BILL NUMBER: AB 50 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 6, 2015
INTRODUCED BY Assembly Member Mullin
DECEMBER 1, 2014
An act to amend Section 123492 of the Health and Safety
Code, add Section 14148.25 to the Welfare and
Institutions Code, relating to perinatal care.
LEGISLATIVE COUNSEL'S DIGEST
AB 50, as amended, Mullin. Nurse-Family Partnership.
Medi-Cal: nurse home visiting programs.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services,
including perinatal services for pregnant women.
Existing law establishes the Nurse-Family Partnership program,
which is administered by the State Department of Public Health, to
provide grants for voluntary nurse home visiting programs for
expectant first-time mothers, their children, and their families.
Under existing law, a county is required to satisfy specified
requirements in order to be eligible to receive a grant.
This bill would declare the intent of the Legislature to develop a
means to leverage public and private dollars to substantially expand
the scale of the Nurse-Family Partnership in California, in
accordance with specified findings. The bill would revise the
requirements relating to the award and use of Nurse-Family
Partnership grants, including eliminating a requirement for nurse
home visitors and supervisors to receive certain training in
effective home visitation techniques.
This bill would require the State Department of Health Care
Services, in consultation with stakeholders, to develop and implement
a plan on or before January 1, 2017, to ensure that Nurse-Family
Partnership and other evidence-based nurse home visiting programs are
offered and provided to Medi-Cal eligible pregnant women, and would
require the department, on or before January 1, 2022, and every 5
years thereafter, to report to the Legislature, as specified. The
bill would also require the department, in developing the plan, to
consider, among other things, establishing Medi-Cal coverage for
evidence-based nurse home visiting program services and incentives
for providers to offer those services.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) According to United States Census Bureau, California has a
poverty rate of 23.5 percent, the highest rate of any state in the
country.
(b) Children born into poverty are at higher risk of health and
developmental disparities, including, but not limited to, premature
birth, low birth weight, infant mortality, crime, domestic violence,
developmental delays, dropping out of high school, substance abuse,
unemployment, and child abuse and neglect.
(a)
(c) In 2014, the Legislature passed Assembly Concurrent
Resolution No. 155 by Assembly Member Raul Bocanegra, recognizing
that research over the last two decades in the evolving fields of
neuroscience, molecular biology, public health, genomics, and
epigenetics reveals that experiences in the first few years of life
build changes into the biology of the human body which
that , in turn, influence the person's physical
and mental health over his or her lifetime.
(b)
(d) On May 3, 2012, Governor Edmund G, Brown Jr. issued
Executive Order B-19-12, establishing the "Let's Get Healthy
California Task Force" to develop a 10-year plan for improving the
health of Californians, controlling health care costs, promoting
personal responsibility for individual health, and advancing health
equity."
(c)
(e) The task force identified several priorities,
including a subset for "Healthy Beginnings," which include reducing
infant deaths, increasing vaccination rates, reducing childhood
trauma, and reducing adolescent tobacco use.
(d)
(f) The final report of the task force states "the
challenge going forward is to identify evidence-based interventions
and quicken the pace of uptake across the state," in order to meet
the ambitious goals in the Governor's directive.
(e) In addition to reducing healthcare costs, the Nurse-Family
Partnership has demonstrated proven outcomes addressing factors that
contribute to toxic stress and made measurable progress towards many
of the goals identified by the task force.
(f) The Nurse-Family Partnership is an evidence-based, community
health program that improves pregnancy outcomes, improves child
health and development, and improves economic self-sufficiency.
(g) Multiple peer-reviewed, randomized, controlled trials and
longitudinal followup studies have clearly demonstrated the efficacy
of the Nurse-Family Partnership programs, through significant
sustained results, in achieving these goals.
(h) The Nurse-Family Partnership provides lifelong health and
economic benefits to both mothers and children served by the program.
(i) These lifelong benefits have the potential to achieve
substantial savings to federal, state, and local governments with
respect to programs and services, including Medicaid, Child
Protective Services, law enforcement, special education, the
Supplemental Nutrition Assistance Program (SNAP), and Temporary
Assistance for Needy Families (TANF) program, among others. These
savings far exceed the costs of implementing the Nurse-Family
Partnership program.
