BILL NUMBER: AB 50 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 21, 2015
AMENDED IN ASSEMBLY MAY 13, 2015
AMENDED IN ASSEMBLY APRIL 21, 2015
AMENDED IN ASSEMBLY APRIL 6, 2015
INTRODUCED BY Assembly Member Mullin
DECEMBER 1, 2014
An act to add Section 14148.25 to the Welfare and Institutions
Code, relating to perinatal care.
LEGISLATIVE COUNSEL'S DIGEST
AB 50, as amended, Mullin. Medi-Cal: evidence-based 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 require the State Department of Health Care
Services, in consultation with specified stakeholders, to
develop and implement a plan on or before January
1, 2017, to ensure that evidence-based home visiting programs are
offered and provided to Medi-Cal eligible pregnant and parenting
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 home visiting program services and
incentives for Medi-Cal providers to offer those
services. services, and would require the department,
in developing the plan, to prioritize the identifi
cation of funding sources, other than General Fund moneys, to
fund evidence-based home visiting program 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.
(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 that, in turn, influence the person's
physical and mental health over his or her lifetime.
(d) On May 3, 2012, Governor Edmund G, 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." equity.
(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.
(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.
(g) Voluntary evidence-based home visiting programs, such as
Nurse-Family Partnership, Healthy Families America, Early Head Start
(Home-Based Program Option), Parents as Teachers, and Home
Instruction for Parents of Preschool Youngsters, strengthen the
critical parent-child relationship and connect families with
information and resources during the pivotal time from pregnancy to
five years of age. Extensive research has shown that evidence-based
home visiting programs serving pregnant and parenting mothers,
prenatal to the child turning five years of age, increase family
self-sufficiency, positive parenting practices, child literacy and
school readiness, and maternal and child health.
(h) Voluntary evidence-based home visiting program models the
prenatal to five years of age range from low to high intensity,
reflecting the broad spectrum of family needs that home visiting can
impact. Many experts hail home visiting program diversity as
essential to providing parents with choices and ensuring that
programs are well matched with local needs and strengths, as well as
responsive to the diverse needs of California's children and
families.
(i) 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 expected to exceed 12 million in
2015.
(j) 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 federal 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.
(k) 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.
(l) With more than three decades of evidence from randomized,
controlled trials and rigorous followup evaluation studies,
evidence-based home visiting programs have demonstrated sustained
improvements in maternal health, child health, positive parenting
practices, child development and school readiness, reductions in
child maltreatment, family economic self-sufficiency, linkages and
referrals, and reductions in family violence.
(m) Evidence-based home visiting programs have specifically
demonstrated reductions in preterm births, preventable maternal
mortality, smoking during pregnancy, complications of pregnancy,
closely spaced subsequent births, childhood injuries resulting in
costly emergency department use and hospitalizations, improved
childhood immunization rates, compliance with well child visit
schedules, lower body mass index rates, higher birth weights, and
improved family well-being, including increased family health
literacy, and parent self-help development. As a result of families
benefiting from evidence-based home visiting, there has
have 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.
(n) The strong evidence of effectiveness and predictable return on
investment demonstrate that evidence-based home visiting programs
should be brought to scale in California to improve maternal and
child health outcomes and help reduce health care costs for
generations to come.
(o) By supporting families from the start, voluntary
evidence-based home visiting programs serving families from prenatal
to five years of age provide a foundation for subsequent early
childhood programs and family support efforts to build upon, and can
help ensure that families are well-equipped to raise California's
next generation of productive, healthy, and successful adults.
(p) Therefore, it is the intent of the Legislature to develop a
means to leverage public and private dollars to substantially expand
the scale of evidence-based home visiting programs throughout
California, beginning with communities and populations with the
greatest need.
SEC. 2. Section 14148.25 is added to the Health and Safety Code,
to read:
14148.25. (a) The department shall, in consultation with
stakeholders, including, but not limited to, representatives
from Medi-Cal managed care plans, public and private hospitals,
evidence-based home visiting programs, and local governments,
develop and implement a plan on or before January
1, 2017, to ensure that evidence-based home visiting programs are
offered and provided to all Medi-Cal eligible
pregnant and parenting women. The department shall consult with
stakeholders from diverse geographical regions of the
state. The department shall consider all of the following in
developing the plan:
(1) Establishing Medi-Cal coverage for evidence-based home
visiting program services.
(2) Incentives for Medi-Cal providers to offer
evidence-based home visiting program services.
(3) Other mechanisms to fund evidence-based home visiting program
services. services for Medi-Cal eligible
pregnant and parenting women.
(4) Identifying among evidence-based home visiting programs those
with established evidence to improve health outcomes, the experience
of care, and cost savings to the health care system.
(b) In developing the plan, the department shall prioritize the
identification of funding sources, other than General Fund moneys, to
fund evidence-based home visiting program services, including local,
federal, or private funds, or any other funds made available for
these program services.
(b)
( c) (1) The
Notwithstanding Section 10231.5 of the Government Code, 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 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)
( d) 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) "Evidence-based home visiting program" means a program or
initiative that does all of the following:
(A) Meets, on or before April 1, 2015, the United States
Department of Health and Human Services Maternal, Infant, and Early
Childhood Home Visiting (MIECHV) criteria, as described in Section
511(d)(3)(A)(i)(l) of Title V of the Social Security Act (42 U.S.C.
Sec. 711).
(B) Contains home visiting as a primary service delivery strategy
by providers satisfying home visiting program requirements to provide
services to families with a pregnant or parenting woman who is
eligible for medical assistance.
(C) Offers services on a voluntary basis to pregnant women,
expectant fathers, and parents and caregivers of children from
prenatal to five years of age.
(D) 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.