BILL ANALYSIS Ó
AB 2589
Page 1
Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2589
(Gomez) - As Amended April 5, 2016
SUBJECT: Lactation services and equipment.
SUMMARY: Requires the California Department of Public Health
(DPH) to coordinate with the Department of Health Care Services
(DHCS) to streamline enrollment into the California Special
Supplemental Nutrition Program for Women, Infants, and Children
(WIC) through the California Health Benefit Exchange (the
Exchange); and, requires DPH and DHCS to coordinate on two
stakeholder processes, first, to develop measures and outcomes
for breastfeeding, and second, to develop and update minimum
breast pump and accessory equipment standards. Specifically,
this bill:
1)Requires DPH and DHCS to coordinate to develop processes,
procedures and an electronic interface for eligibility-related
information sharing to streamline enrollment into the WIC
program as part of the application process for Medi-Cal and
health plans offered through the Exchange.
2)Requires DPH and DHCS to coordinate through a stakeholder
process that includes, but is not limited to representatives
from health care providers, primary care clinics, health
plans, state and local staff from the WIC program and the
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Maternal, Child and Adolescent Health (MCHA) program, and
representatives from organizations representing women, infants
and children to do both of the following:
a) With respect to prenatal care, develop measures and
outcomes for breastfeeding that shall include, at a
minimum, women's intention to breastfeed, including ethnic
diversity; and,
b) After birth and following discharge from the hospital or
other birthing location, develop measures and outcomes for
breastfeeding that include, at a minimum, initiation,
duration, exclusivity, and ethnic disparities.
3)Requires DPH and DHCS, no later than January 1, 2018, and
every five years thereafter, to coordinate through a
stakeholder process to develop and update minimum breast pump
and accessory equipment standards for the provision of
appropriate and effective breast pumps and accessories.
4)Requires the stakeholder process described in 3) above, to
include, but not be limited to representatives from health
care providers, health plans, primary care clinics, lactation
consultants and specialists, state and local staff from the
WIC program, and representatives of manufacturers and
distributors of breast pumps and accessories.
EXISTING LAW:
1)Establishes DPH to protect and improve the health of
communities through education, promotion of healthy
lifestyles, and research for disease and injury prevention and
requires DPH to include in its public service campaign the
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promotion the benefits of mothers breast-feeding their
infants.
2)Requires DPH, to the extent that non-United States Department
of Agriculture (USDA) federal funds and private grants or
donations are made available, to, no later than July 1, 2008
begin expansion of the breast-feeding peer counseling program
at local WIC sites.
3)Requires all general acute care hospitals, and special
hospitals providing maternity care to make available a breast
feeding consultant, or provide information to the mother on
where to receive breast feeding information.
4)Requires all general acute care hospitals and special
hospitals that have a perinatal unit to have an infant-feeding
policy that promotes breastfeeding according to the World
Health Organization's (WHO) Baby-Friendly Hospital Initiative
or the DPH Model Hospital Policy Recommendations.
5)Establishes the Exchange (also referred to as Covered
California) within state government, as an independent public
entity not affiliated with an agency or department, and
requires the Exchange to compare and make available through
selective contracting health insurance for individual and
small business purchasers as authorized under the Patient
Protection and Affordable Care Act (ACA). Specifies the
powers and duties of the board governing the Exchange, and
requires the board to facilitate the purchase of qualified
health plans though the Exchange by qualified individuals and
small employers.
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6)Requires the board to determine the criteria and process for
eligibility, enrollment, and disenrollment of enrollees and
potential enrollees in the Exchange and coordinate that
process with state and local government entities administering
other specified health care coverage programs.
7)Establishes the Medi-Cal program, which is administered by
DHCS, under which qualified low-income persons receive health
care benefits and, in part, governed and funded by federal
Medicaid program provisions. Authorizes DHCS to extend
continuous Medi-Cal eligibility to children 19 years of age
and younger.
EXISTING FEDERAL LAW under the ACA requires health plans and
health insurers to provide coverage for breast pumps at no
cost-sharing, as a preventative service.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, evidence
indicates that early infant feeding practices can affect later
growth and development in children, while significantly
reducing their risk for infections and chronic diseases such
as diabetes, asthma and obesity. The author notes that the
United States Surgeon General, and all the major health
organizations, including the American Academy of Pediatrics
(AAP) and WHO recommend exclusive breastfeeding for most
babies, unless specifically contraindicated, for the first six
months and continued breastfeeding with the addition of
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appropriate foods up to at least one year of age. The author
contends that California has supported breastfeeding policies
that increase rates among low-income women and must continue
efforts, and study and collect data relating to breastfeeding
exclusivity, initiation, and duration not only in a hospital
setting, but at home. The author also states that California
has recognized that low-income and minority women have lower
rates when it comes to breastfeeding duration, initiation, and
exclusivity. The author concludes, in order to help to
achieve health equity for new mothers and their children, we
must expand data collection outside our hospital settings.