(g) In 2013, more than 248,000 Medi-Cal beneficiaries gave birth
to a child. Because Medi-Cal covers half of all births in the state,
this has increased costs for taxpayers. Medi-Cal expansion has
resulted in an 18 percent increase in Medi-Cal enrollment to a total
of 11.3 million, and enrollment is to exceed 12 million in 2015.
(h) The California Health and Human Services Agency recently
submitted its State Health Care Innovation Plan, including the
Maternity Care initiative, which addresses issues of high costs in
maternity care, to the Center for Medicare and Medicaid Innovation.
Child deliveries and related expenses, including high-risk births,
rank among the top 10 high cost episodes of health care, and in the
last 15 years, California has seen a continual rise in maternal
mortality.
(i) The cost of health care specifically related to high-risk
pregnancies, neonatal intensive-care unit (NICU) services, toxic
stress, and emergency room visits has increased and is projected to
continue to rise. Average health care costs for women were 25 percent
more than men primarily due to higher costs of health care during
childbearing years.
(j) The Nurse-Family Partnership is a voluntary, evidence-based,
prevention program that partners low-income, pregnant women having
their first child with a registered nurse who provides home visits
from early in pregnancy until the child's second birthday.
(k) With more than 37 years of evidence from randomized,
controlled trials, the Nurse-Family Partnership has demonstrated
sustained improvements in maternal health, child health and
development, and the economic stability of families.
(l) The Nurse-Family Partnership has consistently demonstrated
reductions in preterm births and preventable maternal mortality via
controlled trial and longitudinal follow-ups over two decades.
(m) Randomized, controlled trials have also demonstrated that the
use of Nurse-Family Partnership nurse home visitors increases
positive outcomes during the prenatal period and the first two years
of life compared to the use of paraprofessionals.
(n) Research has shown that the Nurse-Family Partnership can
reduce smoking during pregnancy, complications of pregnancy, preterm
births, closely spaced subsequent births, and childhood injuries
resulting in costly emergency department use and hospitalizations.
The Nurse-Family Partnership also can improve childhood immunization
rates and compliance with well child visit schedules. As a result of
families benefiting from Nurse-Family Partnership , there has been
cost savings to federal, state, and local governments with respect to
programs and services, including Medicaid, the Supplemental
Nutrition Assistance Program (SNAP), and the Temporary Assistance for
Needy Families (TANF) program.
(o) By enrolling recipients no later than 28 weeks of gestation,
the Nurse-Family Partnership maximizes the impact on prenatal care,
birth outcomes, and critical early brain development of infants.
(p) The Nurse-Family Partnership's evidence base and benefits to
society are well documented and validated by independent analyses.
(q) The Nurse-Family Partnership's strong evidence of
effectiveness and predictable return on investment demonstrate that
this evidence-based intervention should be brought to scale in
California to improve maternal and child health outcomes and help
reduce health care costs for generations to come.
(j)
(r) Twenty-one California counties currently operate a
Nurse-Family Partnership program. program
providing services to 4,000 residents. Only a fraction of
the 100,000 potentially eligible recipients annually
are receiving these highly beneficial and cost-effective services.
(k)
(s) However, if California were to provide these
services to significantly more eligible first-time mothers, the state
could see population-wide health and economic benefits that would
carry over to future generations.
(l)
(t) Therefore, it is the intent of the Legislature to
develop a means to leverage public and private dollars to
substantially expand the scale of the Nurse-Family Partnership
in and other evidence-based nurse home
visiting throughout California, beginning with regions
communities and populations with the greatest
need.
SEC. 2. Section 123492 of the Health and Safety
Code is amended to read:
123492. The department shall develop a grant application and
award grants on a competitive basis to counties for the startup,
continuation, and expansion of the program established pursuant to
Section 123491. To be eligible to receive a grant for purposes of
that section, a county shall agree to do all of the following:
(a) Serve through the program only pregnant, low-income women who
have had no previous live births. Notwithstanding subdivision (b) of
Section 123485, women who are juvenile offenders or who are clients
of the juvenile system, with no history of prior live births, shall
be deemed eligible for services under the program.
