LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 89TH LEGISLATIVE REGULAR SESSION April 27, 2025 TO: Honorable Gary VanDeaver, Chair, House Committee on Public Health FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB4553 by Ordaz (Relating to the mandatory reporting of birth outcomes by licensed midwives in the State of Texas.), As Introduced Estimated Two-year Net Impact to General Revenue Related Funds for HB4553, As Introduced: a negative impact of ($250,000) through the biennium ending August 31, 2027. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. General Revenue-Related Funds, Five- Year Impact: Fiscal Year Probable Net Positive/(Negative) Impact toGeneral Revenue Related Funds2026($250,000)2027$02028$02029$02030$0All Funds, Five-Year Impact: Fiscal Year Probable Savings/(Cost) fromGeneral Revenue Fund12026($250,000)2027$02028$02029$02030$0 Fiscal AnalysisThe bill would require that a midwife disclose the required informed choice and disclosure statement if the midwife is under active investigation by Texas Department of Licensing and Regulation (TDLR) before the client consents to care.The bill would require a licensed midwife to submit a Birth and Outcomes Report to the Department of State Health Services (DSHS) Vital Statistics and TDLR within 10 days of attending any birth in a home birthing center, or other non-hospital setting.The bill would require TDLR to conduct random audits of Birth and Outcome Reports to ensure compliance and accuracy.The bill requires hospitals to report all deaths and morbidities linked to midwife-attended births to DSHS Vital Statistics, and requires DSHS to cross-check the data with midwife-submitted reports. The bill requires an investigation for any missing reports.The bill provides fines and civil and criminal penalties for a midwife who fails to submit a report within the 10-day period.The bill requires TDLR and DSHS to adopt rules for implementation.
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 89TH LEGISLATIVE REGULAR SESSION
April 27, 2025
TO: Honorable Gary VanDeaver, Chair, House Committee on Public Health FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: HB4553 by Ordaz (Relating to the mandatory reporting of birth outcomes by licensed midwives in the State of Texas.), As Introduced
TO: Honorable Gary VanDeaver, Chair, House Committee on Public Health
FROM: Jerry McGinty, Director, Legislative Budget Board
IN RE: HB4553 by Ordaz (Relating to the mandatory reporting of birth outcomes by licensed midwives in the State of Texas.), As Introduced
Honorable Gary VanDeaver, Chair, House Committee on Public Health
Honorable Gary VanDeaver, Chair, House Committee on Public Health
Jerry McGinty, Director, Legislative Budget Board
Jerry McGinty, Director, Legislative Budget Board
HB4553 by Ordaz (Relating to the mandatory reporting of birth outcomes by licensed midwives in the State of Texas.), As Introduced
HB4553 by Ordaz (Relating to the mandatory reporting of birth outcomes by licensed midwives in the State of Texas.), As Introduced
Estimated Two-year Net Impact to General Revenue Related Funds for HB4553, As Introduced: a negative impact of ($250,000) through the biennium ending August 31, 2027. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
Estimated Two-year Net Impact to General Revenue Related Funds for HB4553, As Introduced: a negative impact of ($250,000) through the biennium ending August 31, 2027. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
General Revenue-Related Funds, Five- Year Impact:
2026 ($250,000)
2027 $0
2028 $0
2029 $0
2030 $0
All Funds, Five-Year Impact:
2026 ($250,000)
2027 $0
2028 $0
2029 $0
2030 $0
Fiscal Analysis
The bill would require that a midwife disclose the required informed choice and disclosure statement if the midwife is under active investigation by Texas Department of Licensing and Regulation (TDLR) before the client consents to care.The bill would require a licensed midwife to submit a Birth and Outcomes Report to the Department of State Health Services (DSHS) Vital Statistics and TDLR within 10 days of attending any birth in a home birthing center, or other non-hospital setting.The bill would require TDLR to conduct random audits of Birth and Outcome Reports to ensure compliance and accuracy.The bill requires hospitals to report all deaths and morbidities linked to midwife-attended births to DSHS Vital Statistics, and requires DSHS to cross-check the data with midwife-submitted reports. The bill requires an investigation for any missing reports.The bill provides fines and civil and criminal penalties for a midwife who fails to submit a report within the 10-day period.The bill requires TDLR and DSHS to adopt rules for implementation.
The bill provides fines and civil and criminal penalties for a midwife who fails to submit a report within the 10-day period.
The bill requires TDLR and DSHS to adopt rules for implementation.
Methodology
According to DSHS, the agency would need to modify the Texas Electronic Vital Events Registrar (TxEVER) system to include a Birth and Outcomes registry. DSHS would use existing Information Technology (IT) staff for approximately 100 hours in FY 2026 to implement the TxEVER modifications.Costs related to training of staff and data providers who report births on the new requirements, displaying de-identified statistics on maternal and neonatal outcomes from midwife-attended births, and promulgating any needed rules can be accomplished within existing resources by DSHS.It is assumed that any costs for TDLR and the Health and Human Services Commission can be absorbed within existing resources.
According to DSHS, the agency would need to modify the Texas Electronic Vital Events Registrar (TxEVER) system to include a Birth and Outcomes registry. DSHS would use existing Information Technology (IT) staff for approximately 100 hours in FY 2026 to implement the TxEVER modifications.
Costs related to training of staff and data providers who report births on the new requirements, displaying de-identified statistics on maternal and neonatal outcomes from midwife-attended births, and promulgating any needed rules can be accomplished within existing resources by DSHS.
It is assumed that any costs for TDLR and the Health and Human Services Commission can be absorbed within existing resources.
Technology
One-time costs for TxEVER system modifications are estimated by DSHS to total $250,000 from the General Revenue Fund in fiscal year 2026. Additional IT staff time to implement TxEVER modifications can be absorbed within existing resources by DSHS.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies: b > td > 304 Comptroller of Public Accounts, 452 Department of Licensing and Regulation, 529 Health and Human Services Commission, 537 State Health Services, Department of
304 Comptroller of Public Accounts, 452 Department of Licensing and Regulation, 529 Health and Human Services Commission, 537 State Health Services, Department of
LBB Staff: b > td > JMc, NPe, ER, APA
JMc, NPe, ER, APA