2)BACKGROUND.
a) Breastfeeding rates and recommendations. California
in-hospital infant feeding practices are monitored using
data collected by the Newborn Screening (NBS) Program
within DPH. All non-military hospitals providing maternity
services are required to complete the Newborn Screening
Test Form. In addition to tracking genetic diseases and
metabolic disorders, the NBS Program gathers data on all
infant feedings for about 24 to 48 hours since birth. The
MCAH Program staff analyze this data and publish
breastfeeding rates by hospital, county and the State. In
addition to the Newborn Screening data, all hospitals with
300 or more births are required to report on the Perinatal
Core Measure Set, which includes a measure on exclusive
breast milk feeding.
According to the federal Centers for Disease Control and
Prevention, breastfeeding rates continue to rise in the
United States. In 2011, 79% of newborn infants started to
breastfeed. Yet breastfeeding does not continue for as
long as recommended. Of infants born in 2011, 49% were
breastfeeding at 6 months and 27% at 12 months.
In the policy statement, "Breastfeeding and the Use of Human
Milk," published in the March 2012 issue of Pediatrics, the
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AAP reaffirms its recommendation of exclusive breastfeeding
for about the first six months of a baby's life, followed
by breastfeeding in combination with the introduction of
complementary foods until at least 12 months of age, and
continuation of breastfeeding for as long as mutually
desired by mother and baby. According to the National
Institute of Health, breastfeeding carries many health
benefits for infants and mothers, as well as potential
economic and environmental benefits for communities. Among
the known health benefits are nutritionally balanced meals,
some protection against common childhood infections, and
better survival during the first year of life, including a
lower risk of Sudden Infant Death Syndrome. Other studies
suggest that breastfeeding may reduce the risk for certain
allergic diseases, asthma, obesity, and type 2 diabetes.
It also may help improve an infant's cognitive development.
b) WIC. WIC provides Federal grants to states for
supplemental foods, health care referrals, and nutrition
education for low-income pregnant, breastfeeding, and
non-breastfeeding postpartum women, and to infants and
children up to age five who are found to be at nutritional
risk. WIC requires breast pumps provided to participants
to meet equipment specifications to effectively support
breastfeeding.
c) State breastfeeding support and programs. DPH's MCAH
Division and the Genetic Disease Screening Program (GDSP)
support DPH efforts to promote breastfeeding. MCAH
programs (Black Infant Health Program, Adolescent Family
Life Program, California Home Visiting Program, and Local
MCAH) discuss the benefits of breastfeeding; the importance
of partner and family support; and connect women to peer
support groups and professional lactation consultants as
needed. The Comprehensive Perinatal Services Program
provides technical assistance on breastfeeding to health
care providers and their staff. The Regional Perinatal
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Programs of California assist hospital with quality
improvement efforts to advance the Model Hospital Policies
or Baby Friendly Hospital standards. Some Local MCAH
Programs provide professional breastfeeding support
directly or through community resources, and promote
development of additional lactation professionals in the
community. MCAH oversees the Maternal and Infant Health
Assessment (MIHA) Survey that tracks breastfeeding measures
and outcomes. GDSP collects in-hospital exclusive
breastfeeding initiation and percent of breastfed infants
receiving formula supplementation while in the hospital.
DPH reports "Healthy People 2020" and "California Wellness Plan"
promote the increase of California breast feeding rates. DPH's
Office of Health Equity's "Portrait of Promise: The California
Statewide Plan to Promote Health and Mental Health Equity" cites
the benefits of breastfeeding and positive health outcomes.
DPH's "Let's Get Healthy California" includes priorities for
healthy beginnings and well-being starting with infancy.
DPH offers three types of breast pumps to participants:
multi-user electric, personal-use electric, and manual. Under
the ACA, private insurers must cover the cost of breast pumps;
however, it is up to the plan to decide whether the pump is
manual or electric.
d) Current nutrition program linkages. When a family or
individual is applying for Medi-Cal or Covered California,
the application includes information that identifies the
person as eligible for CalFresh. The system is not
completely automated, because the CalFresh application is
not auto-populated, but an on-line application is made
available and the applicant can fill that out and the
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county is notified of the potential CalFresh participant.
Currently there is no electronic linkage for WIC eligibility in
Medi-Cal or Covered California enrollment. The applications
provide a statewide toll-free number for mothers to call, where
they would receive another number or numbers for a local WIC
agency. The mother would then call that number to find out if
they are eligible.
According to the proponents of this bill, CalFresh is working to
streamline related data sharing, integration and bridging
between programs, including Medi-Cal. WIC and CalFresh are
working on data sharing and analysis, particularly related to
the participation of children.
3)SUPPORT. The California WIC Association (WIC Association) is
a cosponsor of this bill and states that this bill will help
to ensure that California families and young children are
utilizing the programs that will provide them the most help,
and support their own health and nutrition goals as well as
the public health and nutrition goals of California. The WIC
Association also notes that Breastfeeding has been shown to
reduce the incidence of obesity while also contributing to
numerous other positive health outcomes for mother and child,
and California needs to develop and agree upon measures for
breastfeeding in order to evaluate how best to support
California women in meeting their infant feeding goals.