(b) Enroll women in the program while they are still pregnant,
before the 28th week of gestation, and preferably before the 16th
week of gestation, and continue those women in the program through
the first two years of the child's life.
(c) Use as home visitors only registered nurses who have been
licensed in the state.
(d) Have nurse home visitors undergo training according to the
program and follow the home visit guidelines developed by the
Nurse-Family Partnership program.
(e) Have nurse home visitors specially trained in the Nurse-Family
Partnership guidelines for prenatal care and early child
development.
(f) Have nurse home visitors follow a visit schedule keyed to the
developmental stages of pregnancy and early childhood.
(g) Ensure that, to the extent possible, services shall be
rendered in a culturally and linguistically competent manner.
(h) Limit a nurse home visitor's caseload to no more than 25
active families at any given time.
(i) For every eight nurse home visitors, provide a full-time nurse
supervisor who holds at least a bachelor's degree in nursing and has
substantial experience in community health nursing.
(j) Have nurse home visitors and nurse supervisors trained in the
method of assessing early infant development and parent-child
interaction in a manner consistent with the program.
(k) Provide data on operations, results, and expenditures in the
formats and with the frequencies specified by the department.
(l) Collaborate with other home visiting and family support
programs in the community to avoid duplication of services and
complement and integrate with existing services to the extent
practicable.
(m) Demonstrate that adoption of the Nurse-Family Partnership
program is supported by a local governmental or government-affiliated
community planning board, decisionmaking board, or advisory body
responsible for assuring the availability of effective, coordinated
services for families and children in the community.
(n) Provide cash or in-kind matching funds in the amount of 100
percent of the grant award.
(o) Prohibit the use of moneys received for the program as a match
for grants currently administered by the department.
SEC. 2. Section 14148.25 is added to the
Welfare and Institutions Code , immediately
following Section 14148.2 , to read:
14148.25. (a) The department shall, in consultation with
stakeholders, develop and implement a plan on or before January 1,
2017, to ensure that Nurse-Family Partnership and other
evidence-based nurse home visiting programs are offered and provided
to all Medi-Cal eligible pregnant women. The department shall
consider all of the following in developing the plan:
(1) Establishing Medi-Cal coverage for evidence-based nurse home
visiting program services.
(2) Incentives for providers to offer evidence-based nurse home
visiting program services.
(3) Other mechanisms to fund evidence-based nurse home visiting
program services.
(b) (1) The department shall, on or before January 1, 2022, and
every five years thereafter, report to the Legislature on
implementation progress and the effectiveness of evidence-based nurse
home visiting services in improving maternal and child health
outcomes, the experience of care, and cost savings to the Medi-Cal
program and the state.
(2) A report to be submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government Code.
(c) For the purposes of this section, the following definitions
shall apply:
(1) "Evidence-based program" means a program that is based on
scientific evidence demonstrating that the program model is
effective. An evidence-based program shall be reviewed on site and
compared to program model standards by the model developer or the
developer's designee at least every five years to ensure that the
program continues to maintain fidelity with the program model. The
program model shall have had demonstrated and replicated significant
and sustained positive outcomes that have been in one or more
well-designed and rigorous randomized controlled research designs,
and the evaluation results shall have been published in a
peer-reviewed journal.
(2) "Nurse home visiting program" means a program or initiative
that does all of the following:
(A) Contains home visiting as a primary service delivery strategy
by registered nurses to families with a pregnant woman who is
eligible for medical assistance.
(B) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children from
prenatal to two years old; and
(C) Targets participant outcomes that include all of the
following:
(i) Improved maternal and child health.
(ii) Prevention of child injuries, child abuse or maltreatment,
and reduction of emergency department visits.
(iii) Improvements in school readiness and achievement.
(iv) Reduction in crime or domestic violence.
(v) Improvements in family economic self-sufficiency.
(vi) Improvements in coordination of, and referrals to, other
community resources and support.
(vii) Improvements in parenting skills related to child
development.