INTRODUCED BY   Senator Morrell
   (Coauthor: Senator Wolk)

                        FEBRUARY 25, 2015

   An act to amend Section 14134.5 of the Welfare and Institutions
Code, relating to Medi-Cal.


   SB 407, as introduced, Morrell. Comprehensive Perinatal Services
Program: licensed midwives.
   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 comprehensive perinatal services. The Medi-Cal program is,
in part, governed and funded by federal Medicaid program provisions.
Existing law, to the extent that federal financial participation is
available, requires that midwifery services provided by a licensed
midwife be covered under the Medi-Cal program. Existing law
establishes the Comprehensive Perinatal Services Program,
administered by the State Department of Public Health, to maintain,
to the extent resources are available, a permanent statewide
community-based comprehensive perinatal system to provide care and
services to low-income pregnant women and their infants who are
considered underserved in terms of comprehensive perinatal care.
Existing law generally authorizes a health care provider to employ or
contract specified practitioners, including physicians and certified
nurse midwives, for the purpose of providing comprehensive perinatal
   This bill would additionally authorize a health care provider to
employ or contract licensed midwives for the purpose of providing
comprehensive perinatal services. The bill would expand the
definition of "comprehensive perinatal provider" as used in these
provisions to include a licensed midwife. The bill would require the
State Department of Health Care Services to commence, no later than
March 1, 2016, the revision of existing regulations as it determines
are necessary for the implementation of this bill.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


  SECTION 1.  Section 14134.5 of the Welfare and Institutions Code is
amended to read:
   14134.5.  All of the following provisions apply to the provision
of services pursuant to subdivision (u) of Section 14132:
   (a) "Comprehensive perinatal provider" means any general practice
physician, family practice physician, obstetrician-gynecologist,
pediatrician, certified nurse midwife,  licensed midwife,  a
group, any of whose members is one of the above-named 
physicians   providers  , or any preferred provider
organization or clinic enrolled in the Medi-Cal program and
certified pursuant to the standards of this section.
   (b) "Perinatal" means the period from the establishment of
pregnancy to one month following delivery.
   (c) "Comprehensive perinatal services" shall include, but not be
limited to, the provision of the combination of services developed
through the  former  Department of Health Services
Obstetrical Access Pilot  Program.   Program
provided or coordinated by a comprehensive perinatal provider. 
   (d) The comprehensive perinatal provider shall schedule visits
with appropriate providers and shall track the patient to verify
whether services have been received. As part of the reimbursement for
coordinating these services, the comprehensive perinatal provider
shall ensure the provision of the following services either through
the provider's own service or through subcontracts or referrals to
other providers:
   (1) A psychosocial assessment and when appropriate referrals to
   (2) Nutrition assessments and when appropriate referral to
counseling on food supplement programs, vitamins and breast-feeding.
   (3) Health, childbirth, and parenting education.
   (e) Except where existing law prohibits the employment of
physicians, a health care provider may employ or contract with all of
the following medical and other practitioners for the purpose of
providing the comprehensive services delineated in this section:
   (1) Physicians, including a general practitioner, a family
practice physician, a pediatrician, or an obstetrician-gynecologist.
   (2) Certified nurse midwives. 
   (3) Licensed midwives.  
    (4)  Nurses. 
    (5)  Nurse practitioners. 
    (6)  Physician assistants. 
    (7)  Social workers. 
    (8)  Health and childbirth educators. 
    (9)  Registered dietitians.
   The department shall adopt regulations  which 
 that  define the qualifications of any of these
practitioners who are not currently included under the regulations
adopted pursuant to this chapter. Providers shall, as feasible,
utilize staffing patterns  which   that 
reflect the linguistic and cultural features of the populations they
   (f) The California Medical Assistance Program and the Maternal and
Child Health Branch of the State Department of  Public 
Health  Services  in consultation with the
California Conference of Local Health Officers shall establish
standards for health care providers and for services rendered
pursuant to this subdivision.
   (g) The department shall assist local health departments to
establish a community perinatal program whose responsibilities may
include certifying and monitoring providers of comprehensive
perinatal services. The department shall provide the local health
departments with technical assistance for the purpose of implementing
the community perinatal program. The department shall, to the extent
feasible, and to the extent funding for administrative costs is
available, utilize local health departments in the administration of
the perinatal program. If these funds are not available, the
department shall use alternative means to implement the community
perinatal program.
   (h) It is the intent of the Legislature that the department shall
establish a method for reimbursement of comprehensive perinatal
providers  which   that  shall include a
fee for coordinating services and  which  shall be
sufficient to cover reasonable costs for the provision of
comprehensive perinatal services. The department may utilize fees for
service, capitated fees, or global fees to reimburse providers.
However, if capitated or global fees are established, the department
shall set minimum standards for the provision of services including,
but not limited to, the number of prenatal visits and the amount and
type of psychosocial, nutritional, and educational services patients
shall receive.
   Notwithstanding the type of reimbursement system, the
comprehensive perinatal provider shall not be financially at risk for
the provision of inpatient services. The provision of inpatient
services  which   that  are not related to
perinatal care shall not be subject to the provisions of this
section. Inpatient services related to services pursuant to this
subdivision shall be reimbursed, in accordance with Section 14081,
14086, 14087, or 14087.2, whichever is applicable.
   (i) The department shall develop systems for monitoring and
oversight of the comprehensive perinatal services provided in this
section. The monitoring shall include, but shall not be limited to,
collection of information using the perinatal data form.
   (j) Participation for services provided pursuant to this section
shall be voluntary. The department shall adopt patient rights
safeguards for recipients of the comprehensive perinatal services.
  SEC. 2.  The State Department of Health Care Services shall
commence, no later than March 1, 2016, the revision of existing
regulations as it determines are necessary for the implementation of
the amendments made to Section 14134.5 of the Welfare and
Institutions Code by this act, in accordance with the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code).