The California Primary Care Association (CPCA) is a co-sponsor
and states this bill will empower California moms to
breastfeed their babies by streamlining the enrollment process
for the WIC Program, crate new metrics to track breastfeeding
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rates and health outcomes, and require the state to regularly
review breast pump equipment standards and reimbursement
rates. CPCA concludes, with this simple and comprehensive
bill we can support strategies to improve breastfeeding
initiation, duration, and exclusivity.
4)PREVIOUS LEGISLATION.
a) SB 402 (De Leon), Chapter 666, Statutes of 2013,
requires all general acute care hospitals and special
hospitals, that have a perinatal unit by January 1, 2025,
to adopt the "Ten Steps to Successful Breastfeeding," as
adopted by Baby-Friendly USA, per the Baby-Friendly
Hospital Initiative (BFHI), or an alternate process adopted
by a health care service plan that includes evidenced-based
policies and practices and targeted outcomes, or the Model
Hospital Policy Recommendations, as defined.
b) SB 502 (De Leon and Pavley), Chapter 511, Statutes of
2011, establishes the Hospital Infant Feeding Act requires
all general acute care and special hospitals that have a
perinatal unit to have an infant-feeding policy, as
specified, to clearly post the policy and routinely
communicate the policy to perinatal unit staff.
5)SUGGESTED AMENDMENTS. As currently drafted this bill requires
DPH and DHCS to establish a stakeholder process to update
breast pump standards. However, the ACA has existing minimum
requirements for durable medical equipment, which include
breast pumps that must be covered by health insurance. The
Committee may wish to remove this requirement, since it
appears unnecessary and instead amend the bill as follows:
123363. (a) The State Department of Public Health shall
coordinate with the State Department of Health Care
Services, through a stakeholder engagement process that
shall include, but not be limited to, representatives
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from health care providers, primary care clinics, and
health plans, state and local staff from the California
Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC Program) and the Maternal,
Child and Adolescent Health program, and representatives
from organizations representing women, infants, and
children, to do both of the following:
(1)Beginning prenatally and continuing through the
postpartum period and at least until the infant reaches
one year of age, develop measures and outcomes for
breastfeeding rates that include, at a minimum, women's
intention to breastfeed, breastfeeding initiation rates,
exclusivity and duration, and that identify ethnic
disparities and sociodemographic differences. The
stakeholder process shall take no longer than six months,
and the recommendations shall be posted on the
departments' Websites by January 1, 2018.
(1) With respect to prenatal care, develop measures and
outcomes for breastfeeding that shall include, at a
minimum, women's intention to breastfeed, including
ethnic diversity.
(2) After birth and following discharge from the hospital
or other birthing location, develop measures and outcomes
for breastfeeding that shall include, at a minimum,
initiation, duration, exclusivity, and ethnic
disparities.
(b) No later than January 1, 2018, and every five years
thereafter, the State Department of Public Health shall
coordinate with the State Department of Health Care
Services, through a stakeholder engagement process that
shall include, but not be limited to, representatives
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from health care providers, health plans, and primary
care clinics, lactation consultants and specialists,
state and local staff from the WIC Program, and
representatives of manufacturers and distributors of
breast pumps and accessories, to develop and update
minimum breast pump and accessory equipment standards for
the provision of appropriate and effective breast pumps
and accessories, taking into account the current
reimbursement rates for durable medical equipment related
to breastfeeding, including any potential need to modify
the reimbursement rates.
REGISTERED SUPPORT / OPPOSITION:
Support
California WIC Association (co-sponsor)
California Primary Care Association (co-sponsor)
AltaMed Health Services Corporation
Ampla Health
Association of California Healthcare Districts
BreastfeedLA
California Academy of Nutrition and Dietetics
California Advance Lactation Institute
California Breastfeeding Coalition
California Food Policy Advocates
California Nurse-Midwives Association
Children Now
Clinica Sierra Vista
Community Clinic Association of Los Angeles County
Community Clinic Consortium
County Health Executives Association of California
Family Health Centers of San Diego
Fresno EOC WIC Program
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Harmony Health
Health Alliance of Northern California
Health and Life Organization, Inc.
Henry Mayo Newhall Hospital
Kheir Center
L.A. Trust for Children's Health
Marin Community Clinics
Maternal and Child Health Access
Mountain Valleys Health Centers
National Health Law Program
North Coast Clinics Network
North County Health Services
North East Medical Services
Northeast Valley Health Corporation
Omni Family Health
Open Door Community Health Centers
Prevention Institute
Ravenswood Family Health Center
Redwood Community Health Coalition
San Ysidro Health Center
Solano Public Health WIC Program
South of Market Health Center
Strategic Alliance for Healthy Food and Activity Environments
The Santa Cruz County Breastfeeding Coalition
Tiburcio Vasquez Health Center, Inc.
Tulare Reginal Medical Center
United States Lactation Consultant Association
Valley Community Healthcare
Watts Healthcare WIC Program
Westside Family Health Center
White Memorial Community Health Center
One Individual
Opposition
None on file.
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Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097