BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Kevin de León, Chair SB 402 (de Leon) - Breastfeeding. Amended: As introduced. Policy Vote: Health 7-2 Urgency: No Mandate: No Hearing Date: May 23, 2013 Consultant: Brendan McCarthy SUSPENSE FILE. AS PROPOSED TO BE AMENDED. Bill Summary: SB 402 would require hospitals that have a perinatal unit to comply with the "Ten Steps to Successful Breastfeeding" developed by the Baby Friendly Hospital Initiative or an equivalent process recognized by the Department of Public Health. This requirement would go into effect on January 1, 2020. Fiscal Impact: Potential one-time costs to the Department of Public Health to adopt regulations, if the Department recognizes an alternative process to the Ten Steps to Successful Breastfeeding. The costs to adopt a regulation are likely to be between $100,000 and $200,000 (General Fund). Background: Under current law, beginning January 1, 2014, all hospitals that have a perinatal unit are required to have an infant-feeding policy. The purpose of this requirement is to encourage hospitals to facilitate increased breast-feeding rates. The Department of Public Health has also approved "Providing Breastfeeding Support: Model Hospital Policy Recommendations" developed by the Inland Empire Breastfeeding Coalition as guidelines for hospitals. Proposed Law: SB 402 would require hospitals that have a perinatal unit to comply with the "Ten Steps to Successful Breastfeeding" developed by the Baby Friendly Hospital Initiative or an equivalent process recognized by the Department of Public Health. This requirement would go into effect on January 1, 2020. Related Legislation: SB 402 (de Leon) Page 1 SB 502 (Pavley and de Leon) Chapter 551 of 2011 requires hospitals that have a perinatal unit to adopt an infant feeding policy, effective January 1, 2014. SB 464 (Jackson) would require adults who work in infant care programs to promote breastfeeding of infants. That bill is in the Senate Education Committee. Staff Comments: Under the bill, hospitals would be required to adopt either the Ten Steps to Successful Breastfeeding or an equivalent process recognized by the Department of Public Health. The Administrative Procedure Act (beginning at Section 11340 of the Government Code) prohibits state agencies from issuing or enforcing any rule, regulation, order, or standard of general application unless it has been issued as a regulation under the Administrative Procedure Act. Since this bill requires hospitals with perinatal units to adopt either the Ten Steps to Successful Breastfeeding or an equivalent process recognized by the Department, such an equivalent process should be adopted through the regulatory process. The Ten Steps to Successful Breastfeeding generally requires hospitals to facilitate breastfeeding by providing support and education to new mothers. In general, the costs to hospitals to carry out these activities are not likely to be significant. Concerns have been raised that the requirement for hospitals to keep newborns in the same room as the mother could raise logistical problems for some hospitals with smaller recovery rooms, driving up costs. The extent of this impact is unknown. In addition, there could be increased costs to hospitals to train staff on the requirements of the bill and best practices to comply with those requirements. Because hospitals are already required to adopt infant feeding policies (under SB 502) the marginal impact on staff training costs under this bill is not likely to be significant. Because the state Medi-Cal program pays for about half of the births in the state, increased hospital costs related to labor and delivery could increase Medi-Cal costs. However, the complexities of Medi-Cal rate setting and the uncertain financial impact of this bill make any potential cost increase to Medi-Cal unknown. SB 402 (de Leon) Page 2 Conversely, there is academic research indicating that increasing the rate of exclusive breastfeeding improves infant health and reduces obesity later in life. To the extent the bill is successful in increasing exclusive breastfeeding, there could be long-term costs savings in the Medi-Cal program. Proposed author's amendments: would delay implementation to 2025 and add an additional set of recommendations that a hospital could use to comply with the bill.