidities, to identify any correlation in that data to
286	286	women who are uninsured, women who receive health care coverage
287	287	under Medicaid, and women who receive health care coverage through
288	288	a private insurer;
289	289	(4) evaluate the impact of the following health
290	290	conditions on maternal mortality and morbidity:
291	291	(A) cardiac health conditions;
292	292	(B) preeclampsia, eclampsia, and other
293	293	hypertensive disorders;
294	294	(C) hemorrhage;
295	295	(D) obesity; and
296	296	(E) stress-related health conditions; and
297	297	(5) assess the extent to which implicit biases held by
298	298	health care providers against Black individuals affect maternal
299	299	mortality and morbidity among Black women.
300	300	(c) Based on the results of the study conducted under this
301	301	section, the review committee and department shall develop
302	302	recommendations to address disparities in maternal mortality and
303	303	morbidity among Black women, including recommendations on:
304	304	(1) strategies to reduce the incidence of
305	305	pregnancy-related deaths and severe maternal morbidity;
306	306	(2) patient outreach and education;
307	307	(3) health care provider training, including a
308	308	recommendation on the potential benefit of training on cultural
309	309	competency and implicit biases against Black individuals;
310	310	(4) best practices identified as successful in
311	311	reducing maternal mortality and morbidity; and
312	312	(5) the implementation in this state of programs
313	313	operating in other states that have reduced maternal mortality and
314	314	morbidity rates.
315	315	(d) Not later than September 1, 2026, the review committee
316	316	and department shall prepare and submit to the governor, lieutenant
317	317	governor, speaker of the house of representatives, and appropriate
318	318	committees of the legislature a written report that summarizes the
319	319	results of the study and includes the recommendations developed
320	320	under this section. The report may be consolidated with the
321	321	biennial report required under Section 34.015, Health and Safety
322	322	Code.
323	323	(e) This section expires December 31, 2026.
324	324	SECTION 11. The executive commissioner of the Health and
325	325	Human Services Commission shall adopt rules as necessary to
326	326	implement Section 34.022, Health and Safety Code, as added by this
327	327	Act, not later than December 1, 2025.
328	328	SECTION 12. If before implementing any provision of this
329	329	Act a state agency determines that a waiver or authorization from a
330	330	federal agency is necessary for implementation of that provision,
331	331	the agency affected by the provision shall request the waiver or
332	332	authorization and may delay implementing that provision until the
333	333	waiver or authorization is granted.
334	334	SECTION 13. This Act takes effect immediately if it
335	335	receives a vote of two-thirds of all the members elected to each
336	336	house, as provided by Section 39, Article III, Texas Constitution.
337	337	If this Act does not receive the vote necessary for immediate
338	338	effect, this Act takes effect September 1, 2025.