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)
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              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)
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          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.